Chronic intestinal pseudo-obstruction (CIP) is a rare and highly morbid syndrome characterised by impaired gastrointestinal propulsion together with symptoms and signs of bowel obstruction in the absence of any lesions occluding the gut lumen (tumours, adhesive peritonitis, and so on). 1 CIP is thought to have two forms: myogenic and neurogenic. 1 Comorbid urinary retention may also occur. 2 Postural hypotension is not a feature in CIP. However, we recently had such a CIP patient with profound postural hypotension, which was detected only by a head up tilt test, and he was finally diagnosed as pure autonomic failure (PAF).