Sleeping bowel after surgery

Current therapies to shorten postoperative ileus

Rather than meerely wait for bowel sounds to return after patients undergo surgery, we can try to get the gut working again sooner. An active approach might shorten the duration of postoperative ileus, allow patients to go home from the hospital sooner, and improve their outcomes.

In the pages that follow, we review the pathophysiology, diagnosis, and current therapies to alter the course of postoperative ileus.

ILEUS CAN AFFECT THE STOMACH OR SMALL OR LARGE INTESTINES

Ileus is the absence of intestinal peristalsis without mechanical obstruction; postoperative ileus refers to the time after surgery before coordinated electromotor bowel function resumes.

Although ileus classically refers to dysmotility of the small bowel, postoperative ileus can selectively affect the stomach, small intestine, or colon, each with a different mechanism and clinical presentation, and each managed differently (Table 1).

Gastroparesis refers to abnormal gastric motility leading to impaired gastric emptying. This disabling, potentially chronic condition is associated with certain medical conditions such as diabetes, but can also occur after some surgical procedures, as we will discuss. It has been estimated to affect approximately 4% of the adult population, with a strong female predilection.1 Postoperative gastroparesis is probably most common after pancreaticoduodenectomy, in which it occurs in up to 57% of patients.2 Consensus guidelines for grading the severity of gastroparesis have been devised to help standardize the reporting of outcomes.2

Acute colonic pseudo-obstruction (colonic ileus) is often seen in elderly hospitalized patients with multiple medical comorbidities. Of note, it often occurs after surgery to parts of the body other than the abdomen, such as after orthopedic procedures. One study documented an incidence of 1.3% after hip replacement surgery and 1.2% after spine procedures.3

The small bowel normally resumes activity several hours after surgery, the stomach 24 to 48 hours after surgery, and the colon 3 to 5 days after surgery.4 When postoperative ileus persists longer than this, it can be considered pathologic and is sometimes called paralytic ileus.4,5

ILEUS AFFECTS OUTCOMES AND COSTS

Although not usually considered life-threatening, postoperative ileus is harmful for the patient and costly for society.

For the patient, ileus is uncomfortable, leads to nausea and vomiting, delays return to enteral nutrition, and prolongs the stay in the hospital. For many if not most patients undergoing gastrointestinal surgery, return of bowel function is the factor that delays going home. A prolonged hospital stay increases the risk of hospital-acquired infections, deep vein thrombosis, and other conditions.

The economic burden is also considerable. A retrospective review of more than 800,000 patients who underwent surgery in the United States in 2002 found a rate of postoperative ileus of 4.25% according to International Classification of Diseases–Ninth Revision (ICD-9) codes.6 The mean hospital length of stay was 9.3 days in patients with postoperative ileus vs 5.3 days in those without it. The difference in mean total hospital costs was US $6,300 per patient. The costs certainly add up when you consider the number of surgical procedures performed every year.

NEURAL AND CHEMICAL FACTORS

While observing exteriorized bowel in 1872, Goltz7 first noted enhanced spontaneous contractions when the spinal cord was severed at the level of the medulla. Not long after, Bayliss and Starling8 used a device called an “enterograph” to monitor small-bowel activity in vivo in dogs and found that cutting the splanchnic nerves led to vigorous bowel contraction after laparotomy. These early observations formed the foundation of our understanding of postoperative ileus and some of its possible causes.

Normal bowel contractility is influenced by a host of neural and chemical factors, the relative contributions of which vary depending on the segment of bowel.

The migrating motor complex is the basal level of activity in the bowel in the fasting state, serving a “housekeeping” function.9 It has four phases, consisting of escalating electrical and contractile activity punctuated by periods of quiescence. The resumption of this motor complex after surgery is responsible for recovery from postoperative ileus.

Management of Postoperative Ileus (POI)
Following Bowel Resection

Overview of Postoperative Ileus

Ileus, a Latin word derived from Eileos, Greek for intestinal colic, means to squeeze or roll up tightly. In the medical context, ileus refers to an impairment of intestinal motility. Postoperative ileus, therefore, is a malfunction of intestinal motility after major intra-or extra-abdominal surgery. Postoperative ileus affects many patients undergoing bowel resection surgery and can cause significant discomfort and prolong the hospital stay.

