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Intestinal Obstruction Symptoms - Recognizing Ileus
An intestinal obstruction (ileus) causes severe abdominal pain, bloating, and absence of bowel movements. Learn which symptoms indicate a bowel obstruction.
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An intestinal obstruction (ileus) causes severe abdominal pain, bloating, and absence of bowel movements. Learn which symptoms indicate a bowel obstruction.
What is an intestinal obstruction?
An intestinal obstruction, medically known as ileus, is a serious condition in which intestinal contents can no longer move normally through the bowel. It is a medical emergency that requires immediate medical attention. There are two main types: mechanical ileus (physical blockage) and paralytic ileus (paralysis of the intestinal muscles).
Common symptoms of an intestinal obstruction
Symptoms can vary depending on the type and severity of the obstruction. The most common complaints include:
- Severe, colicky abdominal pain: Mechanical ileus typically causes wave-like, cramping pain. Paralytic ileus may cause duller, more diffuse pain.
- Distended, hard abdomen: The abdomen is often severely bloated and tender to the touch.
- Absence of bowel movements and passing of gas: A complete halt in stool and gas passage is a hallmark sign.
- Nausea and vomiting: Nausea and vomiting are common; in advanced cases, vomit may have a fecal odor (known as feculent vomiting).
- Bowel sounds: In mechanical ileus, high-pitched, tinkling bowel sounds may be heard early on. In paralytic ileus, bowel sounds are markedly reduced or absent (silent abdomen).
- General malaise: Fatigue, weakness, and a general feeling of being unwell are frequently present.
Symptoms by type of ileus
Mechanical ileus
Mechanical ileus involves a physical blockage such as adhesions, a tumor, an incarcerated hernia, or a volvulus (twisted bowel). Symptoms often begin suddenly and can be severe:
- Intense, wave-like abdominal cramps
- Distended abdomen
- No bowel movements or passing of gas
- Nausea and vomiting
- Audible, high-pitched bowel sounds
Paralytic ileus
Paralytic ileus occurs when the bowel muscles are paralyzed without a physical blockage. This can be triggered by surgery, infections, medications, or metabolic disorders. Typical symptoms include:
- Diffuse, less crampy abdominal pain
- Severely bloated abdomen
- Absent or markedly reduced bowel sounds
- Nausea and vomiting
- No bowel movements or passing of gas
Warning signs and complications
An intestinal obstruction can deteriorate rapidly and cause life-threatening complications. The following warning signs require an immediate emergency call:
- Sudden onset of very severe abdominal pain
- Board-like rigidity of the abdomen
- Fever (sign of developing peritonitis, i.e., inflammation of the abdominal lining)
- Circulatory collapse, drop in blood pressure, signs of shock
- Feculent-smelling vomit
Diagnosis
Diagnosis of an intestinal obstruction involves:
- Physical examination: Palpation and auscultation of the abdomen
- Abdominal X-ray: Detection of air-fluid levels characteristic of obstruction
- Ultrasound: Assessment of bowel motility and fluid accumulation
- Computed tomography (CT scan): More precise localization and identification of the cause
- Blood tests: Inflammatory markers, electrolytes, and kidney function
Treatment
Treatment depends on the cause and type of obstruction:
- Conservative management: Fasting, nasogastric decompression, intravenous fluids, bowel stimulation (for paralytic ileus)
- Surgical treatment: Mechanical ileus often requires surgery to remove the blockage (e.g., release of adhesions, tumor removal)
- Treatment of the underlying cause: Addressing the triggering cause (e.g., infection, electrolyte imbalance)
When to see a doctor?
Anyone experiencing persistent abdominal pain, absence of bowel movements for more than one to two days, severe bloating, or vomiting should seek medical attention promptly. For sudden, very severe pain, fever, or circulatory problems, emergency services should be called immediately.
References
- Townsend, C. M. et al. - Sabiston Textbook of Surgery, 21st edition. Elsevier, 2022.
- Hayanga, A. J. et al. - Current Management of Small Bowel Obstruction. Advances in Surgery, 2005.
- World Gastroenterology Organisation (WGO) - Global Guidelines on Bowel Obstruction. Available at: www.worldgastroenterology.org
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