Large Bowel (Intestinal) Obstruction

Overview

What is a large bowel (intestinal) obstruction?

A large bowel (large intestine) obstruction is a blockage that keeps gas or stool from passing through the body. An intestinal blockage can occur anywhere in the large intestine.

The large bowel obstruction may block the bowel completely or partially. A blocked intestine may rupture, causing a life-threatening infection.

What is the large bowel (large intestine)?

The large bowel or large intestine is part of the digestive system. It includes the colon and rectum.

The large intestine plays a vital role in removing waste from the body. Liquid food waste from the small intestine goes into the large intestine, where it turns solid. You pass this solid waste as stool when you poop.

Illustration of the large bowel | Cleveland Clinic

How common are large bowel obstructions?

Large bowel obstructions account for about 20% of all intestinal blockages. Small bowel obstructions are more common.

Symptoms and Causes

What causes a large bowel obstruction?

People of all ages and genders can get large bowel obstructions.

Some infants are born with a birth defect called malrotation. The intestines don’t form properly. This condition can cause the intestines to twist (volvulus), causing a blockage.

In children younger than three, a disorder called intussusception may cause blockages. In children with this problem, one segment of the intestine collapses inside another segment (like a telescope). The collapsed segments can block the bowel and blood flow.

Up to half of adults who develop a large bowel obstruction have colorectal (colon) cancer. A cancerous tumor causes the blockage.

Other causes of bowel obstructions in adults include:

What are the symptoms of large bowel obstruction?

You may have sharp stomach pains that come in waves. Eventually, the pain becomes constant. You may also have one or more of these symptoms:

Infants and children experience the same symptoms as adults. Infants can’t tell you where it hurts, but they may pull their legs up toward their bellies and cry. Other symptoms of bowel obstructions in children include:

  • Fever.
  • Blood in stool (rectal bleeding).
  • Green or yellow-green vomit.
  • Lethargy.
  • Swollen, firm belly.

Diagnosis and Tests

How is a large bowel obstruction diagnosed?

Your healthcare provider will perform a physical exam to check for a swollen abdomen or masses. Usually, the stomach isn’t tender to touch.

Your healthcare provider will use a stethoscope to listen to the intestines. Loud or high-pitched bowel sounds or a quiet bowel may indicate a problem.

Your provider may order these tests:

  • Blood tests: A blood test checks for signs of infection and dehydration.
  • X-rays: Abdominal X-rays can show a bowel blockage’s location. These images can also show air around the intestine or diaphragm (the muscle that separates the stomach and chest). Air in these places can indicate a dead bowel or rupture.
  • CT scan: If x-rays reveal a problem, your provider may perform a CT scan. This imaging procedure provides more detailed photos than x-rays.
  • Barium enema x-ray: A barium enema x-ray is a lower gastrointestinal (GI) exam. While you are sedated with anesthesia, a provider inserts a catheter (thin tube) into the anus. The catheter fills the intestine with a safe, white barium liquid. This liquid travels through the intestine while a machine takes x-rays.

Management and Treatment

What are the complications of large bowel obstruction?

A bowel blockage can stop blood flow, causing part of the intestine to die. As pressure builds up from the blockage, intestinal bacteria can leak into the bloodstream.

You may develop peritonitis, an abdominal infection. You are also at risk for a life-threatening system-wide infection called sepsis.

Your healthcare provider may surgically remove a segment of dead intestine. In that case, you may need a colostomy. With a colostomy, poop empties into a sealed bag outside your body.

How is a large bowel obstruction managed or treated?

A large bowel obstruction is a medical emergency. It requires hospitalization. Partial bowel obstructions, especially those due to scarring or adhesions, may clear up without much medical help.

Treatments for large bowel obstructions include:

  • IV fluid replacement: IV fluids and electrolytes (sodium, chloride and potassium) treat dehydration.
  • Medications: Anti-nausea medicine and pain relievers can keep you more comfortable.
  • Nasogastric tube: Your healthcare provider inserts a long, thin tube through your nose. The tube reaches into the stomach or intestine. It suctions out fluids backed up from the blockage.
  • Barium enema: The same endoscopic procedure to detect a blockage can also treat some problems, such as a twisted intestine.
  • Surgery: Your healthcare provider may remove adhesions or tumors that are causing a blockage. Or surgery can fix a hernia. Your provider may place a stent (a mesh tube) to keep the intestine open. Rarely, a provider must remove a segment of the damaged or dead intestine.

Prevention

How do I prevent a large bowel obstruction?

Unfortunately, there is no known way to prevent large bowel obstructions.

Outlook / Prognosis

What is the prognosis (outlook) for people who have a large bowel obstruction?

Most people with large bowel obstructions improve after treatment. Their bowels start to function again.

If an obstruction causes a rupture, the condition can be life-threatening.

Living With

When should I call my healthcare provider?

You should call your healthcare provider if you experience:

  • Fever.
  • Persistent vomiting.
  • Severe abdominal pain or cramping that comes and goes.
  • Signs of dehydration.

What questions should I ask my healthcare provider?

You may want to ask your healthcare provider:

  • Why did I get a large bowel obstruction?
  • What is the best treatment for a large bowel obstruction?
  • Am I at risk for another large bowel obstruction?
  • How can I prevent another large bowel obstruction?
  • Should I look out for signs of complications?

A note from Cleveland Clinic

A large bowel obstruction is a serious medical emergency. Not all bowel blockages require surgery. But you still need to be in the hospital. There, your healthcare provider can treat dehydration and drain excess fluid. This care can prevent more serious problems. Most surgically treated bowel blockages improve, resulting in normal bowel function afterward.

Last reviewed by a Cleveland Clinic medical professional on 12/21/2020.

References

  • Jackson P, Cruz MV. Intestinal obstruction: Evaluation and management. American Family Physician. 2018;98(6):362-7. Accessed 12/03/2020.
  • MedlinePlus. . Accessed 12/03/2020.Bowel Obstruction (https://medlineplus.gov/intestinalobstruction.html)
  • Merck Manual. . Accessed 12/03/2020.Intestinal Obstruction (https://www.merckmanuals.com/home/digestive-disorders/gastrointestinal-emergencies/intestinal-obstruction)
  • Merck Manual. . Accessed 12/03/2020.Intussusception (https://www.merckmanuals.com/home/children-s-health-issues/digestive-disorders-in-children/intussusception)
  • National Cancer Institute. . Accessed 12/03/2020.Gastrointestinal Complications (PDQ®)—Patient Version (https://www.cancer.gov/about-cancer/treatment/side-effects/constipation/gi-complications-pdq#section/all)
  • Radiopaedia. Accessed 12/03/2020.Large Bowel Obstruction. (https://radiopaedia.org/articles/large-bowel-obstruction)
  • Smith DA, Kashyap S, Nehring SM. Bowel obstruction. StatPearls. Accessed 12/03/2020.

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