What Is Intestinal Pseudo-obstruction?

Intestinal pseudo-obstruction is a rare condition in which the intestines behave as if they are blocked (obstructed), but no physical blockage is present. The muscles or nerves that control intestinal movement are impaired, leading to symptoms similar to a true blockage, such as pain, bloating, and constipation.

This condition can affect either the small intestine, large intestine, or both.

What Causes Intestinal Pseudo-obstruction?

There are two main types:

1. Primary (Chronic Idiopathic Intestinal Pseudo-obstruction – CIIP):

• Often inherited or related to neuromuscular dysfunction
• Seen in children and young adults
• Cause is usually unknown or genetic

2. Secondary Pseudo-obstruction:

Occurs due to other underlying health conditions, such as:

• Systemic lupus erythematosus (SLE)
• Scleroderma
• Parkinson’s disease
• Hypothyroidism
• Diabetes
• Amyloidosis
• Use of certain medications (e.g., opioids, anticholinergics)
• After abdominal surgery or infection

What Are the Symptoms of Intestinal Pseudo-obstruction?

Symptoms often mimic a mechanical obstruction and may include:

• Abdominal pain or cramps
• Bloating and distention
• Nausea and vomiting
• Severe constipation or diarrhea
• Poor appetite
• Malnutrition or weight loss in chronic cases

In infants and children, failure to thrive and feeding difficulties may occur.

How Is Intestinal Pseudo-obstruction Diagnosed?

A thorough evaluation is required since there’s no actual blockage. Diagnosis may involve:

• Abdominal X-rays or CT scans – to detect signs of dilation and gas patterns
• Gastrointestinal motility studies – to assess how well the intestines move
• Endoscopy or colonoscopy – to rule out physical obstruction
• Biopsy of intestinal tissue – in some cases
• Blood tests – to evaluate for systemic or autoimmune conditions

How Is Intestinal Pseudo-obstruction Treated?

Treatment depends on the severity and underlying cause.

Supportive Care:

• Nutritional support (oral supplements, feeding tubes, or IV nutrition if needed)
• Hydration and electrolyte balance
• Pain relief

Medications:

• Prokinetics – to stimulate bowel movement (e.g., metoclopramide, erythromycin)
• Antibiotics – if bacterial overgrowth is present
• Anti-nausea drugs – to control vomiting

Surgery:

• Usually avoided unless absolutely necessary
• In severe or localized cases, a surgical bypass or decompression procedure may be performed

What Are the Complications?

Without proper management, intestinal pseudo-obstruction can lead to:

• Malnutrition
• Weight loss
• Vitamin and mineral deficiencies
• Intestinal perforation
• Sepsis in rare, severe cases

Who Is at Risk for Intestinal Pseudo-obstruction?

Those at higher risk include:

• Individuals with neuromuscular or connective tissue disorders
• People with autoimmune diseases
• Those taking medications that slow bowel motility
• Children with congenital gastrointestinal motility disorders
• Patients with a history of abdominal surgeries