Small Bowel Obstruction: Causes, Symptoms, Treatment and Cost

A hernia or adhesions from a prior operation are the most prevalent causes of small bowel obstruction. A small bowel obstruction is a blockage in the small intestine.

• Adynamic ileus: Adynamic ileus is a type of small bowel obstruction caused by a decrease in the normal peristaltic activity of the small intestine, resulting in the buildup of undigested food and fluid in the intestinal lumen.
• Mechanical Small Bowel Obstruction: Mechanical small bowel obstruction is caused by physical blockage of the small intestine due to scar tissue, foreign bodies, tumours, or hernias. This type of obstruction can cause pain and vomiting, as well as other serious complications such as infection or perforation.
• Paralytic ileus:The condition known as paralytic ileus is a form of small bowel blockage that is brought on by a disruption in the normally coordinated movement of the muscles that line the intestines. This disruption makes it impossible for food to go through the digestive system. This condition can be caused by medications, electrolyte imbalances, or abdominal surgery.

• Small bowel obstructions can be caused by a variety of conditions, such as adhesions from previous surgeries, hernias, tumours, blockages due to swallowed objects, and inflammatory bowel diseases.
• Abdominal trauma resulting from a fall or car accident may also cause a small bowel obstruction.
• Idiopathic small bowel obstruction is the term used to describe situations in which the reason of the obstruction cannot be determined.
• In pregnant women, the most common cause of small bowel obstruction is the compression of the intestines due to the enlarged uterus.

Some of the common symptoms include:

• Abdominal pain and cramping :The first symptom of small bowel obstruction is usually abdominal pain and cramping. This pain may be localised or may radiate to the back, sides, and shoulders.
• Nausea and vomiting :Those who are suffering from a blockage of the small intestine may frequently experience nausea and vomiting. The digestive fluid known as bile, which has a yellowish-green colour and is generated by the liver, may be present in vomit.
• Loss of appetite :People with small bowel obstruction often experience a loss of appetite due to nausea and abdominal pain.
• Constipation :Constipation is another common symptom of small bowel obstruction as the stool cannot pass through the blocked area in the intestine.
• Abdominal bloating and distention :The abdomen may become distended (swollen) due to an accumulation of gas or fluid in the intestine, which can lead to severe discomfort.
• Fever :A fever can occur due to infection or inflammation in the intestines caused by a blockage or partial blockage in the intestine.

• Eating a balanced diet: Eating a balanced diet with plenty of fibre can help prevent small bowel obstruction. Fibre helps keep the digestive tract regular and prevents hard stools that can lead to blockage.
• Avoiding high-fibre foods if you have a narrowed intestine: If you have an existing narrowed intestine, it is important to avoid high-fibre foods, as they may increase the chances of obstruction.
• Being aware of risk factors: Being aware of risk factors such as having had abdominal surgery or having Crohn's disease or diverticulitis can help you to be more vigilant in preventing small bowel obstruction.
• Taking medications as prescribed: Taking medications such as antispasmodics or laxatives as prescribed by your doctor can help to keep your bowels regular and reduce the risk of small bowel obstruction.
• Getting regular checkups: Getting regular checkups with your doctor can help to identify any issues early on that may be contributing to an increased risk of small bowel obstruction.

• Abdominal X-ray: An abdominal X-ray is a quick and easy way to diagnose a small bowel obstruction. It can show whether the intestine has become twisted or blocked, as well as any gas build-up in the abdomen.
• Abdominal CT scan: A CT scan is more detailed than an X-ray and may be used to confirm a diagnosis of small bowel obstruction. It can also show if there is any inflammation or infection present, as well as any complications that have arisen from the obstruction.
• Ultrasound: An image of the inside of your body may be created by the use of sound waves with the help of ultrasound, which can be used to detect a minor intestinal blockage.The ultrasound can detect fluid buildup in the intestine which could indicate an obstruction.
• Barium Swallow Study: This procedure involves drinking barium, which helps make your intestines visible on an X-ray or CT scan. The study can help identify narrowing or blockages in the small intestine that could be causing an obstruction.
• Laparoscopy: A laparoscopy is a minimally invasive surgical procedure used to diagnose and treat certain conditions, including small bowel obstructions. During this procedure, your doctor will insert a thin tube with a tiny camera into your abdomen through one or more small incisions so they can view your organs and determine if there are any blockages present.

