A bowel obstruction, also known as intestinal obstruction, is a serious condition that occurs when the normal flow of digested material through the small or large intestine is blocked. This blockage can be partial or complete, and it can lead to severe complications if not treated promptly. While medical interventions are often necessary, dietary modifications play a crucial role in both managing symptoms and preventing future obstructions.
Understanding Bowel Obstruction
Bowel obstruction refers to blockages in the intestines that are not the result of fecal matter. Common causes include twisting of the intestines, a hernia, inflammation, tumors, and adhesions, or scar tissue, from surgery. Obstructions result in a buildup of food, gastric acids, gas, and fluids. As these continue to accumulate, pressure in the bowel increases. This can result in a rupture or split. Whatever was behind the blockage can enter the abdominal cavity and spread bacteria.
Bowel obstructions can vary in severity. Some only partially obstruct the intestines, while others cause complete blockages. Most bowel obstructions require treatment. Medication and bowel rest may treat mild cases, while surgery is necessary in around 20% of cases. Severe obstructions may eventually cause an intestinal rupture without treatment.
Types of Bowel Obstructions
Bowel obstructions can vary depending on the severity of the blockage:
- Complete obstructions: Severe bowel obstruction can entirely block part of the intestine. This may stop all solids, liquids, and gases from passing through the digestive system. Someone with a complete obstruction will find passing a stool or gas difficult, if not impossible.
- Partial obstructions: A partial bowel obstruction is typically less severe. These obstructions block some, but not all, of the intestine. This will slow the progress of solids, liquids, and gases through the digestive system but will not stop them entirely. A partial bowel obstruction may cause discomfort, bloating, and diarrhea.
- Pseudo-obstruction: Intestinal pseudo-obstruction is a rare condition that causes the symptoms of bowel obstruction without the presence of a blockage. It occurs when muscle or nerve issues prevent the normal movement of food, liquids, and gas through the intestines.
Symptoms of Bowel Obstruction
Bowel obstructions can be painful and distressing. Symptoms include:
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- Nausea and vomiting
- Diarrhea
- Bloating
- Constipation
- Cramping
- Decreased appetite
- Inability to pass stools or gas
- Severe pain
- Abdominal swelling
Vomiting and diarrhea are early signs of bowel obstruction. Recognizing these symptoms means that a person can seek treatment before the condition progresses. If a fever develops after some of these symptoms, it can be a sign of an infection, and a person should consult a doctor.
Causes of Bowel Obstruction
There are many possible causes of bowel obstruction. They are either mechanical or nonmechanical.
Mechanical Obstructions
Mechanical obstructions are physical barriers that prevent or restrict the flow of matter through the bowels. These include:
- Adhesions, or scar tissue from surgery
- A twisted bowel, also called volvulus
- Hernias
- Intussusception, which is when a segment of the bowel pushes into the next segment, making it collapse
- Foreign objects
- Gallstones, although this is a rarer cause of obstruction
- Inflammatory bowel disease (IBD)
- Tumors
Nonmechanical Obstructions
The large and small bowels move in coordinated contractions. If something interrupts this process, a nonmechanical obstruction can occur. If a doctor can detect and treat the cause, bowel obstruction is usually a short-term issue.
Causes of nonmechanical bowel obstructions include:
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- Scarring from abdominal or pelvic surgery
- Diabetes
- Electrolyte imbalances
- Hypothyroidism
- Hirschsprung’s disease, a condition where nerve cells are missing from the end of the bowel
- Nerve and muscle disorders, such as Parkinson’s disease
- Severe infection or illness
- General anesthesia
- Certain pain relief medications
Risk Factors for Bowel Obstruction
Some conditions and events increase the risk of a bowel obstruction occurring, such as:
- Cancer, especially in the abdomen
- Crohn’s disease
- Ulcerative colitis
- Previous abdominal or pelvic surgery, which may increase the risk of adhesions
- Radiation therapy
Bowel Obstructions and Age
People of any age may experience full or partial bowel obstructions. However, obstructions can carry additional complications in younger children and older adults. Bowel obstructions are a common reason for intensive care admission in newborns. Abnormal formation of the intestines can often cause obstruction in younger children. For example, intussusception is most common in babies aged under 2 years.
