Intestinal obstruction in adults

Intestinal obstruction is a common surgical pathology among both children and adults. In fact, it is a blockage of the small or large intestine, so doctors separate two variants of the disease: small intestine obstruction and problems of the large intestine. Although the mechanisms of development of pathology are similar, some symptoms may differ. But in general, it is important to know that this is a potentially life-threatening condition that has several causes and requires timely treatment.

Both partial and complete intestinal obstruction is possible, in adults it often leads to difficulty in passing stools and intestinal gases. With complete obstruction, they do not depart at all for a long time. Partial obstruction can cause diarrhea, although this is not a permanent symptom.

What is intestinal obstruction

Obstacles in the path of food masses cause accumulation of food in a certain area of ​​the intestine, stagnation of gastric juice, excessive formation of gases and liquids. As the manifestations continue to increase, the pressure inside the intestinal lumen increases. This can lead to rupture of the intestinal wall with the effusion of masses. What was in front of the blockage area can enter the abdominal cavity, irritate the peritoneum and spread bacteria, provoking the development of peritonitis. This condition can be fatal.

We look at the symptoms and causes of bowel obstruction in adults, how doctors can treat the condition, and what people can do to prevent it from happening.

Symptoms of intestinal obstruction in adults

Although symptoms can vary greatly from person to person, in general, symptoms of bowel obstruction can include sudden abdominal enlargement, severe intestinal cramps, nausea, and severe bloating. Bowel obstruction can be a painful and distressing condition that progresses without help and timely surgery.

Additional symptoms include:

• frequent or uncontrollable vomiting with constant nausea;
• diarrhea;
• severe swelling in one part of the abdomen;
• constipation up to several days;
• strong and sharp spasms, acute pain;
• decreased appetite;
• a sharp increase in the size of the abdomen.

And all this happens against the background of a complete absence of gases and stools. The patient cannot go to the toilet. It is important to note that vomiting and diarrhea are the first signs of intestinal obstruction, the contents depart below the area of ​​obstruction. Recognizing these symptoms means that a person can seek treatment before the condition progresses to severe complications.

If, after the appearance of some of these symptoms, the temperature has increased further, you should consult a doctor. This may be a sign of bowel perforation.

Causes of intestinal obstruction in adults

There is no single reason for all patients without exception. Given the fact that there is at least small bowel and colonic obstruction, there are many possible causes for the development of pathology.

In addition, mechanical and dynamic obstruction is possible, with the development of complications. Accordingly, the causes may be mechanical or non-mechanical.

Mechanical causes are various physical obstacles that completely stop or severely restrict the flow of food gruel through the intestines. These include:

• adhesions or fibrous tissue that may develop after abdominal or pelvic surgery
• diverticulitis (formation of sacs in the intestinal lumen);
• a foreign object that has entered the intestine when swallowed;
• gallstones, although this is a rarer cause of obstruction;
• hernia of the anterior abdominal wall, groin, navel;
• bowel infections;
• inflammatory bowel disease (IBD);
• invagination, when a segment of the intestine is pushed through, absorbed into the next segment, which leads to its collapse, compression;
• tumors of the intestine or neighboring organs;
• torsion of part of the intestine.

Some refer to non-mechanical obstructions as dynamic ileus, or paralytic ileus. This happens when something, various external influences disrupt the entire digestive system.

The large and small intestines move in concert, contracting rhythmically. If something interrupts this process, a non-mechanical obstruction (spasm, paralysis of the intestine, movement disorder and content stoppage) may occur. If a doctor can find and treat the cause, then dynamic (paralytic) ileus is usually considered a short-term problem and can be corrected without surgery. However, some long-term influences or chronic diseases can cause long-term non-mechanical obstruction.

Causes of non-mechanical ileus include:

• abdominal or pelvic surgery with damage to nerve fibers;
• diabetes;
• electrolyte imbalance;
• hypothyroidism;
• Hirschsprung’s disease, a condition in which the nerve cells at the end of the intestine are missing;
• infection;
• certain nerve and muscle disorders such as Parkinson’s disease;
• opioid drugs.

