Obstipation

Medically reviewed by Michele Cho-Dorado, MD on October 19, 2017Written by Rachel Nall, RN, BSN, CCRN on October 19, 2017

What is obstipation?

Proper and regular elimination of wastes is important for maintaining good health. Constipation is a medical condition that can affect your ability to eliminate stool. Obstipation is a severe form of constipation, where a person cannot pass stool or gas.

Constipation is a condition where a person has infrequent bowel movements — usually three or fewer a week. When a person does pass stool, it’s usually a difficult process. The stool may be hard or dry.

Obstipation is different from constipation in that obstipation is when a person cannot pass stool or gas, usually due to an obstruction or blockage of hard, difficult-to-pass stool. Some doctors will also call obstipation “obstructive constipation.” Obstipation is a signal that constipation is chronic and a more severe problem that could lead to serious health side effects if left untreated.

What are the symptoms of obstipation?

Obstipation can cause several signs and symptoms. These include:

  • abdominal distention
  • sensation of bloating
  • constipation or diarrhea
  • dehydration
  • difficulty passing gas
  • fatigue
  • malaise or general feeling of being unwell
  • stomach cramping or pain
  • nausea or vomiting
  • early satiety

Usually, obstipation will not cause a complete and total blockage of the intestine. A small area of the intestine may still allow air and some liquids through. As a result, a person may have a small amount of watery diarrhea that they pass when they experience obstipation.

What are the causes of obstipation?

Many underlying conditions, medications, and even structural abnormalities of the intestines can cause obstipation. Examples of conditions that can cause obstipation include:

  • abnormalities in the intestine, such as intussusception (where one part of the intestine slides over another part, like a collapsible telescope) or when the intestines twist
  • cancer, for example colorectal or intestinal tumor
  • chronic, untreated constipation
  • fecal impaction, where stool becomes so dry and hard that a person can’t eliminate it
  • hernia, where a piece of intestine bulges through the abdominal wall
  • intestinal inflammation
  • polyps in the intestine
  • severe scarring (adhesions) after prior surgeries
  • taking certain medications, especially opioid pain medications, such as morphine or hydrocodone; other medicines that can slow intestinal movement include iron supplements, calcium channel blockers, antipsychotics, clonidine, and diuretics
  • chronic constipation related to an underlying condition, such as Hirschsprung’s disease

Obstipation is a serious condition that can potentially worsen. Regardless of the cause, it’s important to seek treatment if you think you have the condition.

When should you see a doctor?

If you haven’t passed stool in several days and have other symptoms of obstipation, such as stomach discomfort, you should see your doctor.

However, you should seek emergency medical treatment if you have the following symptoms in addition to not passing stool:

  • bloody or black bowel movements
  • fever
  • severe abdominal pain
  • vomiting
  • abdominal distention

How is obstipation diagnosed?

At the appointment, your doctor will start by taking a medical history. They will ask about any medical conditions and symptoms you have and medications you’ve taken.

A doctor may also perform a digital examination of the rectum to ensure there is no hard, collected stool known as an impaction. If a doctor does not identify an immediate impaction, they will likely order other diagnostic tests. These can include:

  • Blood testing. This is done to check for signs of inflammation or infection.
  • Imaging. Imaging tests, such as an X-ray or CT scan, are used to identify areas where the intestines may be obstructed or enlarged or have any abnormalities.
  • Colonoscopy. This procedure involves using a thin, lighted scope inserted into the rectum to visualize the lining of the intestine and check for abnormalities.
  • Barium enema. A barium enema involves administering contrast through the rectum to visualize any anatomical abnormalities or obstruction of the colon.
  • Bowel function testing. These tests may check the muscle tone of the rectum and the nerve functioning of the intestines. If these are affected, a person may not be able to sense and pass stool as well.

Can obstipation cause complications?

Obstipation is a serious condition. If stool doesn’t pass, it can back up into the stomach and make you very ill. The obstruction could also lead to a bowel perforation or rupture.

This is a very serious and potentially deadly condition where the bowel’s contents empty into the abdominal cavity. A bowel perforation can lead to a serious infection known as peritonitis. Due to the potentially dangerous and life-threatening effects of obstipation, a person should never ignore their symptoms.

What are the treatments for obstipation?

The treatments for obstipation depend upon the severity of the condition. Usually, a doctor will prescribe medications to try to soften stool and make it easier to pass or to increase the motion of the intestines so stool will move forward. Examples of these treatments include:

  • stool softeners, such as docusate sodium (Colace)
  • enemas, which involve instilling water mixed with other compounds, such as soap or glycerin
  • increased fluid intake

If these steps do not relieve obstipation, a doctor may manually remove stool that is impacted near the rectal opening.

A doctor will do this by gloving their hands and placing lubricant on their fingers. They will insert their finger(s) into the rectum and manually remove hard, dried stool. Ideally, this step will relieve an obstruction and allow stool to pass more freely.

In rare instances, a doctor may recommend surgery to remove the impacted area of bowel. If the obstruction has damaged an area of intestine, this area may be removed as well. A doctor may also recommend surgery to correct a structural abnormality, such as a hernia, if indicated.

Because obstipation is an indicator of a chronic health condition or effect of medication, a doctor may recommend other treatments to address the underlying cause of the obstipation.

Can obstipation be prevented?

Many of the same steps that prevent constipation prevent obstipation. These include the following:

  • Eat a diet high in fiber-rich foods. These include leafy, green vegetables, fruits (especially those with skins), and whole-grain foods.
  • Drink plenty of water.
  • Exercise for 30 minutes a day or more as you are able. Physical activity helps to encourage intestinal movement, which can relieve constipation.

Talk to your doctor to determine if you need additional supplements or treatments that can reduce the likelihood that obstipation will occur. This includes steps such as taking a stool softener.

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