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processing.... Intestinal Motility DisordersUpdated: Oct 23, 2025
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Overview
BackgroundThe phrase "intestinal motility disorders" applies to abnormal intestinal contractions, such as spasms and intestinal paralysis, and is used to describe a variety of disorders in which the gut has lost its ability to coordinate muscular activity because of endogenous or exogenous causes. [1, 2, 3] Intestinal motility disorders can be categorized as upper gastrointestinal (GI) or lower GI motility disorders. Upper GI motility disorders include the following [4] :
Lower GI motility disorders include the folllowing [4, 5] :
Upper intestinal motility disorders may manifest as the following:
Lower intestinal motility disorders may manifest as the following:
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EtiologyCauses of intestinal motility disorders appear to be multifactorial, and only a few have been identified. AchalasiaStudies on primary achalasia suggest it is primarily an autoimmune disorder. Worldwide, the most common cause of secondary achalasia is Trypanosoma cruzi infection (Chagas disease); another cause is iatrogenic (ie, surgical error in forming fundoplication or gastric banding). [6] Systemic diseases that infiltrate the lower esophageal sphincter can cause a pseudoachalasia, such as tumors of the gastroesophageal junction or gastric cardia and amyloidosis. Gastroesophageal reflux diseaseMany different factors can attribute to gastroesophageal reflux disease (GERD). These include but are not limited to transient lower esophageal relaxations, weak lower esophageal sphincter, delayed gastric emptying, increased gastric acid production, hiatal hernia, and obesity. [7] GastroparesisThe most common etiologies of gastroparesis noted in tertiary care centers include idiopathic (36%), diabetes mellitus (29%), and postsurgical (13%). [8] Less common etiologies include postviral and opioid-induced gastroparesis. Rare causes include paraneoplastic syndrome, Parkinson disease, amyloidosis, and scleroderma. Biliary dyskinesiaThe exact etiology of biliary dyskinesia is unknown. Irritable bowel syndromeThe causes of irritable bowel syndrome (IBS) remain unknown. According to some reports, the small intestine and colon of patients with IBS are more sensitive and reactive to mild stimuli than usual. IBS may be related to the immature status of muscles and nerves in the intestinal wall of affected persons. Colonic inertiaThe underlying etiology of colonic inertia appears to be dysfunction of the enteric nerve plexus. It has been suggested that patients have a decreased number or complete absence of interstitial cells of Cajal. [9] Intestinal pseudo-obstruction (Ogilvie syndrome)The exact etiology of acute colonic pseudo-obstruction is unknown. It has been hypothesized that a dysregulation of nerve impulses in the enteric nervous system results in a large bowel obstruction without an actual physical obstruction. The inciting event is most commonly postsurgical, cardiopulmonary conditions, metabolic disorders, and trauma, among many other reported causes. [10] Pelvic floor dyssynergiaPelvic floor dyssynergia and pelvic floor dysfunction are caused by impaired relaxation of the external anal sphincter, impaired relaxation of the puborectalis muscle, or decreased propulsion of stool through the colon. Similar to other motility disorders, there is an underlying dysfunction of nerve conduction. Defecation specifically involves coordination of the enteric, parasympathetic, and sympathetic nervous systems. Hirschsprung diseaseHirschsprung disease is a congenital disorder that results from absence of ganglion cells in a portion of the colon, most commonly the rectosigmoid colon. This is caused by a failure of neural crest cells to migrate during fetal development. Several genetic mutations have also been found to be associated with Hirschsprung disease. [11] Fecal incontinenceAging, dementia, stroke, Parkinson disease, spinal cord injuries, rectal tears during birthing, diabetes, surgical complications, and neuromuscular disorders (eg, myasthenia gravis) may cause fecal incontinence. Occasionally, fecal incontinence may occur after ingestion of certain foods. Sugars, insoluble fibers, and starches (except rice) are broken down in the intestines, forming a variable amount of gas that must be expelled. Most people who have lactase deficiency cannot digest lactose, a sugar common in several foods (eg, milk, cakes). People who have lactose deficiency may experience uncontrolled liquid diarrhea after lactose ingestion. ConstipationConstipation commonly has several causes, either primary or secondary. The most frequent of these are the following:
