Paralytic Ileus Causes and Treatments
The exact cause of paralytic ileus remains unclear. However, inflammation and nerve problems likely play a role. Paralytic ileus most commonly occurs after abdominal surgery. Other factors that affect paralytic ileus development include anesthetics, prescription pain relievers, and immobility.
This article will explain paralytic ileus signs and symptoms, risk factors, potential complications, and treatment options.
Symptoms of paralytic ileus mainly affect the digestive tract. One of the main symptoms is the inability to pass stool or gas.
Common symptoms of paralytic ileus include:
- abdominal swelling, distension, or bloating
- decreased appetite
- lack of bowel sounds
- nausea, with or without vomiting
- stomach pain
A bowel obstruction occurs when there is a blockage that prevents the passage of intestinal contents. But paralytic ileus occurs in the absence of a physical obstruction. The exact cause is not entirely clear. It is likely that inflammation and nerve problems contribute to the lack of muscle function. However, control of the digestive tract is complex, and the condition may involve several systems that interact with each other.
Paralytic ileus is often a complication of abdominal surgery. This type of surgery is one of the main risk factors for paralytic ileus. Both open surgery and surgery that manipulates the bowel have a higher risk. Laparoscopic surgery, which does not disturb the bowel as much, carries a lower risk. Doctors generally become concerned when bowel function does not return within 3 days of surgery.
Paralytic ileus can also occur with pelvic surgery and spinal surgery that enters through the back of the abdomen.
A number of other conditions are risk factors as well. This includes:
- immobility, which can be significant following major surgery
- abdominal cancers
- certain medications, such as anesthetics, opiates, and sedatives
- chronic medical conditions, such as diabetes
- electrolyte imbalance, especially low potassium
- infection in the abdomen
- inflammation in the abdomen, such as with appendicitis or pancreatitis
- surgical complications, such as bleeding
There are several conditions that can look similar to paralytic ileus. During an evaluation, doctors need to rule out these other conditions. These include:
- bowel perforation
- inflammation of abdominal organs, such as the pancreas or gallbladder
- intra-abdominal abscess
- mechanical bowel obstruction
- small bowel obstruction
A doctor may suspect paralytic ileus development based on a person’s symptoms and medical history, including past surgeries. The main symptoms are the inability to pass gas or have a bowel movement. The physician will also tap the abdomen, which will feel hollow due to air trapped in the intestines. They use a stethoscope to listen for the sound the bowel makes as it contracts. A decrease in bowel sounds is a sign of paralytic ileus. The abdomen may be visibly swollen.
Imaging exams, including X-rays and CT scans, can aid in the diagnosis and present a clear picture of the bowel. These exams can also rule out a physical blockage or other problems, such as ischemia.
Paralytic ileus is usually self-limiting, meaning that it often simply needs time to resolve. In the meantime, treatment mainly consists of supportive measures to increase comfort and prevent complications. Treatment may include:
- electrolyte replacement
- IV (intravenous) fluids and nutrition, if necessary
- oral food and fluid restrictions to allow the bowel to rest
- walking, which may require physical assistance
Medications are of limited use in treating paralytic ileus. Some evidence suggests that chewing gum may help ileus by promoting peristalsis.
For people who experience vomiting and distention, doctors may place a nasogastric tube into the stomach to release the air and drain fluid. Treating any underlying condition, such as infection, is also necessary.
Because there is not much you can do to treat it, prevention is important. This includes using regional anesthesia (as opposed to general anesthesia) and non-opioid pain relievers. Early ambulation after surgery can also help.
Since it is usually self-limiting, the outlook for paralytic ileus is good. However, it can result in a longer-than-expected hospital stay. This can, in turn, lead to complications, such as hospital-acquired infections. Prolonged paralytic ileus can also cause problems with nutrition as well as fluid and electrolyte levels in the body.
Paralytic ileus is a pause in normal intestinal movement without a physical blockage. It is a common complication of abdominal surgery. Paralytic ileus can be uncomfortable, but the outlook is good because it often resolves without treatment.
For severe symptoms or prolonged paralytic ileus, treatment may include stopping oral food and fluids, IV fluid replacement, and draining trapped air to relieve pressure in the bowel.