Chronic intestinal pseudo-obstruction (CIPO) is a rare long-term disease where the intestine looks and behaves like it is blocked, but doctors cannot find any real physical blockage such as a tumor, scar tissue, or twist in the bowel. The problem comes from very weak or uncoordinated movements of the gut wall muscles and nerves, so food, liquid, and gas do not move forward normally. Over time this slow movement can cause repeated attacks of pain, swelling of the belly, vomiting, and problems with nutrition, and it can affect both children and adults.
Chronic intestinal pseudo-obstruction (CIPO) is a long-lasting disease where the intestine behaves as if it is blocked, but tests do not show any real physical blockage. The bowel muscles or the nerves that control them do not work properly. Because of this, food, fluid, and gas move very slowly or may stop moving. People can have pain, swelling of the belly, nausea, vomiting, constipation, diarrhea, or weight loss.[1]
In CIPO, the problem can be in the stomach, small intestine, large intestine, or in all of them. Some patients have this problem from birth, and others develop it later because of nerve disease, muscle disease, autoimmune disease, infection, or unknown reasons. Treatment usually needs a team of doctors, including gastroenterologists, surgeons, dietitians, and sometimes neurologists. Treatment focuses on easing symptoms, improving nutrition, keeping people out of the hospital, and trying to protect the intestine from long-term damage.[2]
Other names
Doctors use several other names for this condition. It is often called CIPO, which is the short form of “chronic intestinal pseudo-obstruction.” Some experts say chronic idiopathic intestinal pseudo-obstruction when the cause is not known, and primary intestinal pseudo-obstruction when the problem comes mainly from disease of the gut nerves or muscles instead of another body disease. In children, you may also see the term pediatric intestinal pseudo-obstruction (PIPO), but this describes the same basic kind of long-lasting gut movement failure.
Types
Experts group CIPO into different types based on where the damage is and what caused it. These groups help doctors plan tests and treatment.
Primary (or idiopathic) CIPO – In this type, no other major body disease explains the gut problem; the intestine itself, especially its nerves or muscles, is the main place of disease.
Secondary CIPO – Here, the gut movement failure happens because of another disease such as connective tissue disease, diabetes, or cancer-related immune problems, or because of certain medicines or radiation to the abdomen.
Neuropathic CIPO – In this type the main damage is in the enteric nerves that control gut movements, so signals to the muscles are not correct even if the muscles are still strong.
Myopathic CIPO – In this type the gut muscles are weak or scarred, so they cannot squeeze properly even if the nerve signals are normal, and contractions become very low in strength.
Mesenchymopathic CIPO – This less common type mainly affects the “pacemaker” cells of the gut called interstitial cells of Cajal, which normally help start and coordinate gut waves.
Congenital CIPO – This form is present from birth or early infancy, often linked to genetic changes or developmental problems of the gut nerves or muscles.
Acquired CIPO – This form develops later in life, for example after infections, autoimmune disease, radiation, or long-term use of certain drugs that slow gut movement.
Localized vs diffuse CIPO – In some patients the condition mainly affects one part of the gastrointestinal tract such as the small bowel or colon, while in others it involves many segments from stomach to colon, making symptoms more severe.
Causes
Doctors think of CIPO causes as things that directly damage gut nerves or muscles or things that secondarily disturb their function. In many people the cause stays unknown, but research has found many possible reasons.
Idiopathic enteric neuropathy – Sometimes the small nerve cells inside the gut wall are damaged or lost without a clear reason, so signals that push food along become weak or uncoordinated, leading to chronic pseudo-obstruction.
Idiopathic visceral myopathy – In some patients the smooth muscle cells of the intestine themselves are abnormal or scarred, so contractions are too weak to move contents, even though the bowel looks open on scans.
Genetic mutations (for example ACTG2 and others) – Certain inherited changes in genes that control smooth muscle or nerve development can cause severe motility problems from birth or childhood, making CIPO part of a broader syndrome.
Connective tissue diseases (such as systemic sclerosis and lupus) – Autoimmune diseases that affect blood vessels and connective tissues can also damage the nerves and muscles of the gut, stiffen the intestinal wall, and lead to pseudo-obstruction episodes.
Autoimmune enteric neuropathy without systemic disease – In some cases the immune system directly attacks enteric nerves, producing inflammation in nerve plexuses and causing severe motility failure even when other organs seem normal.
Paraneoplastic syndromes – Certain cancers, especially small-cell lung cancer, can trigger an immune response that mistakenly targets gut nerves, so the intestine becomes partly paralyzed even if the tumor is far away from the abdomen.
Mitochondrial diseases – Disorders of mitochondria, which supply energy to cells, can weaken smooth muscle and nerve function in many organs including the intestine, so the gut cannot keep a regular propelling action.
Amyloidosis – In this condition abnormal protein material (amyloid) deposits in tissues like nerves and muscles; when it builds up in the gut wall it can destroy normal structure and interfere with motility.
Diabetes mellitus – Long-term diabetes can damage autonomic nerves that control the intestine, much like it damages nerves in the feet, which may lead to slow transit and pseudo-obstruction features in some people.
