Muscle Weakness and Constipation—Could It Be Lyme Disease?
Muscle weakness and constipation in Lyme disease may be caused by neurologic and autonomic nervous system dysfunction—even when imaging and gastrointestinal testing appear normal.
This pattern can be confusing because patients often undergo extensive gastrointestinal evaluations before Lyme disease is considered.
For a broader overview, see Lyme disease symptoms.
Lyme Disease Leads to Muscle Weakness and Constipation
An 80-year-old man, later diagnosed with Lyme disease, was admitted to the hospital with left leg paresis (muscle weakness), pain, and sensory disturbances involving the left abdomen.
He also developed a rash, severe abdominal pain, and constipation that had persisted for four to five weeks.
The patient had previously visited three medical centers because of worsening abdominal pain.
However, colonoscopy and abdominal CT imaging did not explain the severity of his symptoms.
This “symptoms with normal tests” pattern is commonly reported in neurologic Lyme disease.
Atypical Rash and Neuroborreliosis Findings
The rash appeared as a “patchy, pruritic redness with pustules, which was particularly prominent on the left flank and abdomen,” the authors stated.
Testing later revealed Borrelia-specific IgM and IgG antibodies consistent with neuroborreliosis.
“Finally, a diagnosis of Lyme disease was made, which initially manifested itself with autonomic symptoms (constipation) and severe abdominal pain,” followed later by muscle weakness involving the left leg, the authors explained.
The patient’s constipation was believed to reflect autonomic nervous system involvement.
The authors also noted that the rash was atypical for Lyme disease, which may have contributed to delayed recognition.
How Lyme Disease Can Affect the Gut
The autonomic nervous system controls involuntary body functions including digestion and intestinal motility.
When affected by Lyme disease, autonomic dysfunction may lead to:
- Constipation
- Slowed intestinal movement
- Abdominal pain
- Bloating and discomfort
This overlap is discussed further in abdominal pain and constipation in Lyme disease.
Autonomic Lyme disease may produce severe gastrointestinal symptoms despite normal GI testing.
Muscle Weakness and Neurologic Lyme Disease
Lyme neuroborreliosis may affect peripheral nerves, spinal nerve roots, or motor pathways.
Patients can develop:
- Leg weakness or paresis
- Numbness or sensory changes
- Neuropathic pain
- Difficulty walking
See also Lyme disease triggers neuropathy in the legs.
In this case, abdominal symptoms appeared before the neurologic weakness became more obvious.
This progression from autonomic symptoms to neurologic symptoms may serve as an important diagnostic clue.
Response to Lyme Disease Treatment
The patient completed a 21-day course of doxycycline.
Following treatment:
- Constipation resolved
- Abdominal pain improved
- Leg weakness disappeared
The patient was reportedly able to resume his home exercise program within two months and returned to his prior functional baseline.
This case highlights that Lyme-related neurologic and autonomic dysfunction may improve with treatment.
Why This Lyme Disease Pattern Is Often Missed
Lyme disease may be overlooked when symptoms involve multiple systems simultaneously.
Patients with abdominal pain and constipation are often evaluated primarily for gastrointestinal disorders, while neurologic symptoms may initially appear unrelated.
Normal imaging or gastrointestinal testing can further delay diagnosis.
This contributes to Lyme disease misdiagnosis, particularly when symptoms evolve gradually over time.
Frequently Asked Questions
Can Lyme disease cause constipation?
Yes. Lyme disease may affect the autonomic nervous system and interfere with intestinal motility, leading to constipation.
Can Lyme disease cause muscle weakness in the legs?
Yes. Neuroborreliosis may affect peripheral nerves or motor pathways, causing weakness or paresis.
Why are gastrointestinal tests sometimes normal?
Autonomic dysfunction affects nerve signaling rather than structural anatomy, so imaging and colonoscopy may appear normal.
What is autonomic Lyme disease?
Autonomic Lyme disease refers to involvement of the autonomic nervous system, which regulates involuntary body functions such as digestion, heart rate, and blood pressure.
Can these symptoms improve after treatment?
Yes. In this case report, constipation, abdominal pain, and leg weakness improved following doxycycline treatment.
Clinical Takeaway
Muscle weakness and constipation may occur together in neurologic Lyme disease because both the peripheral nervous system and autonomic nervous system can be affected.
Patients with severe abdominal symptoms and normal gastrointestinal testing may require evaluation for neurologic and tick-borne causes.
I have seen patients with unexplained abdominal symptoms, weakness, sensory changes, and autonomic complaints whose Lyme disease diagnosis was initially delayed because symptoms appeared unrelated.
Recognizing the connection between autonomic dysfunction, abdominal symptoms, and neurologic weakness may help prevent missed Lyme disease diagnoses.
Related Articles
Autonomic Dysfunction in Lyme Disease
Neurologic Lyme Disease
Lyme Disease Symptoms Guide
Lyme Coinfections
Post-Treatment Lyme Disease Syndrome
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.
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.