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. In advanced cancer or terminal illness, it is a common complication that requires urgent medical attention.
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Bowel obstruction in palliative care
Key points about bowel obstruction
- Bowel obstruction(or intestinal obstruction) is a condition where your bowel is blocked either partially or totally.
- It could be caused by multiple factors, especially in the context of palliative care.
- Common symptoms are nausea and vomiting, crampy abdominal pain or discomfort, stomach distention, constipation and inability to pass gas (fart).
- See your healthcare provider immediately if you have any of these symptoms.
- Treatment aims to reduce your symptoms and not to cure your condition.
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 medications 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 that occurs suddenly
- nausea and vomiting
- constipation
- distention of your stomach or bloating
- inability to pass gas (fart)
- loud gurgling bowel sounds from your stomach.
It is also normal to feel anxious and distressed when you have symptoms of bowel obstruction.
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See your doctor straight away if you have any of these symptoms. |
Your doctor will ask about your symptoms and your medical history, as well as do a physical examination, including a rectum examination (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 is causing the obstruction.
As the condition is often caused by more than one thing, treatment can be complex. Before treatment is started, your doctor may ask you about your wishes or whether you have an advance care plan. You may be admitted to hospital to receive 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 medications to relieve nausea, vomiting and pain. Depending on the cause of your bowel obstruction, some medications aim to relieve the compression of your bowel by a tumour. Some of these medications 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 through your feelings with your family members or health professionals taking care of you.
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
NZ cancer services – find a hospital/service near you(external link) Healthpoint NZ
More cancer support groups
The following links provide further information about bowel obstruction. Be aware that websites from other countries may have information that differs from New Zealand recommendations.
Your guide to coping with bowel obstruction(external link) NHS Foundation Trust, UK
Intestinal obstruction(external link) Mayo Clinic, US
Intestinal obstruction(external link) MedlinePlus, US
Intestinal or bowel obstruction – discharge(external link) MedlinePlus, US
References
- Bowel obstruction in palliative care(external link) Auckland HealthPathways, NZ
- Bowel obstruction(external link) Scottish Palliative Care Guidelines, UK
Information for healthcare providers on palliative care - bowel obstructionThe content on this page will be of most use to clinicians, such as nurses, doctors, pharmacists, specialists and other healthcare providers. |
Clinical resources
The following information is taken from the palliative care handbook(external link) Hospice NZ, 2019.
Intestinal obstruction is a difficult area of palliative care. There is considerable inter-individual and intra-individual variation in symptoms and optimal management.
Causes
- Can be mechanical or paralytic.
- Blockage of intestine by intraluminal or extraluminal tumour, inflammation or metastasis.
- Blockage can occur at multiple sites in patients with peritoneal involvement.
- May be aggravated by drugs e.g. anticholinergics, opioids.
- Radiation fibrosis.
- Autonomic nerve disruption by tumour.
The management of intestinal obstruction should be tailored to the individual at the time with different strategies being employed when needed.
- Explain the predicament.
- Give dietary advice, eg, foods with minimal residue.
- Minimise colic by stopping osmotic/stimulant laxatives (continue softeners) and give subcutaneous hyoscine butylbromide (20 mg bolus followed by 60 to 80 mg subcut infusion over 24 hours).
- Give analgesia (commonly subcutaneous opioids).
- Reduce vomiting by giving appropriate antiemetics, eg, cyclizine with or without haloperidol – metoclopramide should only be used if there is clear evidence that there is only a partial obstruction.
- Consider alternative measures e.g. surgery, radiotherapy.
- Steroids e.g. dexamethasone should be given a trial.
- IV fluids and nasogastric tubes should be avoided but may be preferred where drug treatment has not worked. Subcut fluids may have a role in some.
- Somatostatin analogues (octreotide) may be used subcutaneously in specialist practice to reduce secretions and minimise symptoms.
- If subacute intestinal obstruction, the aim may be to clear the obstruction using steroids e.g. dexamethasone to reduce the inflammation around the obstruction and hyoscine butylbromide to minimise secretions and colic then, at an appropriate time, to push gut contents through with a prokinetic agent e.g. metoclopramide.
- The timings of each change in therapy will depend on the individual patient and their condition.
- Review the situation regularly.
See our page Palliative care for healthcare providers
Clinical resources and guidelines
Managing constipation in older people(external link) BPAC, NZ, 2019
Serious illness conversation guide Aotearoa(external link) Health Quality & Safety Commission, NZ, 2019
Methylnaltrexone is a subsidised treatment option for opioid-induced constipation in palliative care(external link) BPAC, NZ, 2018
The palliative care handbook(external link) Hospice NZ, 2019
Bowel obstruction – management in the palliative patient(external link) Starship Clinical Guidelines, NZ, 2015
Surveillance of people at increased risk of colorectal cancer(external link) BPAC, NZ, 2012
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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.
Reviewed by: Jarna Standen, Registered Nurse, Mercy Hospice, Auckland
Last reviewed:
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