When the intestines are at a standstill, nothing works in the digestive tract – severe pain, infections and other complications can occur within a very short time. Therefore, intestinal paralysis or intestinal atony must be quickly recognized, monitored and quickly remedied. The following is a brief overview of the possible causes.
What is intestinal paralysis?
Intestinal atony is the loss of tone of the intestine, i.e., a loss of muscular tension of the intestinal wall and thus, simply put, intestinal paralysis. This prevents further food transport, thus leading to constipation and bowel obstruction and a whole host of other complications.
Causes
There are various causes of intestinal atony. A basic distinction is made between circulatory disturbances and reflex intestinal atony – but in both cases, impairment of the nervous system is “to blame” for intestinal wall atony. Circulatory disorders of the intestinal wall are primarily a problem of older people whose blood vessels as a whole have been altered by arteriosclerosis so that less blood passes through them. If the blood vessels in the intestine are constricted, abdominal pain (angina abdominalis) occurs, especially after eating, because then a particularly large amount of blood is needed at the intestine and the supply bottleneck is especially noticeable. In the long term, this can lead to chronic damage to the intestinal wall; acutely, mesenteric infarctions can form as a result of sudden thrombus detachments, embolisms and vascular occlusions (analogous to a heart attack). The intestinal segment then no longer receives blood and the cells die quickly – movement no longer takes place in the intestinal wall. Circulatory disorders can also occur on a regional basis if the intestinal wall is “crushed” from the inside by a tumor, a mechanical intestinal obstruction or a foreign body that is stuck in the intestine, and blood flow is no longer possible. The other major group of causes of intestinal paralysis are intestinal protective reflexes, which can occur in a whole range of disease processes in the abdominal cavity or in the space behind the peritoneum. Again, intestinal obstruction may be involved, reflexively preventing the upstream portion of the intestinal tube from moving food along. Massive inflammations also paralyze the intestinal wall via this mechanism, e.g. large peritonitis. In addition, diseases of other organs such as pancreatitis or kidney stones can irritate the surrounding area and thus also affect the nerves that pass by these organs in the direction of the intestinal wall. A so-called “paralytic ileus” (intestinal obstruction due to paralysis) is therefore often an accompanying symptom of these diseases. Congenital causes such as Hirschsprung’s disease, in which nerve plexuses in lower sections of the intestine are simply missing, can also lead to intestinal atony and associated problems in the first years of life. Finally, modern medicine can also be considered as a cause of intestinal atony: In addition to some medications (opiates), it is primarily major surgical procedures in the abdomen that can reflexively paralyze bowel activity hours to days after surgery.
Symptoms, complaints, and signs
Bowel paralysis causes a variety of gastrointestinal symptoms. Typically, there is constipation to constipation of stools, accompanied by abdominal pain, nausea and vomiting, and a distended abdomen. The symptoms occur mainly after eating and usually persist for a few minutes to hours before slowly subsiding. There is also increased stomach pain and bloating in the morning after getting up and late in the evening. If intestinal atony remains untreated for a prolonged period, further symptoms may develop. In the worst case, the constipation develops into a complete intestinal obstruction. An ileus is always associated with extreme pain and cramps in the abdomen. An intestinal obstruction can also be recognized by the presence of blood in the stool; blood often leaks from the anus. An intestinal obstruction can lead to damage of the intestinal wall, causing peritonitis. In a severe course, ileus leads to death. Postoperative intestinal paralysis is associated with an increased risk of infection, as the hospital stay is significantly prolonged. In addition, there may be wound healing problems, infections and other complications in the surgical area. Externally, intestinal paralysis is usually not recognizable. Only the disturbed bowel movement indicates a disease that must be clarified and treated.
Diagnosis and course
The decreased gastrointestinal passage due to paralysis of the intestinal wall sooner or later leads to paralytic ileus, or complete intestinal obstruction. This initially means that nothing comes out at the bottom. By the time the affected person notices this, however, there are usually already other, more serious symptoms. In particular, the inflammation or lack of oxygen that often underlies intestinal atony usually results in massive abdominal pain. If the intestinal wall dies, blood in the stool or major intestinal bleeding may also occur. Kidney stones cause cramping pain, and pancreatitis causes massive girdling pain in the upper abdomen. A serious complication of paralytic ileus is the passage of intestinal bacteria through the intestinal wall – if these enter the abdominal cavity and inflame the peritoneum (peritonitis), it always becomes life-threatening. Diagnosis is based on anamnesis (typical abdominal pain after eating, atrial fibrillation as a source of embolism, alcohol consumption as an indication of pancreatitis, etc.) and physical examination (abdominal wall tension as a protective reflex, bowel sounds present?, blood on the finger stick during rectal examination, etc.). An x-ray (abdominal overview) may show standing bowel loops and fluid levels, contrast enemas are rarely performed in practice but have specific indications. A cause of bowel atony should be found quickly to assess severity and the need for action.
