Bowel obstruction in palliative care

Bowel obstruction is a condition where your bowel is blocked either partially or totally, keeping food or liquid from passing down your bowel to your rectum. With advanced cancer or terminal illness, it's a common complication that requires urgent medical attention.

There are 2 types of bowel obstruction – mechanical and functional.

Mechanical bowel obstruction is when the blockage is caused by the narrowing of your bowel or bowel compression by external factors. Common causes of a mechanical bowel obstruction include:

• narrowing due to a tumour (cancer) or a foreign body in your bowel
• compression of your bowel by external factors such as liquid in your stomach or tumours outside your bowel
• scars on your bowel after a surgery, that could make your bowel sticky (post-surgical adhesions).

Functional bowel obstruction is when the nerves or muscles of your bowel are damaged, stopping food or liquid from moving down your bowel. The damage could be caused by cancer treatment such as radiotherapy, or surgery to remove a tumour in your stomach. It could also be caused by certain medicines that stop the normal bowel movement (peristalsis).

In advanced cancer or a terminal illness, bowel obstruction is usually caused by a mixture of mechanical and functional factors.

Common symptoms of bowel obstruction are:

• severe crampy tummy pain (crampy means it comes and goes)
• nausea and/or vomiting
• constipation (or no bowel motions)
• distention of your stomach or bloating
• inability to pass gas (fart)
• loud gurgling bowel sounds coming from your stomach.
  
  

It's also normal to feel anxious and distressed when you have symptoms of bowel obstruction.

Your healthcare provider will ask about your symptoms and your medical history, as well as doing a physical examination. This will include a rectal examination (putting a gloved finger up your bottom).

They may also do other tests such as an X-ray of your stomach or a CT scan to diagnose bowel obstruction and find out what's causing the obstruction. 

As the condition is often caused by more than one thing, treatment can be complex. Before treatment is started, your healthcare provider may ask you about your wishes or whether you have an advance care plan. You may be admitted to hospital for treatment and be referred to a palliative care specialist.

Treatment of bowel obstruction often depends on the cause and could be medical or surgical. These treatments are not meant to cure your condition. They aim to make you feel more comfortable by reducing your symptoms. 

• Medical treatment includes prescribing medicines to relieve nausea, vomiting and pain. Depending on the cause of your bowel obstruction, some medicines aim to relieve the compression of your bowel by a tumour. Some of these medicines can be given under your skin (subcutaneously) via a syringe driver.
• Sometimes, a soft tube called a nasogastric tube is inserted into your stomach through your nose to empty your stomach contents and reduce vomiting (being sick).
• Surgical treatment includes performing certain procedures or surgeries – either to relieve the obstruction or remove a tumour if there is one. 

It can be scary to experience the symptoms of bowel obstruction. Talk about your feelings with your family members or healthcare providers. 

Below are some support services and information for people affected by cancer and their family/whānau:

Emotions and cancer(external link) Cancer Society of NZ
How we can help(external link) Cancer Society of NZ
New Zealand cancer services – find a hospital/service near you(external link) Healthpoint NZ
More cancer support groups