Avoid stimulant laxatives (senna, bisacodyl, danthron) if patient has colic. Stop all oral laxatives in complete obstruction. †Dexamethasone (6mg to 16mg) parenterally for 4 to 7 days may reverse partial obstruction.
Several drugs, such as α-glucosidase inhibitors, antineoplastic agents, antipsychotics, dantrolene, drugs for urinary frequency and incontinence, opium alkaloids, and polystyrene sulfonate are known to be associated with paralytic ileus (Ministry of Health, Labour and Welfare, 2008).
Peristalsis-inducing medications (i.e., prokinetic agents such as metoclopramide) are contraindicated in complete mechanical bowel obstruction.
Metoclopramide is the antiemetic and prokinetic drug of choice for symptomatic partial bowel obstruction. It acts at the level of acetylcholine and dopamine receptors, stimulating peristalsis. It is contraindicated in patients with complete bowel obstruction and in those with significant colic.
If a patient comes in vomiting and you suspect a bowel obstruction, use a different agent. The gastroprokinetic activity of metoclopramide will cause the intestines to squeeze against a fixed obstruction and worsen the pain.
Stimulant laxatives should be avoided in patients with suspected intestinal obstruction, inflammatory bowel disease, during pregnancy, and in patients with abdominal pain of unclear etiology.
Most cases of bowel obstruction need some form of medical intervention. Treatment options for bowel obstruction can include: Medication: Opioids can lead to constipation. If this occurs, laxatives and stool softeners can help.
Laxative use can be dangerous if constipation is caused by a serious condition, such as appendicitis or a bowel obstruction. If you frequently use certain laxatives for weeks or months, they can decrease your colon's ability to contract and actually worsen constipation.
Medication Summary
Bowel obstruction frequently necessitates surgical intervention. However, antibiotics should be started in the emergency department. Coverage must include gram-negative aerobic and gram-negative anaerobic organisms.
The use of enemas is contraindicated in patients with a paralytic ileus or chronic obstruction.
Enemas of air or fluid can help clear blockages by raising the pressure inside your bowels. A mesh tube called a stent is a safe option for people who are too sick for surgery. Your doctor puts it in your intestine to force the bowel open.
Hospitalization: Patients with an intestinal obstruction are hospitalized. Treatment includes intravenous (in the vein) fluids, bowel rest with nothing to eat (NPO), and, sometimes, bowel decompression through a nasogastric tube (a tube that is inserted into the nose and goes directly to the stomach).
Most bowel obstructions are partial blockages that get better on their own. The NG tube may help the bowel become unblocked when fluids and gas are removed. Some people may need more treatment. These treatments include using liquids or air (enemas) or small mesh tubes (stents) to open up the blockage.
Some popular brands include bisacodyl (Correctol, Dulcolax, Feen-a-Mint), and sennosides (Ex-Lax, Senokot). Prunes (dried plums) are also an effective colonic stimulant and taste good, too. Note: Don't use stimulant laxatives daily or regularly.
Small bowel obstruction (SBO) is a common illness encountered by general surgeons. However, obstruction caused by diaphragm disease induced by non-steroidal anti-inflammatory drug (NSAID) is exceedingly rare.
Senna (Senokot, Ex-Lax, Senexon)
Sennosides induce defecation by acting directly on the intestinal mucosa or nerve plexus, which stimulates peristaltic activity, by increasing intestinal motility. Senna usually produces its action 8-12 hours after administration.
Fluid replacement with aggressive intravenous (IV) resuscitation using isotonic saline or lactated Ringer solution is indicated. Oxygen and appropriate monitoring are also required. Antibiotics are used to cover gram-negative and anaerobic organisms.
CONCLUSION: With closely monitoring, most patients with small bowel obstruction due to postoperative adhesions could tolerate supportive treatment and recover well averagely within 1 week, although some patients require more than 10 days of observation.
The most common causes of intestinal obstruction in adults are: Intestinal adhesions — bands of fibrous tissue in the abdominal cavity that can form after abdominal or pelvic surgery. Hernias — portions of intestine that protrude into another part of your body. Colon cancer.
Most people affected by a bowel obstruction are unable to pass gas or have a bowel movement, and may have a swollen abdomen. Infrequent bowel movements or hard stools usually do not indicate obstruction.
A partial obstruction can result in diarrhea, while a complete obstruction can make you unable to pass gas or stool. Intestinal obstruction may also cause serious infection and inflammation of your abdominal cavity, known as peritonitis.
Most people with a bowel obstruction experience severe abdominal pain and nausea. The good news is that the intestine can often unblock itself with time and rest. And many people recover from a bowel obstruction without surgery. But surgery may be unavoidable in certain cases, including when complications develop.
DULCOLAX is contraindicated in patients with ileus, intestinal obstruction, acute abdominal conditions including appendicitis, acute inflammatory bowel diseases, and severe abdominal pain associated with nausea and vomiting which may be indicative of the aforementioned severe conditions.
If stool softeners aren't providing enough help, the osmotic laxative polyethylene glycol (MiraLAX or a generic version) is good next step. These products hold water in stool to soften it and increase bowel movements.
Therapeutic Enema
A barium or enema may be used to diagnose and treat an intussusception. During the procedure air or a liquid containing contrast is injected through the rectum into the bowel. The air or liquid will create pressure in the large bowel which will hopefully push out the folded piece of bowel.