Hypothyroidism – Low thyroid hormone levels slow many body processes, including gut movement; in severe or chronic cases this reduced motility can mimic or contribute to chronic pseudo-obstruction.
Radiation enteritis – Radiation therapy to the abdomen or pelvis for cancer can injure the intestinal wall, blood vessels, and nerves, and later cause scarring and motility disorders that appear as CIPO.
Chronic use of narcotic (opioid) drugs – Strong pain medicines like opioids slow gut motility by acting on special receptors in the intestine, and long-term use in susceptible patients can lead to severe constipation and pseudo-obstruction-like states.
Anticholinergic and other motility-blocking medicines – Drugs that block acetylcholine or other motility signals, including some psychiatric medicines and calcium-channel blockers, can markedly slow gut movement and may trigger chronic motility failure in vulnerable people.
Viral infections (for example CMV, EBV, varicella-zoster) – Certain viruses that infect nerves or the gut wall can cause acute or chronic inflammation, and in some patients this damage does not fully heal and progresses to CIPO.
Chagas disease and other protozoal infections – Some long-lasting infections, especially Chagas disease in endemic regions, can destroy autonomic nerves supplying the intestine, leading to severe chronic motility problems.
Post-surgical nerve damage – Large abdominal operations, especially those involving removal of ganglia or nerve plexuses, can injure the enteric nervous system and leave lasting pseudo-obstructive symptoms after the surgery has healed.
Systemic neurologic disorders (such as Parkinson disease) – Diseases that affect the autonomic nervous system can also affect intestinal nerves, and some patients with these neurologic conditions develop chronic severe constipation and pseudo-obstruction features.
Inflammatory myopathies of smooth muscle – Autoimmune or inflammatory diseases that attack smooth muscle fibers in the gut can cause weakness of contractions, resulting in a myopathic type of CIPO.
Systemic mitochondrial or metabolic syndromes with gut involvement – Some inherited metabolic conditions combine muscle weakness, nerve problems, and gut dysmotility, so intestinal pseudo-obstruction is one part of a multi-organ picture.
Truly idiopathic CIPO – In many children and adults no clear cause can be found even after detailed tests, and these patients are labeled as having chronic idiopathic intestinal pseudo-obstruction, which still behaves as a severe motility failure.
Symptoms
Most symptoms of CIPO come from the intestine acting as if it is blocked, with build-up of gas and fluid and poor movement of food along the gut. Symptoms can vary from mild to very severe and may come and go.
Abdominal pain – Many patients feel crampy or constant belly pain because the gut is trying to push its contents against resistance from poor motility and dilated loops.
Abdominal bloating and distension – Trapped gas and fluid make the abdomen look and feel swollen or tight, and clothes may suddenly feel tight during attacks.
Nausea – When food does not move forward, it sits in the stomach and upper intestine and this often causes a persistent feeling of wanting to vomit.
Vomiting – Some patients have repeated vomiting of food or bile, especially during flares, because the bowel cannot push content downwards and pressure builds up.
Constipation – Slow transit through the colon and weak contractions mean stool moves very slowly, so patients often go many days without a bowel movement or feel incomplete emptying.
Diarrhea in some cases – Paradoxically, diarrhea can happen when bacterial overgrowth in stagnant small bowel produces irritation and watery stools, or when only liquid stool passes around hard stool.
Early fullness (early satiety) – Because stomach and small bowel empty slowly, patients feel full after only a few bites and cannot finish normal-size meals.
Difficulty swallowing or upper GI discomfort – If the problem involves the upper gut, some people feel food “sticking” or have significant upper abdominal discomfort after eating.
Failure to thrive in children – Babies and children with CIPO may not gain weight or grow as expected because they cannot take in or absorb enough nutrition due to vomiting, early satiety, and malabsorption.
Weight loss in older patients – Adults often lose weight slowly over months or years as they eat less, vomit more, or avoid food out of fear of pain and bloating.
Signs of malnutrition – Over time, lack of calories and vitamins leads to tiredness, hair loss, muscle wasting, dry skin, and swelling of the legs or feet due to low protein levels.
Recurrent “sub-obstructive” attacks – Many patients have episodes that look exactly like bowel blockage, with severe cramping, no gas or stool passage, and big belly swelling, but imaging shows no physical plug.
Belching and excessive gas – Because contents sit in the gut, gas from swallowed air and bacteria builds up, causing frequent burping and flatulence that can be socially difficult.
Urinary symptoms or autonomic complaints – Some patients with widespread autonomic nerve disease also have bladder problems, dizziness when standing, or changes in sweating along with their gut symptoms.
Emotional distress, anxiety, or depression – Chronic pain, repeated hospital stays, feeding tubes, and uncertainty about the future often lead to low mood and anxiety, which can further worsen appetite and quality of life.
If someone has these kinds of long-lasting symptoms, they should see a doctor or gastroenterologist for proper testing and care. This explanation is only for learning, not for self-diagnosis.
Diagnostic tests
Doctors use many tests to diagnose CIPO. They must prove that the bowel looks blocked on imaging, but has no true physical blockage, and also search for causes like nerve, muscle, or systemic disease. Tests can be grouped into physical exam, manual bedside tests, laboratory and pathology tests, electrodiagnostic motility tests, and imaging tests.