Small bowel obstructions are also a common emergency condition in older adults. Obstructions due to malignant tumors are more common in this population as well. The higher prevalence of additional health complications in older adults can alter treatment programs for bowel obstructions.
When to Seek Medical Advice
If severe abdominal pain develops, a person should contact a doctor immediately. Bowel obstruction can have serious consequences. An individual should seek medical advice if they experience any symptoms of a bowel obstruction.
Diagnosis of Bowel Obstruction
Diagnosis tends to begin with a physical examination. An obstruction can cause a hard lump in the abdomen, which a doctor may be able to feel. The doctor will also assess a person’s medical history during the initial examination.
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A doctor can use a stethoscope to check a person’s bowel activity. A lack of regular bowel sounds or unusually quiet sounds can suggest a bowel obstruction. Depending on individual cases, a doctor may recommend further tests. These can include:
- Blood tests to check levels of electrolytes, liver and kidney function, and blood counts
- Endoscopy, in which a doctor uses a special camera to look inside the gut
- CT scans
- X-rays
- Contrast enemas
Treatment for Bowel Obstruction
Treatment for bowel obstruction depends on the cause and how severe the blockage is. A total mechanical obstruction usually requires surgery. Most cases of bowel obstruction need some form of medical intervention.
Treatment options for bowel obstruction can include:
- Medication: Opioids can lead to constipation. If this occurs, laxatives and stool softeners can help.
- Observation: Doctors will typically observe a person with partial or complete obstructions before considering further options, such as surgery. During this time, the individual should limit their food and drink intake to stop further buildup. Doctors can provide fluid intravenously, meaning directly into the vein, to keep the person hydrated.
- Nasogastric tube: This is a narrow tube that goes up the nose and into the stomach. It removes fluid and gas trapped in the stomach, relieving pressure. This eases pain and vomiting.
- Surgery: Surgeons can remove blocked or damaged sections of the bowel. In cases of IBDs, a strictureplasty may be necessary. Here, a surgeon will widen the narrowed section of the bowel by cutting and sewing.
- Therapeutic enema: A nurse or doctor will push a medication or tap water into the bowel to try to relieve stool impaction, which can happen in severe constipation.
Medication may help ease discomfort due to a bowel obstruction. This can include:
- Antinausea medicines to prevent vomiting
- Pain relief medication
- Antibiotics to fight bacterial infection
People should try to move around when possible and remain hydrated to ensure their electrolytes are balanced. Those with Crohn’s disease may benefit from steroids.
Complications of Bowel Obstruction
A bowel obstruction can lead to other issues, such as:
- Dehydration
- Tissue death in the bowels
- Abscess within the abdomen
- Kidney failure
- Intestinal tears
- Pulmonary aspiration
- Sepsis
People who have had surgery for obstructions are also at risk of other complications, including:
- Abdominal adhesions
- Bowel paralysis
- Nerve damage
- Short bowel syndrome
- Wound reopening
At worst, it can lead to multiple organ failure and death. That is why it is important to treat bowel obstructions as soon as possible.
Dietary Guidelines After Bowel Resection
A bowel resection, also called a colectomy, is an operation to remove part of the large intestine that’s blocked or diseased. After this surgery, dietary adjustments are essential to promote healing and prevent complications.
Initial Post-Surgery Diet
Soon after a bowel resection, you should be able to drink fluids. A few days later, you can start to eat real food. Your doctor may tell you to start with soft foods like cooked vegetables, bananas, avocados, mashed potatoes, and tender proteins. Your intestines may be swollen after surgery, and these foods will travel through them more easily.
