Obstipation - Causes, Symptoms and Treatment

What is Obstipation?

Obstipation, sometimes called obstructive constipation, is the loss of ability to pass stool or gas due to blockage or obstruction in the intestines. It is a persisting or chronic constipation that has developed into a continuous and difficult to control condition [1, 2]. Obstipation, when left untreated may lead to other life-threatening conditions (e.g. peritonitis, strangulated bowel, body malaise, tachychardia) [3].  

 

Signs and Symptoms of Obstipation

Abdominal Symptoms

  • Constipation
  • Abdominal distension
  • Bloating- enlargement or feeling of fullness
  • Persistent cramping and pain
  • Borborygmi- increased bowel sounds

Physical symptoms

  • Foul breath odor
  • Rapid pulse (tachychardia)
  • Nausea and vomiting
  • Fever and dehydration
These symptoms may lead to worse conditions that arised from obstipation, such as strangulated bowel, which leads to malfunction of bowel that may cause dehydration, nausea, vomiting, low blood pressure and rapid heart rate. Also peritonitis, which is an infection in the lining of the intestines.

 

Obstipation vs Constipation

The difference of obstipation to constipation is basically the period of retention time of stool and the severity of the loss of bowel movement. Obstipation is the chronic version of constipation and may develop at a longer period of time (over a year).

In constipation, there is a difficulty in defecation wherein an individual only experience three or less bowel movements in one week while in obstipation, there is an inability to pass stool which means there can be no bowel movement at all [6].

While constipation maybe easily treated and can be regulated, obstipation is more difficult to treat because of its vast causes which is sometimes born of other diseases.

 

Causes of Obstipation

Since the intestines are the longest part of the digestive system, intestinal obstruction is mainly the cause of obstipation. It can be a blocked bowel (small intestine) or a blocked colon (large intestine) [12].

It may also be caused by prolonged or untreated constipation, which is caused by lack of dietary fiber intake, decreased water intake, and decreased physical activity [10].

There are also structural causes such as when the rectal wall did not develop properly. When caused by colon obstruction, it may be due to hernias, tumors, inflammation and structural abnormalities in the intestines [4].

Obstipation may be also due to the following:
  • Colorectal cancer
  • Anal fissure
  • Fecal Impaction
  • Volvulus- twisted bowels
  • Foreign body
  • Hypothyroidism
  • Proctitis
  • Pelvic bone dysfunction
  • Intestinal atresia
  • Hirschsprung’s disease (neurological)

 

Causes in Children

Children often experience constipation because they try to withhold stool to avoid pain. Because of the discomfort caused by bowel movements, they have adapted to increasing pressure on their abdomen to keep the stool in [9]. As their constipation is prolonged, obstipation occurs. Obstipation in children is also caused by low fiber diet and insufficient intake of water.

On the other hand, the cause may be neurological and congenital, such as the Hirschsprung’s disease wherein during fetal development, certain nerve bodies fail to migrate on the colon, in effect losing activity regulation of the colon [11]. Since a certain part of the colon fails to contract, an obstruction is created.

 

Obstipation Treatment

Treatment for obstipation varies according to its cause. However, the most important and usual treatment is a change of diet. Which means discipline is needed. There must be an increase in both fiber and water intake( up to 3 liters per day) [5].

Coffee, alcohol, milk and other fruit juices must be avoided. Exercise is also recommended to improve peristalsis and oxygen circulation to the intestines. Fecal impaction is also done wherein the feces is removed manually by hand [8].

An enema can also be used wherein liquids are introduced into the rectum and colon through the anus. The expansion caused by the increase in volume on the lower intestinal tract results to cramping and peristalsis, which will help to the evacuation of feces.

Children can undergo scheduled toilet breaks [7]. Laxatives such as walnuts, milk of magnesia, and polyethylene glycol may be used [5]. However, in cases of severe obstruction, colonoscopy or laproscopic surgery is needed.

References
  1. http://cal.vet.upenn.edu/projects/sagastro/case5/convobst.htm 
  2. http://www.allhealthsite.com/obstipation.html 
  3. http://en.diagnosispro.com/disease_information-for/obstipation/17265.html 
  4. http://www.livestrong.com/article/63928-colon-obstruction-symptoms/#ixzz2RPxl8bvG 
  5. "American Gastroenterological Association Medical Position Statement: guidelines on constipation".Gastroenterology 119 (6): 1761–6. 
  6. Journal of Gastroenterology and Hepatology 21 (4): 638–646. [7] Walia, R.; Mahajan, L.; Steffen, R. (October 2009). "Recent advances in chronic constipation". Curr Opin Pediatr 21 (5): 661–6 
  7. http://www.aafp.org/afp/2006/0201/p469.html 
  8. http://www.oocities.org/dyemd/obstipation.html 
  9. "Etiologic factors of chronic constipation: review of the scientific evidence". Dig. Dis. Sci. 52(2): 313–6.
  10. "Hirschsprung Disease Overview". In Pagon RA, Bird TC, Dolan CR, Stephens K. GeneReviews 
  11. http://www.healthhype.com/obstructive-constipation-obstipation.html

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