Abdominal distention and pain: why it occurs and how it is treated

The combination of symptoms such as bloating and abdominal pain or, using medical terminology, flatulence and abdominal pain, is observed in gastrointestinal diseases, metabolic disorders and fermentopathies; with gastrointestinal infections and food intoxication.

But these symptoms accompany some physiological processes.

[1], [2], [3], [4], [5], [6], [7]

Causes of the bloating and abdominal pain

According to WHO statistics, from 10 to 25% of healthy people experience bloating, and especially those who have gained weight quickly or suffer from functional constipation. It is assumed that a significant amount of adipose tissue accumulated in the abdominal cavity in a short time simply reduces the space in which the small and large intestines find it difficult to function in a normal manner, and the abdomen begins to perspire constantly. And how interconnected bloating and constipation, read more -  Common causes of constipation.

The pathogenesis of excessive formation and accumulation of intestinal gases -  flatulence (abdominal distention)  - is associated with the habit of swallowing food too quickly (resulting in air swallowing - aerophagy), with its excessive volume and / or large amounts of poorly digested animal fats in the diet, and  products that cause flatulence. In addition, flatulence increases due to carbonated beverages (due to their pH level <5, that is, a high degree of acidity), sugar substitutes and sweeteners (sugar alcohols). For more information see -  Causes of flatulence.

Protein products can also increase the amount of gaseous by-products - with a lack of digestive enzymes or low acidity of gastric juice. People who consume a lot of protein foods and few carbohydrates, worsen the composition of the commensal intestinal microbiota (towards an increase in the proportion of potentially pathogenic bacteria), reduces the synthesis of short-chain fatty acids in the colon and increases the concentration of ammonia and hydrogen sulfide (hydrogen sulfide) in the intestinal gas.

By the way, the gas formed in the colon by bacterial fermentation (in healthy people its volume is about 200 ml), is a mixture of odorless nitrogen, hydrogen, carbon dioxide, oxygen and methane, and the characteristic odor and frequent gases with an unpleasant odor are due to hydrogen sulfide produced by bacteria and sulfur compounds (methanethiol and dimethyl sulfide) - metabolites of protein digestion (cleavage of the amino acid tryptophan by bacteria of the genus Clostridium).

If healthy people feel only short-term bloating after eating and associated abdominal discomfort, then with gastroenterological problems complaints of bloating, heaviness and pain in the abdomen often sound (but this will be discussed below).

Physiological causes include  ovulatory syndrome  — abdominal pain and bloating in women of childbearing age when a mature egg is released from the ovary in the middle of each menstrual cycle. During this period, the synthesis of luteinizing hormone, which has an antagonistic effect on gastrointestinal motility, increases sharply.

But if this condition lasts for more than two days, and the woman feels bloating and pain in the ovary, then it should be examined, because it may be a manifestation of an ovarian cyst, polycystic ovary syndrome or endometriosis.

As for PMS, premenstrual abdominal distention is the result of an increase in progesterone level immediately after ovulation: thus, the endometrium of the uterus is preparing for a possible pregnancy.

Why there is a change in intestinal motility, causing bloating during pregnancy, in detail in the publications:

• Early abdominal bloating
• Flatulence during pregnancy.

For anatomical reasons for the onset of these symptoms, experts refer to abnormalities in the structure or location of the gastrointestinal structure, for example, congenital lengthening of a part of the small intestine - the sigmoid colon, called  dolichosigmoma, protrusion of a part of the intestine (diverticula) or parts of the intestine that do not correspond to normal anatomy, as in  Ledda syndrome

Infections as a cause of flatulence and abdominal pain

Nausea with vomiting, diarrhea, spastic abdominal pain, bloating and fever rising to subfebrile and febrile - symptoms of infectious enteritis, gastroenteritis and  gastroenterocolitis, which are caused by viruses (Rotavirus, Norovirus, Sapovirus, Avastrovirus, Cybertoxica, Cyrus, Norastirus, Sapovirus, Avastrovirus, Cybertoxica, Cybertoxicity, Virus Syndrome Shigella dysenteriae, Salmonella enteritidis, Escherichia coli, Clostridium perfringens, Campylobacter jejuni, etc.). Details -  Types of intestinal infections

Along with enterobacteria, flatulence and abdominal pain can be the result of secondary syphilis, that is, lesions of the lower GI tract (as well as mesenteric lymph nodes) of Treponema pallidum (treponema pallidum).