Low-Fiber Diet
Your stomach doesn’t fully digest high-fiber foods like whole-grain bread and cereals. They go to the large intestine and are taken care of there. Your large intestine is healing, so don’t make it work too hard. A low-fiber diet (your doctor may call it “low-residue”) for 4 to 6 weeks can help.
Foods to Avoid
- High-Fiber Foods: Uncooked fruits and vegetables are high in fiber. They can be crunchy (like carrots) or stringy (like celery) and hard to chew into small pieces. They might have tough skins (like apples) or seeds that are hard to digest. All of this can irritate your large intestine as it heals. Avoid these foods for a few weeks as you recover, then slowly add them back into your diet. Limit foods high in fiber such as old vegetables, grains, legumes, and nuts.
- Fatty and Fried Foods: It’s common to have diarrhea after a bowel resection. Because your large intestine is suddenly shorter, digested food doesn’t have as far to travel (or as much time to form into solid stools) before it leaves your body. Some things can make diarrhea worse: fatty meats, butter and cream, fried foods, greasy snacks like potato chips. The diarrhea will usually go away after a few weeks. Then you can enjoy these foods again from time to time. Limit high-fat foods, fried foods, fast food, processed foods… which can cause indigestion and make the digestive system work harder to digest food.
- Spicy Foods: Spicy foods can irritate your digestive system and cause diarrhea or uncomfortable bloating -- especially as your intestine heals. Your doctor may suggest a bland diet for a few weeks after surgery. And it isn’t just “hot” stuff you need to watch out for. Herbs and spices with rough textures -- like chopped rosemary, crushed peppercorns, or caraway seeds -- can also cause problems.
- Foods That Cause Gas: There’s a type of sugar in beans that isn’t easy for your body to digest. So you might have gas or feel bloated after you eat them. You may also have trouble with lactose, a sugar found in milk and other dairy products. Gas is a normal part of digestion, but while you’re healing from bowel surgery it can be uncomfortable or even painful.
- Caffeinated and Sugary Drinks: Caffeine, which can be found in both these drinks, is a stimulant. That means it speeds up activity in your body -- including the intestines. Drinks made with sugar or artificial sweeteners can also bring on diarrhea. The bubbles in soda may cause gas and bloating. It’s important to stay hydrated after surgery, but water (or a special rehydration drink) is a smarter choice.
- Alcohol: Alcohol can stimulate your intestines and cause more frequent bowel movements. Avoid it until your digestion is back to normal. Plus, most doctors say not to drink alcohol after any type of surgery. It can interfere with your pain meds and slow the healing process.
- Tough and Hard Foods: Limit tough and hard foods such as offal, tendons, and gristle… which will create a nucleus for other foods to clump together.
- Fruits with Resin and Tannins: Avoid eating fruits, and foods with a lot of resin, and tannins, especially on an empty stomach or when eating with high-protein foods. Limit dried fruits and vegetables.
Eating Habits
- Small, Frequent Meals: When you start to eat solid foods again, you may get full faster than before. Try to have several small meals throughout the day instead of three large ones. You’ll digest them easier, and they’ll be less likely to cause gas or bloating.
- Chew Thoroughly: Eat slowly and to chew each bite fully -- to a mashed-potato texture -- before you swallow.
- Avoid Overeating: Eat small meals throughout the day, and avoid overeating.
Reintroducing Foods
Once your digestion is better, you can start to go back to a normal diet. Add one new food a day, one serving at a time, so you can learn how your body reacts to each one. That’ll also help your intestines slowly adjust to digesting more high-fiber foods like fruits, vegetables, and whole grains.
General Dietary Recommendations for Bowel Obstruction
- Eat Well-Cooked Food: Eat well-cooked food and chew thoroughly.
- Drink Plenty of Water: Drink plenty of water, at least 2 liters per day, and fruit juice without pulp. Fluids with sodium and glucose in them will help absorb fluids better than plan water.
- Beneficial Vegetables: Eat plenty of vegetables that are beneficial for the intestines, such as sweet potato, winter melon, potato, carrot, radish, spinach, mushroom… It is advisable to eat slippery Vegetables that easily dissolve in water, preventing constipation such as okra, jute, and amaranth.
