Intestinal Pseudo-obstruction: Signs, Symptoms, & Treatment

Other signs and symptoms of intestinal pseudo-obstruction include loose feces, disliking food, weight loss,

eye problems, difficulty swallowing (known as dysphagia), a feeling of being swollen or filled up in the

stomach, and cramps. The feeling of fullness can occur much earlier than usual. It is worth noting that the

entire area of the digestive system from the esophagus to the rectum can be affected by intestinal

pseudo-obstruction. The esophagus is the tube-shaped structure by which food travels from the mouth to

the stomach. The rectum is the last part of the large intestine (see above).

Over time, intestinal pseudo-obstruction can lead to bacteria infections, muscle problems in other parts of

the body, and poor nutrition. Over time, bladder diseases also occur in some people with intestinal

pseudo-obstruction. In this case, the bladder refers to a muscular organ in the body that collects and

temporarily holds urine until it is ready to leave the body.

WHEN DO THE SIGNS AND SYMPTOMS OF INTESTINAL PSEUDO-OBSTRUCTION FIRST OCCUR?

The signs and symptoms of intestinal pseudo-obstruction can first occur in childhood or not occur until

early adulthood.

DOES INTESTINAL PSEUDO-OBSTRUCTION BEGIN SLOWY OR QUICKLY?

Intestinal pseudo-obstruction usually begins slowly. Only rarely, does it begin suddenly or quickly. Quick

onset of intestinal pseudo-obstruction can occur in Ogilvie's syndrome. Ogilvie's syndrome is pseudo-

obstruction (an apparent blockage that cannot be seen upon physical examination) mostly in the colon.

The colon is the major part of the large intestine. See the first section for a description of the large

intestine.

WHAT CAUSES THE PAIN IN INTESTINAL PSEUDO-OBSTRUCTION?

The cause of the sudden, sharp pain in the stomach and intestines is not well understood. However, there

are a few possibilities that have been offered. First, when passages in the stomach and intestines are

blocked, reflexes in these body areas can cause an increase in muscle activity, leading to painful cramps.

These cramps can cause decreased blood flow, which in turn, can cause pain. Another possible cause of

the pain is that intestinal pseudo-obstruction affects the nerve cells in the stomach and intestines. When

these nerve cells die, this can signal pain.

WHAT ARE THE DIFFERENT TYPES OF INTESTINAL PSEUDO-OBSTRUCTION?

The most common type of intestinal pseudo-obstruction is caused by damage to nerve cells in the wall of

the intestine. The outer layer of the intestinal wall shortens the intestines, whereas the inner layer narrows

the intestines. Between these two layers is a network of nerves known as the enteric nervous system.

The enteric nervous system helps to coordinate the work of the muscle cells. Damage to the nerves in the

enteric nervous leads to a type of intestinal pseudo-obstruction known as neuropathic (or neurogenic)

intestinal pseudo-obstruction.

If the muscles of the intestinal wall get damaged, this can lead to a different type of pseudo-obstruction

which is known as myopathic (or myogenic) intestinal pseudo-obstruction. The damaged intestine muscles

can lead to weakened movements of the intestine and can cause long-term cramps in the stomach and

intestines. Both neuropathic and myopathic intestinal pseudo-obstruction can be passed on from the

parent to the child through genes. Genes are units of material contained in a person's cells that contain

coded instructions as for how certain bodily characteristics (such as eye color) will develop. All of a

person's genes come from his/her parents.

Not all cases of intestinal pseudo-obstruction are passed on from the parent(s) to the child. When

intestinal pseudo-obstruction occurs without being passed from the parent, it is known as idiopathic or

sporadic intestinal pseudo-obstruction. When a disease causes the signs and symptoms of intestinal

pseudo-obstruction, the condition is known as secondary pseudo-obstruction. Secondary is a term used in

medicine that means to be caused by something else. See the next section for some diseases and

conditions associated with intestinal pseudo-obstruction.

ARE THERE ANY OTHER CONDITIONS ASSOCIATED WITH INTESTINAL PSEUDO-OBSTRUCTION?

Yes. Intestinal pseudo-obstruction usually happens in patients with multiple (more than one) jejunal

diverticula. Jejunal diverticula are pouches or sacs that open from the jejunem. The jejunem is the second

part of the small intestine and is where a lot of food absorption occurs. Myopathic pseudo-obstruction

(see previous section) can be caused by familial amyloid neuropathy, a condition in which amyloid (a

starchy type of protein) enters various nerves outside the brain and spine, disturbing the functioning of

these nerves.

Intestinal pseudo-obstruction can occur as a response to peripheral neuropathy (damage to nerve fibers

outside of the brain or spine) as a result of diabetes mellitus. Diabetes mellitus is a complex, long-term

disorder in which the body is not able to effectively use a natural chemical called insulin. Insulin's main job

is to quickly absorb glucose (a type of sugar) from the blood into cells for their energy needs and into the

fat and liver (a large organ that performs many chemical tasks) cells for storage.