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PathophysiologyCoordinated movements of the stomach and intestines are required to digest and propel intestinal contents along the digestive tract. The complex patterns of contraction and relaxation necessary for proper motility of the gastrointestinal (GI) tract are generated in the nerves and muscles within the GI walls. Every day, at any time, many factors can influence GI motility (eg, physical exercise, emotional distress). The pathogenesis of primary intestinal motility disorders probably is multifactorial, but neither biochemical abnormality nor structural abnormality has been demonstrated commonly, except in some forms of intestinal pseudo-obstruction. More recently, there is evidence that low-grade mucosal inflammation and immune activation (particularly with mast cell involvement) in association with impaired epithelial barrier function and aberrant neuronal sensitivity may play a role in functional GI disorders. [12] Although the overall structural organization is similar throughout the digestive tract, each part has distinct motor activities. The musculature of the digestive tract has either extrinsic innervation (both sympathetic and parasympathetic) or intrinsic innervation (Auerbach plexus or myenteric plexus). Intrinsic innervation is fundamental to coordinating GI motor activity. A neural network branching between longitudinal and circular muscle layers of the GI tract constitutes intrinsic innervation. Another nervous intrinsic plexus in the GI tract (Meissner plexus or submucosal plexus) helps to modify mucosal absorption and secretion without influencing motility. Random, unorganized motor activity with occasional peristaltic and antiperistaltic complexes occurs during feeding, and this allows gastric remixing of foods. After this, another motor activity occurs, which is more regular, and this begins the peristaltic waves (ie, contractions of the circular musculature of the small intestine) that allow progression of undigested food through the intestines. These events happen because the gastric pacemaker area, which originates electric slow waves with a frequency of 3 cycles per minute, occurs at the junction between the body and the antrum of the stomach. These electric waves, called migrating myoelectric complexes, determine the frequency of muscular contractions in the antral and pyloric areas through electromechanical coupling. Migrating myoelectric complexes regulate gastric emptying and move gastric contents distally. Every 90 minutes, a cluster of migrating myoelectric complexes arises in the stomach and migrates distally beyond the ileum. Vagal function and the release of nitric oxide, vasoactive intestinal polypeptide, motilin, and nutrients of the meal and other enterohormones also affect GI motility. Knowles and Martin attempted to define a novel classification for intestinal motility disorders, [13] in which these conditions are categorized as well-defined entities, entities with a variable dysfunction-symptom relation, questionable entities, and entities associated with behavioral disorders. Well-defined entities in the Knowles-Martin classification include the following:
Entities with a variable dysfunction-symptom relation include the following:
Questionable entities include the following:
Entities associated with behavioral disorders include the following:
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EpidemiologyAccording to some epidemiologic reports, as many as 30 million Americans have intestinal motility disorders. Available data from the medical literature indicate that worldwide, 30-45% of all gastrointestinal conditions are referable to intestinal motility disorders. When intestinal motility disorders are idiopathic and not related to either malignancies or systemic diseases, morbidity is minimal and mortality from complications is low (1-1.5%); complications usually occur in patients with intestinal pseudo-obstruction. Persons of any age group may be affected, depending on the specific intestinal motility disorder. For example, IBS occurs more frequently in people aged 20-40 years, whereas intestinal pseudo-obstruction may occur in either newborns or elderly patients. Most patients are female, with a female-to-male ratio of 2.8:1. Primary intestinal motility disorders are most common in white persons and are usually thought to be related to diet.
