Can Lyme Disease Cause Constipation and Leg Weakness? A Neuroborreliosis Case
Constipation and severe abdominal pain may reflect Lyme neuroborreliosis
Autonomic dysfunction can slow bowel function
Prompt diagnosis and treatment may lead to recovery
Can Lyme disease cause constipation and leg weakness? Although uncommon, Lyme disease can affect the autonomic nervous system, disrupting normal bowel function. In some patients with Lyme neuroborreliosis, constipation, severe abdominal pain, sensory disturbances, and muscle weakness may occur together.
An 80-year-old man, later diagnosed with Lyme disease, was admitted to the hospital with left leg paresis (muscle weakness), along with pain and sensory disturbances involving the left side of his abdomen. He also experienced severe abdominal pain, constipation, and a rash on his left lower abdomen. These symptoms had persisted for four to five weeks before the diagnosis was established.
The patient sought care at three different medical centers because of worsening abdominal pain. However, neither colonoscopy nor computed tomography (CT) imaging identified a gastrointestinal cause that explained the severity of his symptoms.
Because gastrointestinal symptoms often occur without obvious neurologic findings early in the illness, Lyme disease may not be suspected until weakness or other neurologic symptoms develop. This case illustrates how Lyme neuroborreliosis can initially mimic a primary gastrointestinal disorder.
The rash manifested as a “patchy, pruritic redness with pustules, which was particularly prominent on the left flank and abdomen,” the authors reported.
Laboratory testing demonstrated Borrelia-specific IgM and IgG antibodies, findings that were consistent with the patient’s clinical presentation of Lyme neuroborreliosis.
Can Lyme disease cause constipation?
Constipation is not among the most common symptoms of Lyme disease, but it may occur when the infection affects the autonomic nervous system. Autonomic nerves help regulate intestinal motility, and impairment of these pathways can slow bowel function.
In this case, the authors concluded that the patient’s constipation resulted from autonomic involvement associated with Lyme neuroborreliosis rather than from a primary gastrointestinal disorder.
Although uncommon, this is not an isolated observation. Earlier case reports have described severe constipation, intestinal pseudo-obstruction, urinary retention, and autonomic dysfunction in patients with Lyme neuroborreliosis, with improvement following appropriate antibiotic treatment.
Constipation is one of several gastrointestinal manifestations that may occur when autonomic dysfunction (dysautonomia) develops in Lyme disease, although many other medical conditions are far more common causes.
Why can Lyme disease affect bowel function?
The autonomic nervous system regulates involuntary body functions including heart rate, blood pressure, bladder function, sweating, and intestinal motility. When Lyme disease affects these nerves, patients may develop constipation, abdominal pain, ileus, or, more rarely, delayed stomach emptying (gastroparesis).
Published case reports have also described urinary retention, ileus, intestinal pseudo-obstruction, and syndrome of inappropriate antidiuretic hormone secretion (SIADH) occurring alongside constipation in some patients with Lyme neuroborreliosis, suggesting broader autonomic nervous system involvement.
Other symptoms of autonomic dysfunction may include dizziness upon standing, abnormal sweating, urinary dysfunction, temperature intolerance, and changes in heart rate. These symptoms may occur alongside neurologic manifestations of Lyme disease in some patients.
Because constipation and abdominal pain are common complaints, patients are frequently evaluated for gastrointestinal disorders before Lyme disease is considered. When bowel symptoms occur together with weakness, numbness, sensory changes, facial palsy, or other neurologic findings, clinicians may broaden the evaluation to include Lyme neuroborreliosis.
Additional information about gastrointestinal symptoms associated with Lyme disease can be found in our guide to Lyme disease and the digestive system.
“Finally, a diagnosis of [Lyme disease] was made, which initially manifested itself with autonomic symptoms (constipation) and severe abdominal pain, accompanied by a skin rash” and muscle weakness in the patient’s left leg that appeared later, the authors wrote.
Constipation, Muscle Weakness, and Leg Weakness in Lyme Neuroborreliosis
The investigators emphasized that the patient’s constipation was most likely caused by autonomic involvement from Lyme neuroborreliosis.
“The patient’s constipation is likely due to the autonomic involvement of the disease.”
The rash was atypical for Lyme disease and consisted of a flat, itchy area of redness with pustules, making the diagnosis less obvious during the initial evaluations.
“… serological tests were finally conclusive for Lyme borreliosis, so that the abdominal pain and [constipation] were evaluated as autonomic, and the leg paresis as neurological involvement of neuroborreliosis.”
This case also illustrates how autonomic symptoms may precede more recognizable neurologic findings. Similar reports have documented patients presenting with constipation, abdominal pain, urinary retention, or intestinal pseudo-obstruction before Lyme neuroborreliosis was ultimately diagnosed.
The patient completed a 21-day course of doxycycline.
Following treatment, his muscle weakness resolved completely, along with his abdominal pain and constipation. According to the authors, he was able to “resume his home exercise program within two months and since then he has been on the same physical level as before.”
Frequently Asked Questions
Can Lyme disease cause constipation?
Yes. Although uncommon, Lyme disease can cause constipation when the infection affects the autonomic nervous system. Damage or inflammation involving autonomic nerves may slow intestinal motility, leading to constipation, ileus, or, in rare cases, intestinal pseudo-obstruction. Because constipation has many causes, other gastrointestinal disorders should always be considered.
Can Lyme disease cause leg weakness?
Yes. Lyme neuroborreliosis can affect peripheral nerves and nerve roots, leading to leg weakness, numbness, pain, sensory disturbances, or difficulty walking. Prompt recognition and treatment improve the likelihood of recovery.
Why would constipation and leg weakness occur together?