Parkinson's Disease can cause symptoms of intestinal pseudo-obstruction. Parkinson's Disease is a type

of brain disorder that leads to serious difficulties with muscle movements. Another condition that can lead

to the symptoms of intestinal pseudo-obstruction is systemic lupus erythematosus (SLE). SLE is a long-

term disease in which the connective tissues throughout the body are inflamed because the body's

defense system attacks these tissues as if they were foreign substances.

Scleroderma, which is another type of disease in which the body mistakenly attacks many organs and

tissues of the body, can also lead to the symptoms of intestinal pseudo-obstruction. SLE and scleroderma

can cause either neuropathic or myopathic intestinal pseudo-obstruction. Please see the previous section

for the difference between these two types of intestinal pseudo-obstruction.

CAN MEDICATIONS LEAD TO SYMPTOMS OF INTESTINAL PSEUDO-OBSTRUCTION?

Yes. Medications that affect muscles and nerves can lead to the symptoms of intestinal pseudo-

obstruction. Examples of such drugs would be antidepressants (drugs that work against depression) and

opiates. Opiates are drugs that contain opium (a milky substance found in poppy seeds) that lead to sleep

and pain relief. When a medication causes the signs and symptoms of intestinal pseudo-obstruction, the

condition is known as secondary pseudo-obstruction. Remember from above that "secondary" is a term

used in medicine that means to be caused by something else.

HOW IS INTESTINAL PSEUDO-OBSTRUCTION DIAGNOSED?

Intestinal pseudo-obstruction is difficult to diagnose because the doctor first needs to make sure that

there are not other causes (such as an object or mass blocking the intestines) for the reported problems.

In addition, intestinal pseuodo-obstruction cannot be seen from outside of the patient. At first, the doctor

will take a complete history of the patient's signs and symptoms and do a physical examination. Blood

tests are usually normal in patients with this condition.

It is worth noting that there is no single lab test that is used to diagnose intestinal pseudo-obstruction.

That being said, X-rays of the belly are usually taken to help make the diagnosis, but this test often does

not find any blockages. However, sometimes the pictures from the x-rays will appear as if there is a

blockage. The same is true for CT scans (computerized tomography) scan of the belly. CT scanning is a

more advanced imaging technique that uses x-rays and computer technology to produces more clear and

detailed pictures than a traditional x-ray.

Another type of scan that is sometimes used is an intestinal radionuclide scan. This test involves

scanning the body and producing pictures of the amount of radioactivity that has been absorbed in the

tissues after a radioactive substance has been given to the patient. Radioactivity is a property of nuclei

(the center parts of atoms) in which they break up and send out rays or particles known as radiation.

Atoms are the smallest part of an element that can exist alone or in combination with something else. A

radioactive substance is a substance that sends out radiation. Certain radioactive substances are

absorbed by the body at different rates. The purpose of the previously mentioned scans are to look for

blockages in the intestines and stomach.

Other tests that are used include an ultrasound, gastroscopy, barium enema, and barium meals, but they

often all lead to no abnormal findings as well. An ultrasound is a procedure that uses types of sound

waves to produce images of the body. A gastroscopy is a procedure in which the stomach is examined by

sticking a tube down the patient's throat, which the doctor looks through. A barium meal involves eating a

piece of bread or cookie that is soaked in barium (a metallic chemical). X-rays will then be taken to see

how the food travels through the body to the small intestine. See the first section for a description of the

small intestine. A barium enema involves placing a tube inside the patient's rectum (the last part of the

large intestine) and inserting barium into the rectum through the tube. X-rays are then taken that produce

pictures of the colon.

Sometimes, in patients with advanced myopathic pseudo-obstruction, widened areas of the intestine can

be seen. Remember that myopathic pseudo-obstruction is a type of intestinal pseudo-obstruction in which

the muscles of the intestinal wall get damaged.

Another technique, known as intestinal manometry, is used is to measure the amount of pressure inside

the stomach and small intestines. This is done by taking a flexible tube known as a catheter and sticking

down the patient's nose, down the throat, and into the stomach and small intestine. Along the tube are

electronic devices that send information to a computer about the pressure inside the stomach and small

intestines.

The measurement of pressure inside the stomach and small intestines can help determine if the

movements of the intestine are coordinated like they should be. Usually, in cases of intestinal pseudo-

obstruction, the movements of the intestine are not organized or coordinated, for short or long periods of

time. Intestinal manometry requires special equipment and is only available in certain medical centers.

Overall, manometry is useful in measuring the extent of intestinal pseudo-obstruction, confirming the

diagnosis, and determining the correct treatment.

