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What Is A Bowel Obstruction—and Should You Be Worried?
Bowel obstruction occurs when the small or large intestine (colon) becomes partly or completely blocked. This prevents food, fluids, gas, and stool from passing through the digestive tract. Scar tissue (adhesions) from previous surgeries, hernias, tumors, and inflammatory bowel disease (IBD) are common causes of bowel obstruction. Symptoms include abdominal pain, bloating, constipation, and vomiting.
Bowel obstruction treatment depends on the severity and cause of the obstruction. Medications and intestinal decompression may treat a partial obstruction. Complete bowel obstruction is a medical emergency that requires surgery to remove the blockage. Bowel obstruction can affect people of all ages. It's one of the most common reasons for emergency surgeries in the United States.
Bowel obstructions are often categorized based on: The location of the blockage (small intestine or large intestine) Whether the blockage is partial or complete Healthcare providers determine the most effective treatment based on the type of bowel obstruction. Small Intestine vs. Large Intestine Obstruction Small intestine obstructions are the most common type of bowel obstruction. The small intestine breaks down food, absorbs nutrients, and moves food along the digestive tract to the large intestine. A blockage in the small intestine can lead to symptoms like crampy abdominal pain, bloating, and vomiting. About 25% of bowel obstructions occur in the large intestine. The large intestine (colon) absorbs water and electrolytes from food waste and forms the remaining contents into stool that passes through the rectum and anus. Obstruction in the large intestine can cause abdominal discomfort, constipation, and inability to pass gas. Partial vs. Complete Bowel Obstruction Small and large bowel obstructions can be partial or complete. If you have a partial bowel obstruction, some liquids and gas can pass through the obstruction. If you have a complete bowel obstruction, nothing can pass through. About 85% of complete small-bowel obstructions require surgery, while about 85% of partial small-bowel obstructions resolve with other treatments. Bowel obstruction symptoms may develop gradually or begin suddenly. Symptoms vary in severity based on the type of obstruction and whether the intestine is partially or entirely blocked. Small Intestine Obstruction Symptoms Symptoms of a blockage in your small intestine usually develop suddenly and may include: Abdominal pain or cramping, especially in the upper to mid-abdominal area Nausea Vomiting, which may include vomiting green bile Bloating, or a feeling of fullness in your abdomen Abdominal distension (enlargement) Loss of appetite Dehydration Rapid heart rate Diarrhea Large Intestine Obstruction Symptoms Symptoms of a blockage in your large intestine may develop gradually and tend to be milder than small intestine obstructions. Common symptoms include: Abdominal pain, especially in the lower abdomen Pressure or feeling of heaviness in the lower abdomen Constipation Fever Inability to pass gas Bloating or abdominal distention (swelling) Vomiting (usually hours after other symptoms develop) Loud, high-pitched abdominal sounds Partial vs. Complete Bowel Obstruction Symptoms Symptoms of a partial bowel obstruction may come and go for days or weeks and usually worsen over time until they're treated. Partial bowel obstructions may cause: A complete bowel obstruction is a medical emergency that requires immediate treatment. You will likely experience a sudden onset of severe symptoms, such as: Severe, sudden abdominal pain Inability to pass gas or stool Loss of appetite A bowel obstruction may have a mechanical or functional cause. Healthcare providers can determine the most effective treatment based on the type and cause of obstruction. Mechanical Bowel Obstruction Causes A mechanical bowel obstruction occurs when a physical barrier restricts the normal flow of food, fluids, and waste through the intestines. Common causes of mechanical bowel obstructions include: Hernia: This condition occurs when a portion of the intestine protrudes through a weakened abdominal wall. Adhesions: Scar tissue on the intestine that forms after surgery or due to intestinal inflammation can cause an obstruction. Tumors: Both benign (non-cancerous) and malignant (cancerous) tumors can cause a blockage when inside the intestines or on a nearby structure in the abdominal cavity. Hard objects: Foreign objects (non-food items) and large, hard stools can get stuck in the intestines. Intussusception: This condition occurs when one part of the intestine telescopes (folds) into another, shortening the bowels and causing a blockage. Parasitic infection: Though rare, parasitic worms can collect in the intestines and cause a blockage. Impacted stool: Stool hardens and remains in the rectum, often due to long-term constipation. Structural changes to the intestines: For example, volvulus is a condition that occurs when a loop in the intestine twists around itself. Functional Bowel Obstruction Causes A functional bowel obstruction—also known as ileus, paralytic ileus, or pseudo-obstruction—occurs when intestinal muscles do not function effectively even though there's no physical blockage. This impairs the flow of intestinal contents. Common causes of functional