- Beneficial Fruits: Eat plenty of fruits that are good for the intestines, such as ripe papaya, ripe banana, watermelon… Cook apples as can't eat them raw. And bananas are ok.
- Beneficial Meats: Eat meats such as lamb, pork, beef, fish.
- Dairy: Drink lactose-free milk. Eating yogurt will enhance the digestion of food.
Foods to Generally Avoid
- Foods Containing Tannins: Bezoars often form when we eat a lot of foods containing tannins such as unripe mangoes, guava, soaked persimmons, and foods high in fiber such as bamboo shoots… Therefore, to prevent bowel obstruction, it is necessary to limit the consumption of these foods.
- Red Meat: Limit red meat.
- Alcohol and Carbonated Drinks: Avoid alcohol, carbonated drinks, or other stimulants.
Lifestyle Changes
Simple changes to a person’s diet and lifestyle can help them digest food more easily and lower the impact of bowel obstructions. To help prevent bowel obstruction, a person can aim to:
- Drink plenty of water to remain hydrated
- Exercise regularly to stimulate bowel contractions and circulation. Engage in gentle exercise like walking to stimulate bowel movements.
- Chew their foods well
- Eat smaller meals throughout the day
- Eat sitting up: Eating meals while slouched on a sofa (or lying down immediately after meals) slows food transit times and creates "kinks" in the intestines that slow the passage of stool.
- Avoid habits that cause gas: This includes chewing gum, sipping on straws, and drinking carbonated beverages that add gas to the intestines and make bowel pain worse.
- Take a walk after meals: Engage in gentle exercise like walking to stimulate bowel movements.
- Sip a cup of coffee: Caffeine stimulates the rhythmic movement of the digestive tract, called peristalsis.
Home Remedies for Partial Bowel Obstruction
If you have a partial bowel blockage that causes pain and slows the passage of poop from your body, there are remedies you can try at home to make things better. Partial bowel obstruction makes it harder to pass stool and also causes gas to build up, leading to cramping, bloating, and pain.
- Increase Dietary Fiber: This includes insoluble fiber that helps ease constipation and soluble fiber that creates a gel to make stool smoother.
- Avoid Hard-to-Digest Food: This includes fatty, fried, fast, or ultra-processed foods that are harder to break down in the intestine.
- Prebiotics or Probiotics: Try prebiotics or probiotics. Prebiotics involve foods like chicory, asparagus, bananas, jicama root, cocoa, and seaweed that promote the growth of "good" bacteria in the gut.
- Heating Pads: Applying heat to the abdomen helps ease cramping and may even relax the intestines to improve peristalsis.
- Enemas: An enema involves inserting liquid into your rectum to help you poop. It may not help clear the blockage, but it may stimulate peristalsis to gently encourage the evacuation of the bowel.
- Fiber Supplements: These may be appropriate if you are not getting enough fiber in your diet. Glucomannan is a soluble, bulk-forming fiber is derived from konjac root.
- Herbal Remedies: Herbal remedies for constipation-predominant irritable bowel syndrome: a systematic review of randomized controlled trials.
Examples of Foods to Eat
| Category | Examples |
|---|---|
| Carbohydrates | white bread, white rice, white pasta, white flour, cornflour, low fiber breakfast cereals |
| Fruit | canned peaches and pears, melon, peeled and cored apples, fruit juice, excluding orange juice |
| Vegetables | potatoes without the skin, well cooked squash, carrots, courgette, asparagus, and beetroot |
| Protein | All meant and fish eggs |
| Dairy | milk, cheese, yogurt without fruit |
| Soups | Blended soups are very easy to digest. Lentil soup is high in soluble fibre which is helpful once you are allowed to eat again. |
Caution
The main concern when treating a bowel blockage at home is that you often can't tell how severe it is. A partial bowel blockage is a serious problem that should be seen by a provider but can be managed with certain at-home treatments.