Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
It is important to distinguish between bloating and
distention.
Bloating is the subjective sensation (feeling) that the abdomen is
larger than normal. Thus, bloating is a symptom akin to the symptom of
discomfort.
In contrast, distention is the objective determination (physical
finding) that the abdomen is larger than normal. Distention can be
determined by such observations as the inability to fit into clothes or looking
down at the stomach and noting that it is clearly larger than normal.
In some
instances, bloating may represent a mild form of distention since the abdomen
does not become physically (visibly or measurably) enlarged until its volume
increases by one quart. Nevertheless, bloating should never be assumed to be the
same as distention. Bloating and even very mild cases of distention may be
caused by relaxation of the muscles of the abdominal wall.
There are three ways in which abdominal distention can arise. The causes are
an increase in air, fluid, or tissue within the abdomen. The diseases or
conditions that cause an increase of any of these three factors are very
different from one anther. Therefore, it is important to determine which of them
is distending the abdomen.
There are two types of distention; continuous and intermittent.
Continuous
distention may be caused by the enlargement of an intra-abdominal (within the
abdomen) organ, an intra-abdominal tumor, a collection of fluid around the
intra-abdominal organs (ascites), or just plain
obesity.
Intermittent distention
is usually due to the occasional accumulation of gas and/or fluid within the
stomach, small intestine, or colon.
What causes flatulence?
Flatulence, also known as farting, is the act of passing intestinal gas from
the anus. Gas in the gastrointestinal tract has only two sources. It is either
swallowed air or is produced by bacteria that normally inhabit the
intestines, primarily the colon. Swallowed air is rarely the cause of excessive
flatulence.
The usual source is the production of excessive gas by intestinal
bacteria. The bacteria produce the gas (hydrogen and/or methane) when they
digest foods, primarily sugars and polysaccharides (for example, starch, cellulose),
that have not been digested during passage through the small intestine. (The
bacteria also produce carbon dioxide, but the carbon dioxide is so rapidly
absorbed from the intestine that very little passes in flatus.)
Sugars
Sugars
that are commonly poorly digested (maldigested) and malabsorbed are lactose,
sorbitol, and fructose.
Lactose is the sugar in milk. The absence of the enzyme
lactase in the lining of the intestines, which is a genetic trait, causes the
maldigestion. Lactase is important because it breaks apart the lactose so that
it can be absorbed.
Sorbitol is a commonly used sweetener in low calorie foods.
Fructose is a commonly used sweetener in all types of candies and drinks.
Starches
Starches are another common source of intestinal gas. Starches are
polysaccharides that are produced by plants and are composed of long chains of
sugars, primarily fructose. Common sources of different types of starch include wheat, oats,
potatoes, corn, and rice.
Rice is the most easily digested starch and little
undigested rice starch reaches the colon and the colonic bacteria. Accordingly,
the consumption of rice produces little gas.
In contrast, some of the starches in wheat,
oats, potatoes, and, to a lesser extent, corn, all may reach the colon. These starches, therefore,
may result in the
production of appreciable amounts of gas.
The starch in whole grains produces more gas than the starch in refined
(purified) grains. Thus, more gas is formed after eating foods made with whole
wheat flour than with refined wheat flour. This difference in gas production
probably occurs because of the fiber
(similar to a complex starch) present in the whole grain flour. Much of this
fiber is removed during the processing of whole grains into refined flour.
Finally, certain fruits and vegetables, for example, cabbage, also contain
poorly digested starches that reach the colon and result in the formation of
gas.
Most vegetables and fruits contain cellulose, another type of polysaccharide
that is not digested at all as it passes through the small intestine. However,
unlike sugars and other starches, cellulose is used only very slowly by colonic
bacteria. Therefore, the production of gas after the consumption of fruits and
vegetables usually is not great unless the fruits and vegetables also contain
sugars or polysaccharides other than cellulose.
Small amounts of air are continuously being swallowed and bacteria are
constantly producing gas. Contractions of the intestinal muscles normally propel
the gas through the intestines and cause the gas to be expelled. Flatulence
(passing intestinal gas) prevents gas from accumulating in the intestines.
However, there are two other ways in which gas can escape the intestine.
First,
it can be absorbed across the lining of the intestine into the blood. The gas
then travels in the blood and ultimately is excreted in the breath.
Second, gas
can be removed and used by certain types of bacteria within the intestine. In
fact, most of the gas that is formed by bacteria in the intestines is removed by
other bacteria in the intestines. (Thank goodness!)
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Constipation is defined medically as fewer than three stools per week and severe constipation as less than one stool per week. Constipation usually is caused by the slow movement of stool through the colon. There are many causes of constipation including medications, poor bowel habits, low fiber diets, abuse of laxatives, hormonal disorders, and diseases primarily of other parts of the body that also affect the colon.
Diverticulitis is a condition in which diverticuli in the colon rupture. The rupture results in infection in the tissues that surround the colon. Diverticulitis symptoms include: abdominal pain, abdominal cramps, diarrhea, constipation, and bloating. Treatment methods include prescription medications, and in some cases, diverticulitis surgery.
There are many types of ovarian cancer, epithelial carcinoma is the most common. Women with a family history of ovarian cancer have an increased risk of developing the disease. Some ovarian cancer symptoms include abdominal pain, nausea, diarrhea, constipation, and abnormal vaginal bleeding, however, they usually do not present until the disease has progressed. Early diagnosis is important for successful treatment.