bowel obstruction include: Paralytic ileus: Muscles that move food through the intestines become paralyzed. Intestinal or abdominal infections: For example, appendicitis is an abdominal infection that occurs when the appendix, a small finger-shaped pouch attached to the large intestine, becomes inflamed. Bacteria or viruses can cause intestinal infections like gastroenteritis (e.G., food poisoning or a stomach virus). Certain medications: Drugs like narcotics (opioid pain relievers) and antipsychotics (used to treat psychosis, a condition that occurs when someone experiences a loss of contact with reality) can impair muscle function in the intestines. Ischemia: Decreased blood flow to the bowels can restrict or stop movement of the intestinal muscles. Nutritional deficiencies: Lack of essential minerals or electrolyte imbalances (e.G., potassium) can lead to bowel obstruction. Electrolytes are electrically charged minerals in blood, sweat, and urine that help regulate the nervous system, hydration, muscle function, and blood pH. Underlying medical conditions: For example, many people with kidney disease have chronic constipation, which can lead to a bowel obstruction. Risk Factors People of all ages can be affected by bowel obstructions. However, certain factors may increase your risk. These include: History of hernias Previous abdominal surgery Nutritional deficiencies Inflammatory conditions, such as Crohn's disease—a type of inflammatory bowel disease (IBD) that causes inflammation in the gastrointestinal (GI) tract History of certain cancers, such as colon cancer, ovarian cancer, or stomach cancer Consuming non-food items Diagnosing bowel obstruction involves assessing your medical history and doing a physical examination and diagnostic testing. Your healthcare provider might refer you to a gastroenterologist, a medical doctor who specializes in conditions related to the digestive system. Your provider will check for signs of bloating and listen to your abdomen with a stethoscope. Your bowel will typically make gurgling sounds, but your provider may also hear high-pitched sounds or no sounds. They will also palpate (touch) your belly to check for tenderness or pain. Possible diagnostic tests include: Abdominal X-ray: This imaging test helps visualize any blockages or abnormalities in the digestive tract. Computed tomography (CT) scan: This imaging test provides detailed images to identify the location and extent of the obstruction. Barium enema: An enema is a process where fluids are injected into the rectum (lower part of the large intestine) to cleanse the colon, stimulate defecation, or administer medication. A contrast liquid (barium) given through an enema highlights the large intestine on X-rays, helping identify blockages. Colonoscopy: A flexible tube with a camera is inserted into the rectum to examine the colon and detect tumors, polyps, or other obstruction causes. Blood tests: Blood work can help check for electrolyte imbalances, infection, and other factors related to bowel obstruction. Bowel obstruction requires prompt medical treatment to help restore proper intestinal function and prevent complications. Most bowel obstructions are treated in the hospital, and treatment approaches vary based on the cause and location of the blockage. Medications Intravenous (IV) fluids and medicines can restore the balance of electrolytes in your body and help you stay comfortable. If hard, large stool is causing an obstruction, enemas or stool softeners can help soften stool and relieve the blockage. If you have an infection or the blockage caused a perforation (hole) in your bowel, you will be treated with antibiotics. Intestinal Decompression A flexible tube, called a nasogastric tube, is inserted through your nose and into your digestive tract. The tube removes fluids and gas from your intestines to relieve pressure and pain. You will not be able to eat or drink during this treatment, as this can worsen the obstruction. Colonic Stent A stent is a tubular structure made of a flexible and expandable material. This is inserted into your colon to relieve the blockage. Once in place, the stent expands, allowing stool, gas, and fluids to move through the blocked area. Colonic stents are useful when surgery poses higher risks or when immediate intervention is necessary. Surgery Bowel obstruction surgery is typically done by a colorectal surgeon—a surgeon who specializes in conditions that affect the large intestine. Surgery is necessary in cases of complete obstruction or when non-surgical treatment methods are ineffective. Surgery for bowel obstruction includes: Removal of the bowel obstruction Bowel resection, which involves removing damaged intestinal tissues and stitching the remaining intestines together with stitches or staples You may need a colostomy or ileostomy if your obstruction requires a bowel resection and the remaining intestines cannot be reconnected. Both procedures involve forming a small opening in the abdomen, called a stoma, and bringing the remaining part of the intestine to the surface of the stomach. Waste products are collected in a pouch attached to the stoma outside of your body. Colostomies and ileostomies can be temporary or permanent, depending on how much of the intestine was removed during the bowel resection. Bowel obstruction is not always preventable, as many causes are outside your control. While there are