What is an ileus?
Your intestines are about 25 feet long. This means the foods
you eat have a long way to travel before they’re fully digested or excreted.
Your intestines complete this task by moving in a wave-like motion. Known as
peristalsis, these muscle contractions move forward your digested food.
However, if something slows down or blocks this motion, the result can be a
major traffic jam in your intestines.
Ileus is the medical term for this lack of movement in the
intestines that leads to a buildup or blockage of food material. An ileus can
lead to an intestinal obstruction. This means no food material, gas, or liquids
can get through. It can occur as a side effect after surgery. However, there
are other causes of this condition.
An ileus is a serious concern. But people often don’t know
that food is building up in their intestines and continue to eat. This pushes
more and more material toward the blockage. Without treatment, the ileus can
perforate or tear the intestine. This causes bowel contents, which have high
levels of bacteria, to leak into areas of your body cavity. This can be deadly.
If an ileus does occur, it’s important to get treatment as quickly as possible.
What are the symptoms of an ileus?
An ileus can cause extreme abdominal discomfort. Symptoms
associated with ileus include:
- abdominal cramping
- appetite loss
- feeling of fullness
- inability to pass gas
- stomach swelling
- vomiting, especially vomiting stool-like
Gastrointestinal symptoms are the most common signs of an ileus.
Your stomach and intestines will start to fill with gas that can’t pass out the
rectum. This causes the stomach to take on a tight and swollen appearance.
If you experience these symptoms, especially after surgery,
it’s important to seek immediate medical attention.
What are the causes of an ileus?
An ileus is common after surgery because people are often
prescribed medication that can slow intestinal movement. This is called a paralytic
ileus. In this instance, the intestine isn’t blocked. Rather, it isn’t moving
properly. The result is little or no movement of digested food through your
Examples of medicines that can cause a paralytic ileus
- hydromorphone (Dilaudid)
- tricyclic antidepressants, such as amitriptyline
and imipramine (Tofranil)
However, there are several other causes of an ileus. These
- colon cancer
- Crohn’s disease, which causes the intestinal
walls to get thicker
- Parkinson’s disease, which affects muscles and
nerves in the intestines
These are the most common ileus causes in adults. Children
can also have an ileus. According to the Mayo Clinic, intussusception is the
most common cause for an ileus in children. This is when the intestine
“telescopes” or slides into itself.
Risk factors for ileus
Ileus is the second
most common reason for hospital readmission in the first 30 days after surgery.
An ileus is more likely if you’ve recently had abdominal surgery.
Surgical procedures on the abdomen usually involve stopping
intestinal movement for a period of time; this allows the surgeon to access your
intestines. Sometimes peristalsis can be slow to return. Other people are more
likely to experience scar tissue that can also lead to an ileus.
A number of medical conditions can increase your risk of
ileus. They include:
- electrolyte imbalance, especially for potassium
- history of intestinal injury or trauma
- history of intestinal disorder, such as Crohn’s
disease and diverticulitis
- history of irradiation of or near the abdomen
- peripheral artery disease
- rapid weight loss
Aging also naturally slows down how fast the intestines
move. An older adult is at greater risk for ileus, especially since they tend
to take more medications that could potentially slow digestion.
How is an ileus diagnosed?
A doctor would first listen to a description of your
symptoms. You’ll likely be asked about any history of medical conditions, prescribed
medications, and surgeries, especially recent procedures. Your doctor will then
conduct a physical exam, looking at your abdomen for signs of swelling or tightness.
Your doctor will also listen to your stomach for typical bowel sounds with a stethoscope.
If your bowels aren’t moving because of an ileus, your doctor won’t hear
Imaging studies are usually ordered after a thorough
physical exam. A doctor may use these methods to identify areas where bowel
content seems to be concentrated. Imaging studies can show where the
obstruction is located, a buildup of gas, or an enlarged intestine due to the
obstruction. Examples of imaging studies include:
- X-ray: This may show signs of trapped gas and possibly
the obstruction, but X-rays aren’t always the most conclusive way to diagnose
- CT scan: This scan provides more detailed X-ray
images to help doctors identify the potential area where the ileus is located.
