Intestinal pseudo-obstruction

In people with intestinal pseudo-obstruction, the intestine does not contract and push food, stool, and air through the digestive tract. The cause of the problem is often unknown. However, problems with the bowel's muscles or nerves may be a cause.

The condition may start suddenly or be a chronic or long-term problem. The chronic form of the disorder most often affects the small intestine or large intestine (colon). The acute form of the disorder affects the large intestine.

Risk factors include:

• Cerebral palsy or other brain or nervous system disorders.
• Chronic kidney, lung, or heart disease.
• Staying in bed for long periods of time (bedridden).
• Taking medicines that slow intestinal movements. These include narcotic (pain) medicines and medicines used when you are not able to keep urine from leaking out.
• After surgery.

Symptoms include:

• Abdominal pain
• Bloating
• Constipation
• Nausea and vomiting
• Swollen abdomen (abdominal distention)
• Weight loss

During a physical exam, the health care provider will most often see abdominal bloating.

Tests may include:

• Abdominal x-ray
• Anorectal manometry
• Barium swallow, barium small bowel follow-through, or barium enema
• Blood tests for nutritional or vitamin deficiencies
• Colonoscopy
• CT scan of the abdomen
• MRI of the abdomen
• Antroduodenal manometry
• Gastric emptying radionuclide scan
• Intestinal radionuclide scan

The following treatments may be tried:

• Moving around (walking, changing position in bed).
• Colonoscopy may be used to remove air from the large intestine.
• Fluids can be given through a vein to replace fluids lost from vomiting or diarrhea.
• Nasogastric suction involving a nasogastric (NG) tube placed through the nose into the stomach or small intestine, or a tube through the rectum into the large intestine can be used to remove air from the bowel.
• Neostigmine may be used to treat intestinal pseudo-obstruction that is only in the large bowel (Ogilvie syndrome). This requires cardiac monitoring due to the risk of bradycardia.
• Other medicines may be tried.
• Special diets often do not work. However, vitamin B12 and other vitamin supplements should be used for people with vitamin deficiency.
• Correcting blood disturbances such as low potassium and others.
• Rarely a tube to vent the intestine is placed in the first part of the large intestine (cecum).
• Stopping the medicines that may have caused the problem (such as narcotic medicines) may help.

In severe cases, surgery may be needed.

Most cases of acute pseudo-obstruction get better in a few days with treatment. In chronic forms of the disease, symptoms can come back and get worse over many years.

There is a high risk of perforation (hole) if the cecum dilates to greater than 12 cm in diameter. It may require surgical removal of the involved part of the bowel. This may result in an ostomy (attaching the bowel to the abdomen and stool passes into a bag. If malnutrition happens, you may need to be fed through a tube or the vein. Other parts of the gastrointestinal tract may also have problems from poor contraction.

Complications may include:

• Diarrhea
• Rupture (perforation) of the intestine
• Vitamin deficiencies
• Weight loss

Contact your provider if you have abdominal pain that does not go away or other symptoms of this disorder.

Primary intestinal pseudo-obstruction; Acute colonic ileus; Colonic pseudo-obstruction; Idiopathic intestinal pseudo-obstruction; Ogilvie syndrome; Chronic intestinal pseudo-obstruction; Paralytic ileus - pseudo-obstruction; Acute intestinal pseudo-obstruction

Bharucha AE, Prichard DO. Ileus and pseudo-obstruction syndromes. In: Chung RT, Rubin DT, Wilcox CM, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 12th ed. Philadelphia, PA: Elsevier; 2026:chap 126.

Camilleri M. Disorders of gastrointestinal motility. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 122.

National Institute of Diabetes and Digestive and Kidney Diseases website. Definition & facts of intestinal pseudo-obstruction. www.niddk.nih.gov/health-information/digestive-diseases/intestinal-pseudo-obstruction/definition-facts. Updated October 2021. Accessed August 1, 2026.

Updated by: Todd Eisner, MD, Private practice specializing in Gastroenterology in Boca Raton and Delray Beach, Florida at Gastroenterology Consultants of Boca Raton. Affiliate Assistant Professor, Florida Atlantic University School of Medicine. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.