no guaranteed ways to prevent bowel obstruction, certain habits may help lower your risk: Drink 8-10 cups of fluids (e.G., water) daily. Daily water recommendations vary slightly based on various factors. Eat smaller meals throughout the day, chew foods well, and eat at a relaxed pace. Take a daily multivitamin with mineral supplements to help ensure you get the nutrients your body needs. Manage digestive conditions. For example, follow your treatment plan if you have IBD. Untreated bowel obstruction can lead to complications resulting from trapped fluids, gas, and stool buildup. Possible bowel obstruction complications include: Bowel perforation: Pressure in the blocked intestine can cause it to rupture, leading to a dangerous leakage of its contents into the abdominal cavity. Infection: Accumulated waste and fluids can create an environment conducive to bacterial growth, potentially causing infection within the abdomen. Possible infections include a life-threatening condition known as peritonitis. Electrolyte imbalance: Obstruction can disrupt the balance of essential minerals in the body, leading to electrolyte imbalances that can affect your overall health. Gangrene: Tissue death (gangrene/necrosis) can occur if a bowel obstruction disrupts or stops blood supply to the intestine. Recognizing the symptoms of bowel obstruction and seeking prompt treatment is the best way to prevent complications. Bowel obstruction occurs when your small or large intestine becomes partly or completely blocked. This prevents food, fluids, gas, and stool from passing through the digestive tract. It can lead to symptoms like abdominal pain, bloating, constipation, nausea, vomiting, or diarrhea. Most bowel obstructions are treated in a hospital. Treatment may include intestinal decompression or surgery, depending on the location and severity of the obstruction. Some bowel obstructions are medical emergencies requiring immediate surgery. Contact a healthcare provider if you have symptoms of a bowel obstruction. Prompt diagnosis and treatment can reduce the risk of complications.Could You Have A Bowel Obstruction?
If you've had abdominal surgery recently, it's important to be on the lookout for symptoms of a complication known as bowel obstruction.
A bowel obstruction occurs when the normal flow of digested foods and liquids in the GI tract is interrupted.
While not extremely common, a bowel obstruction — also called intestinal obstruction — can occur when scar tissue forms inside the abdomen after a surgical procedure, causing a kink in the intestines similar to a kink in a hose, preventing fluids from flowing through normally and causing a backup. In some cases, food movement is totally blocked; with a partial bowel obstruction, a limited amount of food can move through.
Other bowel obstruction causes can include cancer, hernia, and inflammation from inflammatory bowel disease (IBD), says Luke DeRoo, DO, a gastroenterologist with University of Michigan Health-West in Wyoming, Michigan.
"Less common causes include gallstones, volvulus (a mechanical twisting of the bowel), or intussusception, when the bowel 'telescopes' within itself," he says.
Identifying Bowel Obstruction SymptomsBowel obstruction symptoms usually come on suddenly, and they are severe — acute pain in the abdomen, along with nausea or vomiting. Bowel obstructions are the cause of 15 percent of hospital admissions for acute abdominal pain in the United States, according to a research paper published in the World Journal of Emergency Surgery in 2019.
Additionally, the vast majority of people affected by a bowel obstruction are unable to pass gas or have a bowel movement. Dehydration and a swollen abdomen are also common, Dr. DeRoo says.
While these symptoms remain persistent in many patients, a small number of people with bowel obstruction will present with intermittent symptoms that resolve and recur again, notes Lauren M. Bleich, MD, MPH, a board-certified gastroenterologist with Gastro Health in Acton, Massachusetts.
Why It's Critical to Treat Bowel ObstructionIf you have bowel obstruction symptoms, it's important to see a doctor right away. "Bowel obstruction is often a medical or surgical emergency," DeRoo says.
If left untreated, it can lead to severe infection, perforation, and ischemia, or the lack of blood flow to the intestine, which can cause the death of bowel tissues.
Doctors may use a CT scan, which creates a cross-sectional picture of your body, to look for an obstruction. Regular abdominal X-rays can also be used. If you have a complete obstruction, immediate surgery is required. The procedure involves fixing the obstruction and any parts of the intestine that are damaged or dead, according to the Mayo Clinic.
Partial bowel obstruction may be treated in a hospital setting with a few days of "bowel rest," a technique in which any remaining food and fluids is drained from a patient's stomach and further food is eliminated. Intravenous fluids help you stay hydrated.
"Placement of a nasogastric tube, a thin tube inserted in the nose and down into the stomach, can decompress contents in the stomach and help resolve a patient's symptoms," says Dr. Bleich. "Most patients will not require additional treatment, as small bowel obstructions resolve with conservative management."
If bowel rest does not work or bowel tissue begins to die because of the blockage, surgery will be necessary.