Invasion of Giardia (protozoan Giardia lamblia or Lamblia intestinalis), as well as infection with helminths (parasitic worms) often occur without symptoms, but can also cause serious pathology. The first signs of   intestinal lambliasis are belching and nausea not associated with eating, pain in the right hypochondrium and abdominal distention with a defecation disorder. When you press on the stomach - pain in the navel; the nature of the pain is sharp paroxysmal.

Roundworms Ascaris lumbricoides cause  ascariasis  with symptoms such as nausea and vomiting, bloating and constipation alternating with diarrhea.

[8], [9]

Fermentopathies and endocrine diseases that cause bloating and pain

Among fermentopathies, gastroenterologists most often consider insufficient production of the enzyme lactase in the small intestine with the impossibility of splitting the carbohydrate of lactose (contained in dairy products) and its incomplete digestion - lactose malabsorption (synonym - lactase deficiency). At the same time, milk sugar is in the distal colon, where it is exposed to enterobacteria enzymes with the formation of hydrogen and acids.

Hydrogen can be excreted with breathing, metabolized in addition by intestinal bacteria or accumulate, which causes such symptoms as severe abdominal pain and bloating with diarrhea and the discharge of fetid gas — half an hour or an hour after ingestion of milk food. Plus, there may be a peristaltic sound created by the movement of the intestinal contents — boronigms or rumbling in the abdomen and pain of a diffuse nature. It should be borne in mind that with age lactase synthesis decreases, so these symptoms appear more often.

In cases of gluten enteropathy - cereal gluten intolerance (gluten), also called  celiac disease  or non-tropical sprue, pathological changes in the intestinal mucosa can cause constipation, constant swelling and abdominal pain.

As soon as maldigestia syndrome is not determined (from lat. Male - poorly and digestum - to digest): both digestive disturbance syndrome, and intestinal (intestinal) malabsorption, and chronic pancreatic insufficiency. The pathogenesis of maldigestia is explained by a violation of food digestion in the stomach cavity - due to a lack of gastric pepsins (often with a deficiency of the hormone gastrin) and pancreatic enzymes. The clinical signs of this syndrome are nausea, dyspepsia, pain in the upper abdomen and bloating, which can be almost constant, and pain felt on the left and right in the hypochondrium.

In severe hyperglycemia, delayed gastric emptying or partial  gastroparesis  in patients with diabetes of both types is considered a manifestation of diabetic autonomic neuropathy, leading to a breakdown of gastric motility. This condition can be defined as diabetic gastropathy or a diabetic stomach. Its most common symptoms include rapid satiety during meals, abdominal discomfort, bloating and epigastric pain, nausea and vomiting.

[10]

Bloating and abdominal pain in gastrointestinal diseases: causes and pathogenesis

Any  pain in the abdomen  should be the cause, and the  causes of abdominal pain  most often lie in the diseases of one of the sections of the gastrointestinal tract or organ of the digestive system - the pancreas, liver, gall bladder, which are considered auxiliary. But very often it is the functional disorders of these organs that are not only risk factors for digestive disorders, but also determine their mechanism and clinical picture.

Localization of pain and its nature, as well as the presence of other symptoms, are important for clarifying the etiology. According to the doctors, patients cope with the definition of “how much pain”, however, there are problems with an indication of the exact place where pain is felt. The fact is that when the abdomen is puffed up, a sensation of its distension and increase in volume appears, and the pain seems to be spread throughout the abdominal cavity.

