Abdominal distension

Abdominal distension occurs when substances, such as air (gas) or fluid, accumulate in the abdomen causing its expansion.[1] It is typically a symptom of an underlying disease or dysfunction in the body, rather than an illness in its own right. People with this condition often describe it as "feeling bloated". Affected people often experience a sensation of fullness, abdominal pressure, and sometimes nausea, pain, or cramping. In the most extreme cases, upward pressure on the diaphragm and lungs can also cause shortness of breath. Through a variety of causes (see below), bloating is most commonly due to buildup of gas in the stomach, small intestine, or colon. The pressure sensation is often relieved, or at least lessened, by belching or flatulence. Medications that settle gas in the stomach and intestines are also commonly used to treat the discomfort and lessen the abdominal distension.

Abdominal distension
Massive abdominal distension caused by liver cirrhosis leading to fluid buildup.
SpecialtyGastroenterology
Causesa variety of causes; most commonly due to buildup of gas in the stomach, small intestine, or colon

Causes

One of the causes of abnormal bloating is excessive eating and air swallowing, known as aerophagia.[2] Other causes of bloating and distension include inflammatory bowel diseases such as Crohn's disease[3][4] and ulcerative colitis, irritable bowel syndrome, diabetes, functional dyspepsia, or transient constipation. In rare cases, bloating may occur in individuals who have milk intolerance (lactose intolerance), parasite infections such as giardia, food poisoning (bacteria), celiac disease, severe peptic ulcer disease, bowel obstruction, or after certain types of abdominal surgery.[5]

Heart failure and cirrhosis are also a common cause of distension. In both of these disorders, fluid accumulates in the abdomen and creates a sensation of fullness. Abdominal distension can also be a symptom of ovarian cancer. Women are more prone to bloating and often identify these symptoms during menstruation.[6] Some individuals who develop distension may have either poor motility of their intestines or may be hypersensitive to gut sensations.[7] Certain medications, such as antidepressants and anti-spasmodics, can contribute to reduced gut motility. Studies have shown that swallowing air during eating or delayed emptying of the stomach from hyperacidity leads to bloating after a meal. Individuals who are constipated also complain of bloating. In some individuals who are hypersensitive, any volume of air may be perceived as fullness and there may not be actual abdominal distension.[8][9]

Abdominal distension (or "distended abdomen") can be a sign of many other conditions, including:

Persistent or recurrent bloating may be caused by intestinal parasites, other infections, or other medical conditions.

Diagnosis

The first step in diagnosis is to determine the etiology of abdominal distension. After making a differential diagnosis of abdominal distension, it is important to take a careful medical history.[10]

Here are the most common causes of abdominal distension classified as an underlying cause and as a secondary disease.

As an underlying disease cause:

  • Constipation
  • Lactose intolerance and other food intolerances
  • Overeating (due to overproduction of gases in the digestion process)

As a secondary disease cause:

  • Celiac disease
  • GERD (gastroesophageal reflux disease)
  • Peptic ulcer disease
  • Accumulation of fluid in the peritoneal cavity (e.g., ascites)

Treatment

Bloating is not life-threatening. In most cases, bloating can be handled with simple home remedies and changes in lifestyle.[11]

Foods

Certain foods have been known to worsen bloating. Poorly digested components of many foods are excreted into the large intestine where they are degraded by bacteria, producing excess gas. Depending on the undigested component, this may affect the odor and the volume of gas created.[12]

Excess dietary fiber intake is a known cause of belching, gas and bloating. Many vegetables are known to cause bloating due to high levels of fiber and undigestible sugars such as raffinose (e.g., beans, cabbage, broccoli).[13]

There are many individuals who are unable to tolerate dairy products because of lactose intolerance. Such foods should be eliminated from the diet if symptoms develop.[14]

Medications

For some people, recurrent distension symptoms worsen their quality of life and thus many resort to health supplements or medications. Dietary supplements containing various enzymes, for example Beano, are formulated to help break down complex carbohydrates and vegetables in order to reduce substances in the gut that cause bacterial overgrowth and subsequent bloating. Though these enzymes can help reduce gas and belching, they may not always reduce bloating.[15]