Physical exam tests
General abdominal inspection and palpation – The doctor looks at the shape of the belly, checking for visible distension, scars, or hernias, and then gently presses with the hands to feel for tenderness, masses, or loops of bowel filled with gas or fluid. In CIPO the abdomen is often distended but without a clear single tender point that would suggest a localized blockage.
Auscultation of bowel sounds – Using a stethoscope, the doctor listens for bowel sounds, which may be high-pitched and rush-like in early obstruction or very quiet in advanced motility failure, helping to judge the severity and stage of pseudo-obstruction.
Digital rectal examination – The doctor gently inserts a gloved finger into the rectum to feel for hard stool, blood, or a very tight sphincter, which helps rule out simple fecal impaction or low rectal obstruction as the main reason for symptoms.
Nutritional and growth assessment – Measuring weight, height, body mass index, and checking for signs like muscle loss, edema, or vitamin deficiency gives clues about how long motility failure has affected nutrition, which is important for diagnosis and treatment planning.
Manual bedside tests
Abdominal percussion – By gently tapping on the abdomen with fingers, the doctor listens to the note produced; a loud, drum-like (tympanic) sound over large areas suggests a lot of gas in dilated bowel loops, which supports a pseudo-obstruction picture.
Assessment of abdominal wall rigidity and guarding – The examiner checks whether the belly muscles tighten involuntarily when pressed; strong guarding or board-like rigidity suggests a surgical emergency like perforation, while CIPO usually has less guarding unless there is a complication.
Manual evaluation for external hernias – The doctor feels groin, umbilical, and previous scar areas while the patient coughs or strains to detect hernias that could trap bowel and cause true obstruction, which must be ruled out before labeling symptoms as pseudo-obstruction.
Manual assessment of rectal stool burden – During digital rectal exam the doctor estimates how much stool is present; removal of a large fecal impaction may resolve symptoms, showing that the problem was not CIPO, whereas in true CIPO symptoms persist despite decompression.
Laboratory and pathological tests
Complete blood count (CBC) – A CBC looks for anemia, infection, or low white blood cells, which can point to chronic malnutrition, inflammation, or bone marrow problems often seen in advanced CIPO or related conditions.
Serum electrolytes and kidney function tests – Levels of sodium, potassium, chloride, bicarbonate, urea, and creatinine show the effect of vomiting, diarrhea, and poor intake, and help guide safe correction while also ruling out electrolyte causes of paralytic ileus.
Liver function tests and serum albumin – These blood tests reveal whether poor nutrition, liver disease, or protein loss is present; low albumin, for example, suggests long-standing malnutrition and may worsen edema and gut wall swelling.
Thyroid function tests – Measuring thyroid-stimulating hormone and thyroid hormones helps detect hypothyroidism, which is a reversible cause of slow gut motility and can worsen or mimic CIPO if not treated.
Autoimmune and connective tissue disease panel – Blood tests like antinuclear antibodies and more specific markers can show diseases such as systemic sclerosis or lupus, which are important secondary causes of chronic intestinal pseudo-obstruction.
Full-thickness intestinal biopsy (pathology) – In selected patients, surgeons obtain small pieces of intestinal wall during an operation or laparoscopic procedure, and pathologists study nerves, muscles, and pacemaker cells to decide whether the disease is neuropathic, myopathic, or mixed.
Electrodiagnostic and motility tests
Antroduodenal manometry – This test places a thin tube with pressure sensors through the nose into the stomach and small intestine to measure how strong and coordinated the contractions are; patterns on the tracing help distinguish neuropathic from myopathic CIPO.
Colonic manometry – A similar catheter is placed into the colon, often during colonoscopy, to record pressure waves along the large intestine, showing whether the colon can generate normal high-amplitude propagated waves or has severely reduced or chaotic activity.
Other motility studies (such as electrogastrography or wireless motility capsule) – These techniques record electrical and pressure activity from the stomach or entire gut using surface electrodes or a swallowed capsule and provide a non-invasive picture of transit times and motility patterns in suspected CIPO.
Imaging tests
Plain abdominal X-ray – Simple X-ray films of the abdomen, especially in standing and lying positions, often show multiple dilated loops of bowel with air-fluid levels in CIPO, but without a clear transition point that would indicate a physical blockage.
Abdominal CT or MRI scan – Cross-sectional imaging gives a more detailed view of the gut and surrounding organs, helping doctors rule out tumors, strictures, or external compression as causes of obstruction, and showing the extent of bowel dilatation and wall changes in CIPO.
Contrast studies (upper GI series or small bowel follow-through) – In these tests the patient swallows a contrast liquid and X-rays are taken over time; in CIPO the contrast moves very slowly and may pool in dilated segments, but no fixed narrowing or blockage is seen.
