- Scar Tissue (Adhesions): Adhesions from prior abdominal or pelvic surgeries are a common cause of intestinal obstruction. These fibrous bands can form within the abdominal cavity, restricting or twisting the intestines.
- Hernias: A hernia occurs when part of the intestine protrudes through a weakened area of the abdominal wall. If the intestine becomes trapped, it may lead to a blockage.
- Tumours: Growths, whether benign or malignant, can block the intestinal passage directly or compress it from outside, interfering with normal function.
- Inflammatory Bowel Diseases: Conditions such as Crohn’s disease or diverticulitis can cause narrowing or scarring of the intestinal walls, increasing the risk of obstruction.
- Intussusception: This condition occurs when one segment of the intestine slides into another segment, creating a blockage. It is most commonly seen in children.
- Medications or Surgery-Induced Paralysis: Certain medications or complications following abdominal surgery can temporarily impair intestinal muscle activity, causing a functional obstruction known as ileus.
Intestinal Obstruction

Dr Chong Choon Seng
MBBS | MRCS | Masters in Medicine (Surgery) | FRCS (Edinburgh)
Intestinal obstruction occurs when the normal movement of contents through the intestines is blocked. This blockage can occur in the small or large intestine and may be caused by various physical or functional factors. It disrupts the digestion process, leading to symptoms such as pain, swelling, and difficulty passing stool or gas.
If untreated, complications such as infection, tissue damage, or perforation can arise.




Symptoms of Intestinal Obstruction
When the intestine becomes obstructed, the symptoms vary according to the severity and location of the blockage, and they can appear suddenly or gradually.
- Abdominal Pain: Pain caused by intestinal obstruction is often cramp-like and may occur in waves as the intestine attempts to push its contents past the blockage. In severe cases, the pain may become constant, indicating complications such as tissue damage.
- Nausea and Vomiting: Vomiting is common, especially in obstructions of the small intestine. It often starts with partially digested food and progresses to bile or faecal material in more severe cases.
- Bloating and Abdominal Distension: The abdomen may appear visibly swollen due to gas and fluid trapped in the intestines. This is particularly noticeable in large intestine obstructions.
- Inability to Pass Stool or Gas: A complete obstruction typically results in an absence of bowel movements and flatulence. In partial obstruction, some stool or gas may still pass, but the amount is reduced.
- Diarrhoea in Partial Obstruction: Partial blockages may cause liquid stool to pass around the obstruction, often accompanied by other symptoms such as pain or bloating.
Causes and Risk Factors
Several factors and conditions can cause intestinal obstruction, and a history of medical or surgical procedures may increase the likelihood of obstruction.
Types of Intestinal Obstruction
Intestinal obstruction can be classified into two broad categories based on its cause. These categories help determine the appropriate treatment approach.
Mechanical Obstruction
This type involves a physical blockage in the intestine, such as adhesions, hernias, tumours, or impacted stool. It typically results in symptoms such as severe abdominal pain, nausea, and visible abdominal swelling. Imaging tests like X-rays or CT scans are often used to confirm the blockage and its location.
Functional Obstruction (Ileus)
In functional obstruction, the intestine fails to move its contents due to impaired muscular contractions. This can occur after surgery, from infections, or due to certain medications. Symptoms may develop gradually, including general discomfort, bloating, and reduced bowel sounds. Treatment focuses on addressing the underlying cause and stimulating bowel function.
Diagnostic Methods
Physical Examination
During the examination, the abdomen is checked for swelling, tenderness, and abnormal bowel sounds. A distended abdomen suggests gas or fluid build-up. High-pitched sounds may indicate the intestine’s attempt to force contents through a blockage, while an absence of sounds may suggest a complete obstruction or ileus.
X-rays and CT Scans
Abdominal X-rays are often the first imaging study performed to identify gas or fluid patterns that indicate a blockage. A CT scan offers a more detailed view, providing precise information about the obstruction’s location, the condition of the bowel, and the underlying cause, such as a tumour or twisted intestine.
