Bowel Obstruction: Large Bowel

________________________________________________________________________

KEY POINTS

• A large bowel obstruction is a blockage anywhere inside your child’s large intestine. A blockage may stop all food, gas, or fluids from passing through or just make it harder to pass through and out of your child’s body.
• Treatment may include enemas, changes in your child’s diet, or surgery to remove the cause of the blockage. Your child may need a colostomy to make an opening in the belly and bring the end of the intestine to the outside. Bowel movements will then leave your child’s body through this new opening.
• It may help if your child exercises daily, eats a diet high in fiber, and drinks plenty of water.
• If your child has a health problem that caused the blockage, be sure you know what to do to manage that health problem and help keep your child from having another blockage.

________________________________________________________________________

What is a large bowel obstruction?

A large bowel obstruction is a blockage anywhere inside your child’s large intestine. The large bowel (also called the colon) is the last 5 feet of the intestines. The rectum is the last few inches of the large bowel. The rectum connects with the anus, where bowel movements come out. A blockage may stop all food, gas, or fluids from passing through or just make it harder to pass through and out of your child’s body.

If a blockage is not treated, it can become a life-threatening medical emergency.

What is the cause?

Common causes of a blockage are:

• Tumors or scar tissue that block the intestine
• Intussusception, which is when one part of the intestine folds into itself, like the way a telescope folds
• A twisting of the intestines
• A hard lump of bowel movement that gets stuck
• Hirschsprung’s disease, which is a problem with nerves and muscles that keep digested food from moving through your newborn’s or child’s large intestine
• A hernia, which is when part of the intestine bulges through a weak area or gap in the muscles in the wall of the belly. The hernia can twist or narrow and block passage of bowel movements.

What are the symptoms?

The first signs of a blockage may be a change in bowel habits, such as little or no gas, or no bowel movements. Other symptoms may include:

• Cramping, swelling, and pain in your child’s belly that comes and goes and becomes more severe
• Nausea or vomiting
• Blood in bowel movements that may look like red jelly

If your child’s intestine is only partly blocked, he may have diarrhea.

How is it diagnosed?

Your child’s healthcare provider will ask about your child’s symptoms and medical history and examine your child. Tests may include:

• X-rays of the belly
• An ultrasound, which uses sound waves to show pictures of your child's belly
• A contrast enema, which is an X-ray taken of the belly after barium or air is inserted through the rectum to show the walls of the intestine and any possible problems. Barium is a liquid that helps the intestines show up well on the X-ray.
• CT scan, which uses X-rays and a computer to show detailed pictures of the intestines
• Blood tests
• Urine test
• Test of bowel movements for blood

How is it treated?

Treatment depends on what is causing the blockage. For example, if your child has intussusception, gently putting air or barium through your child's rectum helps unfold the walls of the intestine. This treatment is very effective in children.

Your child may need to be treated in the hospital with an IV to give him fluids and medicines. Your child may also have a tube put through his nose and into his stomach to help drain fluid and gas. Sometimes a tube is put into your child’s rectum to help relieve gas and make him more comfortable.

Your child may need to have surgery to remove the cause of the blockage. This is more common with complete blockages. A complete blockage is a medical emergency. Part of your child’s intestine may also need to be removed.

Your child may need a procedure called an ileostomy or colostomy for a few months to a year. These procedures are done to connect the healthy part of your child’s intestine to a new opening in the belly called a stoma. Your child’s bowel movements will empty through the opening and collect in a disposable bag outside the body. After your child heals, a second procedure may be done to connect the healthy intestine to the anus. The stoma will be closed during this procedure.

How can I take care of my child?

Follow the full course of treatment prescribed by your child's healthcare provider. Ask your child’s healthcare provider:

• How and when you will get your child’s test results
• How long it will take your child to recover
• If there are activities your child should avoid and when your child can return to normal activities
• How to take care of your child at home
• What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent a large bowel obstruction?

It may help if your child exercises daily and eats a diet high in fiber. Fiber is in foods such as whole wheat, bran, whole rye, oats and oatmeal, flax seeds, nuts, vegetables, fruits, and beans. If your child is not used to high-fiber diets, start slowly. Drinking plenty of water also helps the intestines to work normally.

If your child has a health problem that caused the blockage, be sure you know what to do to manage that health problem and help keep your child from having another blockage.