In some cases, people with bowel obstruction symptoms are found to have no blockage in their intestines. This is known as intestinal pseudo-obstruction, a disorder that happens when nerves or muscles lack the ability to move food through the body, according to a research paper published in StatPearls in 2023. Children and older adults are more likely to develop intestinal pseudo-obstruction. Treatment begins with dietary modificaton and fixing any underlying issues. Then medications are used. If your doctor finds that you have ileus, the inability of the intestines to contract normally, you may need to ingest liquid food through a feeding tube or intravenously.
Bowel obstruction can be a very serious condition requiring immediate medical attention — be aware of the symptoms and contact your doctor to get the treatment you need.
Additional reporting by Ashley Welch.
What To Know About Extravasation
When a healthcare professional administers a drug through a venous cannula, there is a small risk of extravasation, which means the solution leaks out of the veins and into the surrounding tissue.
If the medication is a vesicant drug — meaning that it has the potential to cause tissue damage through blistering and ulceration — doctors call this complication extravasation. Vesicants include several chemotherapy drugs.
Extravasation may occur if the administration of the drug is too quick, the medication is very acidic or basic, or there is an obstruction in the intravenous (IV) line.
The symptoms of extravasation include a painful stinging or burning sensation, swelling, and skin discoloration.
Read on to learn more about extravasation, its causes, and how doctors treat it.
The severity of extravasation depends on how much medication has entered the surrounding tissue and how strongly the tissue reacts to the medication. Very severe cases of extravasation could result in the loss of limb tissue or function.
Doctors use four grades to indicate the severity of extravasation.
Grade oneGrade one is a mild case of extravasation, and the symptoms include:
Grade two is more serious than grade one and involves additional symptoms, such as:
If a person is showing signs of grade three extravasation, they should call a doctor or nurse immediately.
Symptoms include:
Pallor can be difficult to detect in dark skin, so healthcare professionals may check the eyes, palms, and nail beds for signs of discoloration.
Grade fourA person should alert the medical team immediately if they notice the following symptoms:
At this stage, a person could also show signs of tissue death and loss.
The difference between extravasation and infiltration is the type of solution that leaks into nearby tissue. Vesicant drugs are those that can cause tissue death, whereas non-vesicant drugs do not have this effect.
ExtravasationExtravasation occurs when a vesicant drug leaks out of the vein and into the surrounding tissue. When this happens, a person will likely experience serious tissue damage, including ulceration and tissue death, if they do not receive treatment in time.
InfiltrationThis complication arises when a non-vesicant drug seeps out of the vein into nearby tissue. Infiltration can cause symptoms and signs in the affected area, but if damage occurs, it is typically less severe than it would be with extravasation. For example, a person will not experience ulcers, blisters, and tissue death.
Extravasation occurs in 0.1–6.0% of adults. However, improvements in infusion techniques and a higher awareness among healthcare professionals of the early signs of extravasation are causing the rate to decrease.
Extravasation has many possible causes, including:
It is important that the person receiving the medication or their medical team notice the signs and symptoms of extravasation early to prevent permanent tissue and limb damage.
Some general signs and symptoms of extravasation include:
Skin that starts to discolor significantly and becomes cold to the touch indicates severe tissue damage.
Doctors diagnose extravasation by examining and inspecting the skin area around the cannula. If they suspect extravasation, they will stop the drug infusion and elevate the limb. Doing this as soon as possible should prevent serious complications from developing and stop the extravasation from escalating to a higher grade.
The medical team will continue to monitor the skin for 24 hours after stopping the infusion to check for signs of infection. The extravasation grade diagnosis will determine the treatment that the person receives. Grades three and four will require more intensive treatments than grades one and two.
As soon a doctor or nurse suspects extravasation, they will:
The healthcare team will continue to monitor the person and may take photographs to document the healing process.
Depending on the type of drug that has leaked into the tissue, doctors may warm or cool the affected area to stop the drug from spreading.
Healthcare professionals should implement standardized, evidenced-based techniques when inserting cannulas to minimize the risk of extravasation.
Other preventive strategies include:
A person should get medical help if they are experiencing pain and swelling where the cannula enters the skin. They should not wait until their symptoms get worse, as the sooner doctors treat extravasation, the better the outcome.
If healthcare teams do not treat extravasation in time, a person may experience serious complications, which can include tissue death and a loss of limb function.
Extravasation occurs when IV medications, which can destroy tissue, seep out of veins and into the surrounding skin and muscle.
Grade one is the least severe form of extravasation, and if a person receives treatment at this stage, the risk of permanent tissue damage is small.
Grade four is the most severe form, and a person could lose limb function or the affected part of the limb itself if the medication has spread from the infusion site to other areas.
As soon as a person experiences any pain or swelling at the infusion site, they should let their healthcare team know.
The sooner a person receives treatment, the greater their chance of making a full recovery with no lasting tissue damage.
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