Can Lyme Disease Cause Constipation, Ileus, or Abdominal Pain?

Can Lyme disease cause constipation or abdominal pain?
Lyme neuroborreliosis may slow intestinal motility through autonomic dysfunction
Early recognition and treatment may improve gastrointestinal symptoms

Can Lyme disease cause constipation? Yes. Although uncommon, Lyme disease can affect the nerves that regulate the digestive tract, leading to constipation, abdominal pain, ileus, intestinal pseudo-obstruction, and other digestive symptoms. These gastrointestinal complications are most often reported in patients with Lyme neuroborreliosis, particularly when autonomic dysfunction develops.

The following case illustrates how Lyme disease initially appeared to be a stroke before evolving into Bell’s palsy, abdominal pain, ileus, and severe constipation.

Welcome to another Inside Lyme Podcast. I am your host, Dr. Daniel Cameron. In this episode, I discuss the case of a 65-year-old woman whose Lyme neuroborreliosis presented with abdominal pain, ileus (intestinal paralysis), and constipation due to autonomic nervous system involvement.

Zulfiqar and colleagues first described this case in the article The Many Manifestations of a Single Disease: Neuroborreliosis, published in the Journal of Community Hospital Internal Medicine Perspectives.¹

A 65-year-old woman receiving hormonal therapy for estrogen receptor-positive breast cancer presented to the Emergency Department with sudden seventh cranial nerve palsy, commonly called Bell’s palsy.

One week earlier, she developed burning back pain that radiated around to her abdomen. She had also experienced progressively worsening constipation over the preceding several months.

Stroke, herpes virus, or Lyme disease?

Because of her sudden facial weakness, physicians initially admitted the patient with concern for an acute stroke. However, brain CT and MRI showed no evidence of a cerebrovascular event.

Her physicians also considered herpes zoster and prescribed the antiviral medication valacyclovir.

Further history revealed several important clues. The patient frequently worked in her backyard and had regular exposure to wooded areas. She also recalled developing a rash on her abdomen approximately 11 days before hospital admission.

“Lyme serum antibody (IgG and IgM) was positive with confirmatory Western blot resulting in multiband reactivity,” the authors wrote. Cerebrospinal fluid testing also supported the diagnosis of Lyme neuroborreliosis.

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

Despite treatment, she developed worsening diffuse abdominal pain, abdominal distension, and increasing constipation while hospitalized.

An abdominal radiograph demonstrated a mild ileus. A CT scan of the abdomen with contrast suggested constipation without mechanical obstruction or significant ileus. Colonoscopy was likewise normal.

The patient was also diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH) after laboratory evaluation revealed a sodium level of 129 mmol/L together with characteristic urine findings.

How can Lyme disease affect the digestive system?

The authors reviewed several published reports showing that Lyme disease may occasionally present with gastrointestinal symptoms, particularly when the nervous system is involved.

In Lyme neuroborreliosis, inflammation affecting the autonomic nervous system may interfere with normal intestinal movement. Rather than a mechanical blockage, the bowel slows because the nerves controlling intestinal motility are not functioning normally. This process can contribute to constipation, abdominal pain, ileus, or intestinal pseudo-obstruction.

Patients with autonomic dysfunction in Lyme disease may also experience dizziness, rapid heart rate, urinary symptoms, abnormal sweating, temperature intolerance, and digestive complaints, reflecting widespread involvement of the autonomic nervous system.

Autonomic dysfunction may also contribute to delayed stomach emptying, known as gastroparesis, although this appears to be an uncommon manifestation. While this article focuses on constipation, some patients may instead experience diarrhea or alternating bowel habits.

The authors note that previous reports have described pseudo-obstruction, severe constipation, abdominal pain, and radicular pain radiating around the abdomen as manifestations of Bannwarth syndrome, a neurologic form of Lyme disease.

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This patient also experienced anorexia and lost 14 pounds during her illness. The authors note that one study of 314 patients with early Lyme disease found that approximately 23% reported anorexia, highlighting that gastrointestinal symptoms may occur more often than many clinicians recognize.

Shamim and colleagues also reported patients with Lyme disease who presented with severe constipation and hyponatremia, similar to this case.

Other published reports describe Lyme neuroborreliosis as a cause of chronic intestinal pseudo-obstruction. As diagnosis and treatment are delayed, patients may develop progressive constipation, obstipation, abdominal distension, and diffuse bowel dilation despite the absence of a mechanical obstruction.

Several reports have also linked Lyme neuroborreliosis with syndrome of inappropriate antidiuretic hormone secretion (SIADH), suggesting that neurologic involvement may contribute to abnormalities in sodium regulation in selected patients.

Although gastrointestinal complications remain uncommon, this case illustrates how Lyme disease can occasionally present with digestive symptoms before more typical neurologic findings become apparent.

Why this case matters

Constipation is common and usually has causes unrelated to Lyme disease. However, physicians should consider Lyme disease in patients who live in or have traveled to endemic regions when constipation is accompanied by neurologic symptoms such as Bell’s palsy, radicular pain, severe headache, meningitis, sensory changes, or other evidence of neuroborreliosis.

Prompt recognition is important because autonomic dysfunction associated with Lyme disease may improve with appropriate antibiotic treatment, while delayed diagnosis may allow neurologic and gastrointestinal complications to worsen.

Authors’ conclusion: Lyme disease should be considered in patients from endemic regions who present with abdominal pain, constipation, ileus or intestinal pseudo-obstruction, SIADH, and cranial neuropathies such as Bell’s palsy (facial palsy).

Frequently Asked Questions

Can Lyme disease cause constipation?

Yes. Although uncommon, Lyme disease—particularly Lyme neuroborreliosis—may interfere with the autonomic nerves that regulate intestinal movement, leading to constipation, ileus, or intestinal pseudo-obstruction.

Can Lyme disease cause abdominal pain?

Yes. Some patients with Lyme neuroborreliosis develop abdominal pain because inflamed spinal nerve roots, known as radiculoneuritis, can produce pain that wraps around the abdomen. Others develop abdominal discomfort related to slowed intestinal motility.

What is ileus?

Ileus is a temporary slowing or paralysis of intestinal movement. Unlike a bowel obstruction caused by a physical blockage, ileus results from impaired bowel motility.

What is intestinal pseudo-obstruction?

Intestinal pseudo-obstruction produces symptoms that resemble a bowel obstruction even though no mechanical blockage is present. It has been reported in rare cases of Lyme neuroborreliosis.

Can autonomic dysfunction affect digestion?

Yes. Autonomic dysfunction may slow stomach or intestinal movement, contributing to constipation, bloating, nausea, abdominal discomfort, urinary symptoms, dizziness, and abnormal heart rate regulation.

Clinical Takeaway

Most patients with constipation do not have Lyme disease, and most gastrointestinal complaints have more common explanations. Nevertheless, clinicians should keep Lyme disease in the differential diagnosis when constipation, abdominal pain, ileus, or intestinal pseudo-obstruction occur together with facial palsy, radicular pain, meningitis, SIADH, or other neurologic findings in patients with possible tick exposure.

Recognizing these uncommon presentations of Lyme neuroborreliosis may lead to earlier diagnosis and treatment while avoiding unnecessary delays and invasive gastrointestinal evaluations.

Related Articles

Read more about gastrointestinal, neurologic, and autonomic manifestations of Lyme disease:

Can Lyme Disease Cause Digestive Symptoms?
Can Lyme Disease Cause Bell’s Palsy?
Lyme Disease Symptoms Guide
Persistent Lyme Disease Overview

 

 

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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