She’d seen seven specialists in 18 months, but no one could explain her Lyme disease abdominal pain. The tests were normal. The pain was not.

Her doctors never considered that Lyme disease abdominal pain often begins long before anything shows up on imaging.

Ultrasound: normal. CT scan: normal. Endoscopy: normal. Colonoscopy: normal.

The final GI note read: “Likely functional. Consider stress management.”

That’s when she asked about Lyme disease.

“Normal GI tests don’t rule out real pain — they just mean we haven’t asked the right question yet.”

Why Lyme Disease Abdominal Pain Gets Missed

Abdominal pain rarely points to one diagnosis, so she was sent through every standard test to rule out ulcers, gallbladder disease, IBD, or cancer. When all of it came back normal, her pain was quietly placed in the “functional” category — a medical way of saying, “We don’t know.”

And that’s where the investigation usually stops.
But her story didn’t fit the pattern of a functional disorder. The timing felt wrong. The symptoms too sudden. The rest of her body was clearly involved.

How Lyme Disease Abdominal Pain Starts

Lyme disease doesn’t just affect joints or the brain — it can disrupt the autonomic fibers of the vagus nerve, the main signaling path between the gut and the rest of the nervous system. When those neural pathways misfire, digestion slows, sensitivity heightens, and the gut loses its rhythm.

Many patients also develop constipation that seems to appear out of nowhere — a sign of slowed motility from vagal dysfunction rather than a primary GI disorder.

And for some, the disruption goes even further.
Lyme-related GI issues don’t look the same in every patient. Certain individuals develop sudden-onset gastroparesis — food sitting in the stomach for hours, early fullness after small meals, or nausea that feels out of proportion. Others experience functional dyspepsia, bloating, or the sense that their stomach simply “won’t empty.” These aren’t separate diseases; they’re different expressions of the same autonomic problem.

By the time patients reach me, they’ve often completed every GI test imaginable. What they haven’t been evaluated for is nerve-driven gut dysfunction — the kind that doesn’t show up on imaging but is felt deeply in daily life.

She put it this way: “It feels like my stomach just stopped working.”

Why Lyme Disease Abdominal Pain Doesn’t Show Up on Imaging

Traditional GI tests look for visible problems — blockages, inflammation, structural changes.
But Lyme disease abdominal pain is driven by disrupted signaling, not damage you can see on a scan.

That’s why the pattern feels so confusing:

1. Migrating cramping

2. Bloating that worsens throughout the day

3. Nausea in waves

4. Pain that intensifies with POTS or standing

5. Test after test returning normal

It’s not IBS developed slowly over time. It’s abrupt autonomic disruption.

Co-Infections Complicate the Picture

Co-infections don’t just add symptoms — they amplify autonomic instability, making Lyme disease abdominal pain more intense and more unpredictable.

When It Actually IS IBS or Gastritis

Not all abdominal pain points to Lyme disease. True IBS tends to unfold gradually, with predictable bowel patterns and clear dietary triggers. Gastritis often improves with acid suppression or avoiding irritants.

Her case didn’t match either.
Her pain was sudden, migrating, systemic — and stubbornly unresponsive to typical GI treatments.

That mismatch matters.

Treating Lyme Disease Abdominal Pain: What Actually Helps

Her story took a turn when she recalled a tick bite six months before her symptoms began. Around that time, she also developed joint pain, dizziness, night sweats, and a racing heart when standing — clues pointing away from GI disease and toward infection-driven autonomic dysfunction.

So we treated Lyme and Babesia together.

Within three weeks, the nausea began to ease.
By six weeks, the cramping episodes were fewer and less severe.
At three months, she told me: “I can finally eat a normal meal again.”

Her pain had always been real.
The cause had simply been missed.

The Bottom Line

For many patients, Lyme disease abdominal pain is a neurologic symptom — not a GI mystery. Recognizing that difference opens the door to answers instead of more dead ends.

Share Your Story

Have you had abdominal pain dismissed despite normal testing?
Did your symptoms begin after a tick bite or along with dizziness, palpitations, or fatigue?

Share your story below — your voice may help someone else finally be heard.

Resources

1. Case Rep Orthop. Abdominal pain as first manifestation of lyme neuroborreliosis in children, case report and review of literature
2. CDC. The many manifestations of a single disease: neuroborreliosis
3. Dr. Daniel Cameron: Lyme Science Blog. Sep 11 Abdominal pain, ileus and constipation due to Lyme disease
4. Dr. Daniel Cameron: Lyme Science Blog. Lyme disease leads to muscle weakness of the leg and constipation