When should one go to the doctor?
If symptoms such as nausea and vomiting or constipation occur, there is possibly a serious disease of the gastrointestinal tract. That is why a doctor should be consulted immediately in case of mentioned complaints. The physician can determine intestinal atony on the basis of a physical examination and take the necessary steps. Treatment is necessary in any case and can prevent complications, provided it is carried out at an early stage. However, if bowel atony is left untreated, a medical emergency may occur. For example, an intestinal infarction can occur, which in the worst case leads to the death of the patient. Constipation and a distended abdomen are signs of such a severe course. Anyone who notices these symptoms is best to contact the emergency physician immediately. Depending on how far the intestinal atony has already progressed, a longer hospital stay may be necessary. To avoid further complications and a recurrence of intestinal paralysis, the causes of the symptoms must be determined concomitantly. The right contact for this is the gastroenterologist or even a nutritionist.
Treatment and therapy
There are some emergencies associated with intestinal atony that require immediate therapy:
In blood flow-related mesenteric infarction, for example, intestinal tissue dies by the minute, and the intestine can only be saved with timely interventional measures or open surgery. If too much intestinal tissue has already died, it can no longer be replaced; in the worst case, the affected person is then no longer viable. In all other cases of disease-related or postoperative intestinal atony, gentle measures can be taken to stimulate intestinal activity. In addition to a cautious diet, these include primarily enemas, but also drug trials (e.g., with the parasympathomimetic neostigmine).
Outlook and prognosis
The prognosis is determined by the cause and thus the underlying disease of the bowel paralysis. The prospects for recovery improve the sooner the patient seeks medical treatment. Without care, significant deterioration of health occurs and a life-threatening condition may result. If treatment is successful, bowel function returns to normal after a few days or weeks. Freedom from symptoms subsequently returns and the patient is discharged from treatment as cured. In some cases, there is a possibility that normal bowel function is regained after only a few hours of medical care. With a healthy diet adapted to the needs of the weakened body, the patient can make a significant contribution to the rebuilding of his health. Harmful substances such as nicotine or alcohol as well as the intake of fatty foods are to be avoided.The healing process is thus facilitated and intestinal activity is gently stimulated with an adapted diet. In the course of life, intestinal atony may recur. The prognosis is unchanged if it recurs. The disease can be optimally counteracted with a healthy lifestyle and a balanced diet. In many cases, successful prevention and permanent recovery are possible.
Prevention
Prevention of intestinal atony is not specifically possible and would have to start with prevention of the underlying diseases (e.g., healthy lifestyle to avoid atherosclerosis, no alcohol abuse to avoid pancreatitis, etc.).
Follow-up
In most cases of intestinal atony, the patient has few measures and options for follow-up care. The affected person must first and foremost see a doctor in this disease to prevent further complications or, in the worst case, even death of the affected person. The earlier the intestinal atony is recognized and treated, the better the further course of this disease usually is. The patient should therefore consult a doctor at the first signs and symptoms of intestinal atony. In emergencies, an emergency doctor can also be called. The treatment itself is a surgical procedure. After this operation, the patient should rest and take care of his body. Strict bed rest should be observed. Most patients are dependent on the help and care of their own family and friends. This care usually has a positive effect on the course of the disease and can also prevent psychological upsets or depression. Greasy or very sweet foods should be avoided after the procedure. It cannot be generally predicted whether this condition will result in a decreased life expectancy for the patient.
Here’s what you can do yourself
Measures that sufferers of intestinal atony can take themselves are limited only to positively stimulating the remaining intestinal activity and limiting risk factors. An advanced bowel atony that is already causing or has caused obstruction or tissue damage cannot be improved without medical means. Affected persons are urged to adapt their diet in two ways: First, it must be easily tolerated and promote soft and regular bowel movements. This includes, among other things, the intake of sufficient fiber, fluids and a diet that is considered healthy in general. Second, the diet must prevent or counteract atherosclerosis. This is achieved by low alcohol, low processed fats and with enough antioxidants and vitamins. This will help regulate digestion and reduce the tendency to atherosclerosis. Food should also be consumed in well-chewed, small portions. Meals should be spread throughout the day. In addition, food should not be taken in a normal amount until the intestines are working again in the first place. Enemas – possibly with mild substances – can stimulate bowel activity. Heat, moderate and regular exercise, and relaxing baths can also help. Relevant in taking action is a consideration of the cause of the bowel paralysis.
