Bloating and Distension

Two of the most common gastrointestinal symptoms related to the gut-brain interaction our patients experience include chronic bloating and abdominal distension. Bloating refers to the sensation of the abdomen feeling full, whereas distension refers to the visible increase in abdominal girth. Typically, ingesting food triggers an abdominophrenic response, causing the diaphragm to contract and the abdominal wall to relax. This mechanism increases gastric volume and prevents distension. However, a counter-response called abdominophrenic dyssynergia (APD) may occur after ingesting food where the diaphragm relaxes and the abdominal wall contracts, decreasing gastric volume and thus causing distension. Patients with irritable bowel syndrome (IBS) and functional dyspepsia commonly experience APD. Other mechanisms that may contribute to bloating and distension include but are not limited to small intestine bacterial overgrowth (SIBO), H. Pylori, pelvic floor dysfunction, endometriosis, and food sensitivities/intolerances. Diaphragmatic breathing, a low FODMAP diet, cognitive behavioral therapy, gut-directed hypnotherapy, and atypical antidepressants are treatment options that may be helpful with bloating and distension. 

Reference:

Damianos, John A., et al. “Abdominophrenic Dyssynergia: A Narrative Review.” American Journal of Gastroenterology, vol. 118, no. 1, 2022, pp. 41–45., https://doi.org/10.14309/ajg.0000000000002044