Data from the United States government Office of the Federal Register Health Care Financing Administration show an overall incidence of postoperative ileus of 8.5% for common abdominal surgeries in the United States in 1999-2000.1 The incidence varied with procedure, ranging from 4.1% for abdominal hysterectomy to 14.9% for large-bowel resection and 19.2% for small-bowel resection. These data concern only postoperative ileus that was documented and coded in the medical record. The true incidence of clinically significant postoperative ileus is probably higher.

Postoperative ileus is categorized as either primary, caused by surgery and concomitant opioid treatment, or secondary, concurrent with other precipitating factors or complications such as an anastomotic leak and subsequent abscess, hematoma, or other infection.

Duration and Manifestations

There are no standardized parameters for the duration of postoperative ileus. The delimitation of prolonged postoperative ileus varies among surgeons and appears to be dependent on procedure, technique (laparoscopic versus open), and other factors. Generally, the duration is longer than would be expected for the particular procedure. For example, paralytic or adynamic ileus is generally considered to persist for more than 3 days. Manifestations of postoperative ileus are listed in Table 1.2

Table 1. Signs and Symptoms of Postoperative Ileus

• Anorexia
• Abdominal distention
• Abdominal pain
• Nausea/vomiting
• Delayed passage of flatus/stool
• Belching
• Hiccups

Resolution

Because a patient must have relatively normal bowel function before being discharged from the hospital, the question of when ileus is resolved arises. Here, too, there are no clear parameters, but several criteria can help to determine whether resolution has been achieved. The first is the return of bowel sounds, although experience has shown this to be extremely unreliable. Other signs of resolution include passage of flatus, tolerance of oral intake, and bowel movement. Any of these signs may indicate that the patient has coordinated motility from the gastroesophageal junction to the anus. Proof of this is ability to tolerate oral intake without nausea or distension.

Persistent postoperative ileus should prompt investigation of whether it is secondary to a problem relating to the procedure, such as a leak, abscess, retained foreign body, or mechanical obstruction. Other secondary causes may include pneumonia, pancreatitis, or urinary tract infection. Primary issues are related to surgery or opioid treatment and can occur after an extended case with a lengthy lysis of adhesions and prolonged case length. A normal white blood cell count and fever curve, good urine output, and minimal abdominal pain are reassuring and are consistent with primary causation.

Consequences

Well-known clinical consequences of postoperative ileus are nausea, vomiting, and delays in enteral nutrition, absorption of oral medications, wound healing, and ambulation. There may also be complications including atelectasis, bacterial translocation, aspiration, nosocomial infection, dehiscence, and venous thromboembolism.2,3 Withholding enteral nutrition has negative consequences because early enteral nutrition reduces mucosal atrophy, promotes mucosal immunity, and increases visceral blood flow. Moreover, it promotes the maintenance of normal enteric flora and secretions as well as wound healing. A meta-analysis of 11 randomized, controlled studies confirmed the benefits of early enteral feeding versus nothing by mouth postoperatively for patients after gastrointestinal surgery. There was a significant reduction in the risk of infection, particularly wound infection. with early feeding.3

From an economic perspective, other consequences of postoperative ileus include longer hospital stay (the primary determinant of which is the duration of postoperative ileus), use of nasogastric intubation, intravenous hydration, total parenteral nutrition, extra nursing care, additional laboratory testing, and imaging studies. The readmission rate for postoperative ileus after major abdominal surgery is 5%. All of these increase costs to the health care system, which are estimated at $750 million to $1 billion per year in the United States.4

Normal Physiology

Normal gut motility depends on the integration of smooth muscle activity within the gut wall, sympathetic (inhibitory) and parasympathetic (excitatory) neural input, and a variety of hormonal interactions. Activity of the myenteric plexus generates impulses that can be measured as electrical activity. This excitatory activity is usually interrupted by surgery but returns, in stages, to the small intestine within 24 hours after surgery, then to the stomach, and finally to the colon after 2 to 3 days.5 However, coordinated propulsive activity may not recover appropriately.

Pathophysiology

Postoperative ileus is thought to result from inflammation, deranged neural input, or medications taken in conjunction with surgery. Large-volume intraoperative fluid resuscitation and prolonged procedure time associated with extensive dissection may contribute to the development of these events. Inflammation is mediated by the release of macrophages, which orchestrate other intermediaries including nitric oxide, prostaglandins, and cytokines. The presence of these inflammatory mediators inhibits smooth-muscle contraction and decreases the normal propulsive activity of the intestine. Other possible causes of ileus are listed in Table 2.

