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Signs and Symptoms of Tube Feeding Intolerance: What to Know
Drew Sutton

Fact Checked

By Drew Sutton, Drew Sutton | MD

Last Updated on December 11th, 2023

Geriatric Nutrition

Signs and Symptoms of Tube Feeding Intolerance: What to Know

Your healthcare team made a careful decision to put you or your loved one on tube feeding. This means that you need help to keep up with proper nutrition. Before making this choice, your doctor considered your current and prior medical conditions. They also analyzed how well you could feed yourself. 

The most common reason to put a feeding tube in a person is a neurological (brain-related) disease such as stroke. But there are many other reasons. 

If you’re experiencing a hard time with tube feeding intolerance, you’re not alone. The transition to tube feeding and managing feeding tube issues in older adults can be challenging for anyone, families, and caregivers. The process can make you self-conscious. It can also be uncomfortable and embarrassing. 

A feeding tube can stay in place for as long as needed, but in many cases, it’s for life. There are many other details about tube feeding and tube feeding intolerance. That’s why education for families on tube feeding care is essential.

Some people experience something called tube feeding intolerance. You may hear your healthcare provider refer to it as enteral feeding intolerance. There’s no clear, widely accepted definition of tube feeding intolerance, and managing it can be difficult. Tube feeding intolerance comes with several possible gastrointestinal symptoms. These include diarrhea, nausea and vomiting, and bloating. 

If you or your loved one is experiencing tube feeding intolerance, this article will help you learn more about its signs and symptoms and how to create comfortable solutions. The section on managing feeding tube issues in older adults will also give you tips to ensure adequate at-home care for older adults. 

Understanding Tube Feeding in Older Adults

Most tube feeding is done through a gastrostomy tube (G-tube) placed by a qualified doctor. It involves using surgery to place a tube directly into the stomach. 

Tube feeding replaces your food and can be used to give you medications. Your surgeon will put your G-tube through your skin (percutaneous) using lighted tubes with cameras (endoscopes) and X-rays. It’s safe to get a G-tube. Your procedure usually has minimal complications.1 

Your surgeon will administer local anesthetics such as lidocaine into your skin to make the procedure painless. In most cases, your surgeon will insert the feeding tube in less than an hour with you lying back in a comfortable position.

The nutrition you will receive will replace your regular nutrition or a specialized prescribed diet. It will promote overall health, including joint health. Your doctor can adjust the tube feeding for various dietary needs and illnesses. They can also insert medications in liquid form or crushed pills. 

What are the Signs and Symptoms of Tube Feeding Intolerance in Older Adults?

You may feel sick from tube feeding or not get the nutrition you need from tube feeding. That is intolerance, too, since your body may not be accepting the replacement. You can think of tube feeding intolerance as not being able to be fed.

The most common gastrointestinal signs and symptoms you may have include:

  • Nausea & vomiting
Old man feeling Nausea

  • Abdominal distension (fullness)
Man feeling abdominal distension

  • Abdominal pain
Women holding her Stomach

  • Diarrhea or constipation
Doctor holding Intestine dummy

To manage your tube feeding intolerance, you will need a nutritional support team. Your team may include the following professionals:

  • Clinicians
  • Nutritional nurse specialists
  • Dieticians
  • Pharmacists 

Studies have shown that there can be increased efficacy and safety with a team approach.2 

Your clinician will decide on the best feeding regime. Your nutritional nurse specialist will teach you and your family. Both can help determine whether you are merely adjusting to the tube feeding or suffering from intolerance.

Your nurse will supervise the use of the tube while monitoring for potential problems. Your nurse will also work with the clinician to solve those problems. Your dietician will evaluate what nutrition you will need, including fluids. Your pharmacist will work to make sure you are on the right tube feeding and there are no problems with taking your medications with it.

What Causes Tube Feeding Intolerance in Older Adults?

Tube Fedding drawbacks

There are several causes of tube feeding intolerance. Many are interrelated. 

1. Motion

Your nerves act as the power source. Nerves are controlled by your brain and hormones produced by glands. The hormones that help you tolerate tube feeding range from those that speed up or slow down your gut.

Sometimes, tube feeding will cause your stomach and intestines to not function properly. This is called disordered GI motility. 

The primary goal of the gastrointestinal (GI) system is for food and liquids to get from one place to another. Your body will do this by using muscles (voluntary and involuntary) and nerves. 

Your doctor may prescribe medications such as an antibiotic called erythromycin to help you. The type of medication will be dependent on you, your doctor, and the circumstances.

2. Drugs and Illness

If you are like most people, you may already be on medications when you need tube feeding. These medications can affect your ability to tolerate tube feedings. 

You may also be on medications for a condition, such as an infection like pneumonia, and they may affect how your tube feedings work. 

3. Emptying of the stomach 

How well your stomach empties can determine whether your tube feeding is working. Your nurse will monitor how much tube feeding is left in your stomach during and after feeding.

Your stomach muscle contractions may be weaker and slower than regular stomach contractions.3 You may experience symptoms such as fullness, nausea, and vomiting.

Your doctor will help decide what the problem may be with your tube feeding. It may be related to your stomach, intestines, or both.

4. Diarrhea

Tube feeding may cause you to have diarrhea — a sign of poor gastrointestinal function. Diarrhea can cause malnutrition because it doesn’t allow the tube’s nutrients to be adequately absorbed.

You may have other possible causes of diarrhea, of course. These reasons may include medications, underlying illness, and liver and pancreas dysfunction. Your doctor considers these factors when treating tube feeding complications in the elderly.