• Vomiting: Vomiting is a common complication of small bowel obstruction as the contents of the stomach are unable to pass through the obstruction, leading to an accumulation of fluid and gas in the stomach.
• Dehydration: As vomiting continues and fluid is not replaced, dehydration can occur.
• Infection: Bacteria from the contents of the small intestine can enter into the abdominal cavity and cause infection if allowed to accumulate for a prolonged period of time.
• Perforation: If an obstruction is not treated promptly, pressure can build up in the intestine leading to rupture or perforation and contamination of the abdomen with bacteria from inside the gut.
• Bowel Ischemia: Inability to pass food or gas through an obstruction over time can cause injury to or death of tissue beyond the point of blockage due to lack of oxygen supply (ischemia).

• Virechana: Virechana is a type of purgation therapy in Ayurveda. It is utilised to rid the body of pollutants and to bring about a state of equilibrium that had been lost. It helps to reduce small bowel obstruction by removing the blockage caused due to accumulation of toxins.
• Lavana Sweda: Lavana Sweda is a type of sweat therapy used in Ayurveda which helps to reduce inflammation in the small intestine and soften the blockages caused due to accumulation of toxins. This helps to relieve obstruction in the small intestine.
• Panchakarma: Panchakarma is a five-step therapeutic process that helps to cleanse and detoxify the body as well as restore balance and health. It helps to reduce small bowel obstruction by removing any blockages and clearing out any toxins from the body.
• Abhyanga: Abhyanga is an ayurvedic massage technique which helps to improve circulation, nourish the tissues, and relax muscles. This helps to reduce small bowel obstruction by improving digestion and removing any blockages in the intestines due to accumulated toxins or inflammation.

• Clear liquids: The primary recommendation for someone with small bowel obstruction (SBO) is to avoid solid foods and consume only clear liquids, such as water, diluted juice, broth, and gelatin. This helps prevent further blockage of the intestines and can help reduce symptoms such as nausea and vomiting.
• Low-fibre foods: Low-fibre foods that are easier to digest may be recommended for someone with SBO. Examples include mashed potatoes, white bread, cooked cereal, applesauce without seeds, soft cooked vegetables without skins or seeds, and eggs without the yolk.
• Nutritional supplements: Nutritional supplements such as Ensure or Boost may be recommended to help ensure adequate nutrition while avoiding solid foods. These supplements contain carbohydrates, proteins, fats, vitamins and minerals that provide necessary nutrition for the body.
• Probiotics: Taking probiotics or eating fermented foods may help reduce inflammation in the gut and promote healing of the intestines. Examples include yoghurt with live cultures or probiotic supplements containing Lactobacillus acidophilus or Bifidobacterium bifidum species.

• High Fiber Foods: Foods high in fibre, such as raw fruits and vegetables, nuts, and seeds, should be avoided because they can worsen the obstruction.
• Caffeine: Consuming caffeinated drinks such as coffee and soda can lead to cramping or distension of the abdomen.
• Dairy Products: Lactose found in dairy products may cause uncomfortable bloating or abdominal cramps that make matters worse for those suffering from small bowel obstruction.
• Processed Foods: Eating processed or prepackaged snack foods can make an individual more susceptible to experiencing a blockage due to their often high levels of fat and sodium.
• Fatty Foods: Excessively greasy or fatty foods should be avoided as they require more time for digestion which may cause other gastronomical complications when dealing with an intestinal blockage.

• Compressive Laxative Therapy: The goal of this treatment is to use medications like polyethylene glycol (PEG) to help remove the obstruction and restore normal motility of the bowel.
• Endoscopic Procedures: This could involve cystoscopy, introducing a balloon-tipped catheter or inserting an endoscope directly into the intestine to reduce pressure or unblock any obstructions.

A gastroenterologist is the best doctor to consult for small bowel obstruction. They specialise in the diagnosis and treatment of conditions that affect the digestive system, including small bowel obstruction.

