Abdominal Pain, Ileus, and Constipation Due to Lyme Disease
ABDOMINAL PAIN WITH NORMAL TESTS?
LYME DISEASE MAY AFFECT GUT FUNCTION
“Everything came back normal—but the symptoms kept getting worse.”
Lyme disease is not typically thought of as a gastrointestinal illness. Yet in some patients, abdominal pain and severe constipation are among the most troubling symptoms.
Quick Answer: Abdominal pain, ileus, and constipation in Lyme disease are often caused by autonomic nervous system dysfunction affecting gut motility—even when imaging and GI tests are normal.
Clinical Insight: When abdominal symptoms occur alongside neurologic findings, Lyme neuroborreliosis may be disrupting nerve signaling rather than causing a primary gastrointestinal disorder.
This pattern reflects autonomic dysfunction in Lyme disease, where nerve involvement affects multiple organ systems. :contentReference[oaicite:0]{index=0}
When symptoms don’t fit a GI diagnosis
A 65-year-old woman presented with Bell’s palsy and a history of worsening constipation and abdominal pain.
She had previously developed burning back pain radiating to the abdomen—an important neurologic clue.
This overlap between abdominal pain and nerve-related symptoms is often seen in Lyme disease abdominal pain and Lyme-related constipation.
Stroke, herpes, or Lyme disease?
The patient was initially evaluated for stroke, but brain imaging was normal.
Herpes zoster infection was also considered, and antiviral treatment was started.
However, Lyme testing was positive, and spinal fluid confirmed neuroborreliosis.
This pattern—serious symptoms with normal imaging—is common in neurologic Lyme disease.
Constipation and abdominal pain worsened
During hospitalization, the patient developed worsening abdominal distension, pain, and constipation.
Imaging showed:
- Mild ileus
- No mechanical obstruction
- Normal colonoscopy
Despite extensive testing, no primary gastrointestinal cause was identified.
Constipation as a neurologic symptom
Lyme neuroborreliosis can affect the autonomic nervous system, which controls gut motility.
This can lead to:
- Constipation
- Ileus
- Pseudo-obstruction
These are not primary GI disorders—they are neurologic manifestations.
This pattern is also seen in Bannwarth syndrome, where radicular pain and autonomic symptoms occur together.
A broader pattern of autonomic dysfunction
In Lyme disease, autonomic dysfunction may affect:
- Gut motility (constipation, ileus)
- Heart rate (palpitations, POTS)
- Blood pressure regulation
This explains why symptoms often involve multiple systems and may not fit a single diagnosis.
Why diagnosis is often delayed
Patients with abdominal symptoms are typically evaluated for gastrointestinal disorders first.
When tests are normal, symptoms may be dismissed or attributed to functional disorders.
However, when abdominal pain and constipation occur with neurologic symptoms—such as facial palsy or radicular pain—the diagnosis should shift toward systemic causes.
Clinical takeaway
Constipation and abdominal pain in Lyme disease are often neurologic—not gastrointestinal.
When symptoms are severe, unexplained, and accompanied by neurologic findings, Lyme neuroborreliosis should be considered.
Recognizing autonomic dysfunction early can prevent prolonged symptoms and unnecessary testing.
Frequently Asked Questions
Can Lyme disease cause constipation?
Yes. Lyme disease can affect autonomic nerves that control gut motility, leading to constipation and ileus.
Why are GI tests normal in Lyme-related constipation?
Because the problem is neurologic, not structural—standard GI tests may not detect it.
What is ileus in Lyme disease?
Ileus is reduced or absent bowel movement caused by impaired nerve signaling to the gut.
How is Lyme-related constipation different?
It often appears suddenly, worsens despite treatment, and occurs with neurologic symptoms.
Related Reading
- Lyme Disease Abdominal Pain
- Lyme Disease Gut Symptoms
- Autonomic Dysfunction in Lyme Disease
- Back Pain and Lyme Disease
References
- :contentReference[oaicite:1]{index=1}
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
I have had two very bad contraction episodes. The worst ever and I had 2 children one in her 40s and one almost 30. They are not fun. They paralyze you.
Just wondering what treatment that lady got for her lyme.
Great podcast! I sound like the case study but without breast cancer. This podcast makes me fight harder in education to my medical team. Thanks
What treatment did this lady get. I have been sick with Lyme for 39 years. I wasn’t diagnosed until 4 years ago. Antibiotics didn’t help me.
The authors did not specify the antibiotics used. I find that I have to individualize treatment for each patient.
I have a very similar situation to yours but with more details. Please contact me at ga******@*ol.com
The Lyme Disease Asscoiation of Australia linked this article, ironicallly same week I nearly ended up in hospital due to ileus. I have tried every gut thing known to man (diet shifts, probiotics, motility agents etc) and like many chronic patients, have had to do daily / twice daily enemas for years to avoid obstipation.
My Lyme diagnosis is relatively recent – 4 years in 30 years of CFS/ fibromyalgia/ MCAS – but unfortunately the antibiotics and herbs haven’t improved the gut symptoms
There are so many overlapping issues affecting the gut. I hope they find an answer for you soon.
First I experienced 6th nerve palsy-ER ruled out stroke, tumor,MS. 3 days later I had severe back pains. I couldn’t sleep for 3 days so went back to ER. Diagnosed with constipation. Pain continued-I didn’t sleep for 2 weeks-return to Urgent Care and ER for the pain 2 more times. They kept telling me it was constipation so they couldn’t give me anything for the pain. Then 7th nerve palsy developed, so an ER doc connected the dots and ordered a Lyme test which was positive. After 2 months only the 6th nerve palsy remains. So glad the pain is gone-it was very intense across my back and abdomen. Praying my vision heals. I hope more health professionals get educated on these symptoms.
Dr. Cameron, do you know if there is any connection w/ Lyme and Eosinophilic Esophagitis (EOE)?