Medical News Today: What to know about ileus

Ileus is a temporary and often painful lack of movement in the intestines.

An ileus occurs when the intestines do not move food through in the normal way. It often occurs after abdominal surgery.

This is a severe condition because, if left untreated, an ileus can cut off blood supply to the intestines and cause tissue death. This can result in an intestinal tear or life-threatening infection of the abdominal cavity.

Read on to learn more about recognizing and treating an ileus.

Causes

ileus demonstrated by 3D render of intestines.
Abdominal or pelvic surgery may cause ileus.

Typically, muscles in the intestines contract and relax to cause a wave-like motion called peristalsis. This movement helps food to travel through the intestines.

When an ileus occurs, it stops peristalsis and prevents the passage of food particles, gas, and liquids through the digestive tract.

If people continue to eat solid food, it can lead to a backlog of food particles, which may cause full or partial obstruction of the intestines.

An ileus most commonly occurs after abdominal or pelvic surgery. According to some estimates, ileus or other bowel obstruction is the second most common cause for readmission to the hospital within the first month following surgery.

This may be because:

  • normal peristalsis is slow to return after surgery
  • medications prescribed after surgery affect intestinal movement
  • post-surgical scarring can cause a blockage

Some of the medicines that affect muscles and nerves in the digestive tract include:

  • opioid pain-relieving drugs
  • anticholinergics, which are used to treat many conditions including bladder conditions, COPD, and Parkinson’s disease
  • calcium channel blockers, which are often used to treat heart conditions

Other causes of ileus include infections and disorders of the muscles and nerves, such as Parkinson’s disease.

In children, intussusception or ‘telescoping’ often causes ileus. Intussusception is when part of the intestine slides into itself, much like the closing of a telescope.


Risk factors

Some factors that may increase the risk of ileus include:


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Symptoms

Stomach pain in person clutching stomach.
Stomach pain is a characteristic symptom of ileus

Symptoms of ileus include:

  • stomach cramps and pain
  • bloated or swollen stomach
  • nausea
  • vomiting
  • constipation, or passing small amounts of watery stool
  • loss of appetite
  • feeling full
  • inability to pass gas


Ileus versus intestinal obstruction

An ileus and an intestinal obstruction have similarities, but an ileus results from muscle or nerve problems that stop peristalsis while an obstruction is a physical blockage in the digestive tract.

However, a type of ileus known as paralytic ileus can cause a physical block due to a buildup of food in the intestines.

Other causes for obstruction include:

  • areas of fibrous tissue that form after surgery (intestinal adhesions)
  • cancer of the colon
  • diverticulitis, inflamed pouches in the digestive tract
  • a hernia
  • impacted feces
  • inflammatory bowel diseases (IBD)

Diagnosis

To diagnose an ileus, a doctor will first ask about symptoms and take a full medical history. They will ask about:

  • current or past medical conditions
  • medication use
  • surgical history

The doctor will then perform a physical examination to check for swelling or pain in the abdomen. They may use a stethoscope to listen for bowel sounds. Absent or excessive bowel noises suggest an ileus, although imaging tests are usually required to confirm a diagnosis.

Imaging tests

Imaging tests help locate an ileus by highlighting abnormalities in the intestine, such as a buildup of gas or an enlargement of the intestine. Sometimes, there may be a physical blockage. Tests used include:

  • X-ray. An abdominal X-ray may show some obstructions, but they do not always show up an ileus or other intestinal problem.
  • Computerized tomography (CT). A CT scan provides more detail than standard X-ray images. These scans are more likely to highlight an ileus because they show the intestines from different angles. Sometimes, a person swallows a special dye that creates a clearer image.
  • Ultrasound. Doctors often diagnose children with a suspected ileus using an ultrasound scan. Ultrasound scans typically show a coiled area in the intestine when intussusception is present.
  • Air or barium enema. This involves inserting air or liquid barium into the colon through the rectum and then taking X-rays of the abdomen. This procedure can resolve an ileus caused by intussusception in some children.


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Treatment

Treatment options for an ileus include waiting for the ileus to resolve, making dietary changes, or adjusting medication use. Sometimes, surgery is necessary. The treatment will depend on the severity of the ileus and its underlying cause.

Possible treatments for an ileus include:

Hospital care

Man in hospital bed with doctor talking to them.
Some people experiencing ileus may require treatment in the hospital.

Surgery-related ileus often heals within a few days of surgery, and paralytic ileus usually resolves once a person makes changes to their medication. However, individuals may require a stay in the hospital until the issue resolves fully.

Treatment at the hospital can include:

  • intravenous fluids to prevent dehydration
  • nasogastric decompression, which uses a tube to suction out materials that a person might otherwise vomit up
  • pain relief

Dietary changes

Conditions such as Crohn’s disease and diverticulitis can cause a partial intestinal block. Some bowel material can pass through the intestine, but not all of it.

A doctor may recommend that people with this issue follow a low-fiber diet to make it easier to pass stool. This involves cutting down on whole-grain foods, raw vegetables, and nuts.

Medication changes

A paralytic ileus that is caused by medication can often be treated by taking another medicine, such as metoclopramide (Reglan), to stimulate the movement of the intestines.

Another option is to discontinue use of the medication that is causing the ileus. However, only do this with a doctor’s supervision. It is not always advisable to stop antidepressants and some other medications suddenly.

Surgery

If medication or dietary changes do not resolve the ileus, or if the blockage is severe, then a person may need surgery.

Surgical procedures involve removing the blockage, or repairing or removing the damaged portion of the intestine.

Older adults or people with colon cancer may not be suitable candidates for extensive surgery. Instead, they may be fitted with a stent (tube) to keep the intestine open and allow bowel materials to pass through more easily.

In some cases, a person may need to have their entire intestine removed. In this case, the surgeon will perform an ostomy. They will create an opening in the abdomen, called a stoma, allowing stool to pass from the intestine into a pouch.

Although an ostomy requires care, a person can live a healthy life without the intestine.

Complications

An undiagnosed and untreated ileus can cause severe and potentially life-threatening complications, such as:

Necrosis

Necrosis is tissue death. Necrosis occurs when blood cannot reach the intestine. The intestinal tissue dies and becomes weakened. A weak intestinal wall is prone to tearing, which causes bowel contents to leak out.

Infection

Bowel contents are full of bacteria. When they leak into the abdominal cavity, they cause a serious infection called peritonitis. Bacterial peritonitis can lead to sepsis, a widespread infection that can be fatal.


Recovery

After surgery, intestinal function usually returns to normal within 5 days. If it persists for longer than this, it is considered a paralytic ileus.

Recovering from an ileus depends on getting the proper treatment for the underlying cause.

Outlook

Ileus is a relatively common condition that is easy to treat. It is especially prevalent in those who have undergone recent abdominal or pelvic surgery.

An awareness of the symptoms is key to improving the outlook and reducing the risk of complications. It is essential to seek prompt medical treatment as soon as symptoms appear.

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