Other over-the-counter formulas recommended for bloating include simethicone and activated charcoal. Probiotics are also used to treat bloating based on the theory that improved gut flora will improve digestion and lessen gas generation.[16]

See also

References
  1. "Intestinal gas, belching, bloating and flatulence". MedicineNet. 2010-01-27.
  2. de Jesus, Lisieux Eyer; Cestari, Ana Beatriz C.S.S.; da Silva, Orli Carvalho; Fernandes, Marcia Antunes; Firme, Livia Honorato (2015). "Pathologic aerophagia: a rare cause of chronic abdominal distension". Revista Paulista de Pediatria. 33 (3): 371–375. doi:10.1016/j.rpped.2015.01.003. ISSN 0103-0582. PMC 4620966. PMID 26100594.
  3. Götz, Vera Nina (December 2013). "Crohn's disease—What the medical registrar and acute physician needs to know!". Journal of Acute Medicine. 3 (4): 132–137. doi:10.1016/j.jacme.2013.10.001.
  4. Nóbrega, Viviane Gomes; Silva, Isaac Neri de Novais; Brito, Beatriz Silva; Silva, Juliana; Silva, Maria Carolina Martins da; Santana, Genoile Oliveira (September 2018). "The Onset of Clinical Manifestations in Inflammatory Bowel Disease Patients". Arquivos de Gastroenterologia. 55 (3): 290–295. doi:10.1590/S0004-2803.201800000-73. PMID 30540094.
  5. Xavier, Ramnik J; Thomas, Harry J (2013). "Gastrointestinal Diseases". Hunter's Tropical Medicine and Emerging Infectious Disease: 18–27. doi:10.1016/B978-1-4160-4390-4.00003-5. ISBN 9781416043904. PMC 7173482.
  6. American College of Gastroenterology. "Belching, Bloating and Flatulence" 2010-01-27.
  7. Goldfinger, Stephen E, MD. "Gas and bloating overview" 2010-01-27.
  8. "Abdominal Distension (Distended Abdomen)". Cleveland Clinic.
  9. "Abdominal Distension". medindia.net. November 3, 2014.
  10. Mari, Amir; Abu Backer, Fadi; Mahamid, Mahmud; Amara, Hana; Carter, Dan; Boltin, Doron; Dickman, Ram (2019). "Bloating and Abdominal Distension: Clinical Approach and Management". Advances in Therapy. 36 (5): 1075–1084. doi:10.1007/s12325-019-00924-7. ISSN 0741-238X. PMC 6824367. PMID 30879252.
  11. "Abdominal bloating: Causes, symptoms and remedies". www.medicalnewstoday.com. 2022-05-27. Retrieved 2022-11-29.
  12. Hasler, William L. (2006). "Gas and Bloating". Gastroenterology & Hepatology. 2 (9): 654–662. ISSN 1554-7914. PMC 5350578. PMID 28316536.
  13. "Gas in the Digestive Tract – National Digestive Diseases Information Clearinghouse". Digestive.niddk.nih.gov. Archived from the original on 2014-10-11. Retrieved 2014-01-22.
  14. Szilagyi, Andrew; Ishayek, Norma (2018-12-15). "Lactose Intolerance, Dairy Avoidance, and Treatment Options". Nutrients. 10 (12): 1994. doi:10.3390/nu10121994. ISSN 2072-6643. PMC 6316316. PMID 30558337.
  15. Celleno, Leonardo; Tolaini, Maria Vittoria; D'Amore, Alessandra; Perricone, Nicholas V.; Preuss, Harry G. (2007-01-24). "A Dietary supplement containing standardized Phaseolus vulgaris extract influences body composition of overweight men and women". International Journal of Medical Sciences. 4 (1): 45–52. doi:10.7150/ijms.4.45. ISSN 1449-1907. PMC 1796956. PMID 17299581.
  16. Lacy, Brian E.; Gabbard, Scott L.; Crowell, Michael D. (2011). "Pathophysiology, Evaluation, and Treatment of Bloating". Gastroenterology & Hepatology. 7 (11): 729–739. ISSN 1554-7914. PMC 3264926. PMID 22298969.
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