Can Lyme Disease Cause Constipation and Abdominal Pain?

Lyme neuroborreliosis may affect the gastrointestinal system
Constipation, ileus, and abdominal pain can reflect autonomic dysfunction
Neurologic Lyme disease may be overlooked in atypical gastrointestinal cases

Constipation, abdominal pain, ileus, and urinary dysfunction are not typically considered classic Lyme disease symptoms.

However, neurologic Lyme disease may occasionally affect the autonomic nervous system and gastrointestinal tract, leading to symptoms such as constipation, pseudo-obstruction, abdominal distention, and abdominal pain.¹

For a broader discussion of autonomic complications, visit our Autonomic Dysfunction in Lyme Disease hub.

Listen to the Inside Lyme Podcast episode on abdominal pain, constipation, ileus, and autonomic dysfunction in Lyme disease:

Zulfiqar and colleagues described a 65-year-old woman who initially presented with seventh nerve palsy, commonly referred to as Bell’s palsy.¹

One week earlier, she had developed burning back pain radiating into the abdomen and progressive constipation.¹

The patient was admitted to the hospital for suspected stroke, although brain CT and MRI studies were negative.¹

Doctors also considered herpes zoster infection and prescribed valacyclovir.

The woman frequently worked in wooded areas and recalled developing a rash on her abdomen approximately 11 days before hospitalization.¹

Lyme Testing Confirmed Neuroborreliosis

Lyme serum antibody testing was positive for both IgG and IgM antibodies with confirmatory Western blot testing showing multiband reactivity.¹

Spinal tap testing was also positive for Lyme disease.

The patient was diagnosed with neuroborreliosis and treated with oral doxycycline.¹

However, while hospitalized she developed worsening abdominal pain, diffuse abdominal distention, and severe constipation.¹

Abdominal imaging suggested ileus and constipation without mechanical obstruction.¹

Colonoscopy findings were normal.

Autonomic Dysfunction and Gastrointestinal Symptoms

The patient was also diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH), based on hyponatremia and abnormal urine findings.¹

Zulfiqar and colleagues reviewed prior reports linking Lyme neuroborreliosis with gastrointestinal and autonomic complications including:

• abdominal pain
• pseudo-obstruction
• ileus
• constipation
• obstipation
• radicular abdominal pain
• urinary dysfunction
• SIADH

The authors noted that Bannwarth syndrome and autonomic dysfunction may contribute to back pain radiating into the abdomen, bowel dysfunction, and severe constipation.¹

For more on neurologic Lyme complications, visit our Neurologic Lyme Disease hub.

Delayed Diagnosis Can Worsen Gastrointestinal Symptoms

The authors emphasized that worsening constipation and bowel dilation may occur when diagnosis and treatment are delayed.¹

Lyme neuroborreliosis may occasionally mimic gastrointestinal disorders, spine disease, abdominal emergencies, or primary neurologic conditions.

Patients with atypical gastrointestinal symptoms may therefore experience delayed recognition of Lyme disease.

For more on delayed recognition, visit our Delayed Lyme Disease Diagnosis hub.

Weight Loss and Gastrointestinal Symptoms

The patient also experienced anorexia and a 14-pound weight loss.¹

Other studies cited by the authors found that patients with Lyme disease may experience appetite loss, constipation, abdominal pain, and autonomic dysfunction symptoms.¹

These symptoms may overlap with co-infections, medication effects, dehydration, or neurologic involvement.

For more on overlapping tick-borne illnesses, visit our Lyme Coinfections hub.

Frequently Asked Questions

Can Lyme disease cause constipation?

Yes. Neurologic Lyme disease may occasionally affect autonomic nervous system function and contribute to constipation or bowel dysfunction.¹

Can Lyme disease cause abdominal pain?

Some patients with Lyme neuroborreliosis develop abdominal pain due to radiculopathy, autonomic dysfunction, or gastrointestinal involvement.¹

What is ileus in Lyme disease?

Ileus refers to impaired bowel motility without mechanical obstruction and has been reported in some neuroborreliosis cases.¹

Can Lyme disease cause SIADH?

Several case reports have linked Lyme neuroborreliosis with SIADH and hyponatremia.¹

Can neurologic Lyme disease affect the autonomic nervous system?

Yes. Lyme neuroborreliosis may occasionally affect autonomic regulation involving the gastrointestinal, cardiovascular, or urinary systems.

Can Lyme disease mimic gastrointestinal disorders?

Yes. Lyme disease may occasionally resemble gastrointestinal illness, abdominal emergencies, neuropathy, or spinal disorders.

Clinical Takeaway

Lyme neuroborreliosis may occasionally present with constipation, abdominal pain, ileus, SIADH, urinary dysfunction, and autonomic nervous system involvement.

Patients with atypical gastrointestinal symptoms and compatible Lyme exposure risk may require evaluation for neurologic Lyme disease.

Constipation and abdominal pain may represent underrecognized manifestations of Lyme neuroborreliosis and autonomic dysfunction.

Related Articles

These related articles explore autonomic dysfunction, neurologic Lyme disease, abdominal symptoms, persistent symptoms, and delayed recognition.

Neurologic Lyme Disease Presenting as Abdominal Pain
Post-Treatment Lyme Disease Syndrome
Bannwarth Syndrome and Weight Loss
Lyme Disease Symptoms Guide
Lyme Disease Misdiagnosis

References

1. Zulfiqar S, Qureshi A, Dande R, Puri C, Persaud K, Awasthi S. The many manifestations of a single disease: neuroborreliosis. J Community Hosp Intern Med Perspect. 2021;11(1):56-59.

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Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention