Bloating and Abdominal Distention Judith D. Laval, MD

Bloating and Abdominal Distention

Judith D. Laval, MD

History

Abdominal distention is a common complaint, particularly among women, who often note that the problem becomes more pronounced during the latter part of the day. Patients and physicians usually ascribe the problem to excess gaseousness. The ingestion of food causes relaxation of the stomach and rectus muscles. Any weakening of the rectus muscles, therefore, leads to more-pronounced distention. Because the largest meal usually is taken in the evening, distention following this meal is more pronounced than observed after breakfast. Although gaseousness is not the dominant cause, excess gas ingestion or generation will add to the problem. The absence of significant associated complaints such as vomiting, diarrhea, fever, and severe pain is often helpful in determining whether the complaint is caused by muscle relaxation or gastrointestinal structural pathology. A long history of symptoms also supports a functional cause. Women who have had one or more pregnancies or individuals who have undergone abdominal surgeries or have debilitating diseases may lose rectus muscle tone and thus distend easily.

Physical Examination

The most important clinical observation is whether the distention is present in the erect and recumbent positions. If the evaluation is in the late afternoon and the patient is able to show abdominal distention while standing erect, the patient should be asked to lie recumbent on the examining table. If the distention is no longer apparent to the physician and patient, the diagnosis has been established. Many patients unfortunately have been subjected to numerous endoscopic and radiographic procedures and treated with a variety of drugs for a problem that is primarily mechanical. If the distention persists while the patient is recumbent, an obstruction series should be obtained and appropriate studies directed to determine whether the disorder is related to abnormal motility (pseudo-obstruction) or to a partial bowel obstruction.

Management

Efforts can be directed toward reducing the swallowing of air, the use of carbonated beverages, and the ingestion of foods that generate colonic gas such as cabbage, broccoli, cauliflower, and baked beans. A larger lunch and smaller dinner may prove beneficial. Dietary manipulation unfortunately is less helpful for patients with distention than for individuals with belching or flatulence. If weakened rectus muscles are thought to be the cause, younger patients may benefit from exercises aimed at strengthening the muscles (rectus-tensing exercises that are variations of the standard sit-up), but this strategy is not likely to be effective in older individuals. An abdominal support garment can reduce the cosmetic problems associated with distention.

References

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2. Downs NM, Stonebridge PA: Gastric rupture due to excessive sodium bicarbonate ingestion. Scott Med J 34:534, 1989

3. Fordtran JS, Morawski SG, Santa Ana CA, et al: Gas production after reaction of sodium bicarbonate and hydrochloric acid. Gastroenterology 87:1014, 1984

4. Galati JS, McKee DP, Quigley EMM: Response to intraluminal gas in irritable bowel syndrome. Dig Dis Sci 40:1381, 1995

5. Jain NK, Patel VP, Pitchumoni CS: Efficacy of activated charcoal in reducing intestinal gas: A double-blind clinical trial. Am J Gastroenterol 81:532, 1986

6. Kahrilas PJ, Dodds WJ, Dent J, et al: Upper esophageal sphincter function during belching. Gastroenterology 91:133, 1986

7. Lasser RB, Bond JH, Levitt MD: The role of intestinal gas in functional abdominal pain. N Engl J Med 293:524, 1975

8. Levitt MD: Only the nose knows. Gastroenterology 93:1437, 1987

9. Levitt MD, Lasser RB, Schwartz JS, et al: Studies of a flatulent patient. N Engl J Med 295:260, 1976

10. Lifschitz CH, Irving CS, Smith EO: Effect of simethicone-containing tablet on colonic gas elimination in breath. Dig Dis Sci 30:426, 1985

11. Mastrangelo MR, Moore EW: Spontaneous rupture of the stomach in a healthy adult man after sodium bicarbonate ingestion. Ann Intern Med 101:649, 1984

12. Maxton DG, Martin DF, Whorwell PJ, et al: Abdominal distention in female patients with irritable bowel syndrome: Exploration of possible mechanisms. Gut 32:662, 1991

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