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.
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:
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.
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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