Abdominal distension

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

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.

Contents

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]

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.[ citation needed ]

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. [9]

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

As an underlying disease cause:

As a secondary disease cause:

Treatment

Bloating is not life-threatening. In most cases, bloating can be handled with simple home remedies and changes in lifestyle. [10]

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. [11]

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). [12]

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. [13]

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. [14]

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. [15]

See also

Related Research Articles

Flatulence is the expulsion of gas from the intestines via the anus, commonly referred to as farting. "Flatus" is the medical word for gas generated in the stomach or bowels. A proportion of intestinal gas may be swallowed environmental air, and hence flatus is not entirely generated in the stomach or bowels. The scientific study of this area of medicine is termed flatology.

<span class="mw-page-title-main">Lactose intolerance</span> Inability to digest lactose

Lactose intolerance is caused by a lessened ability or a complete inability to digest lactose, a sugar found in dairy products. Humans vary in the amount of lactose they can tolerate before symptoms develop. Symptoms may include abdominal pain, bloating, diarrhea, flatulence, and nausea. These symptoms typically start thirty minutes to two hours after eating or drinking something containing lactose, with the severity typically depending on the amount consumed. Lactose intolerance does not cause damage to the gastrointestinal tract.

<span class="mw-page-title-main">Crohn's disease</span> Type of inflammatory bowel disease

Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract. Symptoms often include abdominal pain, diarrhea, fever, abdominal distension, and weight loss. Complications outside of the gastrointestinal tract may include anemia, skin rashes, arthritis, inflammation of the eye, and fatigue. The skin rashes may be due to infections as well as pyoderma gangrenosum or erythema nodosum. Bowel obstruction may occur as a complication of chronic inflammation, and those with the disease are at greater risk of colon cancer and small bowel cancer.

<span class="mw-page-title-main">Defecation</span> Expulsion of feces from the digestive tract

Defecation follows digestion, and is a necessary process by which organisms eliminate a solid, semisolid, or liquid waste material known as feces from the digestive tract via the anus or cloaca. The act has a variety of names ranging from the common, like pooping or crapping, to the technical, e.g. bowel movement, to the obscene (shitting), to the euphemistic, to the juvenile. The topic, usually avoided in polite company, can become the basis for some potty humor.

<span class="mw-page-title-main">Constipation</span> Bowel dysfunction

Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass. The stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement. Complications from constipation may include hemorrhoids, anal fissure or fecal impaction. The normal frequency of bowel movements in adults is between three per day and three per week. Babies often have three to four bowel movements per day while young children typically have two to three per day.

<span class="mw-page-title-main">Irritable bowel syndrome</span> Functional gastrointestinal disorder

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by a group of symptoms that commonly include abdominal pain, abdominal bloating and changes in the consistency of bowel movements. These symptoms may occur over a long time, sometimes for years. IBS can negatively affect quality of life and may result in missed school or work or reduced productivity at work. Disorders such as anxiety, major depression, and chronic fatigue syndrome are common among people with IBS.

<span class="mw-page-title-main">Stomach rumble</span> Noise produced by gastrointestinal system

A stomach rumble, also known as a bowel sound, peristaltic sound, abdominal sound, bubble gut or borborygmus, is a rumbling, growling or gurgling noise produced by movement of the contents of the gastrointestinal tract as they are propelled through the small intestine by a series of muscle contractions called peristalsis. A trained healthcare provider can listen to these intestinal noises with a stethoscope, but they may be audible enough to be heard with the naked ear as the fluid and gas move forward in the intestines. The lack of bowel sounds is indicative of ileus, intestinal obstruction, or some other serious pathology.

<span class="mw-page-title-main">Abdominal pain</span> Stomach aches

Abdominal pain, also known as a stomach ache, is a symptom associated with both non-serious and serious medical issues. Since the abdomen contains most of the body's vital organs, it can be an indicator of a wide variety of diseases. Given that, approaching the examination of a person and planning of a differential diagnosis is extremely important.

<span class="mw-page-title-main">Fructose malabsorption</span> Medical condition

Fructose malabsorption, formerly named dietary fructose intolerance (DFI), is a digestive disorder in which absorption of fructose is impaired by deficient fructose carriers in the small intestine's enterocytes. This results in an increased concentration of fructose. Intolerance to fructose was first identified and reported in 1956.

<span class="mw-page-title-main">Malabsorption</span> Medical condition

Malabsorption is a state arising from abnormality in absorption of food nutrients across the gastrointestinal (GI) tract. Impairment can be of single or multiple nutrients depending on the abnormality. This may lead to malnutrition and a variety of anaemias.

<span class="mw-page-title-main">Small intestinal bacterial overgrowth</span> Medical condition

Small intestinal bacterial overgrowth (SIBO), also termed bacterial overgrowth, or small bowel bacterial overgrowth syndrome (SBBOS), is a disorder of excessive bacterial growth in the small intestine. Unlike the colon, which is rich with bacteria, the small bowel usually has fewer than 100,000 organisms per millilitre. Patients with bacterial overgrowth typically develop symptoms which may include nausea, bloating, vomiting, diarrhea, malnutrition, weight loss and malabsorption, which is caused by a number of mechanisms.