Non-pharmacological Treatments (Therapies and Others)
Careful eating pattern (small, frequent meals)
Eating small meals many times a day can reduce pressure in the intestine and help food pass more easily.[3] Meals are softer and easier to digest, so there is less pain and bloating. The purpose is to lower the workload on weak bowel muscles. The mechanism is simple: less food at one time means less stretching of the gut and fewer “mini-blockage” symptoms.Low-fat, low-fiber, easily digested diet
Some people feel better with low-fat and low-fiber food because these are easier for the weak intestine to move.[3] This diet reduces gas, bloating, and cramping. The purpose is to avoid foods that slow gastric emptying or cause large stools. The mechanism is that lighter, softer food moves through the gut with less muscle effort.Liquid or semi-liquid diet during flares
When symptoms are very bad, doctors may suggest liquid food, like soups, broths, and special drinks. Liquids need less mixing and squeezing by the intestines. The purpose is to give calories and fluids while resting the bowel.[3] The mechanism is reduced need for strong contractions, which lowers pain and bloating.Enteral tube feeding (gastrostomy or jejunostomy feeding)
If eating by mouth is not enough, a feeding tube into the stomach or small bowel can give liquid nutrition.[4] The purpose is to keep weight and strength stable. The mechanism is direct delivery of nutrients beyond the stomach or problem areas so the body still receives protein, vitamins, and calories.Parenteral nutrition (IV nutrition)
Some patients cannot absorb enough food from the gut. In that case, nutrition is given by a vein (total parenteral nutrition, TPN).[3] The purpose is to prevent malnutrition and protect organs. The mechanism bypasses the bowel completely so nutrients go straight into the bloodstream, but it needs close hospital or clinic supervision.Careful fluid and electrolyte management
Vomiting and poor absorption can cause dehydration and loss of salts such as sodium, potassium, and magnesium.[2] The purpose of fluid therapy is to keep blood pressure and organ function stable. The mechanism is simple replacement of water and salts by mouth or IV to support the heart, kidneys, and muscles.Abdominal decompression with nasogastric tube
When the stomach and intestines are very swollen, doctors may place a soft tube through the nose into the stomach to suck out fluid and gas.[5] The purpose is fast relief of distension, pain, and vomiting. The mechanism reduces pressure in the gut so blood flow and motility improve.Endoscopic or colonoscopic decompression
In severe colonic distension, an endoscope can be used to let out trapped gas and stool.[6] The purpose is to prevent bursting (perforation) of the bowel and reduce pain. The mechanism is mechanical release of pressure through the scope, sometimes with a decompression tube left in place.Percutaneous endoscopic gastrostomy (PEG) for venting
A venting PEG tube allows gas and fluid to escape from the stomach out through the abdominal wall.[4] The purpose is long-term control of nausea and distension. The mechanism is simple: opening a “safety valve” at the stomach so pressure does not keep rising.Jejunostomy tube for feeding or decompression
A tube placed into the small intestine (jejunum) can give nutrients or relieve trapped contents below the stomach.[4] The purpose is to bypass diseased upper segments. The mechanism is direct access to a part of bowel that still moves better, improving calorie intake.Pelvic floor and breathing physiotherapy
Physical therapy focused on posture, breathing, and gentle core exercises can help some patients pass gas and stool more easily.[7] The purpose is to use gravity and muscle control to support gut movement. The mechanism is better coordination of abdominal and pelvic floor muscles during straining.Gentle physical activity (walking, light stretching)
Short, frequent walks after meals may stimulate natural gut movement.[1] The purpose is to reduce bed-rest-related slowing of the gut. The mechanism is that body movement and gravity encourage peristalsis and reduce gas pooling in loops of bowel.Bowel habit training and toileting routine
Sitting on the toilet at regular times, especially after meals, can help the colon respond to natural reflexes.[7] The purpose is to build a pattern that supports bowel emptying. The mechanism uses the “gastro-colic reflex,” where eating signals the colon to move.Psychological support and cognitive-behavioral therapy
Chronic pain, hospital stays, and feeding problems can cause anxiety and depression. Talking therapies and coping skills training can improve quality of life.[2] The purpose is to help people manage stress, which can worsen gut symptoms. The mechanism is lowering stress hormones and improving sleep and self-care.Pain management strategies without strong opioids
Non-drug methods like heat packs, relaxation breathing, and pacing activities can reduce pain and may lower the need for opioid painkillers, which can slow the bowel even more.[1] The purpose is pain control with less motility harm. The mechanism is changing how the brain senses pain.Education about medicines that slow the bowel
Many drugs, such as opioids, some antidepressants, and anticholinergics, can worsen CIPO symptoms. Teaching patients and families about these medicines helps them talk with doctors before new drugs are started.[1] The purpose is prevention of avoidable flares. The mechanism is simple avoidance of medicines that reduce gut contractions.Infection control and vaccination
People on IV lines or with poor nutrition may be more prone to infections. Good hand hygiene, line care, and vaccines (for example flu and pneumonia) help lower infection risk.[2] The purpose is to avoid illnesses that can trigger flares. The mechanism is reducing exposure to germs and improving immune preparedness.Dietitian-guided micronutrient replacement
CIPO can lead to low vitamins and minerals such as B₁₂, folate, iron, fat-soluble vitamins, and trace elements. A dietitian can plan safe supplements and foods.[3] The purpose is to protect blood, nerves, and bones. The mechanism is targeted replacement based on blood tests.Multidisciplinary care and written care plan
Because CIPO is complex, a shared plan between gastroenterologist, surgeon, dietitian, and primary doctor helps avoid conflicting advice.[2] The purpose is smoother, safer care. The mechanism is clear communication about when to adjust nutrition, medicines, or hospital care.Patient support groups and peer networks
CIPO is rare, so many patients feel alone. Support groups, in person or online, let people share coping ideas and emotional support.[2] The purpose is to reduce isolation and improve confidence. The mechanism is learning practical tips and feeling understood by others with the same condition.