Constipation may reflect autonomic nervous system involvement, while leg weakness may result from neurologic involvement of Lyme neuroborreliosis. Although this combination is uncommon, it should prompt consideration of neurologic causes when accompanied by abdominal pain, rash, or other neurologic symptoms.
Can Lyme disease cause severe abdominal pain?
Yes. Severe abdominal pain has been reported in patients with Lyme neuroborreliosis. The pain may result from radiculoneuritis or autonomic dysfunction rather than a primary gastrointestinal disorder, making diagnosis challenging.
Does constipation improve after Lyme disease treatment?
It may. Published case reports describe improvement in constipation, abdominal pain, urinary dysfunction, and muscle weakness after appropriate antibiotic treatment for Lyme neuroborreliosis, although recovery varies depending on the severity of neurologic involvement.
Clinical Takeaway
Constipation and severe abdominal pain are usually investigated as gastrointestinal disorders, but this case demonstrates that Lyme neuroborreliosis can rarely present with autonomic symptoms before more obvious neurologic findings develop. The patient’s extensive gastrointestinal evaluation delayed recognition of the underlying neurologic infection.
Multiple published case reports now describe similar presentations involving constipation, urinary retention, intestinal pseudo-obstruction, SIADH, abdominal pain, and muscle weakness that improved after treatment for Lyme neuroborreliosis.
Although rare, published evidence shows that constipation, severe abdominal pain, urinary dysfunction, and leg weakness can all represent manifestations of Lyme neuroborreliosis affecting the autonomic and peripheral nervous systems. When these symptoms occur together—particularly in someone with possible tick exposure—Lyme disease should remain part of the clinical differential diagnosis.
Related Articles
These articles explore additional gastrointestinal, neurologic, and autonomic manifestations of Lyme disease.
Abdominal pain, ileus, and constipation due to Lyme disease
Lyme disease triggers neuropathy in the legs
Atypical symptoms of Lyme disease: numbness, paresthesias, and abdominal wall weakness
Autonomic dysfunction and Lyme disease
Lyme disease and gastrointestinal symptoms
References
- Ahrend H, Fibbe C, Jasper D, Ahrend A, Woelfel M, Layer P, Rosien U, Stope MB. Atypical Acute Neuroborreliosis With Leg Paresis and Constipation. In Vivo. 2024;38(2):940-943. doi:10.21873/invivo.13523.
- Leone M, Iqbal A, Bonatti JRH, Anwar S, Feaga C. A Patient with SIADH, Urinary Retention, Constipation, and Bell’s Palsy following a Tick Bite. Case Rep Nephrol. 2022;2022:5937131. doi:10.1155/2022/5937131.
- 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. doi:10.1080/20009666.2020.1831746.
- Schefte DF, Nordentoft T. Intestinal Pseudoobstruction Caused by Chronic Lyme Neuroborreliosis. A Case Report. J Neurogastroenterol Motil. 2015;21(3):440-442. doi:10.5056/jnm14118.
- Shamim EA, Shamim SA, Liss G, Nylen E, Pincus JH, Yepes M. Constipation Heralding Neuroborreliosis: An Atypical Tale of 2 Patients. Arch Neurol. 2005;62(4):671-673. doi:10.1001/archneur.62.4.671.
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
Dr. Cameron, you may want to suggest to Lyme patients with muscle weakness that they begin taking the supplement Urolithin A. It is an anti aging “post biotic” or stomach metabolite. There are studies that back up it’s efficacy, in this exact space.
I have had Lyme since 2011. One of my biggest complaints over the years has been leg muscle weakness. Have you had that also?
I had Lyme disease in July of 2022. I was treated with doxycycline for 14 days.i had extreme pain in both legs when I was first infected. But now ,almost 2 years later I legs still ache. Not as bad as when I was diagnosed. I also have insomnia since the Lyme disease diagnosis. Trying to find a Dr who believes me is impoi.
You are not alone
Yes, we are alone. Because no one knows how to treat and diagnose advanced Lyme w/o the drugs almost killing us. . I was initially treated by Dr.Burrascano who helped me the first time and we know why he had to stop practicing. Criminal and have lost all hope.
So many people don’t believe when you have symptoms. To them, Lyme Disease has an easy fix with a pill for 14 days.
Back in Spring of 2016, I suddenly was battling flu-like symptoms, but so much worse. The arthritis pain in my hands so severe I could only close them part way, both of my legs hurt to the point that I was crying, headaches, every muscle was on fire effecting nerves felt like I never knew was humanly possible. I had several unexplained patches of a red rash. After a week of suffering, I finally was driven to my doctor. At that single visit, blood was drawn to check for Lyme. It came back positive. Put on doxy pills for 2 weeks. Within that time, 3 bullseye circles had shown up on my inner thighs. Never knew I was infected.
I spent months trying to walk on both weak legs, my arms lost strength, and my brain fog had taken over. I had even gone to an Infectious Disease Doctor in Pittsburgh/Monroeville. He told me nothing more could be done. It was like getting slapped with a death sentence.
I was 52 yrs old back then, healthy and strong and enjoyed gardening. Now I can only shop holding onto a cart or walking short distances. Gardening is no Ionger possible. I am technically disabled and depressed. My grandkids keep me going.
So sorry about the long reply, but this was the first I had ever told strangers of my battle with the disease.
It can be crippling as I found out.
Thanks for sharing. There are too many with similar stories.
I had Lyme disease as a young teen and developed strange neurological symptoms over the next two decades, such as a drop foot and upper motor neuron signs. I have no idea if Lyme was the cause, and neurologists don’t know either. I haven’t seen a lot of research on the incidence of Lyme and upper motor neuron symptoms.
I have not seen much either.