Visible peristaltic waves are rolling movements across the abdomen caused by increased strength and frequency of intestinal contractions. They often indicate intestinal obstruction, as the gut tries to push contents past the blockage. These waves appear suddenly and disappear as either the obstruction is overcome or the bowel becomes atonic.

They’re best detected by stooping at the patient’s side and observing the abdominal contour while the patient lies supine.

History and Physical Examination

History

• Ask about previous conditions predisposing to obstruction:

  • Pyloric ulcer, stomach cancer, chronic gastritis → pyloric obstruction

  • Intestinal tumors, polyps, gallstones, chronic constipation, hernias

• Enquire about recent abdominal surgery or adhesions.

• Obtain a drug history (constipating medications, e.g., antipsychotics, antidepressants).

• Characterize symptoms:

  • Pain – spasmodic (small bowel), colicky (pyloric).

  • Vomiting – note amount, color, consistency (undigested food, bile, fecal material).

  • Other – anorexia, weight loss, distention.

Physical Examination

• Inspect abdomen (supine): note distention, scars, adhesions, or visible loops of bowel.

• Auscultate: high-pitched, “tinkling” bowel sounds.

• Perform succussion splash (gently jar the bed or roll the patient) for pyloric obstruction.

• Palpate for rigidity, tenderness; percuss for tympany.

• Assess hydration (skin turgor, mucous membranes).

• Check vital signs for tachycardia or hypotension (hypovolemia).

Medical causes

Special considerations

• Visible peristalsis is an early sign of obstruction — monitor closely.

• Keep the patient NPO (nothing by mouth) pending evaluation.

• Prepare for abdominal X-rays, ultrasound, or barium studies.

• If obstruction is confirmed, insert a nasogastric tube for decompression.

• Maintain oral hygiene; monitor for dehydration (dry tongue, mucosa).

• Record vital signs and intake/output frequently.

Patient counseling

• Explain dietary/fluid recommendations once obstruction is resolved.

• Encourage stool softeners and high-fiber foods for chronic constipation.

• Stress early reporting of persistent vomiting, colicky pain, or distention.

Pediatric pointers

• Infants: visible waves may signal pyloric stenosis.

• Children: may be normal with protuberant abdomen or indicate obstruction (volvulus, congenital anomaly, foreign body).

Geriatric pointers

• Always check for fecal impaction in elderly patients.

• Review constipating medications (e.g., tricyclics, antipsychotics).

References

• Buttaro, T. M., Tybulski, J., Bailey, P. P., & Sandberg-Cook, J. (2008). Primary Care: A Collaborative Practice (pp. 444–447). St. Louis, MO: Mosby Elsevier.

• Colyar, M. R. (2003). Well-Child Assessment for Primary Care Providers. Philadelphia, PA: F.A. Davis.

• McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2010). Pathophysiology: The Biologic Basis for Disease in Adults and Children. Maryland Heights, MO: Mosby Elsevier.

• Sommers, M. S., & Brunner, L. S. (2012). Pocket Diseases. Philadelphia, PA: F.A. Davis.