Obstipation (Obstructive Constipation)

Obstipation is a medical condition, which is characterized by the inability to pass stool or gas, due to a blockage or obstruction that appears at the level of the intestines. Also known as obstructive constipation, this is a chronic or persistent condition and, if left untreated, it can lead to serious complications. It is important to understand that obstipation can transform into a permanent problem, being quite difficult to control.

Every person has his/her own pattern of bowel movements. In general, it is said that it is normal to pass one or two stools per day or even at two days. In the situation that too many stools are passed, this is known as diarrhea. On the other hand, if someone has less than three stools in a week, this is known as constipation. Obstipation refers to a condition that has become chronic, as you will have the opportunity to find out below.

Obstipation vs Constipation

As you have seen above, obstipation is known as obstructive constipation. This means that it has transformed into the chronic version of the constipation, being persistent over a long period of time (for example, for more than a year). When someone is constipated, there are varied periods, when the stool is retained and the person is not able to pass gas. While constipation can be more easily kept under control, obstipation is a sign of a more serious, underlying problem.

Obstipation Signs and Symptoms

These are signs and symptoms that can occur in patients suffering from obstipation:

  • Constipation (chronic/persistent)
  • Inability to pass gas
  • Distension of the abdomen
  • Bloating (the patients describe a feeling of fullness at the level of the abdomen)
  • Abdominal cramps (persistent)
  • Abdominal discomfort/pain
  • Increased sounds at the level of the abdomen

Apart from these, it is possible that the patients experience systemic symptoms:

  • Halitosis (bad breath)
  • Increased heart rhythm
  • Nausea
  • Vomiting
  • Fever
  • Dehydration
  • State of general malaise.

Causes of Obstipation

These are the most common causes that can lead to the appearance of the obstipation:

  • Intestinal obstruction (blockage at the level of the small or large intestine)
  • Prolonged/untreated constipation
    • Lack of dietary fiber intake
    • Decreased water intake
    • Decreased physical activity
  • Structural causes
    • Colon obstruction
    • Hernia (femoral, inguinal)
    • Tumor
    • Inflammation
    • Structural abnormality at the level of the intestinal wall
  • In children
    • Withholding of the stool (so as to avoid the discomfort or pain associated with bowel movements)
    • Low fiber diet
    • Insufficient water intake
    • Neurological/congenital causes
      • Hirschsprung’s disease
  • Other causes
    • Cancerous growth (most common – colorectal cancer)
    • Fissures at the level of the anal sphincter
    • Fecal impaction (dry stool that cannot be eliminated)
    • Volvulus (the bowels are twisted, with necrosis occurring as a secondary problem)
    • Foreign body present at the level of the intestines
    • Hormonal imbalances (reduced levels of thyroid hormones)
    • Inflammation of the prostate gland (proctitis)
    • Dysfunction at the level of the pelvic bones
    • Atresia of the intestines
    • Neurological constipation (Hirschsprung’s disease)
    • Adhesions caused by post-operative scarring
    • Gallstones
    • Intestinal polyps (adenomatous colonic polyps)
    • Medication for:
      • Depression
      • Pain
      • High blood pressure
    • Diabetes
    • Multiple sclerosis
    • Pregnancy.

Diagnosis

These are the most common methods that can be used for the diagnosis of obstipation:

  • Medical history
    • Medication or other treatments
    • Previous surgical interventions
    • Usage of:
      • Laxatives
      • Suppositories
      • Enemas
  • Physical examination
    • Rectum/vaginal examination
    • Muscle tone check
    • Identification of bleeding and damage at the level of the rectum
  • Blood tests
    • Leukocyte levels – signs of infection
    • Thyroid hormone levels (thyroid function)
    • Kidney function assessment
  • Ultrasound
    • Identification of obstipation cause and location
  • X-ray/CT scan/MRI
    • Identification of obstipation cause and location
    • May be performed with/without contrast (better visualization of the intestines)
  • Barium enema
    • Can be performed in order to allow for a better visualization of the intestines (before the X-ray investigation)
  • Colonoscopy
    • Assessment of the intestines (damage of the tissues)
    • The doctor might also decide to take a small sample from the intestines (sent to the laboratory for biopsy – confirm/infirm the cancer diagnosis)
  • Bowel function test
    • Check the muscle tone of the bowels
    • May be useful in assessing the nerve sensitivity of the intestines and anus.

Obstipation Treatment

These are the most common measures of treatment that can be taken for obstipation:

  • Change of diet
    • Increase in fiber
    • Increase in water intake
  • These should be avoided:
    • Coffee
    • Alcohol
    • Milk
    • Fruit juices
  • Physical exercise
    • Improves the bowel movements and promotes the passing of the stool
    • Stimulates the circulation of the oxygen at the level of the intestines
  • Manual removal
    • Recommended for those who suffer from fecal impaction (the doctor removes the dry and hard feces by hand)
  • Enema
    • Liquids are introduced through the anal sphincter into the rectum and anus
    • The liquid forces the bowels to become active, the peristalsis contributing to the elimination of the feces
  • For children
    • Scheduled toilet breaks
    • Natural/light laxatives
      • Walnuts
      • Milk of magnesia
      • Glycol-based laxatives
  • Severe cases
    • Colonoscopy
    • Laparoscopic surgery.

Complications of Obstructive Constipation

Among the life-threatening complications that can occur in those who suffer from obstipation, there are the strangulated bowel and peritonitis.

Prevention

These are the measures that you can take in order to prevent a chronic problem such as obstipation:

  • Drink the recommended amount of fluids per day (soften the bowel movements, so that the stool is passed with more ease)
  • Increase your fiber intake (through diet or by taking fiber supplements); the fiber adds bulk to your stool, making it easier to pass. Among the foods that are rich in fiber, there are: beans, whole grains, fresh vegetables and raw fruits. It is recommended that one should consume at least 20 grams of fiber per day.
  • Listen to your urges and never ignore your bowel movements. Constipation often occurs in those who wait for too long to go to the toilet or those who ignore such urges. Try to go to the bathroom at the same hour each day, so as to develop a habit. It is recommended that you visit the toilet after breakfast, as this is the best time for such activities.
  • Make a habit to exercise every day. The more active you are, the more active your bowels are going to be.

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