Another way to diagnose intestinal pseudo-obstruction is to take a sample of tissue from the intestine and

study it under a microscope. Such tissue samples can be taken by a doctor who places a tube-shaped

object known as a scope down the throat and into the intestines. However, tissue samples obtained with

this procedure are not good enough for evaluating intestinal pseudo-obstruction because they are only

tissue samples of the first layer of the intestines. The nerves and the muscles of the intestines are located

deep in the wall of the bowel. Thus, surgery needs to be done to take tissue samples of the deeper areas

of the intestines in order to evaluate intestinal pseudo-obstruction. When such samples are taken, they

are examined with high-powered microscopes that can detect even small changes in the nerves and

muscles.

After all of tests are done, some doctors may mistakenly diagnose irritable bowel syndrome. Irritable

bowel syndrome is a disorder of the intestine that is characterized by large amounts of mucus (a thick

slippery fluid) being released from the intestine and pass through into the feces. If the patient is

misdiagnosed with irritable bowel syndrome, they risk being treated for a condition that is less serious that

intestinal pseudo-obstruction.

It is often very difficult to tell the difference between different diseases of the intestine just by knowing the

signs and symptoms. This is because the signs and symptoms are often alike in many different types of

intestinal disorders. There is no single sign or symptom that only occurs in intestinal pseudo-obstruction.

This is why the tests described above need to be done in addition to a physical examination. Most

importantly, somebody needs to raise the possibility of intestinal pseudo-obstruction with the doctor at

some point because this possibility can be easily overlooked.

A good reason to expect intestinal pseudo-obstruction is if the patient continues to see the doctor or is

admitted to the hospital because of suspected blockages in the intestine, episodes of vomiting, a large

belly, and a feeling like food and liquid is standing still and not moving through the intestines. If the large

intestine is mainly affected it will lead to difficulty pooping.

HOW IS INTESTINAL PSEUDO-OBSTRUCTION TREATED?

There currently is no cure for intestinal pseudo-obstruction. Thus, treatment is aimed at relieving

symptoms and improving nutrition. Medicine can be given to help relieve some of the intestinal problems,

such as pain. However, since the reason(s) for the pain in the intestines is not well understood, it is

difficult to treat it effectively.

Another problems is that pain killers known as opiates, although effective in the short-term, can provide

problems in the movement of the intestines. Opiates are drugs that contain opium (a milky substance

found in poppy seeds) that lead to sleep and pain relief. This decreased movement caused by opiates

may lead to more pain in the intestines. The pain leads to taking more opiates, which then leads to less

intestinal movement, more pain, and taking opiates again. The person can then be caught in a cycle that

they can't escape from because they need to opiates to decrease the pain. Relaxation techniques can

also be used to help the patient deal with the pain.

There are other medications that are known as pro-kinetics, which improve the movement of the intestines

and stomach. Two such drugs are Propulsid and Prepulsid. A drug called Neostigmine, helps improve

movement in the intestines. This drug is usually given when the blockage is in the large intestine. Drugs

that affect the tension of the muscles in the intestine can help decrease cramps. Drugs that copy the

effect of some hormones in the stomach and intestine have been known to provide some relief to people

suffering from this condition. Hormones are types of chemicals in the body that affect other cells.

Hormones, muscles, and nerves need to work together for coordinated movements in the intestines to

occur.

Medications are also available for most of the other symptoms of intestinal pseudo-obstruction. For

example, medications known as antiemetics help treat nausea and vomiting. Medications that reduce the

level of acid in the body help decrease heartburn. Difficulty pooping can be treated with medications

known as stool softeners and bulking agents. Antibiotics are also used to treat any bacterial infections.

Intestinal pseudo-obstruction is usually treated by providing extra nutrients to prevent poor nutrition.

Nutrition can be bad because the intestines are not absorbing the nutrients and/or because the person

does not want to eat anymore because of the symptoms they experience while eating. Eating food

stimulates the intestines and stomach to move. However, in people with intestinal pseudo-obstruction,

these movements can lead to symptoms such as cramps. So for people with intestinal pseudo-obstruction,

it is often helpful to eat food that are free of dietary fiber because the nutrients from these foods will be

absorbed with little movement of the intestines, leading to less symptoms. Dietary fiber is a term for

chemical substances in the cells of plants that cannot be digested by the human body. Some people with

intestinal pseudo-obstruction are able to benefit form eating small, frequent meals.

For patients who refuse to eat, they can receive nutrients in liquid or part-liquid form through a tube that is

placed in the stomach or small intestine. This process is known as tube feeding and is not a pleasant

experience. One option for tube feeding is a nasal-gastric (NG) tube, which is placed down the nose and

throat to the stomach. Another option is a gastrostomy (G tube) in which surgery is used to cut a hole into

the wall of the belly in order to insert a tube directly into the stomach. A G tube will not be effective,

however, if the problem is in the stomach. If the problem is in the stomach, a jejunostomy (J tube) can be

used, in which surgery is used to cut a hole into the wall of the belly in order to insert a tube directly into

the small intestine. The G tube and the J tube can both be used to help decrease pressure and pain as

well.