In lactose intolerance, the digestive system cannot digest lactose (the main sugar in milk). Symptoms of lactose intolerance include diarrhea, flatulence, abdominal pain, abdominal bloating, abdominal distention, and nausea. There are several tests to diagnose lactose intolerance. Treatment is generally made with dietary changes, supplements, and adaptation to small amounts of milk.
IBS (irritable bowel syndrome) is a common gastrointestinal disorder involving abnormal gut contractions (motility) characterized by abdominal pain,
bloating, mucous in stools, and irregular bowel habits with alternating diarrhea
and constipation, symptoms that tend to be chronic and to wax and wane over the
years. Treatment options include medication and lifestyle changes such as diet, exercise, and stress management to control symptoms. Also called spastic colitis, mucus colitis, nervous colon syndrome.
Celiac disease is a result of an immune reaction to gluten, a protein found in wheat or related grains and present in many foods that we eat. Celiac disease causes impaired absorption and digestion of nutrients through the small intestine. Signs and symptoms of celiac disease include malabsorbption (diarrhea, foul smelling gas, bloating, and increased amounts of fat in the stool) and malnutrition (weight loss, edema, anemia, bruising easily, neuropathy, and infertility). Treatment for celiac disease is a gluten free diet, and at times if necessary, medications
Gallbladder (gall bladder) pain can be caused by gallbladder disease such as gallstones or cholecystitis. Causes of gallbladder pain can be caused from biliary colic. Biliary colic is pain caused by gallstones trapped in the bile ducts. Cholecystitis is inflammation of the
gallbladder. Symptoms of gallbladder disease include nausea, vomiting, abdominal bloating and belching, sweating, and shortness of breath. Treatment of gallbladder pain depends on the cause.
Small intestinal bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria (at least 100,000 bacteria per ml of fluid) are present in the small intestine and the types of bacteria in the small intestine resemble more the bacteria of the colon than the small intestine. There are many conditions associated with small intestinal bacterial overgrowth, to include: diabetes, scleroderma, Crohn's disease, and others. There is a striking similarity between the symptoms of irritable bowel syndrome and SIBO. It has been theorized that SIBO may be responsible for the symptoms of at least some patients with irritable bowel syndrome. Symptoms of SIBO include: excess gas, abdominal bloating, diarrhea, and abdominal pain.
Dyspepsia (indigestion) is a functional disease in which the gastrointestinal organs, primarily the stomach and first part of the small intestine, function abnormally. It is a chronic disease in which the symptoms fluctuate infrequency and intensity. Symptoms of dyspepsia include upper abdominal pain, belching, nausea, vomiting, abdominal bloating, early satiety, and abdominal distention (swelling). These symptoms are most often provoked by eating.
Colic is crying or fussing that begins suddenly, lasting for a total of three hours a day and happening more than three days a week for about three weeks. Symptoms include the baby's face turning red, the belly is distended, the feet may be cold, the hands clenched, and the legs may alternate between being flexed or extended. Treatment may involve ruling out other causes of the fussing and the doctor prescribing anti-gas bubbly medicine.
Obesity is the state of being well above one's normal weight. A person has traditionally been
considered to be obese if they are more than 20 percent over their ideal weight.
That ideal weight must take into account the person's height, age, sex, and
build.
Gastroparesis is a medical condition in which the muscle of the stomach is paralyzed by a disease of either the stomach muscle itself or the nerves controlling the muscle. As a consequence, food and secretions do not empty normally from the stomach. Gastroparesis symptoms are nausea and vomiting; abdominal bloating, and pain can result.
Patients with celiac disease are required to eat a gluten-free diet. Gluten is found in rye, barley, and wheat. Gluten damages the intestine in patients with celiac disease. Some mediations contain gluten, so careful monitoring of products consumed is imperative. Patients with celiac disease are also at risk for developing nutritional deficiencies. The information in this article contains both foods that contain gluten, and foods that do not contain gluten.
Hirschsprung's disease (Hirschsprung), is a disease of the nerve cells of of the large intestine. The primary symptom of Hirschsprung's disease is constipation. Hirschsprung's disease is diagnosed through barium enema, and treatment is surgery.
Heartburn is a burning sensation experienced from acid reflux (GERD). Symptoms of heartburn include chest pain, burning in the throat, difficulty swallowing, the feeling of food sticking in the throat, and a burning feeling in the chest. Causes of heartburn include dietary habits, lifestyle habits, and medical causes. Treatments for heartburn include lifestyle changes, OTC medication, prescription medication, and surgery.
Abdominal adhesions (scar tissue) bands of scar tissue that form between abdominal organs and tissues. Symptoms of abdominal adhesions are pelvic or abdominal pain. Abdominal adhesions on the intestines can cause bowel obstruction, which is a medical emergency. Treatment for abdominal adhesions is generally surgery to cut the adhesions away from the internal tissues and organs. There is no way to prevent abdominal adhesions.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Irritable bowel syndrome (IBS) in children is a functional gastrointestinal disorder with symptoms of abdominal pain, bloating, diarrhea or constipation. The cause of IBS is unknown, however, certain foods, stress, anxiety, and depression may contribute to the symptoms of IBS. There is no cure for IBS in children; however, medications, dietary changes, and stress management may relieve symptoms.
Irritable bowel syndrome (IBS) is a functional disease that can affect the quality of those who suffer from this condition. Individuals with IBS can make lifestyle changes that may modify or control the number and severity of episodes. Certain foods, medications, and hormone levels may trigger IBS episodes. Learn how to prevent the number and severity of IBS episodes of diarrhea and constipation.
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