Table 2. Possible Causes of Ileus

FUNCTIONAL ISSUES
Systemic illness
• Congestive heart failure, hypoxia

Infection
• Sepsis, pneumonia, peritonitis
• Anastomotic leak

Metabolic derangements
• Diabetes mellitus
• Hypothyroidism
• Electrolytes

Pharmacologic
• Opiates, tricyclics, anticholinergics, phenothiazines

Neurologic
• Multiple sclerosis, myotonic dystrophy, Chagas disease

Autoimmune
• Lupus erythematosus, scleroderma, dermatomyositis

MECHANICAL OBSTRUCTION
Adhesions

Deranged neural input manifests as an increase in sympathetic tone—which is inhibitory—and an increase in catecholamine release. In contrast, there is an inhibition of acetylcholine release. Notably, these effects are magnified, and there is greater inhibition if the intervention is extensive. Thus, there is more sympathetic output postoperatively in a patient subjected to extensive adhesiolysis and bowel handling than in a patient who had a short, uncomplicated laparotomy or laparoscopy. Preclinical studies have shown that surgical sympathectomy reduces the duration of ileus in dogs and pigs. An epidural is equivalent to chemical sympathectomy, which may account for the decrease in the incidence of ileus in conjunction with epidural analgesia.

Use of Opioid Drugs

Perioperative drugs, such as inhalation agents, may increase postoperative ileus, but they are short acting, with transitory effects. Although endogenous opioids increase during and immediately after a procedure, exogenous opioids administered to control pain intraoperatively and postsurgically have more profound inhibitory effects and contribute significantly to postoperative ileus. Opioids affect µ receptors in the central nervous system and in the gastrointestinal tract. In the central nervous system, µ1 receptors mediate pain control. In the gastrointestinal tract, however, µ2 receptors bind opioids, resulting in intestinal atony. Increasing opioid dosages, therefore, extend the duration of postoperative ileus (Figure 1).6

Figure 1. Time to Bowel Movement Versus Opioid Use

Use of Nasogastric Tubes

A Cochrane Collaboration analysis of 33 trials that evaluated the efficacy of nasogastric tube use found that there was an earlier return of bowel function in the absence of nasogastric tubes (P < .00001).7 The study included 5,240 patients – 2,628 randomized to routine tube use and 2,612 randomized to selective or no tube use. Patients without routine tube use had an earlier return of bowel function (P < .00001), a decrease in pulmonary complications (P = .01), and insignificant trends toward increased risk of wound infection (P = .22) and ventral hernia (P = .09). The incidence of anastomotic leak did not differ between groups (P = .70). Routine tube use appeared to result in less vomiting but increased patient discomfort. When no tube was used, length of hospital stay was shorter; however, the heterogeneity encountered in this analysis makes it difficult to draw rigorous conclusions for this outcome. No adverse events specifically related to tube insertion (direct tube trauma) were reported. The use of tubes made no difference with respect to anastomotic complications. The study concluded that routine use of nasogastric tubes should be abandoned.

Use of Intraoperative Intravenous Fluids

The use of intraoperative intravenous fluids is essential in the care of patients during surgery, but prolonged ileus may be caused by excessive or large-volume fluid resuscitation. A prospective study assessed 156 patients who were randomized to receive liberal or restricted intraoperative fluids after major gastrointestinal surgery.8 The liberal protocol group received a 10 mL/kg bolus in the operating room, followed by intravenous fluids administered at 12 mL/kg/h. The restricted protocol group did not receive a bolus and received intraoperative intravenous fluids administered at 4 mL/kg/h. After surgery, fluid levels were managed by surgeons who were blinded to patient group. Patients on the restricted protocol showed significant differences from those on the liberal protocol, including faster return of bowel function, shorter hospital stay, and fewer complications than patients on the liberal protocol. In another study, 20 hemicolectomy patients were randomized to normal (n = 10) or restricted (n = 10) postoperative fluids.9 The restricted group received half the normal saline (≤ 77 mmol/day) and ≤ 2 L water/day, and the normal group received ≥ 154 mmol saline/day and ≥ 3L water/day. The restricted group showed significant improvements in time to gastric emptying and time to return of bowel function and also had a shorter hospital stay.

