Intestinal Pseudo-obstruction
Intestinal pseudo-obstruction is a name given to a group of
disorders in which various signs and symptoms (see below)
suggest that something is blocking the intestines from moving,
yet there is no visual evidence of anything physically blocking
the intestine when the they are examined. The intestine is a tube
shaped structure that is part of the digestive tract. It stretches
from an opening in the stomach to the anus and occupies most
of the lower parts of the belly. The intestine is divided into two
main sections: the small intestine and the large intestine. The
small intestine takes in all of the nutrients (healthy substances)
that the body needs. The large intestine absorbs moisture from
the matter that is left, and excretes the waste (i.e., feces) from
the anus. Excrete means to release from the body as waste.
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Food and waste products are normally pushed through the stomach and intestine in a
series of wavelike, coordinated contractions and relaxations, in a process known as
peristalsis. In intestinal pseudo-obstruction, peristalsis is either partially or totally
impaired. Thus, the intestines do not move food and waste products along as well as
normal. This, in turn, causes poor digestion of food and poor absorption of nutrients.

As a result, increased growth of bacteria can occur in the small intestine. The build up in
bacteria can lead to increased difficulties absorbing nutrients. Thus, people with intestinal
pseudo-obstruction can find themselves in a vicious cycle.
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The most common symptom of intestinal pseudo-obstruction is
sharp, sudden pain in the stomach and intestines. The second most
common symptom is poor nutrition. Nausea and vomiting are most
common if the disorder is present in the upper part of the stomach
and intestines. If the lower part of the stomach and intestines are
affected, the most common signs and symptoms are a large belly,
difficulty pooping, and belly pain. If the problem is mostly in the small
intestine (see above) or more widespread, the signs and symptoms
usually include a large belly, belly pain, vomiting, and a feeling of
blockage in the stomach and intestine.
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.


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


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


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.


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.


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.


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.


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

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

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.


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
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

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.


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.


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


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


Intestinal pseudo-obstruction is also known as idiopathic 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."