Colon Blockage
When a physical intestinal obstruction
Requires immediate attention

In this article, we discuss one of the possible causes of constipation: colon blockage.

As we have seen in the introductory article, the causes of constipation can be multiple. Some can be external: a nutritional imbalance, a drug protocol, too much of a particular dietary supplement, etc.

Some are inherent to your body and caused by a problem located within your gastrointestinal tract. Colon blockage belongs to the latter category. It causes a complete obstruction of your bowel and requires immediate attention.

In this article, we describe the most common types of blockages, along with treatment options.

What is a colon blockage?

We define a colon blockage as a physical obstruction in your gastrointestinal tract that prevents fecal masses from moving along.

Symptoms:

  • One of the obvious symptom is constipation, since the food residues get stuck in the colon, getting overly dehydrated and forming a plug.
  • But liquid stools and leakage can also be a manifestation. Some fecal matter can indeed manage to pass around a potential plug, but can only do so in semi-liquid or liquid form.
  • Cramps and pain in the abdomen is usual, often near the site of the colon blockage.
  • Nausea and vomiting may also accompany the pain.

This obstruction is typically caused by a malformation or degenerescence of the bowel.

Different types of colon blockage

In the following sections, we will cover the following main types of intestinal obstructions:

  • Volvulus of the colon
  • Sigmoid diverticulitis
  • Sigmoid Endometriosis
  • Strictures caused by Irritable Bowel Disease
  • Fecal impaction
  • Colon cancer

Volvulus of the Colon

Volvulus is a twisting of a portion of the colon around itself, causing a knot. Volvulus occurs most often in the sigmoid section of the colon. It can also happen in the right colon and the cecum, although less frequently.

See the pictures below.

Normal colon without volvulus

Colon with elongation in the sigmoid area (still no volvulus)

Colon with sigmoid volvulus and colon blockage

Volvulus is a pretty serious condition, and can be life threatening if not diagnosed and resolved in a timely manner. The knot being formed prevents blood circulation to feed the tissues in the knot.

As a result, gangrene of the blood-deprived colonic tissues may ensue, along with perforation and leakage of fecal material into the abdomen.

Causes

Volvulus occurs often in older patients, sometimes living in nursing homes, with a history of chronic constipation which led to distension of the colon.

But it can also occurs in children suffering from an enlarged colon due to chronic constipation. In infants, it can occur due to a condition called “intestinal malrotation”, a problem arising during fetal development where the intestine does not take a proper positioning in the abdomen.

Volvulus can be caused by abdominal adhesions, or bands of scar tissue that have formed following an injury to the abdomen (e.g. after a car accident), a serious infection, chronic inflammation (as with Inflammatory Bowel Disease) or a surgical procedure.

Symptoms, Diagnosis

The person will feel a serious distention of the abdomen where the knot is located, with colicky pain. Rectal examination will reveal an absence of feces, since they are stuck higher up in the colon. Physical examination will uncover a palpable mass at the volvulus location.

An X-Ray of the abdomen will uncover a dilated portion of the colon at the location of the knot.

Treatment

The first step is to try to untwist the knot. Your specialist may attempt to do this via endoscopy, in a minimally invasive manner. This procedure may be performed at a hospital, outpatient center, or at a gastroenterologist office. A lubricated tube will be used to try to untwist the knot.

This method works is expected to work in 80% of the volvulus cases (1).

If the mucosa is healthy and there are no gangrenous tissues, your doctor may end this first procedure, and propose a follow-up procedure to reduce the risk of recurrence, which can be fairly high, representing 35% to 60% of the cases(1). The second procedure may involve a removal of the elongated section of the colon (also called a “resection”) at risk of further twisting.

If the mucosa is not healthy, the resection will be done immediately during the first procedure.

Sigmoid diverticulitis

Before talking about diverticulitis, we need to talk about diverticulosis.

Diverticulosis is the formation small pouches in the lining of your colon. See picture below. It is most common in the sigmoid area of the colon, the last section before the rectum.

Sigmoid colon with diverticulosis

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the proportion of the American population with diverticulosis is as follows:

  • 10% of people older than 40;
  • 50% of people older than 60.

When those small pouches become inflamed, diverticulosis becomes diverticulitis. 10% to 20% of people suffering from diverticulosis will develop diverticulitis(2).

Then diverticulitis can progress toward colon blockage. The repeated infections are strenuous to the colon mucosa. Fibrous and tough scar tissues are formed and replace the flexible colon mucosa. Too much scaring and toughening can reduce the size of the tube and lead to colon blockage.