Drug Treatments
(Drug classes and general patterns are based on FDA prescribing information and CIPO reviews. Uses in CIPO are often off-label and must be guided by a specialist.)
Metoclopramide (dopamine-2 receptor antagonist prokinetic)
Metoclopramide helps the stomach empty faster and can reduce nausea and vomiting.[8] It is usually taken several times a day before meals and at bedtime for short periods as described in the prescribing information. The purpose is to improve gastric motility. It works by blocking dopamine receptors and increasing acetylcholine in the gut. Possible side effects include tiredness, restlessness, and movement disorders such as tardive dyskinesia with long-term use.Prucalopride (5-HT4 receptor agonist prokinetic)
Prucalopride is a selective serotonin 5-HT4 agonist approved for chronic idiopathic constipation.[9] It is usually taken once daily, with dose adjusted by the doctor. The purpose in CIPO is to enhance colonic motility and bowel movements. The mechanism is stimulation of colonic peristalsis. Common side effects include headache, abdominal pain, diarrhea, and sometimes mood changes.Octreotide (somatostatin analogue)
Octreotide is an injection medicine that copies the hormone somatostatin.[10] In some CIPO patients, especially with scleroderma or certain motility patterns, low-dose octreotide may improve small-bowel contractions. It is given as subcutaneous injections or long-acting depot forms on schedules defined in the label. Side effects can include gallstones, abdominal cramps, and changes in blood sugar.Erythromycin (motilin receptor agonist antibiotic)
Erythromycin is an antibiotic that also stimulates motilin receptors in the upper gut and can trigger strong stomach and small-bowel contractions.[11] It is sometimes used in low doses before meals for motility support, but long-term benefit may fade. The purpose is to help empty the stomach and reduce vomiting. Side effects include nausea, diarrhea, and risk of heart rhythm problems, especially with other QT-prolonging drugs.Pyridostigmine (acetylcholinesterase inhibitor)
Pyridostigmine increases acetylcholine at nerve endings and can strengthen muscle contractions in the intestine.[12] It is used in some cases of severe constipation or recurrent pseudo-obstruction, usually in divided oral doses. The purpose is to improve colonic and small-bowel motility. Side effects may include cramps, diarrhea, sweating, and slow heart rate.Neostigmine (IV acetylcholinesterase inhibitor for acute decompression)
Neostigmine is given by slow IV injection in hospital for acute colonic pseudo-obstruction under heart monitoring.[1] The purpose is rapid, strong activation of colonic contractions to relieve dangerous distension. The mechanism is potent cholinesterase inhibition. Side effects can include low heart rate, low blood pressure, and bronchospasm, so it must be used with emergency backup.Linaclotide (guanylate cyclase-C agonist)
Linaclotide is approved for chronic idiopathic constipation and IBS-C.[13] It is taken once daily on an empty stomach, as described in the label. In selected CIPO patients with severe constipation, it may help draw fluid into the bowel and increase transit. Side effects include diarrhea and risk of dehydration, especially in young children, so age restrictions are strict.Lubiprostone (chloride-channel activator)
Lubiprostone increases chloride and fluid secretion into the gut, softening stool and promoting motility.[14] It is taken with food and water, usually twice daily. In CIPO, it may help constipation symptoms in some patients. Side effects include nausea, diarrhea, and headache.Rifaximin (poorly absorbed gut antibiotic)
Rifaximin is an oral antibiotic that stays mostly inside the intestine.[15] In CIPO, slow gut flow can lead to small-intestinal bacterial overgrowth (SIBO), causing gas and diarrhea. Rifaximin courses can reduce bacterial load and gas production. It is taken several times a day for short periods. Side effects are usually mild, such as nausea or headache.Proton pump inhibitors (PPIs, e.g., omeprazole class)
PPIs lower stomach acid and are used when reflux, ulcers, or irritation occur with CIPO and tube feeding.[2] They are usually taken once or twice daily before meals. The purpose is to protect the upper gut and esophagus. Mechanism is blocking acid production in gastric parietal cells. Side effects include headache, diarrhea, and, with long use, possible nutrient malabsorption.Antiemetics (e.g., ondansetron – 5-HT3 antagonist)
Antiemetic drugs reduce nausea and vomiting and help patients keep food and medicines down.[1] Ondansetron, for example, blocks serotonin 5-HT3 receptors. It is given in divided doses by mouth or IV, guided by the doctor. Side effects can include constipation, headache, and rare heart rhythm changes.Tricyclic antidepressants at low dose (e.g., amitriptyline class)
Low doses of some tricyclics can help chronic abdominal pain and nausea by calming pain pathways in the brain–gut axis.[2] They are usually taken at night. The purpose is neuromodulation of pain. Mechanism is blocking reuptake of serotonin and norepinephrine. Side effects include drowsiness, dry mouth, and sometimes constipation.Gabapentinoids (e.g., gabapentin for neuropathic pain)
If nerve pain contributes to abdominal discomfort, gabapentin-type medicines may be used.[2] They are taken in divided doses, titrated slowly. The purpose is to reduce nerve-related pain signals. The mechanism is modulation of calcium channels in nerve cells. Side effects include dizziness, sleepiness, and swelling of legs.Short-course opioids with strong caution
