Blockages (obstructions) within the digestive tract are a common complication of inflammatory bowel disease (IBD). Two causes of blockage in people with IBD are strictures and adhesions. Difficult-to-digest foods can also cause an intestinal blockage. Because IBD varies widely from person to person, some people find certain foods more difficult to tolerate than others. Popcorn, nuts, and stringy vegetables are common culprits, but each person discovers what they can tolerate best.
What is a stricture?
A stricture is a section of the digestive tract that has become abnormally narrow.
To understand how a stricture forms, it helps to know how the digestive tract normally heals itself.1 A healthy digestive tract sometimes gets injured. When this happens, certain cells make special proteins that repair the damage. These special proteins are called collagen and fibronectin. If you have IBD, you have ongoing inflammation in your digestive tract. In this case, the repair process happens continually. Over time, the collagen and fibronectin build up, making a section of the digestive tract too narrow. When this happens, food and waste cannot pass normally.
Are strictures more common in Crohn's or ulcerative colitis?
About 11% of people have narrowing or stricture when they are diagnosed with Crohn’s disease, one of the two main forms of IBD.1 By 10 years after their diagnosis, about half of people with Crohn's disease have had a stricture. Strictures are most common in the end of the small intestine (ileum), where it joins the large intestine. This area is where 40% to 55% of strictures form.1 However, a stricture can form wherever there is inflammation. About 20% form in the colon and 10% form in the upper part of the digestive tract.
Strictures are less common in people with the other main form of IBD, ulcerative colitis. Strictures are found in less than 5% of people with ulcerative colitis.2 However, strictures are more serious in people with ulcerative colitis, as they are likely to be cancerous.3
Strictures also may form after surgery. Some people with IBD need surgery to remove a section of the intestine that has become badly damaged. The place where the intestine is rejoined is called an anastomosis. Strictures are common at the anastomosis.
What is an adhesion?
An adhesion is a band of tissue that forms after surgery.4,5 After intestinal surgery, an adhesion may form between the intestine and abdominal wall. An adhesion can also form between 2 loops of the intestine or between the intestine and another organ.5 The band of tissue prevents the organs from moving freely. This can cause the intestine to twist or move out of place. Once this happens, food or waste can not pass.4
Adhesions occur after many different kinds of abdominal surgery, not just IBD related procedures. In a general patient population, adhesions cause about 60% of bowel obstructions.6
What are the symptoms of an intestinal blockage?
An intestinal blockage can lead to symptoms such as nausea, vomiting, and abdominal pain or swelling. Other signs are being unable to have a bowel movement or pass gas.6
What other conditions can cause bowel obstruction?
Other common causes of bowel obstruction are tumors and hernias.4 If you have symptoms of a bowel obstruction, your health care provider will ask questions and perform tests to figure out what has cause the blockage. Tell your provider that you have Crohn’s disease. Mention any surgeries that you have had.
How is bowel obstruction evaluated and diagnosed?
There are several different ways that your health care provider can look at your digestive tract. These procedures identify the size and location of the blockage.
A computed tomography (CT) scan is the most common way of looking at a blockage.1 A CT scanner uses x-rays to create detailed cross-sectional pictures of areas in your body.7 You may be asked to drink a liquid contrast material before the CT scan. The contrast material helps the radiologist to see your small intestine better.8
Magnetic resonance imaging (MRI) may be used as an alternative to a CT scan. Instead of x-rays, MRI uses magnets and radio waves to take pictures of certain areas of your body.
Another procedure that is sometimes used is called a “small bowel series” or “barium small bowel follow-through. You will be asked to drink a contrast material called barium. Simple x-rays will be taken of your stomach, small intestine, and large intestine every 20 minutes. This allows the radiologist to see how the barium moves through your digestive tract. This procedure shows how complete the blockage is.
How is bowel obstruction treated?
If you have a bowel obstruction, you may need to stay in the hospital for a few days. You will be evaluated and treated in the hospital.
To treat the obstruction, your health care provider may try medication and bowel rest first.1,6 You may be given corticosteroids to take by mouth or intravenously (IV). These can help to reduce inflammation and swelling in your digestive tract. Antibiotics, immunomodulators, or biologic medications are sometimes used as well.1,6 A small tube may be inserted through your nose into your stomach or small intestine.6 This tube is used to remove fluid and gas build up behind the blockage. You probably will be put on bowel rest, that is, you will be told not to eat or drink for a few days. Fluids will be given to you through an IV. These measures help to clear up many obstructions.
If a small stricture (less than 4 cm) has caused the obstruction, your doctor might be able to open it up with a procedure called balloon dilation. Another term for this procedure is “endoscopic dilation.”1 Your doctor performs this procedure with a long, thin tube with a very small camera, a light, and a small balloon. The camera lets your doctor see inside your digestive tract. The scope is inserted via your rectum and travels through your colon. Once it has reached the stricture, the balloon is inflated. As it inflates, it opens up the area that has gotten narrow. Some patients with small strictures can avoid surgery this way.
For large obstructions, surgery may be needed. Strictures—and the complications they cause—are a main reason for surgery in people with IBD.1 Surgery can be done to widen the passage way or remove the affected section. The surgeon will try to leave as much of your intestine as possible. This is important so that you can digest food normally after you recover.
What are complications of bowel obstruction?
Bowel obstruction can cause dehydration and electrolyte imbalance. The section of the intestine before the blockage can stretch out as food or waste builds up.6Abscesses and fistulas may form in the area behind the blockage where food and waste build up.1
People with IBD may need multiple surgeries over time. If too much of the digestive tract is removed, it becomes hard to digest and absorb nutrients properly. This is called “short bowel syndrome.” It can lead to malnutrition and other complications.1 For this reason, your surgeon will plan the procedure carefully. The surgeon will remove as little as possible and take steps to prevent adhesions from forming.