Ileus: symptoms, causes, treatment and how long it lasts

Ileus is a problem with how the bowel moves, not with a physical blockage. Patient.info's professional reference says the term is now most often used to mean non-mechanical intestinal obstruction, and that paralytic ileus describes the condition in which the bowel stops working and there is no peristalsis.

North Bristol NHS Trust explains that after bowel surgery there is a delay in bowel movement or contractions, known as peristalsis, which is generally due to the handling of the bowel during the operation and the bruising that creates swelling. Cambridge University Hospitals similarly says the bowel can take a few days to work after surgery because of handling of the bowel and anaesthetics.

Because nothing is physically blocking the bowel, ileus is different from an obstruction caused by adhesions, a hernia or a tumour, even though the symptoms can overlap.

North Bristol NHS Trust says that if an ileus occurs and your bowels temporarily stop working you may have increased bloating, abdominal pain, nausea and vomiting.

Patient.info adds that in paralytic ileus there is no bowel movement and no flatus (wind), that pain is less or absent compared with a mechanical obstruction, and that doctors may find a distended abdomen and a quiet abdomen when listening with a stethoscope. In a blockage, by contrast, bowel sounds are very active.

• A swollen, bloated tummy.

• Nausea and vomiting.

• Abdominal pain, which is often milder than with a blockage.

• Not passing wind or stool.

Surgery is the commonest situation. Patient.info lists prolonged abdominal, pelvic or colorectal surgery, open surgery, and the period after childbirth among situations in which it can occur. It also lists chest infection, heart attack, stroke, acute kidney injury, trauma, severe hypothyroidism, electrolyte disturbance and diabetic ketoacidosis. Postoperative ileus is described as a significant problem, with less handling of the bowel at operation recommended.

Patient.info also lists conditions that increase the risk of bowel obstruction in general, such as Parkinson's disease, multiple sclerosis and dementia, which can be linked to constipation and related bowel problems.

North Bristol NHS Trust notes that similar symptoms may occur if a blockage (bowel obstruction) develops. After surgery, an obstruction is generally caused by adhesions (sticking of bowel tissue) or kinking of the bowel. It says initial management is usually the same as for ileus, that in the majority of cases an obstruction also settles down on its own, and that a small percentage of patients need a further operation or intervention.

Patient.info says that diagnosing intestinal obstruction and ileus involves fluid charts to monitor intake and output, blood tests including a full blood count, urea and electrolytes and creatinine, and imaging. A plain abdominal X-ray can still be important, and it says CT scanning is now the gold standard for imaging bowel obstruction. In paralytic ileus the small bowel is distended throughout its length on X-ray.

Differentiating ileus from obstruction on examination alone is often not possible, which is why imaging and blood tests are used.

Treatment is mostly supportive while the bowel recovers. The Mid Cheshire NHS trust describes treatment as stopping eating and drinking, having fluids through a drip, and a tube down your nose into your stomach (a nasogastric tube) to drain bile and stop you feeling sick. It says this usually gets better with time.

North Bristol NHS Trust describes managing it by stopping dietary intake and allowing the bowel to rest, with a small tube through the nose into the stomach if needed to relieve symptoms. Patient.info says fluid and electrolyte correction is important and that in paralytic ileus a nasogastric tube will reduce vomiting.

North Bristol NHS Trust says keeping mobile and chewing gum will help prevent an ileus, and that you can return to a normal diet once your bowels start working again.

North Bristol NHS Trust says it can take a few days before bowel movements occur normally again and you start to pass both wind and stool. It also says you are not necessarily expected to have opened your bowels before going home, but you would be expected to be eating and drinking without significant abdominal bloating, nausea or vomiting.

The time varies with the type of surgery and your overall health, so ask your surgical team what to expect in your case.

After an operation, contact your surgical or colorectal team for advice if you have worsening bloating, repeated vomiting, or you are not passing wind or stool. Mid Cheshire NHS trust says to contact your colorectal nursing team or go to A&E for urgent medical review for any concerns about post-operative complications.

Patient.info says severe pain and tenderness suggest ischaemia or perforation of the bowel, which need urgent surgical assessment. Call 999 or go to A&E for severe, worsening abdominal pain, a rigid tummy, fever with vomiting, or feeling faint.

Ileus is usually treated in hospital, either as a complication after a planned operation or after an emergency admission. It is managed by the surgical team, on the NHS or in a private hospital, in the same way. If symptoms appear after you have gone home, follow the instructions in your discharge information about who to call.