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Intestine, and pelvic cancer prostate and ovaries ; usually compresses the rectum. Continuous pain is attributable to visceral mass growth compressing the intestine, intestinal distention, or hepatomegaly, whereas a severe, superimposed colicky activity upstream of the obstruction in the small or large intestine may worsen the symptomatology. The eventual appearance of paradoxical diarrhea results from a leak of fluid stool due to bacterial activity from fecal impaction and generally occurs in the setting of large bowel obstruction. As luminal contents accumulate proximal to the obstruction, the bowel becomes distended, further stimulating intestinal fluid secretion. The fluid accumulation further stretches the bowel wall. The increasing intraluminal pressure obstructs venous drainage from the obstructed segment, thus interfering with oxygen consumption and eventually leading to intestinal gangrene or perforation. The rate of accumulation of secretions determines abdominal distention, and the body may superimpose colicky activity in an attempt to surmount the obstacle. Although there is little or no through-movement of intestinal contents, the bowel still continues to contract with increased, uncoordinated peristaltic activity. A vicious circle represented by distention-secretion-motor activity leads to a worsening clinical picture, producing a hypertensive state in the lumen and damage to the intestinal epithelium, with a consequent inflammatory response enhancing the cyclooxygenase pathway and the release of prostaglandins--potent secretagogues--either by a direct effect on enterocytes or via an enteric nervous reflex and bicalutamide.

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