Do Patients with Ileus Have Abdominal Pain?
Yes, patients with ileus typically experience abdominal pain, though the character and severity differ from mechanical bowel obstruction. 1, 2
Clinical Presentation of Pain in Ileus
Ileus presents with abdominal pain that is generally less severe and less colicky compared to mechanical obstruction. The pain in ileus tends to be:
- Diffuse and constant rather than the intermittent colicky pain characteristic of mechanical obstruction 1
- Associated with abdominal distension which occurs in approximately 65% of cases and contributes to discomfort 1
- Accompanied by bloating as a common symptom 1
Distinguishing Ileus from Mechanical Obstruction
The key clinical difference lies in the pain pattern:
- Mechanical obstruction causes colicky abdominal pain that worsens with peristaltic waves attempting to overcome the blockage 1
- Ileus (adynamic/paralytic) causes more constant, diffuse discomfort due to bowel distension without the intense colicky waves 3, 4
Absent bowel sounds are typical in ileus, whereas mechanical obstruction often presents with hyperactive bowel sounds initially 1, 4
Pathophysiology of Pain in Ileus
The abdominal pain in ileus results from multiple mechanisms:
- Intestinal dilatation and increased luminal pressure causing gut wall distension 2
- Abdominal fluid sequestration leading to increased intra-abdominal pressure 2
- Gut wall ischemia from distension and increased pressure 2
- Intestinal inflammation with cytokine release contributing to discomfort 2
Serious Complications Requiring Recognition
Severe, intense pain unresponsive to analgesics should raise immediate concern for complications such as:
- Bowel ischemia or strangulation (mortality up to 25% if untreated) 1
- Abdominal compartment syndrome when intra-abdominal pressure exceeds 20-25 mmHg 2
- Bowel perforation which can occur as a consequence of prolonged ileus 5
Clinical Pitfalls to Avoid
Do not dismiss abdominal pain in postoperative patients as "expected" without proper assessment, as ileus is a common postoperative complication that requires management 3, 5
Elderly patients may present with less prominent pain, requiring higher clinical suspicion for ileus 6
Opioid analgesics, while appropriate for pain control, can exacerbate ileus through gut dysmotility, creating a clinical dilemma that requires careful balancing 3