In very severe pain, short courses of opioids may be needed, but they can greatly slow the bowel and are used only when absolutely necessary.[1] Dosing and timing are strictly managed by specialists. The purpose is crisis pain relief, not long-term use. Side effects include constipation, nausea, drowsiness, and dependence.Antispasmodics (e.g., hyoscine class) – carefully selected
Some patients have painful spasms, but anticholinergic antispasmodics can worsen motility. They are sometimes used at low doses for short periods when benefit seems to outweigh risk.[2] Side effects include dry mouth, blurred vision, and urinary retention.Bisacodyl or stimulant laxatives (with specialist guidance)
Stimulant laxatives may help some people empty the colon, but in CIPO they can also worsen cramping or be ineffective. They are used cautiously and usually intermittently.[3] The purpose is controlled stimulation of colonic movement. Side effects include cramping and electrolyte imbalance.Osmotic laxatives (e.g., polyethylene glycol solutions)
Osmotic laxatives pull water into the bowel and soften stool. They may be used as part of a bowel routine when obstruction has been ruled out.[3] Doses vary according to response. Side effects include bloating and, if overused, dehydration or salt imbalance.Broad-spectrum IV antibiotics for sepsis or perforation risk
When there is fever, high white blood cell count, or suspected perforation, IV antibiotics are essential.[1] The purpose is to control life-threatening infection. Mechanism is killing or stopping growth of bacteria that leak from the intestine into the blood or abdomen.Parenteral vitamin and mineral preparations
If absorption is very poor, vitamins (like B₁₂) and minerals (like iron) may be given by injection or IV.[3] The purpose is to avoid anemia, nerve damage, and bone disease. Mechanism is direct replacement without relying on the gut.Probiotics (as a medically supervised add-on)
Some doctors may recommend certain probiotic strains to support the gut microbiome in selected patients, especially after antibiotics.[7] Evidence in CIPO is limited. The purpose is to reduce gas-producing or harmful bacteria. Side effects are usually mild bloating; immune-weakened patients must be monitored.
Dietary Molecular Supplements
(Always discuss supplements with a doctor or dietitian. Some may not be appropriate in severe disease or with TPN.)
Medium-chain triglyceride (MCT) oil
MCT oil contains fats that are easier to absorb and can provide calories when fat digestion is poor.[3] It is usually taken in small amounts mixed with food or drinks several times a day. Function: energy support. Mechanism: MCTs are absorbed more directly into the portal blood, needing less bile and pancreatic enzymes.Whey protein or hydrolyzed protein formulas
These protein sources are broken down into smaller pieces that are easier to absorb.[3] They are used as drinks or in tube feeds. Function: maintain muscle and immune function. Mechanism: pre-digested peptides require less intestinal work, which helps in malabsorption states.Oral rehydration solutions (electrolyte drinks)
Special solutions with balanced salts and sugar help replace losses from vomiting or diarrhea.[2] They are taken in small, frequent sips. Function: support circulation and kidney function. Mechanism: glucose-sodium transport in the small intestine pulls water into the body.Multivitamin with trace minerals
A complete multivitamin can help cover gaps when diet is very limited.[3] Dose and type are chosen by the doctor or dietitian. Function: prevent deficiencies of vitamins A, D, E, K, B group, zinc, selenium, and others. Mechanism: direct replacement to support blood, nerves, and immunity.Vitamin D supplement
Vitamin D is important for bones, muscles, and immunity, and deficiency is common in chronic gut disease.[3] Dose is based on blood levels. Function: maintain bone strength and modulate immune responses. Mechanism: acts on vitamin D receptors in many tissues.Iron preparations (oral or IV, depending on tolerance)
Chronic disease and poor intake can cause iron-deficiency anemia.[3] When safe, iron supplements are used under monitoring. Function: improve red blood cell production and oxygen delivery. Mechanism: provides the key mineral needed for hemoglobin.Folate and vitamin B₁₂
These vitamins are needed for DNA synthesis and red blood cell formation. Malabsorption or bacterial overgrowth can reduce their levels.[3] Replacement can be oral or by injection. Function: prevent anemia and nerve problems. Mechanism: support normal cell division.Omega-3 fatty acids
Omega-3s may support general heart and immune health. In some chronic inflammatory conditions they have modest benefits.[7] Doses and formulations differ. Function: anti-inflammatory support. Mechanism: change cell membrane fatty acids and eicosanoid production.Zinc supplements
Zinc is often low in people with chronic diarrhea or poor intake.[3] Supplementation is guided by blood tests. Function: support wound healing, taste, and immunity. Mechanism: cofactor for many enzymes in metabolism and immune cells.Glutamine (in selected cases)
Glutamine is an amino acid that is fuel for intestinal cells. Evidence is mixed, but it may support gut barrier function in some patients.[7] Dose and form are set by specialists. Function: gut cell energy. Mechanism: used directly by enterocytes and immune cells in the gut.
