Constipation or Intestinal Obstruction?

• Constipation and intestinal obstruction They share similar symptoms, such as abdominal pain and difficulty passing stool normally. However, intestinal obstruction occurs when food and fluids cannot pass through the intestines. Without treatment, it can be fatal.
• Symptoms of constipation and intestinal obstruction can be prevented by modifying diet and lifestyle habits. Regularly observe your symptoms. If constipation is accompanied by bloating, abdominal fullness, vomiting, or rectal bleeding, promptly consult a doctor for proper diagnosis and treatment. Those aged 45 or older should have colorectal cancer screening once a year.

Although constipation does not cause life-threatening harm, many suffer from abnormal bowel movements affecting both body and mind, causing stress, loss of appetite, abdominal discomfort, and fatigue. It can also lead to complications such as hemorrhoids, anal or rectal ulcers, and may signal serious conditions like intestinal obstruction or colorectal cancer.

Constipation (Constipation)

Constipation is a condition characterized by difficult or infrequent bowel movements fewer than three times per week. It may require prolonged straining, produce small, hard stools, and a sensation of incomplete evacuation or abdominal fullness. If constipation persists for more than three months, especially if symptoms began over six months ago and remain untreated, it may develop into chronic constipation, a common gastrointestinal problem affecting over 30% of the general population, particularly the elderly and women at twice the rate of men.

Constipation symptoms

• Hard, pellet-like stools
• Feeling of incomplete bowel evacuation
• Sensation of blockage near the anus
• Need for assistance to pass stool
• Prolonged straining time
• Excessive straining effort

Causes of constipation

Constipation arises from various causes, broadly divided into two main types:

• Primary type Caused by abnormal function of the large intestine and defecation system, typically due to decreased colonic motility that slows stool transit. This is rare, occurring in only 5-6% of cases.
• Secondary type Caused by other factors such as low-fiber diet, insufficient fluid intake, lack of exercise, certain medications or supplements, and conditions affecting endocrine or gastrointestinal systems.

Constipation treatment

• Behavioral modifications: Constipation is not life-threatening and can initially be treated by eating fiber-rich foods, increasing water intake, exercising regularly, establishing a regular bowel routine, and avoidingusing phoneswhile defecating, as well as appropriate use of laxatives.
• Biofeedback training: Teaching patients to properly use the muscles involved in defecation with tools that monitor muscle activity. This is for chronic constipation patients suspected of abnormal large intestine function or improper straining techniques. Some patients contract or fail to relax the anal sphincter during defecation, causing dyssynergia. Diagnosis is confirmed by anorectal manometry, which measures muscle function in the distal colon and anal sphincter.

However, if constipation occurs with warning signs such as weight loss, bloody stools, alternating constipation and diarrhea, palpable abdominal mass, family history of colorectal cancer, or onset after age 50, prompt medical evaluation is necessary due to the risk of colorectal cancer.

Intestinal obstruction (Intestinal Obstruction)

Intestinal obstruction is a condition where intestinal contractions are disrupted or blocked, preventing normal passage of food and fluids. It results in symptoms like abdominal pain, bloating, nausea, and vomiting. Symptoms often indicate the obstruction location, which may be partial or complete. Untreated obstruction can lead to severe complications or death.

Symptoms of intestinal obstruction

depend on the obstruction site, categorized as follows:

1. Small bowel obstruction

• Bloating, abdominal fullness, inability to pass gas
• Tenderness upon abdominal palpation
• Severe intermittent abdominal pain around the navel or under the ribs, sometimes with rapid pulse
• Nausea and vomiting

2. Large bowel obstruction

• Bloating, abdominal fullness
• Severe abdominal pain
• Constipation
• Stools mixed with blood

Causes of intestinal obstruction

are divided into two types:

• Mechanical obstructions Caused by a physical blockage in the intestinal tract, often from adhesions after abdominal surgery, colorectal cancer, small bowel tumors, gallstones, hernias, or congenital intestinal abnormalities. It may also result from inflammatory bowel disease such as Crohn’s disease.

• Paralytic ileus (Nonmechanical obstructions) Caused by impaired intestinal motility preventing normal contractions, affecting bowel function. Causes include abdominal or pelvic surgery, infections, certain medications, and muscle or nerve disorders such as Parkinson’s disease or diabetes.

Treatment of intestinal obstruction

requires identifying the cause and assessing the patient's condition, including:

• Partial obstruction where some food and fluids pass: initial treatment involves a liquid diet. If symptoms improve, a low-fiber diet may be recommended long-term. If no improvement occurs, surgery may be necessary.
• Complete obstruction where no food or fluids pass: surgical intervention is required to remove the blockage or resect damaged intestine.
• Treatment of paralytic ileus includes tube feeding to prevent malnutrition. If symptoms persist, medications to stimulate intestinal motility or surgery to remove damaged sections may be needed. In cases of intestinal dilation, treatment includes manual stool evacuation combined with endoscopy.

Constipation and intestinal obstruction share many similar symptoms,

especially abdominal pain and difficulty passing stool. However, constipation treatment is simpler and less complex than intestinal obstruction therapy. Constipation is not life-threatening, while intestinal obstruction can be fatal if untreated.

Nevertheless, whether temporary constipation, chronic constipation, or intestinal obstruction, these conditions should not be ignored as they may cause complications affecting other health aspects, including intestinal perforation, hemorrhoids, kidney failure, or death if obstruction blocks blood flow causing tissue death, bloodstream infection, and organ failure.

Prevention of constipation and intestinal obstruction

Both conditions can be prevented by reducing risk factors through dietary and lifestyle changes.

• Choose low-fat foods,
• eat fiber-rich vegetables and fruits,
• avoid smoking,

and monitor symptoms closely. If constipation occurs with bloating, fullness, vomiting, or rectal bleeding, seek medical evaluation promptly.

Additionally, because gastrointestinal diseases have overlapping symptoms, people aged 45 and older experiencing these signs should consult a doctor and undergo colorectal cancer screening annually to detect and exclude serious diseases.

Thanks to the information provided by Dr. Krisakamon Sitthithun, Orthopedic Surgeon specializing in knee and hip joints, license number W.27713,Samitivej Sukhumvit Hospital