Author: Jenny Howe
Abdominal bloating, or distention, is a condition characterized by a feeling of fullness or tightness in the abdomen. It may lead to pain and discomfort. Technically speaking, “distention” is the objective enlargement of the abdomen and may be caused by too much fluid, fat, excessive formation of intestinal gas, physical or functional obstruction of the intestines; plus more seriously, tumors, parasite infections, cancers of the liver, uterus, stomach, and ovary; plus ovarian cysts.
The standard characteristic of abdominal bloating is water retention. In women the main reason for this occurrence is hormone fluctuation during PMS and menstruation. Diseases such as congestive heart failure and hypertension can also bring on fluid retention, and the overload can be quite dangerous since it makes the heart work harder. People can also retain too much water if they eat a diet high in sodium, which can lead to the risks of high blood pressure. Furthermore, medications, such as prednisone and popular anti-inflammatories, can also cause excess water gain.
Common Physiological Causes of Abdominal Bloating and Distention
A typical cause of abdominal bloating and distention is excessive gas production by bacteria. The amount of gas that bacteria produce varies with each individual. Some people have bacteria that produce more gas, either because there are more of the bacteria or because their particular bacteria are better at producing gas. Also, the small intestine may digest and absorb foods poorly, allowing more undigested food to reach the bacteria in the colon. The more undigested food the bacteria come into contact with, the more gas they produce. Lactose intolerance, pancreatic insufficiency, and Celiac disease are examples of conditions that involve poor digestion and absorption.
Bacterial overgrowth can also occur in the small intestine and lead to bloating. When this bacterial spread occurs, the presence of undigested food in the small intestine causes the intestinal bacteria to form gas. Under normal conditions, the bacteria that produce gas are limited to the colon. In some medical conditions, these bacteria spread into the small intestine.
A small physical bowel obstruction is another cause of intermittent abdominal bloating. It can occur anywhere from the stomach to the rectum and is most commonly due to adhesion’s from a previous surgery. For example, scarring of the pylorus (pyloric stenosis) can obstruct the opening from the stomach into the intestines, thereby blocking the complete emptying of the stomach. As a result, the stomach distends further. To make matters worse, the distention that is caused by the physical obstruction stimulates both the stomach and intestines to secrete fluid, which adds to the distention.
Another type of bowel blockage-a functional obstruction-is caused by poor activity of the stomach and intestine muscles, which propel the contents of the intestine. When these muscles are not working normally, the intestinal contents will accumulate and distend the abdomen. Examples of functional obstruction include gastroparesis-a paralysis of the stomach, chronic intestinal pseudo-obstruction-a condition where the muscles of the small intestine do not work normally, and Hirschprung’s disease-where missing nerves cause a small stretch of colonic muscle to not contract normally. Fats in food also have an effect on the intestine that mimics a functional obstruction. Dietary fat reaching the small intestine slows down the transportation of digested food, gas, and liquid within the intestines, which leads to bloating and distention.
Severe constipation or fecal impaction (hardened stool in the rectum) can also block the flow of intestinal contents and result in bloating and distention.
Other Causes of Abdominal Bloating-Swallowed Air & Gas-Producing Foods
Swallowing air, a practice referred to as aerophagia, is a common cause of bloating. The swallowed gas is mainly composed of oxygen and nitrogen. The oxygen and nitrogen from the swallowed air ends up in the bloodstream from the small intestine, and any excess continues its journey through the bowel for expulsion. Most of the swallowed oxygen is absorbed by the mucous lining of the gut or is used up by colon bacteria-very little oxygen appears in the flatus. In contrast, nitrogen is poorly absorbed by the mucous lining; therefore, most of the swallowed nitrogen shows up in the flatus.
Certain types of fruits and vegetables contain starches that are well digested by bacteria and produce gas as a by-product. These include beans, lentils, cabbage, Brussel sprouts, onions, carrots, cucumbers, green peppers, onions, peas, artichokes, asparagus, radishes, cauliflower, potatoes, apples, pears, prunes, bananas, melons, apricots, peaches, and prunes.
Treatment of Bloating and Intestinal Gas
- Drink plenty of water. The average adult should drink at least 8 to 10 eight-ounce glasses of water per day. This does not include alcoholic beverages and carbonated drinks, which may trigger bloating.
- Mal-digestion of specific sugars-lactose, sorbitol, or fructose can be treated by eliminating the offending sugars from the diet. In the case of lactose in milk, enzymes that are similar to intestinal lactase can be added to the milk in order to break down the lactose prior to its ingestion, so that it can be absorbed normally. People have found that yogurt, in which the lactose has been partially broken down by bacteria, produces less gas than milk.
- Cutting the intake of gas-producing fruits and vegetables, as well as foods that are fried and fatty, full of sugar, and most processed foods, should reduce gas and flatulence. Note that the list of gas-producing foods is rather long, and it may be difficult to eliminate all of them without severely restricting the diet.
- When mal-digestion is caused by pancreatic insufficiency, people can replace the missing enzymes by taking supplemental pancreatic enzymes. If mal-digestion and mal-absorption are caused by a disease of the intestinal lining, then a small bowel biopsy should be performed to identify the specific disease. Treatment can then be targeted for that condition. For example, if Celiac disease is found on the biopsy, a gluten-free diet can be recommended.
- An interesting form of treatment for excessive gas is alpha-D-galactosidase, an enzyme that is produced by a mold. This enzyme can be consumed with meals either as a liquid or tablet. It will break down some of the difficult-to-digest polysaccharides in vegetables so that they may be absorbed. This prevents them from reaching the colonic bacteria and causing unnecessary production of gas.
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