Treatment of intestinal obstruction in adults

In order to start the treatment of this pathology in a timely manner, to determine the correct tactics for managing the patient, it is necessary to correctly and quickly make a diagnosis. It is difficult to do this at home, so hospitalization is needed.

Diagnostics

After a preliminary examination by emergency doctors and the assumption that there may be intestinal obstruction, the patient is usually referred to a surgical hospital. The emergency room doctor may recommend urgent blood tests to check liver and kidney function.

Diagnosis usually begins with a physical examination. An obstruction can cause a lump in the abdomen, which a doctor can feel when they feel it. The doctor will also ask questions and review the person’s medical history.

During the examination, the surgeon may use a stethoscope to check the person’s bowel activity. Absence of regular characteristic bowel sounds (peristalsis or gurgling) or unusually quiet sounds may indicate bowel obstruction. Depending on individual cases, the doctor may recommend further tests. They may include:

• blood tests to check electrolyte levels, biochemical parameters, and the number of blood cells (especially white blood cells);
• endoscopy, in which the doctor uses a special camera to look inside the intestines
• computed tomography;
• x-rays with contrast – Doctors may inject a liquid substance called contrast through an enema, the contrast allows the bowel to be seen more clearly on imaging tests.

Modern treatments

The management of a patient with intestinal obstruction depends on the cause and severity of the obstruction. Complete mechanical obstruction usually requires surgery to remove the obstruction. Most cases of dynamic bowel obstruction require medical intervention, including possible surgery.

Treatment options for bowel obstruction may include:

Medicines. Opioids can cause constipation and intestinal spasm. In this case, laxatives and stool softeners, as well as opioid antidotes, will help.

Observation. A buildup of stool or ileus may need to be watched for a few days and will resolve over time. During this time, people should limit food and drink to prevent further accumulation of feces. Doctors may give fluid intravenously to keep the body hydrated.

Nasogastric tube. This is a narrow tube that is inserted through the nose and into the stomach. Through it, the liquid and gas stagnant in the stomach is removed, relieving pressure on it. This relieves pain and vomiting.

Operation. Surgeons may remove blocked or damaged sections of the intestine. In the case of IBD, stricturoplasty may be required. The surgeon will widen the narrowed portion of the intestine by cutting and suturing.

Therapeutic enema. A nurse or doctor injects medicine or tap water into the intestines to try and relieve blockages from excessively dry stools, which can happen with severe constipation.

Medications can help relieve discomfort caused by bowel obstruction. Treatment may include:

• anti-nausea medicines to prevent vomiting;
• anesthetizing;
• antibiotics to fight bacterial infection.

Prevention of intestinal obstruction in adults at home

Simple diet and lifestyle changes can help reduce the risk of bowel obstruction. They will also help you recover from an episode of obstruction. Aging slows down the digestive system. As a result, people can make changes to their diet later in life to balance digestive disturbances and eliminate constipation.

Suggested dietary changes:

• eat smaller meals more often
• chew food well;
• Avoid high-fiber foods such as whole grains and nuts
• reduce caffeine intake, which can irritate the intestines;
• avoiding tough or sticky foods like celery or dried meats
• peel the skin of fruits and vegetables to make them easier to digest;
• cook food until it becomes soft;
• focus on eating moist foods, such as those with sauces.

A set of lifestyle changes can help improve digestive health. The following steps need to be considered:

• maintain physical activity, play sports to the best of your ability;
• stay hydrated (drink more fluids);
• try to limit stress;
• quit smoking;
• drink less alcohol.

If a person has problems with bowel movements, stool softeners may help.

Popular questions and answers

We asked questions about the development of intestinal obstruction and its possible consequences Pathologist, Junior Researcher, National Research Center for Pediatric Hematology, Oncology and Immunology named after N.N. Dmitry Rogachev to Dmitry Abramov.