Postoperative ileus is a significant problem with multiple causes, and thus treatment should be multimodal. It is well established that early enteral feeding results in better outcomes. To reduce the occurrence and duration of postoperative ileus, it is advisable to mitigate opioid use and limit the use of nasogastric tubes in routine, uncomplicated bowel-resection procedures. The effect of intraoperative fluids on postoperative ileus requires more data before specific recommendations can be made. Surgeons should be proactive in monitoring and recognizing the early signs and symptoms of postoperative ileus so that they can implement appropriate interventions in a timely manner.

Case 2

A 60-year-old man was scheduled for a right colectomy for colon cancer. His medical history included coronary artery disease and diabetes, and he had a surgical history of transurethral resection of the prostate. The patient was also a smoker.

Interactive Clinical Question:
Given this patient’s history and present condition, which of the following choices represent reliable ways to prevent prolonged postoperative ileus?

  1. Perform an open resection
  2. Perform a laparoscopic resection, if possible
  3. Use a µ-opioid receptor antagonist, such as methylnaltrexone or alvimopan

Digestive tract can shut down after surgery

DEAR DR. DONOHUE: Please explain ileus. What causes it, and how can it be prevented? I have had two recent surgeries: heart bypass and knee replacement. Immediately after each, I suffered from an ileus. The recovery from that was worse than the recovery from the surgery.

DEAR DR. DONOHUE: Please explain ileus. What causes it, and how can it be prevented? I have had two recent surgeries: heart bypass and knee replacement. Immediately after each, I suffered from an ileus. The recovery from that was worse than the recovery from the surgery.
I have had other surgeries without a problem. I am faced with further surgery in the future, and the thought of the misery and discomfort of the post-surgery recovery with a tube in my nose makes me reluctant to have another operation. Is there a way to prevent this from happening?
— D.B.
Ileus is an intestinal tract shutdown. When all is working well, muscles that encircle the intestine contract to push the intestinal contents downward and eventually outward. If those muscles stop contracting, the tract fills with gas, and the bloating produces severe abdominal pain. Surgeons question their post-op patients daily about passing gas or having a bowel movement. Their questioning is so incessant that patients often feel obligated to send out official notifications of these events when they occur, to family and friends. The surgeons are worried about an ileus, the treatment of which consists of decompressing the intestinal tract through a long tube passed through the nose and into the stomach.
Major contributors to ileus are drugs like morphine or Demerol, which are used to control surgical pain. Sometimes an imbalance of sodium, potassium and chloride brings it on. When scheduled for another procedure, tell the surgeon what happened to you; perhaps a change in painkillers can avoid another encounter with ileus.
Ileus often happens after abdominal surgery, when the intestine has to be manipulated. That’s a different issue. The literal meaning of “ileus” is “obstruction.”
DEAR DR. DONOHUE: It appears that I am a prime candidate for a hip fracture. I am white, female, 84, 5 feet 3 inches tall and weigh 100 pounds. My mother sustained a hip fracture at 76. I am quite active and keep up my vitamin D and calcium intake. I don’t smoke. What else can I do? Can you explain why hip fractures are so often the cause of death when other immobilizing injuries and conditions are not? I have several elderly friends who have been wheelchair-bound for years, and they are in good health. What is the difference between hip fracture immobility and years of immobility for other reasons?
— F.S.
In the United States, more than 250,000 hips are broken every year, and most of those breaks occur in older people. About one-quarter of people who break their hip die within a year of the break. Death doesn’t come from immobility. Thanks to the skill of orthopedic surgeons, most broken-hip patients are up and moving around a day or so after the operation. Mortality has to do with the age of these people and their related health problems. Many have serious illnesses, like heart, lung or kidney disease.
You do fit the profile for developing osteoporosis. You can ask your doctor for a bone density test to see if you would benefit from osteoporosis medicines. And you should get some daily exercise, like walking.
DEAR DR. DONOHUE: In a recent column, spironolactone was said to help older women with acne because it blunts the effect of male hormones on oil glands. My husband took this medicine and developed gynecomastia (growth of the male breast). I understand this is not an infrequent side effect for male users of it. Do women on this drug need to fear a change in breast tissue or breast cancer?
— M.C.
Spironolactone has many uses. It was originally sold as a diuretic — a water pill. It blocks the action of an adrenal gland hormone that makes the body hold on to salt and water. It’s a blood pressure medicine too. It’s used frequently for congestive heart failure. Because it lessens the effect of male hormones (women do make them), it also lessens acne in women who produce too much male hormone. It has no effect on female hormones. Therefore, it has no effect on the female breast or breast cancer. Breast tissue grows in some male users because of its effect on male hormones. Female hormones go unopposed by male hormones. Men do make female hormones.
Readers may write to Dr. Donohue or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

What to know about constipation after surgery

Share on PinterestWalking or moving around will help encourage a bowel movement.