• Surgical Intervention: This is the most common and effective treatment for small bowel obstruction. It involves an operation to open and clear the blocked area of the intestine.The severity of the symptoms and the underlying reason of the obstruction will determine the type of surgery that is performed.It may involve removing a section of the intestine or performing a bypass procedure.
• Gastrointestinal Decompression: This is a procedure used to relieve pressure from an obstructed bowel, allowing it to heal or pass stool more easily. It is usually done as part of surgical intervention, but can also be done separately with a catheter placed through the nose or mouth into the stomach or small intestine.

• Laxatives: These are substances that help ease or stimulate bowel movements and are often used to treat constipation. Examples include polyethylene glycol, magnesium hydroxide, lactulose, and senna.
• Antispasmodics / Smooth Muscle Relaxants: These drugs help relax the smooth muscles that line the intestine, which can reduce cramping pain associated with SBO. Examples include hyoscyamine, dicyclomine hydrochloride, and peppermint oil.
• Promotility Agents: These drugs work to speed up digestion and help move food through the intestine more quickly, reducing the chances of it becoming stuck in one area and causing an obstruction. Examples include erythromycin and metoclopramide hydrochloride (brand name Reglan).
• Opioids: In severe cases of SBO that cause a lot of pain, opioids may be prescribed to manage the discomfort until a doctor can take measures to correct the obstruction surgically or naturally via laxatives or stool softeners like docusate sodium (brand name Colace). Examples of commonly prescribed opioid medicines for pain relief include codeine and morphine sulphate.
• Nutritional Supplements: In cases where patients require assistance with nutrition due to their inability to absorb nutrients from food in their blocked intestines, certain intravenous vitamin supplements or high calorie nutritional shake replacements may be prescribed by a doctor to ensure adequate intake for health maintenance purposes

Recovery from a small bowel obstruction typically takes several days to a week.

It can take longer if the obstruction is severe or if the patient has other health conditions that complicate the recovery process.

• The outcomes of therapy for blockage of the small bowel might be variable.
• Most cases can be managed medically, with dietary and lifestyle changes, medications, and supplemental nutrition.
• In more severe cases, an urgent or emergency surgical procedure may be necessary to restore normal bowel functioning. In the majority of instances, these therapies can alleviate symptoms while also lowering the risk of consequences.
• However, the results are not permanent; recurrence is possible in some individuals due to underlying causes such as chronic inflammation or adhesions.

• Clear liquids are typically started after the obstruction is relieved and then advanced to a low-fat, low-residue diet.
• Medications may be prescribed to reduce cramping, nausea and vomiting.
• The patient should avoid carrying heavy objects and straining during bowel movements or other activities which might lead to further obstruction.
• Patients may need to take iron supplements if they have been anaemic due to the obstruction.
• Any severe physical activity should be avoided until the patient has been given the all-clear by their attending physician. The patient's level of activity should be progressively raised over time as it is tolerated by the patient.
• To ensure that the patient's development is being monitored appropriately and appropriately, the doctor should be contacted at regular intervals for follow-up consultations.

The cost of treating an obstruction of the small bowel in India might fluctuate substantially based on the degree of the obstruction as well as the therapy that is administered.

Generally, surgery is required to treat a small bowel obstruction and the cost can range from around Rs 50,000 to Rs 3 Lakhs.

• The side effects of Small Bowel Obstruction treatments can include pain, nausea, vomiting, fever, abdominal tenderness, bloating and distention, constipation, dehydration, electrolyte imbalances (such as sodium and potassium levels), and infection.
• In more severe cases, surgery may be required to remove the obstruction.
• Complications of surgery can include bleeding, infection, organ damage, and death.
• Other associated risks can include blood clots in the legs or lungs.

Obstruction of the small bowel is a problem that should not be taken lightly as it can pose a threat to the patient's life and calls for immediate medical intervention. It is caused by a blockage in the small intestine, which can occur due to hernias, adhesions, tumours, or foreign objects. Its treatment typically involves intravenous fluids, medications to reduce pain and nausea, and possibly surgery.