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PrognosisPrimary intestinal motility disorders or disorders that are not secondary to malignancy or debilitating pathology have a good prognosis. According to many reports, the prognosis is excellent for patients with irritable bowel syndrome and mild fecal incontinence. The prognosis is worse for patients with intestinal pseudo-obstruction, which has a high mortality. ComplicationsComplications of intestinal motility disorders vary greatly, depending on the specific type of disorder under consideration. Intestinal pseudo-obstruction is often associated with a high mortality (15-30%), in most cases due to delayed diagnosis. Constipation may have a severe complication, impaction. If this condition is not recognized early, the patient may die. Impaction is the collection of dry and hardened feces in the rectum or colon. Symptoms of impaction may be similar to those of constipation or may be unrelated to the gastrointestinal system. If abdominal distention occurs, movements of the diaphragm are compromised and cause insufficient aeration with subsequent hypoxia and left ventricular dysfunction. In addition, hypoxia can precipitate angina or tachycardia. When a vasovagal response begins, the patient may have hypotension. Patients with impaction may experience vomiting, diarrhea, and resultant dehydration. They may present in an acutely confused and disoriented state, with tachycardia, fever, and altered blood pressure. Irritable bowel syndrome is not usually associated with complications. Fecal incontinence may cause psychological problems in affected patients.
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Patient EducationPatients with intestinal motility disorders must be educated in ways of coping with their condition and instructed to avoid any situation or substance that may cause the symptoms to worsen. Psychological counseling may be helpful. Patient support groups, such as the Association of Gastrointestinal Motility Disorders, Cyclic Vomiting Syndrome Association, Gastroparesis Patient Association for Cures and Treatment, International Foundation for Gastrointestinal Disorders, and IBS Patient Support Group provide advice, information, educational meetings, and psychological support to patients and their families.
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References
Disclaimer: This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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Contributor Information and DisclosuresAuthor
Mia L Manabat, DO Gastroenterologist, Aurora Health Care
Coauthor(s)
Michael H Piper, MD Clinical Assistant Professor, Department of Internal Medicine, Division of Gastroenterology, Wayne State University School of Medicine; Consulting Staff, Digestive Health Associates, PLC
Chief Editor
Burt Cagir, MD, FACS Associate Regional Dean and Professor of Surgery, Geisinger Commonwealth School of Medicine; Director, General Surgery Residency Program, Executive Director, Donald Guthrie Foundation for Research and Education, Guthrie Robert Packer Hospital; Medical Director, Guthrie/RPH Skills and Simulation Lab; Associate in Surgery, Guthrie Robert Packer Hospital and Corning Hospital
Additional Contributors
Vivek V Gumaste, MD Associate Professor of Medicine, Mount Sinai School of Medicine of New York University; Adjunct Clinical Assistant, Mount Sinai Hospital; Director, Division of Gastroenterology, City Hospital Center at Elmhurst; Program Director of GI Fellowship (Independent Program); Regional Director of Gastroenterology, Queens Health Network
Nafisa Kuwajerwala Goswami, MD Staff Surgeon, Breast Care Center, William Beaumont Hospital
Luigi Santacroce, MD Assistant Professor, Medical School, State University at Bari, Italy
Venkata Subramanian Kanthimathinathan, MD Fellow in Bariatric/Advanced Laparoscopic Surgery, University of Missouri Healthcare
Acknowledgements
Silvia Gagliardi, MD Consulting Staff, Department of Surgery, Medical Center Vita, Italy Disclosure: Nothing to disclose. Douglas M Heuman, MD, FACP, FACG, AGAF Chief of GI, Hepatology, and Nutrition at North Shore University Hospital/Long Island Jewish Medical Center; Professor, Department of Medicine, Hofstra North Shore-LIJ School of Medicine Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, and American Gastroenterological Association Disclosure: Novartis Grant/research funds Other; Bayer Grant/research funds Other; Otsuka Grant/research funds None; Bristol Myers Squibb Grant/research funds Other; Scynexis None None; Salix Grant/research funds Other; MannKind Other Sandeep Mukherjee, MB, BCh, MPH, FRCPC Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center Sandeep Mukherjee, MB, BCh, MPH, FRCPC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada Disclosure: Merck Honoraria Speaking and teaching; Ikaria Pharmaceuticals Honoraria Board membership Shivkumar Prabhu, MD Consulting Staff, Department of Internal Medicine, St John Detroit Riverview Hospital Disclosure: Nothing to disclose. Daniel Schafer Department of Surgery, University of Nebraska Medical Center Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment
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