Intestinal Gas (Belching, Bloating, Flatulence) (cont.)
What are the causes of intermittent abdominal bloating/distention?
Excessive production of gas
Excessive production of gas by bacteria is a
common cause of intermittent abdominal bloating/distention. Bacteria can produce
too much gas in three ways.
- First, the amount of gas that bacteria produce
varies from individual to individual. In other words, some individuals may have
bacteria that produce more gas, either because there are more of the bacteria or
because their particular bacteria are better at producing gas.
- Second, there may
be poor digestion and absorption of foods in the small intestine, allowing more
undigested food to reach the bacteria in the colon. The more undigested food the
bacteria have, the more gas they produce. Examples of diseases of that involve
poor digestion and absorption include
lactose intolerance, pancreatic
insufficiency, and celiac disease.
- Third, bacterial overgrowth can occur in the
small intestine. Under normal conditions, the bacteria that produce gas are
limited to the colon. In some conditions, these bacteria spread into the
small intestine. When this bacterial spread occurs, food reaches the bacteria
before it can be fully digested and absorbed by the small intestine. Therefore,
the bacteria in the small intestine have a lot of undigested food from which to
form gas. This condition in which the gas-producing bacteria move into the small
intestine is called bacterial overgrowth of the small intestine (bowel).
Excessive production of gas by bacteria usually is accompanied by flatulence. Increased flatulence may not always occur, however, since gas
potentially can be eliminated in other ways - absorption into the body,
utilization by other bacteria, or possibly, by elimination at night without the
awareness of the gas-passer.
Physical obstruction
An obstruction (blockage) can occur virtually anywhere
from the stomach to the rectum. When the blockage is temporary or partial, it
can cause intermittent abdominal bloating/distention. 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. After
meals, the stomach is normally filled with food and swallowed air. Then, during
the next hour or two, the stomach secretes acid and fluid, which mix with the
food and assist in digestion. As a result, the stomach distends further. When
the obstruction is incomplete, the food, air, and fluid eventually pass into the
intestines and the bloating/distention resolves.
An obstruction in the small bowel, which is most commonly due to adhesions
from a previous surgery, is another cause of intermittent abdominal distention.
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.
Severe constipation or fecal impaction (hardened stool in
the rectum) can also obstruct the flow of the intestinal contents and result in
distention. In this case, however, the bloating/distention usually is constant
and progressive and is relieved by bowel movements or removal of the impacted
stool.
Functional obstruction
A functional obstruction is not caused by an actual
physical blockage, but rather by the poor functioning of the muscles of the
stomach or intestines that propel the intestinal contents. When these muscles
are not working normally, the intestinal contents will accumulate and
distend the abdomen. Examples of functional obstruction include:
- gastroparesis (paralysis of the stomach) of
diabetes;
- chronic intestinal pseudo-obstruction,
an unusual condition in which the muscles of the small intestine do not work
normally; and
- Hirschsprung's disease, in which a small stretch of colonic
muscle does not contract normally due to missing nerves.
There is accumulating scientific evidence that some patients with abdominal bloating and distention due to gas may have a functional abnormality of the intestinal muscles that prevents gas from being normally transported through the intestine and expelled. Instead, their gas accumulates in the intestine. Among patients with
irritable bowel syndrome (IBS) with
abdominal bloating or distention as an important symptom, the gas accumulates in the small intestine and not the colon. The gas accumulates during the day and is greatest in the evening.
Fats in food have an effect on the intestine that mimics a functional obstruction. Dietary fat reaching the small intestine causes transport of digesting food, gas, and liquid within the intestines to slow. This can promote the accumulation of food, gas, and liquid and lead to bloating and/or distention.
Dietary fiber or fiber used for treating constipation can cause bloating
without increasing the production of gas in the intestine. It is believed
that this sensation of bloating (and possibly even distention) is caused by the
slowed passage of gas through the intestine which is caused by fiber. Of course,
some types of fiber may lead to increased production of gas because they are
digested to some extent by the colonic bacteria.
Intestinal hypersensitivity
Some people appear to be very sensitive (hypersensitive) to distention of their intestines, and they may feel bloated even with normal amounts of digesting food, gas, and fluid in the intestine after a meal. The bloating may be aggravated or even progress to distention if the meal contains substantial amounts of fat.
Next: How is belching, bloating/distention, and flatulence evaluated? »
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