<span class="mw-page-title-main">Short bowel syndrome</span> Medical condition

Short bowel syndrome is a rare malabsorption disorder caused by a lack of functional small intestine. The primary symptom is diarrhea, which can result in dehydration, malnutrition, and weight loss. Other symptoms may include bloating, heartburn, feeling tired, lactose intolerance, and foul-smelling stool. Complications can include anemia and kidney stones.

<span class="mw-page-title-main">Toxic megacolon</span> Potentially lethal large intestine emergency

Toxic megacolon is an acute form of colonic distension. It is characterized by a very dilated colon (megacolon), accompanied by abdominal distension (bloating), and sometimes fever, abdominal pain, or shock.

Food intolerance is a detrimental reaction, often delayed, to a food, beverage, food additive, or compound found in foods that produces symptoms in one or more body organs and systems, but generally refers to reactions other than food allergy. Food hypersensitivity is used to refer broadly to both food intolerances and food allergies.

Abdominal bloating is a short-term disease that affects the gastrointestinal tract. Bloating is generally characterized by an excess buildup of gas, air or fluids in the stomach. A person may have feelings of tightness, pressure or fullness in the stomach; it may or may not be accompanied by a visibly distended abdomen. Bloating can affect anyone of any age range and is usually self-diagnosed, in most cases does not require serious medical attention or treatment. Although this term is usually used interchangeably with abdominal distension, these symptoms probably have different pathophysiological processes, which are not fully understood.

<span class="mw-page-title-main">Sucrose intolerance</span> Medical condition

Sucrose intolerance or genetic sucrase-isomaltase deficiency (GSID) is the condition in which sucrase-isomaltase, an enzyme needed for proper metabolism of sucrose (sugar) and starch, is not produced or the enzyme produced is either partially functional or non-functional in the small intestine. All GSID patients lack fully functional sucrase, while the isomaltase activity can vary from minimal functionality to almost normal activity. The presence of residual isomaltase activity may explain why some GSID patients are better able to tolerate starch in their diet than others with GSID.

Chronic diarrheaof infancy, also called toddler's diarrhea, is a common condition typically affecting up to 1.7 billion children between ages 6–30 months worldwide every year, usually resolving by age 4. According to the World Health Organization (WHO), diarrheal disease is the second greatest cause of death in children 5 years and younger. Diarrheal disease takes the lives of 525,000 or more children per year. Diarrhea is characterized as the condition of passing of three or more loose or watery bowel movements within a day sometimes with undigested food visible. Diarrhea is separated into three clinical categories; acute diarrhea may last multiple hours or days, acute bloody diarrhea, also known as dysentery, and finally, chronic or persistent diarrhea which lasts 2–4 weeks or more. There is normal growth with no evidence of malnutrition in the child experiencing persistent diarrhea. In chronic diarrhea there is no evidence of blood in the stool and there is no sign of infection. The condition may be related to irritable bowel syndrome. There are various tests that can be performed to rule out other causes of diarrhea that don't fall under the chronic criteria, including blood test, colonoscopy, and even genetic testing. Most acute or severe cases of diarrhea have treatment guidelines revolving around prescription or non prescription medications based on the cause, but the treatment protocols for chronic diarrhea focus on replenishing the body with lost fluids and electrolytes, because there typically isn't a treatable cause.

FODMAPs or fermentable oligosaccharides, disaccharides, monosaccharides, and polyols are short-chain carbohydrates that are poorly absorbed in the small intestine and ferment in the colon. They include short-chain oligosaccharide polymers of fructose (fructans) and galactooligosaccharides, disaccharides (lactose), monosaccharides (fructose), and sugar alcohols (polyols), such as sorbitol, mannitol, xylitol, and maltitol. Most FODMAPs are naturally present in food and the human diet, but the polyols may be added artificially in commercially prepared foods and beverages.

Non-celiac gluten sensitivity (NCGS) or gluten sensitivity is a controversial disorder which can cause both gastrointestinal and other problems.

A low-FODMAP diet is a person's global restriction of consumption of all fermentable carbohydrates (FODMAPs), recommended only for a short time. A low-FODMAP diet is recommended for managing patients with irritable bowel syndrome (IBS) and can reduce digestive symptoms of IBS including bloating and flatulence.

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" Archived 2010-05-01 at the Wayback Machine 2010-01-27.
  7. ↑ Goldfinger, Stephen E, MD. "Gas and bloating overview" 2010-01-27.
  8. ↑ "Abdominal Distension (Distended Abdomen)". Cleveland Clinic.
  9. ↑ 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.
  10. ↑ "Abdominal bloating: Causes, symptoms and remedies". www.medicalnewstoday.com. 2022-05-27. Retrieved 2022-11-29.
  11. ↑ Hasler, William L. (2006). "Gas and Bloating". Gastroenterology & Hepatology. 2 (9): 654–662. ISSN   1554-7914. PMC   5350578 . PMID   28316536.
  12. ↑ "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.
  13. ↑ 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.
  14. ↑ 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.
  15. ↑ 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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