Bowel Obstruction

A need for laxatives doesn’t mean there’s a bowel obstruction. People who are seriously ill often have trouble with bowel function. Laxatives are used to treat this before it has a chance to create a bowel obstruction.

Two main reasons why a person who’s ill may need a laxative are:

• Some cancers affect how the bowel works. Any tumor located near the bowel may press on it and make it difficult for the bowel to work properly. For example, ovarian cancer may do this because the ovaries are located near the bowel.
• Many medications affect how the bowel works. For example, opioid medications, such as morphine or Dilaudid, cause the bowel to slow down and not work well. Someone taking such medications needs to take a laxative also, in order to promote bowel movement.

As long as someone is passing regularly formed stools (stool consistency unchanged), and reasonably frequently (at least every three days), then it’s unlikely that person has a blocked bowel. A bowel obstruction produces abdominal pain that’s different from pain related to the underlying illness. It also produces nausea. The person is unlikely to pass any stool at all. At times there may be diarrhea or loose stool, as this can pass around a blockage. X-rays are often used to determine if someone has a bowel obstruction.

It’s important to contact a health care provider immediately if any of these symptoms appear:

• no bowel movement within three days;
• unusually high number of stools per day;
• blood in the urine, stool or anal area;
• no bowel movement within one day of taking a laxative;
• persistent cramps and vomiting.

Several things affect how long someone can live with a blocked large intestine (also called a bowel obstruction).

Surgery may be considered if it has the potential to solve the problem by removing or reducing the obstruction. Surgery is an option if the blockage is caused by a tumor pressing on the bowel, or if there’s scar tissue or twisting of the bowel that prevents movement of stool. Surgery is only considered if someone can tolerate the surgical procedure and recovery that is required.

The patient, the family or the health care team may decide that surgery is not an option. Then, non-surgical treatments are used to try to decrease the degree of blockage, to stimulate the bowel, and to manage symptoms. These treatments may include the following:

• A medication called dexamethasone (Decadron®) may decrease the swelling around a tumor and improve bowel function;
• Other medications may stimulate the bowel to move;
• A medication, called octreotide (Sandostatin®) may decrease the amount of fluids normally produced by the digestive tract. It’s usually used when a patient is no longer taking any food or fluids orally. With less fluid, there may be less nausea and abdominal discomfort;
• A nasogastric tube also known as an NG tube (tube inserted through the nose into the stomach) may reduce pressure and ease symptoms.

The length of time someone can live with an obstruction depends on several factors:

• Overall strength and condition
  People who are active and have a fair amount of reserve strength and energy do better than people who are very weak.
   
• Degree of blockage
  A full blockage is a bigger problem than a partial blockage. With a partial blockage, people usually can sip fluids or take ice chips, which lengthens survival time.
   
• Effect of treatments
  If treatments can decrease the blockage or reduce pressure, then the person may be able to sip fluids or take ice chips, which lengthens survival time.
   
• Complications
  Complications may reduce survival time. There may be infections such as pneumonia, or intestinal bleeding. The obstructed bowel may not be getting enough oxygen, or the bowel may become perforated, that is, a hole may develop in the intestinal wall. These complications are unpredictable, and may bring death within a few hours.

Without any fluids (either as sips, ice chips or intravenously) people with a complete bowel obstruction most often survive a week or two. Sometimes it’s only a few days, sometimes as long as three weeks. With fluids, survival time may be extended by a few weeks or even a month or two. With a bowel obstruction, things may go better than expected, but it’s important to prepare for sudden, unexpected changes.

In people with cancer, swelling of the stomach or abdominal area can have a few different causes.

• Fluid may collect in the area of the body containing the abdominal organs. This fluid is called ascites. It may result from the tumor causing the body to produce more fluid, or the tumor may be blocking the normal flow of fluid through the lymph and other body systems. Ascites can make someone feel bloated, uncomfortable and short of breath. If this does not bother the patient, it can be left alone. If there is discomfort, then the fluid sometimes can be drained. The draining of ascites from the abdominal cavity is called paracentesis. At times, medications can help the body eliminate the fluid. The medications often are not that helpful, because it’s not that there is too much fluid in the body, rather it is just collecting in the wrong places.
   
• Sometimes the bowels do not empty well. Stool may build up and gas may cause bloating. This can be due to constipation from opioids, from a general slowing of the bowels due to weakness, or a blockage of the bowel due to a tumor. In all these cases the patient usually has symptoms of constipation. Constipation from medication or slowed bowels can be treated with laxatives.
   
• As some illnesses progress, there can be swelling under the skin and in other body tissues. This is called edema.

Sometimes the causes of swelling can be treated and swelling decreased. For example, bowel functioning may be improved if a blockage is removed. At other times the cause of the swelling can’t be treated and it’s best to treat the symptoms associated with it. For example, if the swelling is causing shortness of breath, there are medications to ease this.