A large bowel obstruction occurs when there is partial or total blockage in the large intestine (also called the large bowel or colon). As a result, waste cannot move through the bowel properly and out of the body. Treatment is needed right away to remove the blockage. This can relieve painful symptoms. It can also prevent serious complications such as tissue death or rupture of the large bowel. Without treatment, a large bowel obstruction can be fatal.
Causes of Large Bowel Obstruction
A large bowel obstruction can be caused by the following:
- Twisting of the bowel (volvulus)
- A narrowing (stricture) of the bowel caused by conditions such as diverticulitis and Crohn's disease
- Sliding of a portion of the bowel into another portion (intussusception)
- A hard lump of stool (impacted feces)
Symptoms of Large Bowel Obstruction
Common symptoms include:
- Abdominal cramping and pain
- Abdominal swelling and bloating
- Inability to pass gas
- Inability to pass stool (constipation)
Diagnosing Large Bowel Obstruction
Your doctor will ask about your symptoms and health history. You'll also have a physical exam. In addition, tests may be done to confirm the problem. These can include:
- Imaging tests. These provide pictures of the large bowel. Common tests include x-rays and a computed tomography (CT) scan.
- Blood tests. These check for infection and other problems such as dehydration.
- Air enema or contrast enema. One of these tests is done to take pictures of the inside of the large bowel. A thin tube is inserted into the rectum through the anus. Then either air or contrast fluid is sent through the tube. This makes the bowel show up clearly on x-rays.
- Colonoscopy. This test is done to see inside the large bowel with a colonoscope ("scope"). The scope is a thin, flexible tube with a tiny camera on the end. It is inserted into the rectum through the anus. This lets the doctor check for problems and collect tissue samples (biopsy), if needed.
Treating Large Bowel Obstruction
Treatment takes place in a hospital. As part of your care, the following may be done:
- No food or drink is given by mouth. This allows your bowels to rest.
- An intravenous (IV) line is placed in a vein in your arm or hand. It's used to give you fluids and nutrition. It's also used to give medications. These may be needed to relieve pain and other symptoms. They may also be needed to treat or prevent infections.
- A soft, thin, flexible tube (nasogastric tube) is inserted through your nose and into your stomach. The tube is used to remove extra gas and fluid in your stomach and bowels. An air or contrast enema may be done as well. It can remove gas or help clear a blockage.
- In some cases of large bowel obstruction, procedures with a colonoscope are done as treatment. For instance, the scope may be used to "straighten" a twisted colon that is causing a blockage. Or, tools may be passed through the scope to widen narrowed areas of the colon or to place a stent in the colon. A stent is an expandable tubelike device. Placing it in the colon can help relieve symptoms.
- More often, surgery is done as treatment for a large bowel obstruction. During surgery, the blockage is removed. If a portion of the bowel has died due to lack of blood flow, this must also be removed. The healthy ends of the bowel are then reconnected. If a long portion of the bowel is removed, a small opening (stoma) may need to be made in the abdomen. This provides a new way for waste to leave the body. The stoma may be temporary or permanent. Depending on the cause of the blockage, other repair may be done as well.
- Once treatment is done, you'll be observed in the hospital until your symptoms improve. Your doctor will tell you when can return home. If a stoma was created during surgery, you'll be taught how to care for it properly before leaving the hospital.
After treatment, many people recover with no lasting effects. If a long portion of the bowel was removed, you're at higher risk of lifelong digestive problems such as irregular bowel movements. If you have cancer or other conditions, you'll need to continue seeing your doctor for treatment. Work with your doctor to learn the best ways to manage your condition and to protect your health.
When to Call the Doctor
Call your doctor right away if you have any of the following:
- Fever of 100.4°F or higher
- Abdominal swelling or cramping that won't go away
- Inability to pass stool or gas
- Nausea and vomiting
- Rectal bleeding