Treatment for Bowel Obstruction

Intestinal obstruction occurs due to the blockage of small or large bowel. This blockage could be total or partial and it prevents the passage of liquids and foods through the bowels. Due to intestinal obstruction, there is a buildup of food, gas, fluids and gastric acids behind the area of blockage. This buildup can lead to increase in pressure resulting in rupture of intestines, leaking bacteria and intestinal contents into the abdominal cavity, which is a life-threatening medical emergency. Bowel obstruction treatment depends upon the cause, severity and location of the obstruction.

First Know the Causes of Bowel Obstruction

1. Mechanical obstruction

They occur when the intestines are blocked by something physically. The causes of mechanical obstruction in small intestines are:

• Adhesions, which is made of fibrous tissue and that may form after any type of pelvic or abdominal surgery or inflammation
• Twisting of bowel or Volvulus
• Telescoping of one segment of bowel into another section, also referred to as Intussusception
• Intestinal malformations, particularly in newborns
• Small intestinal tumors
• Gallstones in rare cases
• Swallowed objects, particularly in children
• Intestinal hernias, in which a part of intestine protrude into another body part
• Inflammatory bowel disease including Crohn’s disease
• Diverticulitis

Causes of mechanical obstruction in large intestines or colon are:

• Impacted feces
• Adhesions due to surgeries or infections in the pelvic region
• Cancer of the ovaries
• Colon cancer
• Intussusception
• Volvulus
• Formation of stricture, narrowing of colon due to inflammation or scarring

2. Nonmechanical Obstruction

A Nonmechanical obstruction may occur if the normal coordinated contractions of the intestines are interrupted by something, resulting in functional obstruction. The temporary form is known as ileus and chronic form is known as pseudo-obstruction.

Causes of ileus are:

• Pelvic or abdominal surgery
• Infections including appendicitis or gastroenteritis
• Certain medicines such as opioids
• Imbalances in the electrolytes

Pseudo-obstruction of the intestines may be caused by:

• Multiple sclerosis, Parkinson’s disease and other disorders of muscles and nerves
• Hirschsprung’s disease, a disease characterized by absence of nerves in areas of large bowel
• Diseases which cause injury to nerves such as diabetes
• Hypothyroidism
• Certain medicines which affect nerves and muscles such as tricyclic antidepressants and opioids

Bowel Obstruction Treatment

The treatment of bowel obstruction depends upon the cause that has led to the blockage and usually needs hospitalization. Management is aimed at correcting the physiologic derangements that are caused by intestinal obstruction, resting the bowel and removing the cause of obstruction.

1. Hospitalization for stabilizing your situation

When you initially reach the hospital, physicians will work toward stabilizing your situation so that your treatment can be started. This process usually includes:

• Putting an IV (intravenous) line in a vein in your arm to administer fluids
• Placing a NG (nasogastric tube) via your nose to your stomach so that fluids and air can be sucked out to relieve swelling of the abdomen
• Putting a catheter (flexible, thin tube) in your urinary bladder to drain and collect your urine for testing
• Antibiotics are given to treat overgrowth of bacteria in the intestines

2. Treatment for Intussusception

An air or a barium enema is utilized both as a treatment and diagnostic procedure for children who have Intussusception. If enema works, no further treatment is required.

3. Partial Obstruction

In case the obstruction is partial (where some fluid and food can still pass through the intestine) further treatment may not be required once your condition stabilizes. You may be given IV fluids and your bowels are rested. Resting the bowels means that you will not be given anything to eat or only clear liquids during this time. Partial obstruction of the small intestine often gets better within few days. The naso-gastric tube is removed if it was used. At this time, you may be given few sips of fluid and if you are able to tolerate this, then you may be given liquid diet for one or more days. This will be followed by a diet of solid foods, which are easily digested.

If your doctor can find the cause of your intestinal obstruction, then they will treat that as well. Dehydration is also treated simultaneously by giving intravenous fluids. If your obstruction is not relieved by any of these measures, then surgery may be required to treat the cause of partial obstruction.

4. Complete Obstruction

A complete obstruction will require surgery to treat the blockage. The type of operation depends upon the location and type of obstruction.

• A laparatomy is a surgery performed under general anesthesia in which an abdominal incision is made to search and manage the cause of the intestinal obstruction. If the cause of bowel obstruction is stricture, tumor or adhesions, then they are removed or if it is a hernia then it is repaired.
• A laparoscopy (keyhole surgery) is a procedure during which a small tube that has a camera and a light at the end of it (a laparoscope) is inserted via a tiny incision in the intestine. It is usually used to remove adhesions or to treat obstruction of the small bowel.
• Endoscopic stenting is a procedure in which a stent that is self-expanding is inserted in the intestine. It helps to keep the intestinal passage open and is usually considered in palliative treatment of patients suffering from cancer and in the treatment of elderly patients.
• In a colonoscopy or sigmoidoscopy, a flexible, thin tube that has a light and small camera attached at one end of it, is inserted via rectum in the colon along with a long rubber tube (flatus tube) to untwist and decompress the bowel.

During bowel obstruction treatment surgery, the surgeon may remove either only the cause resulting in the blockage or a segment of the intestine, stitching ends of remaining segments together. In severe cases of blockage, an ileostomy or colostomy may be required where an opening (stoma) is created in the abdominal wall so that the stools can be collected in a plastic bag via the stoma.

Medicines such as opioid painkillers, corticosteroids, antiemetics or antispasmodics may be given to relieve symptoms of blockage in patients who are not able to cope with the surgical procedure.

5. Treating Pseudo-obstruction

If it is determined by your physician that your obstruction is due to paralytic ileus, then your condition may be monitored by them for a couple of days in the hospital while treating the cause at the same time (if the cause is known). Paralytic ileus may get better with time on its own. Meanwhile, you will be administered food via a nasal tube or IV so as to avoid malnutrition.

If pseudo obstruction does not get better on its own, you may be given medicines to cause muscle contractions of the intestines, which will help move fluids and food through the intestines. If the cause of paralytic ileus is a medicine or an illness, the physician will stop the medicine or treat the illness. In rare cases, surgery may be required.

Outlook for Bowel Obstruction

If left untreated, bowel obstruction may cause death of the tissue of the affected part of the intestine. It may also result in a perforation or formation of a hole in the intestinal wall, severe infection or shock.

The overall outlook of intestinal obstruction treatment depends on the cause, your age, whether you received treatment on time and whether there are any other associated illnesses present or not. Most of the cases of bowel obstruction can be treated. However, some causes of obstruction such as cancer, need treatment and monitoring for long duration. Intestinal obstruction that is not accompanied by cancer has a good prognosis, particularly in people who otherwise have a good health.