- ultrasound: This imaging technique is more
commonly used to identify an ileus in children.
In some instances, a doctor may use a diagnostic procedure
known as an air or barium enema. A doctor will insert air or barium — a
radioactive substance that shows up on an X-ray — to view any potential
obstruction. In some children, this procedure can treat an ileus that is caused
What complications can an ileus cause?
An ileus can develop into a serious and potentially life-threatening
situation. Two of the most severe complications are:
Also known as dead tissue, necrosis can happen when an
obstruction cuts off blood supply to the intestine. Without blood, oxygen can’t
get the tissue, causing it to die. Dead tissue weakens the intestinal wall.
This makes it easy for the intestine to tear and leak bowel contents. This is
known a bowel perforation.
The bowel perforation mentioned earlier can cause peritonitis.
This is a serious infection in the abdominal cavity. Your bowel contains many
bacteria, like E. coli. They are supposed to remain in your intestines, not
roam free in your body cavity. Peritonitis can turn into sepsis, a life
threating condition that can result in shock and organ failure.
How is an ileus treated?
Treatments for an ileus depends on its severity. Examples
Sometimes a condition like Crohn’s disease or diverticulitis
will mean that part of the intestine isn’t moving. But some bowel material can
get through. In this instance, a doctor may recommend a low-fiber diet. This
can help reduce the bulky stool, making it easier to pass. However, if that
doesn’t work, surgery to repair or move the affected portion of the bowel may be
A complete obstruction is a medical emergency. Treatment
will depend upon your overall health. For example, some people can’t handle an
extensive abdominal surgery. This includes the very elderly and those with
colon cancer. In this case, a doctor may use a metal stent to make the
intestine more open. Ideally, food will start to pass with the stent.
Abdominal surgery to remove the blockage or the damaged
intestine portion may still be needed though.
Treatment for a paralytic ileus starts by identifying the
underlying cause. If medicine is the cause, a doctor may be able to prescribe another
medication to encourage motility (intestine movement). An example is
metoclopramide (Reglan). Discontinuing the medications that caused the ileus, if
possible, can also help. However, you shouldn’t stop taking a medicine,
especially an antidepressant, without your doctor’s approval.
Treatment without surgery is possible during the early
stages of paralytic ileus. But you may still require a hospital stay to get the
proper fluids until the issue is fully resolved. A doctor may also use a
nasogastric tube. Known as nasogastric decompression, this procedure calls for
a tube to be inserted into your nasal cavity to reach your stomach. Essentially
the tube suctions out the extra air and material that you may otherwise vomit.
According to Mount Sinai Hospital, most surgery-related ileus
will resolve in two to three days. However, some people do require surgery if
the condition doesn’t improve.
Considerations for surgery
Your intestines are very long, so you can live without a
portion of it. While it may affect the digestive process, most people do live a
healthy life with a part of their intestine removed.
In some instances, a doctor may have to remove the entire
intestine. In this case, a doctor will create a special pouch called an ostomy.
The bag allows stool to drain from the stomach. You have to care for the
ostomy, but you can live without your intestine after an ileus.
Outlook for ileus
An ileus is common, but it’s highly treatable. If you’ve had
a recent surgery, or have other risk factors for an ileus you should be aware
of the symptoms. Seeking medical care is important in the hopes the ileus can
be resolved without invasive medical treatment.
Can an ileus be prevented?
Most of the risk factors associated with ileus aren’t
preventable. Examples include an injury or chronic illness. If surgery is necessary,
the possibility for ileus should be considered. But it shouldn’t keep you from
having a needed surgery.
Being aware of the symptoms of an ileus are important in
seeking prompt treatment to keep it from getting worse.