What causes obstipation and how to treat obstructive constipation?

Obstipation is a condition characterized by severe constipation. It results from an obstruction in the intestines, leading to a state where the intestines can’t fully empty.

While normal bowel movement patterns vary from person to person, the ideal frequency is about once a day. The medical criteria for a constipation diagnosis is passing stool less than three times per week, and passing stool more than three times a day is labeled as diarrhea.

All of these cases mentioned have some degree of stool excretion, but cases of obstipation have no stool or gas passed at all.

What causes obstipation?

There are a multitude of causes that can lead to obstipation, but all involve intestinal obstruction. Severe cases of constipation leading to hardened stool may lead to fecal impaction, which is a cause for intestinal obstruction. While compete obstructions are uncommon, accumulation of food, water, or even air can plug up any remaining space, leading partial obstructions to quickly progress to complete obstructions.

Although obstipation is defined as a failure to pass stool or gas, cases of passing very little stool in the form of watery diarrhea may still occur. This is most likely because liquid has a higher chance of bypassing an obstruction rather than solids.

The intestines are composed of small and large sections and are the longest part of the alimentary tract—pathway by which food enters the body and solid wastes are expelled. These two sections are the usual sites of obstruction. Here are some causes of obstipation:

Adhesions: The formation of scar tissue inside the abdomen. These commonly form in patients who have had a previous abdominal surgery. This scar may form a lump or mass that traps surrounding organs, leading to obstipation.

Hernia: A protrusion of abdominal organs through a weakened abdominal wall cavity. This may result in strangulation of the intestine, resulting in obstruction.

Intussusception: This occurs when the intestine “telescopes” onto itself, resulting in blockage.

Tumors: The development of an abnormal mass in the abdominal cavity may lead to obstruction.

Volvulus: This occurs when the intestines twist, leading to obstruction and ischemic damage.

Diverticulitis: The inflammation of pouches found protruding from the outside of the colon may lead to scarring or tissue formation that can lead to obstruction.

Hirschsprung’s disease: A congenital defect where one of the parts of the colon is not present or is dysfunctional. The affected portion of the colon fails to relax or there is no reflex of contraction, which can lead to obstruction.

Inflammatory bowel disease: A group of inflammatory conditions that can result in hypertrophy and fibrosis of the intestinal walls, leading to obstruction.

Symptoms of obstipation

The symptoms of obstipation are unlikely to be identified immediately without diagnostic investigation, However, the following are commonly seen symptoms that may point to the condition:

• Abdominal distention
• Nausea and vomiting
• Fever
• Loss of appetite
• Increased bowel sounds which may later progress to diminished bowel sounds
• Bloating
• Abdominal pain
• Constipation or diarrhea
• Increased heart rate

Diagnosis of obstipation

Typically, not having normal bowel moments is enough to suspect some form of constipation. A physical exam of your rectum will most likely be done to exclude foreign object obstruction. Muscle tone and the presence of bleeding from the rectum will also be assessed. Once these preliminary steps are done, your doctor will likely choose to do one of the following tests:

• Blood test: Looking for the signs of infection or checking thyroid function.
• Ultrasound: Can give a good indication of the cause and site of your obstipation.
• X-ray/CT: Imaging tests to get a picture of your obstructed bowels.
• Barium enema: Used in combination with an x-ray to get a detailed view of the bowel pathway, looking for obstruction of the dye.
• Colonoscopy: Looking directly into the colon with a camera can help see if you have tissue damage. Biopsies may also be taken to be assessed for colon cancer.
• Bowel function test: Used to check muscle tone and nerve sensitivity of the intestines and anus.

Treating obstipation

Cases of obstipation vary from person to person, inevitably dictating what form of treatment is required. In cases of anatomical obstruction, such as in the case of a volvulus or a hernia, surgery will be required to correct the abnormality. However, if your obstruction is not due to any serious condition, it may be beneficial to try some natural treatments for the condition. These include:

• Eating foods that are high in fiber. This includes apples, oranges, almonds, oats, wheat bread, and green leafy vegetables.
• Increase water intake to four–five liters a day.
• Exercise for at least 30 minutes a day. Running or walking can be enough to prevent obstipation.

There are also herbal remedies known to aid in cases of severe constipation. It is important to note that these herbal medications should be used only if diet and exercise have failed. Herbal medications that may be useful for treating obstipation include:

• Aloe Vera
• Elderflower
• Licorice
• Guava, orange, and papaya

Obstipation vs. constipation

The primary difference between these very similar conditions is the duration. Constipation is defined as three or fewer bowel movements per week, whereas obstipation is not having any bowel movements at all.

Related: Bland diet for gastritis, ulcers, diarrhea, and reflux disease