Unfortunately, there is no best tool for measuring how well your body absorbs tube feedings. But doctors know that having diarrhea means you are not getting enough nutrition (due to the tube feeding leaving your body without proper digestion).

5. Psychological stress

Signs and symptoms of tube feeding intolerance in older adults can cause psychological stress. You are not alone in these feelings. Your emotional strain can impact how your gastrointestinal system works, too. Having the right support system is key to overcoming these issues.

How to Treat and Manage Tube Feeding Intolerance

Tube feeding intolerance can be a serious concern, particularly if you suffer from another illness. 

Fortunately for most people, tube-feeding intolerance can be managed. Your treatment may include the following recommendations:

  • Slow or stop the tube feedings until comfortable
  • Slow down the tube feeding rate
  • Sit upright at a 45-degree angle
  • Try a different formula
  • Make sure you use the proper amount of tube-feeding formula
  • Never use a formula that you’ve opened and left at room temperature for longer than recommended
  • Proper hand washing and cleaning of supplies
  • Replace tube feeding equipment as recommended
  • Consider increasing the amount of water added to the feeding tube
  • Increase daily activity

Your physician may recommend a medication known as a prokinetic agent. Prokinetic means the drug will promote movement in the gut. 

Prokinetic agents act on the nervous system and come in various forms. A common medication is metoclopramide (Reglan). Always check with your healthcare provider about your situation and whether this or other medications are right for you.

Don’t neglect the emotional strain of tube feeding intolerance. Your healthcare team can offer strategies to deal with the stress and potential embarrassment.

For Caregivers and Families

Managing feeding tube issues in older adults is best accomplished by a team approach. Using the best supplies available and meticulous hygiene is highly recommended. 

Many support groups, such as ASPEN (American Society for Parenteral and Enteral Nutrition), can provide education and resources for patients and families. It is important to know that people who rely on tube feeding are not alone. Help and advice is always available.

Caregivers and families can help make sure you or your loved one has the best chance of the tube feeding working. They can help with the following:

  • Checking the feeding tube and feeding set to make sure there are no kinks, bends, or defects
  • Flushing the tube with warm sterile water before and after administration of medications and after feeding
  • Absolutely no pureed foods or liquids should be given through the tube unless authorized by a healthcare provider
  • No mixing of anything into the formula without consultation or recommendation of a healthcare professional
  • Medicines should be administered by liquid or finely crushed powder
  • If the tube appears to be clogged, do not try to unblock it without consulting an expert
  • If the tube falls out, never try to reinsert it. Instead, cover the opening with a clean bandage and consult with your healthcare provider.

Preventing Complications of Tube Feeding and Enhancing Quality of Life

The best way to prevent complications is to know what to look for and be proactive. If you are just starting tube feeding, it will take days or even weeks to adjust to both the formula and life adjustment. 

Tube feeding intolerance can fluctuate with unpredictable and unpleasant symptoms. These can vary from mild feelings of bloating or discomfort to vomiting or diarrhea, or worse. 

You should try simple changes first, such as changing positions or increasing daily activity. Adapting to the lifestyle changes of tube feeding is the goal.

When to Seek Professional Help

You should never hesitate to ask about your tube feedings, discuss concerns, and let others know how you feel. Often, your healthcare provider or team can offer very helpful tips.

You and your family need to learn how to recognize red flags and know what to look for before calling the doctor. If you have doubts, getting advice from a professional is always best. 

Also equally important is maintaining a strong support system. This includes families, friends, neighbors, and caregivers. 


Knowing help is available when you have signs or symptoms of tube feeding intolerance can be as important as any treatment.

Older adults who rely on tube feeding should know the signs and symptoms of tube feeding intolerance and when to seek professional help.

Managing tube feeding issues in the elderly should have a team approach. This includes your healthcare team, family, friends, and neighbors.

Education, awareness, and proactive care are the cornerstones of good tube-feeding care.


    1. Philipose J, Gurala D, Polavarapu AD, Idiculla PS, Gumaste V. A Novel Approach to Percutaneous Endoscopic Gastrostomy Tube Replacement: Can You Save the Site? Cureus. 2021;13(12):e20718. Published 2021 Dec 26. doi:10.7759/cureus.20718

    1. Ortiz-Reyes LA, Castillo-Martinez L, Lupian-Angulo AI, Yeh DD, Rocha-Gonzalez HI, Serralde-Zuniga AE. Increased Efficacy and Safety of Enteral Nutrition Support with a Protocol (ASNET) in Noncritical Patients: A Randomized Controlled Trial. J Acad Nutr Diet. 2018 Jan. 118 (1):52-61. Published: December 20, 2017DOI:

    1. Yasuda H, Kondo N, Yamamoto R, et al. Monitoring of gastric residual volume during enteral nutrition. Cochrane Database Syst Rev. 2021;9(9):CD013335. Published 2021 Sep 27. doi:10.1002/14651858.CD013335.pub2

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Drew Sutton

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Drew Sutton

Drew Sutton | MD

Drew Sutton is a retired ENT doctor who now lives in the Southeastern US. He was an American Academy of Otolaryngology member and a Fellow of the American College of Surgeons. He earned his bachelor’s degrees in biology and psychology from Rice University and an MD from the University of Rochester. In addition, he completed his internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at the University of Rochester. For almost 30 years, Dr. Sutton practiced in all aspects of ENT, including specializing in disorders of the ear and skull base. He is passionate about communicating his clinical experiences and making his knowledge more accessible to the general public.

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