Ultrasound
Ultrasound is useful for detecting intussusception or structural abnormalities, especially in children and some adults.lts. This imaging technique provides real-time visualisation without exposing the patient to radiation, making it a safer choice for specific populations such as paediatric patients or pregnant individuals.
Blood Tests
Blood tests evaluate complications such as infection, dehydration, or loss of electrolytes. Elevated white blood cell counts can indicate inflammation or tissue damage, while abnormal electrolyte levels indicate dehydration or impaired absorption due to the blockage.
Contrast Studies
In selected cases, a contrast agent is used during imaging studies like CT or MRI. This highlights the intestinal passage, helping to distinguish between complete and partial obstructions and assess the bowel’s functionality.
Treatment Options
The treatment for intestinal obstruction depends on the severity of the blockage. Non-surgical treatments are typically attempted first in cases where immediate intervention is not required.
Non-Surgical Treatment
- Nasogastric Tube for Decompression: A nasogastric tube is inserted through the nose into the stomach to remove trapped gas, fluids, and food build-up above the blockage. This relieves pressure and reduces symptoms such as pain, bloating, and vomiting, allowing the bowel to rest.
- Intravenous Fluid and Electrolyte Therapy: Obstruction often causes dehydration and electrolyte imbalances. Intravenous fluids are administered to restore hydration and normal electrolyte levels, improving the patient’s overall stability. This step is necessary before considering further treatments, including surgery.
- Medications: For ileus (functional obstruction), medications may be prescribed to stimulate bowel contractions. In some cases, reducing or adjusting medications that contribute to the condition, such as certain painkillers, can help resolve the obstruction.
- Observation and Monitoring: Partial obstructions or cases where the bowel shows signs of recovery may be managed conservatively under close observation. This includes regular assessments of symptoms, abdominal examinations, and monitoring of vital signs.
Surgical Treatment
- Adhesion Removal (Adhesiolysis): For obstructions caused by scar tissue, adhesiolysis involves carefully cutting and removing adhesions to free the affected intestine. This procedure restores normal intestinal movement without compromising surrounding structures.
- Hernia Repair: In cases where a hernia is causing the blockage, surgery is performed to reposition the protruding intestine and repair the weakened abdominal wall. This may involve using synthetic mesh to strengthen the area and prevent recurrence.
- Bowel Resection: If part of the intestine is severely damaged or diseased, such as from a tumour, restricted blood flow, or perforation, the affected segment is removed. The healthy ends of the intestine are then reconnected (anastomosis). If healing time is required, a temporary or permanent stoma may be created to divert stool.
- Tumour Removal: Obstructions caused by tumours may require surgery to remove the growth. Depending on the tumour’s size and location, part of the intestine may also need removal. Additional treatments, such as chemotherapy or radiation, may be considered for malignant growth.
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Prevention and Management
Preventing intestinal obstruction involves addressing modifiable risk factors, such as maintaining a diet rich in fibre to prevent impacted stool and following medical advice after abdominal surgery to reduce adhesions. Regular monitoring for those with conditions like Crohn’s disease can help manage the risk. For individuals who have experienced obstruction, early medical evaluation for recurring symptoms can prevent complications.
Frequently Asked Questions
Can intestinal obstruction recur after treatment?
Yes, certain causes, such as adhesions or chronic conditions like Crohn’s disease, may lead to recurrence. Preventive measures, including dietary changes and regular medical check-ups, may help reduce this risk.
Can certain foods increase the risk of intestinal obstruction?
Yes, hard-to-digest foods like seeds, nuts, fibrous fruits, popcorn, and tough meat can worsen blockages, especially in individuals with intestinal narrowing or scar tissue. Chewing thoroughly and avoiding these foods may help minimise the risk.
How does dehydration worsen intestinal obstruction?
Dehydration reduces lubrication in the intestines, making it harder for contents to move through. It can also lead to compacted stools and slower bowel motility, increasing the risk and severity of obstructions. Staying hydrated is necessary for prevention and management.
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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 10 years of experience as a colorectal and general surgeon.
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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