Untreated constipation can be uncomfortable and lead to complications, particularly after surgery.

However, it is vital to always ask a doctor before using constipation relief, as some methods may not be safe after certain medical procedures.

The methods for constipation relief below may be sufficiently mild for people to use after surgery, as long as they follow the advice of a doctor:

Keep the body moving

As soon as a doctor gives the go-ahead, people should start moving around. Going for short walks around the hospital or home or doing other physical activity will help move food through the intestines and stimulate a bowel movement.

Research has shown that insufficient physical activity and excessive sedentary behaviors correlate with constipation. Physical activity may prevent people from feeling constipated.

People who are unable to get out of bed can move their arms and legs where possible to promote circulation and help the bowels move.

Laxative medications

A doctor may prescribe a stool softener for people with post-surgical constipation.

These medications, which include docusate sodium (Colace), draw water from the intestines to moisten the stool. Moist stools are easier to pass.

Alternatively, a doctor may recommend a fiber laxative, such as psyllium (Metamucil or Konsyl) or methylcellulose fiber (Citrucel).

Doctors do not recommend fiber laxatives for people whose constipation results from opioid medication use, as they could cause severe abdominal pain and potential bowel obstruction.

Other medications for constipation include:

  • Stimulants, such as bisacodyl (Ducodyl or Dulcolax), which make the intestines contract to produce a bowel movement.
  • Osmotic drugs, such as magnesium hydroxide (milk of magnesia), to move fluids through the colon.
  • Lubricants, such as mineral oil.
  • Enemas and suppositories, which can soften the stool.

People should not take over-the-counter (OTC) remedies for constipation without speaking to a doctor first. Not all constipation medications are suitable for everyone, especially during post-surgery recovery.

Alternative pain relief

Many people take opioid drugs after surgery to reduce pain. According to estimates, up to 40 percent of people on these medications experience constipation.

For post-operative pain that is mild or moderate, OTC pain relievers offer an alternative treatment. Examples include ibuprofen (Advil) and acetaminophen (Tylenol).

People experiencing constipation as a result of using opioids should speak to a doctor to see if other medications would be more appropriate for their needs.

Magnesium

Magnesium is a muscle relaxant, and it is a primary ingredient in many laxative medications. It can relax the bowels to alleviate constipation.

According to some research, magnesium oxide is safe for people with mild constipation to use. Standard doses typically produce a bowel movement within 6 hours.

However, anyone wishing to take magnesium for constipation should speak to a doctor first, as some people have a higher risk of magnesium toxicity and other complications.

The doctor can also check whether the magnesium will interact with any other medications that people are taking.

Probiotics

Probiotics are beneficial bacteria and yeasts that play an important role in gut health.

A review of 14 studies on probiotic supplements found that some types may help treat constipation. These probiotics may increase the frequency of bowel movements and soften stools so that people can pass them more easily.

It is essential to speak with a doctor before taking probiotics for constipation after surgery.

I am all for avoiding surgery of any kind. But………… sometimes surgery is unavoidable. Now there is surgery and SURGERY. But by its very nature, surgery is pretty traumatic.

A prolonged bout of anaesthesia and extensive poking, prodding and cutting in the nether regions, along with the pain meds, can leave your gut paralyzed. Quite literally.

The official terminology for the problem is postoperative ileus.

It is a big deal – you are not allowed to leave the hospital, until your gut wakes up.

Waking up slowly

The part of the gut which usually has the most trouble waking up, is the colon.

The stomach and small intestine typically manage to come back on line, within 24 hours of the surgery. But colons can still be off line 120 hours after the event.

The snoozing gut problem is the reason why your doctor is obsessed with your bowel movements. He may just be making casual conversation when he asks how you slept, but the question about your bowel movements is different, he really cares about your bowel movements.

What does it take to arouse the gut ?

Same thing that it takes to arouse someone who has passed out. Moving and shaking, lots of it.

Activity IN THE GUT is going to produce moving.

Slipping food, even just a little into the gut, should trigger moving and shaking, which is why, the nursing staff encourage you to tuck into the ice cold dinner, shortly after you open your eyes.