Immune-Modulating / Regenerative / Stem-Cell–Related Therapies
(These are specialist or experimental options. They are not routine and may only be used in selected autoimmune or severe cases, often in studies.)
Corticosteroids (e.g., prednisone for autoimmune CIPO)
When CIPO is linked to an autoimmune disease attacking gut nerves or muscles, doctors may use steroids for a limited time.[2] Function: dampen harmful immune attack. Mechanism: broad suppression of inflammatory gene activity. Side effects include weight gain, infection risk, bone loss, and blood sugar changes.Other immunosuppressants (e.g., azathioprine, mycophenolate)
In some patients, steroid-sparing immunosuppressants help control autoimmune damage to the enteric nervous system.[2] They are taken daily with careful blood tests. Function: long-term immune control. Mechanism: block lymphocyte proliferation. Side effects include low blood counts and infection risk.Intravenous immunoglobulin (IVIG)
Case reports describe improvement in some autoimmune gut motility disorders with IVIG.[7] It is given by IV in hospital on special schedules. Function: modulate the immune system and neutralize harmful antibodies. Mechanism: complex; involves Fc receptor interactions and immune network effects. Side effects include headache and infusion reactions.Biologic agents (e.g., rituximab in selected autoimmune enteric neuropathy)
In rare, severe autoimmune cases, B-cell–targeting biologics such as rituximab have been tried.[7] They are given by IV under close supervision. Function: reduce antibody-producing B cells. Mechanism: monoclonal antibody binding to B-cell surface antigens. Risks include serious infections.Hematopoietic stem cell transplantation (very rare, high-risk)
In very selected patients with severe autoimmune disease, stem cell transplant has been explored as a way to “reset” the immune system.[7] Function: replace diseased immune system with new cells. Mechanism: high-dose chemo followed by infusion of stem cells. Risks are major and include infection and death; this is only considered in research or extreme situations.Experimental mesenchymal stem cell or regenerative therapies
Research is ongoing into stem-cell–based approaches to repair damaged gut nerves or muscles.[7] These are not standard clinical care. Function: potential regeneration of enteric neurons or smooth muscle. Mechanism: stem cells may release growth factors or integrate into tissues. Use is limited to trials with strict safety rules.
Surgeries (Procedures and Why They Are Done)
Venting gastrostomy (PEG) without major resection
A tube is placed into the stomach through the abdominal wall. The main purpose is to let gas and fluid escape and to allow tube feeding.[4] This procedure helps control vomiting and distension when medicines alone are not enough.Jejunostomy for feeding or decompression
A tube is placed directly into the small intestine. It is used when stomach emptying is very poor or when nutrition needs to bypass diseased segments.[4] It can also help remove trapped contents. The goal is safer long-term feeding.Segmental bowel resection (removal of a damaged segment)
If tests show a short, very diseased area causing most problems, surgeons may remove that segment.[13] This is uncommon, because many CIPO patients have diffuse disease. The purpose is to reduce severe localized stasis or repeated infections.Creation of ostomies (ileostomy or colostomy)
Surgeons may bring part of the small or large bowel to the skin surface to let stool exit into a bag.[4] This can reduce distension, help decompression, and make nutrition easier. It is usually considered when symptoms are very severe and other options have failed.Intestinal transplantation (small bowel ± multivisceral transplant)
In extreme cases with life-threatening intestinal failure and TPN complications, small bowel transplant may be considered.[13] The purpose is to provide a new working intestine. It is a major operation with risks of rejection and infection and is only done in specialized centers.
Ways to Help Prevent Worsening
Work closely with a gastroenterologist and follow the written care plan.[2]
Avoid medicines that slow the bowel (especially opioids and strong anticholinergics) unless absolutely necessary.[1]
Treat infections early and keep up with vaccines to reduce illness-related flares.[2]
Maintain adequate fluid and salt intake as advised, especially during hot weather or diarrhea.[3]
Keep a stable, nutrient-dense diet and avoid long periods of not eating.
Monitor weight regularly and report rapid loss to your doctor.[3]
Protect veins and IV lines with proper care to reduce catheter infections in those on TPN.[3]
Practice gentle daily movement, within your energy limits, to support gut motility.[1]
Attend scheduled follow-up appointments, even if you feel a little better, to adjust treatment early.[2]
Seek mental health and social support to handle stress, which can worsen symptoms and self-care.[2]
When to See a Doctor Urgently
You should see a doctor or go to emergency care immediately if you have any of these warning signs:
Sudden, very strong belly pain that does not ease or keeps getting worse.[1]
A very swollen, tight abdomen with severe tenderness or fever.
Vomiting that does not stop, especially if you cannot keep down fluids.
No gas or stool passing for many hours or days together with pain and swelling.