Think of a metallic pipe that you have been banging out of shape. After a while, water won’t be able to flow through it.

Causes

Once you have diverticulosis, it is easy to imagine the progression to diverticulitis. Small pouches located in your colon can accumulate fecal matter, which putrefies and irritate the surrounding mucosa.

So the real question is, why does diverticulosis develop in the first place?

The theory you will find mentioned most often is lack of fiber due to the introduction of industrialized process of grains. Because of this lack of fibers in modern flours and cereals, the stools are less spongy and more compact, requiring more straining to evacuate. This added intra-colonic pressure creates distention of the colonic mucosa that can then become diverticula (small pouches) in the long run.

Too simplistic. It is not just the industrialization of grains, it is the overall change of lifestyle and switch from a diet rich in unprocessed everything (vegetables, fruits, good fats, good meats) to a very modern diet where no ingredient is recognizable in its whole form.

I will give my complete views on a colon-friendly diet in a future article. I am not a fan of “added fiber everywhere” (from wheat bran to all-bran cereals to Metamucil) and I will explain why.

Avoiding constipation is the key, whatever the causes are. Straining creates distension of the tissues in the colon. Repeated straining, with aging of the tissues as we get older, is the most plausible cause.

And as we have seen on this web-site, the causes of constipation can be multiple and vary from one person to the other. Just adding more fibers is ridiculously short-sighted. Get to know yourself, then eliminate your constipation triggers. That will be your most effective prevention strategy.

Symptoms, Diagnosis

Let’s start with diverticulosis, the condition that eventually leads to diverticulitis and possibly colon blockage.

Unfortunately diverticulosis is often asymptomatic. You won’t feel anything, or rather you will feel occasional low-level pain that will just be drowned into the noise of bad digestion, bloating and a busy life. “Who doesn’t get occasional tummy ache” is something I hear on a regular basis in my naturopathic clinic.

Diverticulosis is often diagnosed accidentally, via colonoscopy done to screen for possible polyps or tumors.

Both diverticulosis and diverticulitis can be diagnosed via ultrasound. A CT-scan (X-Rays showing cross-sections of your colon) is also able to show the presence of an inflammatory mass in the colon, likely suggesting diverticulitis.

Diverticulitis comes with acute symptoms, mainly intense abdominal pain and sometimes nausea, vomiting, and bleeding.

Treatment - Dietary

For prevention and ongoing management of small but chronic crises, there is undoubtedly a lot we can do via nutrition. I won’t linger too much on colon-friendly nutrition on this page because I will dedicate a whole section of this website to this topic.

But I will just give my guiding principle. When diverticulosis is present, you should not obsess on seeds, nuts, tomatoes, or other foods that might get stuck in the diverticula. This was an old belief that has been recently refuted(3).

The thing is, any undigested food will be an issue. Not just seeds and nuts. Once the food residues reach the colon, it should all be digested, or the undigested remains will create trouble.

So the focus should be to eat the right foods, but more importantly eat those foods the right way. We will see that there is a lot we can do by combining the right foods together, pairing them up in an optimal way so that our enzymes work at their fullest potential.

I am not a fan of blindly adding fibers and bulking agents to the diet, as I know for a fact that it makes things worse in certain patients.

Treatment - Conventional

For diverticulitis, your doctor may prescribe antibiotics to clear-up the infection.

You may also want to consider the liquid diet mentioned in the colonic inertia article, to make sure the food residues reaching the colon are as inoffensive as possible, giving your inflamed colon time to calm down.

If diverticulitis leads to colon blockage, due to scarring tissue as explained previously, colon resection surgery (removing the blocked area and reconnecting the healthy sections) will need to be performed.

After the surgery, your goal will be prevention, avoiding the development of further diverticulosis through diet and lifestyle.

Sigmoid endometriosis

Endometriosis is the abnormal growth of endometrium in places other than the uterus.

Endometrium cells have a lifecycle of their own. They grow in a thick layer, then they get shed and need to be evacuated as part of the menstruation process. When they grow in the uterus that is.

When they grow in places like the colon, they still shed their cells every month, but they cannot evacuate the dead cells. The endometrium tissues typically get rooted on the outside of the colon mucosa, inside the muscular layer of the organ. They do not have access to the inside of the colon for evacuation.

So they keep building up, accumulating, creating inflammation and then scar tissues, sometimes tumors that risk obstructing the bowel and creating a colon blockage.