YUK !

The gargantuan challenge

Ice cold hospital food – can be tough to eat when you’re feeling great.

When you’re feeling like death warmed up, propping yourself up in the bed is already a trial, so actually eating the congealed chicken and soggy broccoli unaided, can be pretty close to impossible.

And if you do succeed in swallowing a few bites to get things moving along, there is no guarantee that the moving and shaking will be in the RIGHT direction.

A lot of the time, the moving and shaking ends up being in the wrong direction i.e. dinner is followed by a bout of nausea and vomiting.

Chew on it

Turns out you can move and shake without actually eating. And you don’t need some expensive pharmacological intervention to do it.

Feeding without feeding – the technical term for it is sham feeding, can be achieved by popping a piece of chewing gum into the mouth and then CHEWING.

Something that is do-able, even in a semi-comatosed postoperative state.

Brain thinks its food

You do need to give the chewing gum, A BIG LONG CHEW.

But the movement of the mouth, is enough to stimulate the cephalic-vagal reflex – which triggers the release of a whole bunch of GI hormones and enzymes. And the GI hormones shake the gut into action.

Prompting peristalsis all the way down the tract and….triggering that all important bowel movement……

Needed for you to be discharged.

Home James, don’t spare the horses

Clinical trials suggest chewing gum can get you going home from the hospital, at least a day or two earlier.

Saving you (or your medical aid) money and aggravation.

So if you’re having an op, when you put together your hospital bag, slip in a packet or two of chewing gum in with the pyjamas.

Or if you’re visiting a friend after surgery – ditch the flowers or magazine, rather gift them with a packet of chewing gum. Just remember to keep your cell phone out of sight when visiting a hospital.

Postoperative ileus chewed away

Then postoperatively get CHEWING.

PS. You might want to include a little honey in the hospital kit bag too. Researchers have found bee kisses beat fancy creams at healing nasty wounds.

Gum chewing reduces postoperative ileus? A systematic review and meta-analysis. Int J Surg (2009) 7(2):100-5. Noble EJ, Harris R, Hosie KB, Thomas S, Lewis SJ

Further reading

Should you feed a heart attack a high fat meal ? Add chewing gum to your to-do-list to lose weight A dab of cream can rewire brain circuits fried in a stroke

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Chewing gum after surgery to help recovery of the digestive system

There was little difference in mortality, infection risk and readmission rate between the groups. Some studies reported reduced nausea and vomiting and other complications in the intervention group. CG was generally well-tolerated by participants. There was little difference in cost between the groups in the two studies reporting this outcome.

Sensitivity analyses by quality of studies and robustness of review estimates revealed no clinically important differences in effect estimates. Sensitivity analysis of ERAS studies showed a smaller effect size on TFF, larger effect size on TBM, and no difference between groups for LOHS.

Meta-regression analyses indicated that surgical site is associated with the extent of the effect size on LOHS (all surgical subgroups), and TFF and TBM (CS and CRS subgroups only). There was no evidence that ROB score predicted the extent of the effect size on any outcome. Neither variable explained the identified heterogeneity between studies.

Patient Education

Ileus

Ileus occurs when there is a problem with motility in the stomach and small or large intestine (bowel). Motility is the movement of food and waste through the digestive tract. Ileus is not caused by a physical blockage (obstruction).

Normally, muscles in the bowel walls contract to move waste along. Signals from nerves tell the muscles when to contract. With ileus, this movement slows down or stops completely. As a result, waste can’t move through the bowels and out of the body. This can cause belly (abdominal) pain and other symptoms. Treatment is needed to restore normal movement and ease symptoms.

Causes of ileus

Ileus can be caused by the following:

  • Abdominal surgery

  • Abdominal infection

  • Injury to blood vessels that supply blood to the abdomen

  • Low levels of sodium or potassium (electrolyte imbalance)

  • Certain medicines, such as opioid pain medicines

  • Certain kidney or lung diseases

  • Certain health problems, such as cystic fibrosis and diabetes

Symptoms of ileus

Common symptoms of ileus include:

  • Belly swelling or bloating

  • Upset stomach (nausea) and vomiting

  • Belly cramps

  • Constipation or diarrhea

  • Loss of appetite

  • Not able to keep food down

  • Not able to pass stool or gas

Diagnosing ileus

Your healthcare provider will ask about your symptoms and health history. You’ll also have a physical exam. If your provider thinks you may have ileus, tests may be done to confirm the problem. These can include:

  • Imaging tests. These provide pictures of the bowels. Common tests include X-rays and a CT scan.

