Intestinal Pseudo-Obstruction

An intestinal pseudo-obstruction is an uncommon condition where the intestines have all the signs of being obstructed, but there is not a true mechanical obstruction present. Unlike a true bowel obstruction, there is no actual blockage of the intestinal tract in a pseudo-obstruction. This is why it is known as a "pseudo" obstruction: pseudo means "imitation." This is not to say that it is not a real condition, or that it is something that a person makes up. It is a very real problem.

The cause is not understood, but there are some known risk factors. With a pseudo-obstruction, the small or the large intestines are not moving food and waste material through as they do when the gastrointestinal tract is healthy.

Woman holding her stomach in pain

 

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Signs and Symptoms

Many of the signs and symptoms of pseudo-obstruction are similar to those that occur with other digestive diseases. It can be acute, coming on suddenly, or it can be chronic and recurrent.

Symptoms can be non-specific and may include:

  • Abdominal pain, which may be crampy in nature
  • Abdominal swelling or distention
  • Constipation
  • Fewer than 3 bowel movements in a week
  • Nausea and vomiting
  • Unintentional weight loss
  • Nutritional deficiencies, fatigue

Risk Factors

A pseudo-obstruction is more common in the very young and the very old, but it can happen to just about anyone.

Risk factors for pseudo-obstruction include:

  • Nervous System Disease: A disease such as cerebral palsy that affects the nervous system can interfere with the motility of the digestive tract.
  • Immobility: Being unable to get out of bed and move around is another risk factor for pseudo-obstruction.
  • Pain Medications: Certain pain medications, specifically narcotics, can alter the functioning of the intestines.

Diagnosis

As part of your evaluation, your doctor will rule out other, more dangerous causes of your symptoms, such as an infection, a physical obstruction, or a tumor. Testing will usually begin with blood tests and may involve imaging studies of the abdomen, such as a plain X-ray or computed tomography (CT).

Depending on the specific symptoms and results, further testing is sometimes necessary. With intestinal pseudo-obstruction, diagnostic studies will not identify any blockage.

Treatment

There are several treatment strategies that can be beneficial for the treatment of intestinal pseudo-obstruction and its effects. If the pseudo-obstruction is caused by a medication, stopping that medication will help in getting the intestines moving again. 

Medical treatment of pseudo-obstruction can include drugs that stimulate the colon to move the waste material along, such as certain antibiotics, dopamine antagonists, and somatostatin analogs. Other medications may be given to help relieve the associated symptoms of nausea, vomiting, and pain.

Any nutritional deficiencies caused by the pseudo-obstruction will also require treatment. In some cases, enteral nutrition given via a nasogastric (NG) tube may be needed until you can eat solid food again.

Decompression, to let trapped air out of the intestinal tract either through a nasogastric (NG) tube or colonoscopy, may also be used as a treatment.

In rare cases, surgery might be necessary. Surgery can decompress the bowel and provide feeding options. Removal of a section of the intestine or intestinal transplants are not usual procedures used to treat pseudo-obstruction of the intestines.

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  • Bharucha AE, ed. "Intestinal Pseudo-obstruction." National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 26 Feb 2014. 1 Oct 2015.