If feeding through the tube does not work, nutrients can be given through a vein by using surgery to

implant a tube in it. The nutrients then travel through the tube and into the vein. Depending on the severity

of the case, only some nutrients can be delivered this way, or all of them can be. Veins are blood vessels

that carry blood to the heart. Providing nutrients through the veins can be risky because of the possibility

of developing a blood clot in the vein, developing an infection, and/or developing life-threatening liver

problems. The liver is the largest organ in the body and is responsible for filtering (removing) harmful

chemical substances, producing important chemicals for the body, and other important functions.

Other types of treatment include nasogastric suction, in which a tube is placed from the nose to the

stomach so that air and liquids can be sucked out of the intestines to relieve pressure. Fluids may be

administered through a needle that is placed in a vein to replace fluid that is lost from vomiting or diarrhea

(loose, watery poop). Special diets usually do not work as far as treatment, although vitamins are given to

patients who are not getting enough through their diet.

Surgery is often not an effective treatment for patients with intestinal pseudo-obstruction. In fact, it can

sometimes make patients worse. Surgery is most effective when it can treat a specific symptom. For

example, a myotomy (cutting of muscle) can be used to treat achalasia, which is an abnormal condition in

which the muscle does not relax. Another example of surgery is removing all or part of the colon if there is

very slow movement of food products through it (a condition known as slow transit constipation). The

colon is the major part of the large intestine. See the first section for a description of the large intestine.

In severe cases, surgery may be used to remove part of the intestines. This is usually done if a part of the

intestine is not working at all and continues to cause complications. The small intestines may be removed

if the patient develops life-threatening liver-complications from being fed through a tube implanted in a vein

(see above). Another drastic option is replacing the intestines with the intestines from an organ donor.

Some positive results have occurred when using this technique with children, but it is still being developed

and it is unclear how much it will help people with intestinal pseudo-obstruction. Overall, surgery should

only be used to treat intestinal pseudo-obstruction when all other treatments have been attempted.

HOW LONG DOES INTESTINAL PSEUDO-OBSTRUCTION LAST?

Intestinal pseudo-obstruction usually lasts for many years and does not tend to go away by itself.

However, the severity of the signs and symptoms usually vary, so that a person can go through a period

with few or no signs symptoms, and then go through a period with many severe signs and symptoms.

Some people, however, experience the signs and symptoms to a very similar degree throughout the

course of their illness.

WHAT CAUSES INTESTINAL PSEUDO-OBSTRUCTION?

Please see our section above on the different types of intestinal pseudo-obstruction for information on

factors that lead to the development of this condition. Our basic summary of it in this section is that

intestinal pseudo-obstruction can be caused by nerve damage (this is known as neuropathic or

neurogenic intestinal pseudo-obstruction) or damage to the muscles of the intestine wall (this is known as

myopathic or myogenic intestinal pseudo-obstruction). Intestinal pseudo-obstruction can be acquired after

an illness.

As was mentioned above, medications that affect muscles and nerves can lead to the symptoms of

intestinal pseudo-obstruction. Scleroderma, which is a type of disease in which the body mistakenly

attacks many organs and tissues of the body, can also lead to intestinal pseudo-obstruction. Certain

types of cancers can also lead to intestinal pseudo-obstruction. Cancer is a group of diseases in which

symptoms are due to an abnormal and excessive growth of cells in one of the body organs or tissues.

See our section on other conditions associated with intestinal pseudo-obstruction for more information on

potential causes of this condition.

There is evidence that some people, especially children, develop intestinal pseudo-obstruction through the

genes on their parents. Genes are units of material in a persons cells that contain coded instructions as

for how certain bodily characteristics (such as eye color) will develop. All of a person's genes come from

his/her parents. Some genes are normal whereas others may be abnormal. Abnormal genes can cause

diseases.

WHO USUALLY GETS INTESTINAL PSEUDO-OBSTRUCTION?

Intestinal pseudo-obstruction usually happens in children and young adults.

WHAT ELSE IS INTESTINAL PSEUDO-OBSTRUCTION KNOWN AS?

Intestinal pseudo-obstruction is also known as idiopathic intestinal pseudo-obstruction.

WHAT IS THE ORIGIN OF THE TERM, INTESTINAL PSEUDO-OBSTRUCTION?

Intestine comes from the Latin word "intestinus" meaning "inner." Pseudo comes from the Greek word

"pseudes" meaning "false." Obstruction comes from the Latin word "obstruere" meaning "to build against."

Put the words together and you get "false inner building against."