Endometriosis of the colon affects 15% to 37% of all patients suffering from pelvic endometriosis(4) (which englobes all forms of endometriosis, including the most common form: endometriosis of the ovaries and fallopian tubes).

Causes

Why pieces of endometrium develop in areas other than the uterus is unknown today, although a few hypotheses exist.

It is possible that endometrial tissue gets moved around during abdominal surgery, say a C-section, and gets implanted in unwanted areas. It is also possible that they migrate during a physical trauma, say a serious car accident with abdominal injuries.

Whatever the cause of the migration is, the immune system should be able to catch those unwanted cells in unwanted places and destroy them. Some studies have shown an immune system imbalance in patients suffering from endometriosis, with an inability of macrophages to destroy the outsider(5).

Symptoms, Diagnosis

At the beginning of the condition, when pieces of endometrium start to develop on the colon, there may not be any symptoms at all.

Once the area begins to scar and enlarge, symptoms may include pain during bowel movements, constipation, abdominal pains. It rarely includes bleeding. Symptoms are sometimes much worse and even debilitating at the time of menstruation.

The symptoms are however not very specific (except for the worsening during menstruation which is a good clue), and could be common to multiple types of gastrointestinal problems.

Diagnostic is therefore difficult. A colonoscopy is usually not conclusive because again, the endometrium tissues do not grow on the inside of the bowel and thus cannot be seen via colonoscopy.

The only way to diagnose colon endometriosis is via a laparoscopy, done by a doctor experienced in this condition and who knows what type of tissues to look for. Unfortunately a conclusive diagnostic is usually arrived at during surgery for another misdiagnosed condition.

Treatment

Surgery is the only treatment. The most elegant and the less drastic approach is to just locally remove the affected nodule of the colon (as one would remove a wart on the skin).

But this procedure is tricky to administer and requires extensive experience. Some doctors will therefore sometimes recommend a resection, which involves removing a whole section of colon – more drastic but less risky.

In cases where endometriosis leads to colon blockage, a resection will be the only viable approach.

Strictures caused by Irritable Bowel Disease

Irritable Bowel Disease is a family of conditions that have a common denominator: chronic inflammation of the gut. Crohn disease and ulcerative colitis belongs to this family.

As we have seen in the previous sections, chronic inflammation of any type creates in the long run some scar tissues. Those scars reduce the flexibility of the bowel, creating narrowing of the colon and possibly leading to colon blockage.

We will therefore keep this section short. If there is blockage due to years of Crohn or ulcerative colitis, the treatment options mentioned above (mostly resection of the obstructed part of the colon) will also apply.

Fecal impaction

Fecal impaction has already been covered in details in a separate article. It can be a cause of colon blockage.

Colon cancer

Colon cancer is a complex condition that cannot be given justice here. In the context of this article, let’s just mention that if a tumor grows to a point where it creates a complete bowel obstruction, it can clearly be a cause of colon blockage.

Conclusion

In this article, we have described the most common types of colon blockage, an extreme type of constipation.

Lingering constipation can sometimes hide a more serious situation that needs to be dealt with immediately. As we have seen, chronic constipation can for instance lead to diverticulitis, which can then lead to scarring and potentially blockage in the long run.

The goal of this article is not to worry you unnecessarily. As frustrating as chronic constipation can be, it is usually benign. The goal is rather to keep growing our knowledge of the causes of constipation, and continue to keep an eye open in case we suspect something more serious.


References for "Colon Blockage"

(1) J.J. Tuech, M.D., P. Pessaux, and J.P. Arnaud, M.D. "Obstruction of the colon (benign pathology), Department of Visceral Surgery Angers University Hospital, Angers, France

(2) Bauer VP. "Emergency management of diverticulitis". Clin Colon Rectal Surg. 2009 Aug;22(3):161-8.

(3) Strate L, Liu Y, Syngal S, Aldoori W, Giovannucci E. Nut, "Corn, and Popcorn Consumption and the Incidence of Diverticular Disease". JAMA. 2008;300(8):907-914.

(4) Yoshida M, Watanabe Y, Horiuchi A, Yamamoto Y, Sugishita H, Kawachi K. "Sigmoid colon endometriosis treated with laparoscopy-assisted sigmoidectomy: significance of preoperative diagnosis". World J Gastroenterol. 2007 Oct 28;13(40):5400-2.

(5) Portelli M, Pollacco J, Sacco K, Schembri-Wismayer P, Calleja-Agius J. "Endometrial seedlings. A survival instinct? Immunomodulation and its role in the pathophysiology of endometriosis". Minerva Ginecol. 2011 Dec;63(6):563-70.


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