- Adhesions: Bands of scar tissue from previous abdominal or pelvic surgery are the most common cause of bowel obstruction. These adhesions can pull on or trap sections of the intestine, restricting movement.
- Hernias: A portion of the intestine may become trapped in a weakened area of the abdominal wall, leading to obstruction and potential damage to the affected segment.
- Tumours: Both cancerous and non-cancerous growths can press against the intestine from within or outside, gradually narrowing the passage and, in some cases, invading the bowel wall.
- Inflammatory Bowel Disease: Chronic inflammation, as seen in Crohn’s disease, can cause thickening and scarring of the intestinal wall, progressively narrowing the passage and increasing the risk of obstruction.
- Volvulus: A twisting of the intestine around itself cuts off blood supply and creates a physical blockage, requiring urgent medical intervention.
- Foreign Bodies: Swallowed objects that cannot pass through the digestive tract may cause a blockage and, in some cases, lead to intestinal wall damage.
Bowel Obstruction
Dr Chong Choon Seng
MBBS | MRCS | Masters in Medicine (Surgery) | FRCS (Edinburgh)
A bowel obstruction occurs when the normal movement of intestinal contents is blocked, either partially or completely. This blockage can affect either the small or large intestine, preventing the passage of food, fluids, and gas through the digestive tract. The condition leads to the build-up of intestinal contents above the blockage point, which can cause severe abdominal pain, vomiting, and in some cases, life-threatening complications if left untreated.
Symptoms of Bowel Obstruction
Patients with bowel obstruction typically experience a range of symptoms that develop over hours to days, depending on the location and severity of the blockage.
- Severe Abdominal Pain: Pain often occurs in waves, worsening as the obstruction persists. It may be localised or spread across the abdomen, depending on the blockage location.
- Abdominal Distention: The abdomen becomes visibly swollen and firm to touch due to the accumulation of gas and fluid above the blockage point.
- Vomiting: The body attempts to relieve pressure by expelling stomach contents. Vomit may contain partially digested food, bile, or have a foul odour, especially in prolonged obstruction.
- Constipation and Inability to Pass Gas: Complete obstruction prevents the passage of stool and gas, though some partial obstructions may allow small amounts to pass.
- Loss of Appetite: Patients experience reduced appetite and feel full quickly due to the backup of intestinal contents.
- Dehydration Signs: Reduced fluid intake combined with vomiting leads to dry mouth, decreased urination, dark-coloured urine, and increased thirst.
Causes and Risk Factors
Bowel obstruction can result from various conditions, with risk increasing based on medical history and prior abdominal procedures.
Types of Bowel Obstruction
Mechanical Obstruction
A physical blockage disrupts the normal movement of intestinal contents, while the intestinal wall remains structurally intact at first. Adhesions, hernias, and tumours are common causes.
Functional Obstruction (Paralytic Ileus)
The intestine loses its ability to contract and move contents forward, despite no physical blockage. This occurs due to nerve or muscle dysfunction affecting intestinal motility. Common triggers include abdominal surgery, infections, certain medications, and electrolyte imbalances.
Partial Obstruction
The intestinal passage is partially blocked, allowing some contents to pass through. Symptoms may be intermittent and, in some cases, managed without surgery. However, if the obstruction worsens, it can progress to a complete blockage, requiring more urgent intervention.
Diagnostic Methods
Physical Examination
The abdomen is assessed for distension, tenderness, and abnormal bowel sounds. Hernias and surgical scars are also checked, as these may indicate potential causes of obstruction. This initial evaluation helps determine the need for further testing.
X-ray Imaging
Abdominal X-rays reveal dilated intestinal loops and air-fluid levels, which are characteristic of bowel obstruction. Serial X-rays taken over time can monitor changes in obstruction severity and response to treatment.
CT Scan
This imaging technique provides detailed information about the location and cause of the obstruction. It also detects complications such as reduced blood supply (ischemia) or intestinal perforation, helping to determine whether emergency intervention is required.
Blood Tests
Laboratory analysis identifies signs of infection, inflammation, and dehydration. It also evaluates kidney function and electrolyte levels, which are necessary for managing fluid and nutritional imbalances.
Contrast Studies
X-rays with contrast material help determine the precise location and severity of an obstruction. This method is particularly useful for diagnosing partial obstructions, where some intestinal passage remains open.
Treatment Options
The treatment approach for bowel obstruction depends on its cause, location, and severity, with options ranging from conservative management to emergency surgery.
Non-Surgical Treatment
- Bowel Rest: Temporarily stopping oral intake allows the bowel to recover. Intravenous fluids and electrolytes are provided to maintain hydration and correct imbalances. This approach is often effective for partial obstructions and paralytic ileus.
- Nasogastric Tube Decompression: A tube inserted through the nose into the stomach helps drain accumulated fluid and gas, relieving pressure and discomfort. This technique can aid in resolving some partial obstructions and is also used to stabilise patients before surgery if needed.
- Medical Management: Addressing underlying conditions such as inflammation or infection can help resolve functional obstructions. In cases of paralytic ileus, medications to stimulate bowel motility may be used, though the primary focus remains on treating the root cause.
Surgical Treatment
- Adhesiolysis: Surgical removal of adhesions that obstruct the intestine. This procedure may be performed through open surgery or laparoscopy, depending on the extent and location of the adhesions. Recovery time varies based on the surgical method used.
- Bowel Resection: When the bowel’s blood supply is compromised or cancer causes obstruction, the affected segment is surgically removed. The remaining healthy sections are reconnected to restore normal intestinal function. Post-operative monitoring helps detect complications such as infection or leakage at the reconnection site.
- Hernia Repair: Surgical correction of hernias that have trapped intestinal segments relieves obstruction and reduces the risk of recurrence. The technique used depends on the hernia’s size and location, with mesh reinforcement often applied to strengthen larger defects.
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Prevention and Management
Preventive strategies focus on maintaining bowel health and reducing risk factors. Regular exercise, adequate hydration, and a fibre-rich diet help prevent constipation, though dietary adjustments may be needed for those with intestinal narrowing. After abdominal surgery, following post-operative care and early mobilisation can reduce adhesion formation. Early hernia repair reduces the risk of complications, while ongoing medical monitoring supports effective management of chronic bowel conditions.
Frequently Asked Questions
Can bowel obstruction recur after treatment?
Yes, recurrence is common, especially in patients with prior abdominal surgeries, adhesions, or conditions like Crohn’s disease. Preventive measures such as dietary modifications and medical follow-up can help reduce recurrence risk.
What signs indicate a bowel obstruction emergency?
Severe, constant abdominal pain, fever, rapid heart rate, or signs of shock warrant immediate medical attention. These symptoms may indicate complications such as intestinal perforation or compromised blood supply, requiring emergency surgical intervention.
Is bowel obstruction more common in certain age groups?
Yes, older adults are more prone to bowel obstruction due to a higher likelihood of conditions such as diverticulitis, tumours, and previous surgeries leading to adhesions. Newborns can also develop obstructions due to congenital conditions like intestinal atresia.
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Dr Chong Choon Seng
MBBS (NUS)
MRCS (Edinburgh)
Masters in Medicine (Surgery)(NUS)
FRCS (Edinburgh)
Dr Chong is the former Program Director of General Surgery Residency at NUHS, and has more than 20 years of experience in clinical practice.
As an esteemed professional in minimally invasive surgery, Dr. Chong remains committed to achieving optimal outcomes for all surgical conditions, from piles to cancer treatment.
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