  • Blood tests. These are done to c heck for infection and other problems, such as fluid loss (dehydration).

  • Upper GI (gastrointestinal) series. This test takes X-rays of the upper digestive tract, from the mouth to the small intestine. An X-ray dye (contrast fluid) is used. The dye coats the inside of the upper digestive tract so that it will show up clearly on X-rays.

Treating ileus

In most cases, ileus goes away by itself when the main cause clears up. The goal is to manage symptoms until movement in the digestive tract returns to normal. Treatment takes place in a hospital. As part of your care, the following may be done:

  • No food or drink is given by mouth. This allows your bowels to rest.

  • An IV (intravenous) line is placed in a vein in your arm or hand. The IV line is used to give fluids and nutrition. It may also be used to give medicines. These may be needed to improve movement in your digestive tract, or to ease pain. They may also be needed to treat any underlying infections or conditions you have.

  • A soft, thin, flexible tube (nasogastric tube) is inserted through your nose and into your stomach. The tube is used to remove extra gas and fluid in your stomach and bowels. This helps to ease symptoms such as pain and swelling.

  • You’ll be watched closely in the hospital until your symptoms get better. Your provider will tell you when you’re well enough to go home. This is usually within a few days.

  • In rare cases, problems may occur. Other treatments, such as surgery, may then be done. Your provider will tell you more about other treatments, if needed.

Long-term concerns

After treatment, most people recover completely. In some cases, you may need to see your provider for a follow-up appointment.

When to call your provider

Call your healthcare provider right away if you have any of the following:

  • Fever of 100.4°F (38°C) or higher, or as advised by your provider

  • Belly swelling or pain that won’t go away

  • Not able to pass stool or gas

  • Nausea and vomiting

  • Getting full very easily with only small amounts of food or drink

  • Bleeding from the rectum

  • Black, tarry stool

Researchers unravel mechanism behind bowel paralysis after surgery

In the days following abdominal surgery, patients’ intestinal contents pass more slowly or not at all. New research at KU Leuven (University of Leuven), Belgium, has now shown that this phenomenon—known as post-operative ileus or bowel paralysis—is not caused by the cells previously identified as the main players. Quite the opposite, in fact: the cells even help restore bowel function. The findings are very important for further research into post-operative patient treatment.

After undergoing abdominal surgery, patients have to stay in hospital for several days because the procedure causes post-operative ileus or bowel paralysis. As a result, the patients cannot tolerate food or empty their bowels. This leads to personal discomfort and prolongs the hospital stay, which in turn increases the economic cost.

Scientists have long been looking for ways to prevent bowel paralysis or to speed up bowel function recovery. The assumption has always been that monocytes, a specific type of white blood cells, were most to blame for the bowel paralysis. Professor Gianluca Matteoli and Professor Guy Boeckxstaens from the TARGID unit at KU Leuven have now shown that the opposite is true.

“Abdominal surgery always leads to a subtle inflammation of the intestinal muscle. This inflammation mostly consists of monocytes,” says Professor Matteoli. “We did research on mice that were genetically modified to make it impossible for monocytes to leave the bloodstream and enter the intestinal muscle. We expected that this would enable us to prevent bowel paralysis. To our surprise, however, the mice still developed bowel paralysis, and their recovery was even slower than expected.”

Further research confirmed that monocytes have a positive impact on bowel function recovery. “We noticed that monocytes initially contribute to inflammation. After a while, however, they start removing the damaged tissue—they clean it up, so to speak. After that, their function drastically changes and they even help to restore proper bowel functioning,” Professor Boeckxstaens continues. “If we can speed up this switch from cleaning up to restoring, we may also increase the pace of the patient’s recovery.”

Explore further

Scientists pinpoint key bowel disease gene More information: Giovanna Farro et al, CCR2-dependent monocyte-derived macrophages resolve inflammation and restore gut motility in postoperative ileus, Gut (2017). DOI: 10.1136/gutjnl-2016-313144 Journal information: Gut Provided by KU Leuven Citation: Researchers unravel mechanism behind bowel paralysis after surgery (2017, June 20) retrieved 2 February 2020 from https://medicalxpress.com/news/2017-06-unravel-mechanism-bowel-paralysis-surgery.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.

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