High fever, shaking chills, or feeling very unwell, which may mean infection or sepsis.[1]
Dizziness, confusion, or feeling like you will faint, which can mean severe dehydration or low blood pressure.
Blood in vomit or stool, or stool that looks black and tarry.
Rapid weight loss, extreme weakness, or signs of malnutrition.[3]
For any new or worse symptoms, even if not “emergency,” you should contact your regular doctor or gastroenterologist to review your plan.
Simple Food Tips: What to Eat and What to Avoid
Eat: small, frequent meals of soft or pureed foods. Avoid: very large meals that stretch the stomach.[3]
Eat: well-cooked vegetables without tough skins. Avoid: raw salads with lots of rough fiber and seeds.
Eat: low-fat proteins such as fish, eggs, tofu, or smooth nut butters if tolerated. Avoid: very fatty, fried, or greasy foods that slow emptying.
Eat: white rice, mashed potatoes, and refined grains during flares. Avoid: heavy whole-grain breads or high-bran cereals if they worsen symptoms.
Drink: oral rehydration solutions, broths, and water in small sips throughout the day. Avoid: large amounts of fizzy drinks that increase gas.[3]
Eat: lactose-free dairy or alternatives if milk causes bloating. Avoid: full-fat milk and large amounts of ice cream if poorly tolerated.
Use: dietitian-approved liquid nutrition drinks when you cannot manage solid food. Avoid: random “meal replacement” products without medical advice.[3]
Choose: simple seasonings and avoid very spicy, peppery foods if they make symptoms worse.
Limit: caffeine if it triggers cramps or diarrhea; some people tolerate small amounts, others do not.
Avoid: alcohol and smoking, as they can harm overall gut health and nutritional status.[2]
A dietitian experienced in CIPO or intestinal failure is the best person to build a personal meal plan.
Frequently Asked Questions (FAQs)
Is CIPO the same as a mechanical bowel obstruction?
No. In CIPO, symptoms look like obstruction, but scans and surgery do not show a physical blockage. The problem is in the nerves or muscles of the bowel, not a tumor or scar closing the tube.[1]Can CIPO be cured completely?
For many people, CIPO is a long-term condition. Some cases related to infection or certain autoimmune diseases may improve if the cause is treated, but many patients need ongoing management to control symptoms and protect nutrition.[2]Is surgery always needed?
No. Most patients are managed mainly with nutrition support, medicines, and decompression methods. Surgery is usually reserved for severe, selected cases, such as repeated life-threatening distension, complications, or intestinal failure.[13]Why do doctors worry about TPN complications?
Long-term IV nutrition can save lives but carries risks, including infections from central lines, liver problems, and blood-clot issues.[3] This is why teams try to use as much safe enteral feeding as possible and monitor TPN closely.Are motility drugs safe to take for many years?
Most prokinetic drugs have side effects that limit long-term use, such as movement disorders with metoclopramide or gallstones with octreotide.[8] Doctors weigh benefits and risks, often using the lowest effective dose and reviewing treatment regularly.Why do I sometimes feel worse after laxatives?
In CIPO, the bowel muscles may be too weak or uncoordinated to respond well to strong laxatives. This can cause cramps or fluid shifts without good emptying.[3] That is why laxatives must be chosen and adjusted by a specialist.Can CIPO affect other organs?
CIPO itself is in the gut, but poor nutrition and repeated infections can affect the heart, kidneys, bones, and general immunity.[2] Some patients also have nerve or muscle problems elsewhere in the body.Is CIPO more common in children or adults?
CIPO can occur at any age. There are forms that present in childhood and others in adults. Pediatric guidelines highlight that it is a major cause of intestinal failure in children.[4]Can stress really make my symptoms worse?
Yes. Stress and anxiety can change gut motility, pain perception, and how you eat and drink.[2] Supportive therapy, relaxation, and good sleep can help reduce flares.Will I always need a feeding tube or TPN?
Not always. Some patients need only short-term support during severe flares. Others with very weak intestines may need long-term tube feeding or TPN. The plan depends on nutrition goals, complications, and response to other treatments.[3]Is exercise safe with CIPO?
Gentle movement like walking is usually helpful, but intense exercise during flares may worsen symptoms. A doctor or physiotherapist can suggest safe levels and types of activity for you.[1]Are probiotics or “gut health” products enough to treat CIPO?
No. CIPO is a serious motility disorder. Probiotics, if used, are only a small optional add-on. The main care plan involves medical evaluation, nutrition support, and sometimes specialized medicines or procedures.[7]Can I manage CIPO without seeing a specialist?
Because CIPO is rare and complex, care by or in partnership with a gastroenterologist experienced in motility disorders is strongly recommended. Local doctors can support daily care, but specialist input reduces risks.[2]Is it safe to try new diets or supplements on my own?
No. Sudden diet changes or untested supplements can worsen malnutrition, interact with medicines, or cause side effects. Always discuss changes with your care team, especially if you are on tube feeding or TPN.[3]What is the most important thing I can do today?
The most important step is to have a clear, written care plan with your doctor. This includes what to eat and drink, which medicines to use or avoid, and when to seek urgent help. Keeping close follow-up and asking questions early can greatly improve safety and quality of life.[2]
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: January 24, 2026.