Abdominal distension and stomach pain (gastralgia) in most cases occur in patients with hyperacid gastritis. Helicobacter pylori campylobacter causing inflammation of the gastric mucosa produces an enzyme (urease) that neutralizes the acidic component of the gastric juice through a cascade of biochemical reactions with the release of carbon dioxide. Therefore, after waking up, there is belching, bloating and pain in the abdomen. If gastritis turned into an ulcer, the pain intensifies and becomes acute.

Accumulation of gas with constipation characteristic of hypoacid gastritis, can cause dull moderate abdominal pain and bloating in the morning.

With inflammation of the duodenum (duodenitis) and ulceration of its mucous membrane, pain is localized in the right hypochondrium, and abdominal distention is supplemented by hyperhidrosis and general weakness. The nature and intensity of pain depends on the degree of damage: the pain can be aching, but after eating a sharp pain in the abdomen and bloating most often occurs.

Similar localization of pain, often accompanied by increased gas formation in patients with cholecystitis and / or stones in the gallbladder, as well as in the inflection of the gallbladder with bile stasis.

Liver diseases, in the first place, cirrhosis and malignant neoplasms (primary or metastatic) may cause abdominal distension and pain in the right side.

Given the anatomical topography of the stomach and duodenum, as well as the variability of the location of the inflammatory focus in these structures of the gastrointestinal tract, gastritis and duodenitis can induce pain in the left hypochondrium and bloating. Inflammation of the pancreas can also occur - pancreatitis. With all its types, with the fatty degeneration of the pancreas or dystrophy of its parenchyma, the synthesis of enzymes (trypsin, amylase, lipase) is reduced, and the consequences of their deficiency are manifested in serious disruptions of the digestive process.

Pain in the left side and bloating with constipation are combined with intestinal adhesions or lengthening of the sigmoid colon, worsening the patency of the intestine, or its inflammation.

The pathogenesis of partial obstruction of the small intestine, which is accompanied by acute abdominal pain and bloating, is caused by about two-thirds of the intestinal adhesions (scar tissue); in other cases, the patients are diagnosed with a hernia, granulomatous enteritis (Crohn's disease), and malignant tumors.

In patients with renal insufficiency or chronic adrenal insufficiency, mineral metabolism and acid-base homeostasis with the development of alkalosis and a deficiency of potassium in the blood are disturbed. Hypokalemia negatively affects the functioning of the migrating myoelectric complex (providing cyclical increase of electrical potentials and contractility of the smooth muscles of the gastrointestinal tract) and leads to intestinal dyskinesia, and then to dynamic  intestinal obstruction  (intestinal obstruction) with severe pain and bloating.

Chronic inflammatory processes in the transverse colon, enteritis, duodenitis, pancreatitis and diverticula of the small intestine are most often associated with abdominal distension and pain in the navel or in the navel.

Belching after waking up, bloating and pain in the stomach and intestines (after eating or independently of food), heartburn, nausea, moderate delay in gastric emptying or, conversely, its rapid emptying — without identified gastroenterological disease — is called  functional dyspepsia. Such a diagnosis is often made when one cannot find out the true cause of a given condition and its pathophysiology.

Equally diverse manifestations of such disorders as  irritable bowel syndrome, which is increasingly associated with its dyskinesia, causing epigastric pain and bloating, spastic pain in the lower abdomen, diarrhea or constipation, depending on the intensity of intestinal motility. And peristalsis (cyclical contraction of smooth muscle fibers of the intestinal walls) is controlled by its own (local) autonomic nervous system, called the enteric one. It includes the plexus of afferent and efferent neurons in the walls of the digestive tract - from the esophagus to the anus. The relatively new area of medicine, neurogastroenterology, deals with the problems of motility disorders (motility) of the gastrointestinal tract. And today, this condition can be defined either as a lazy bowel syndrome, or as intestinal atony, or as a syndrome of vegetative dysfunction (according to the international classification - somatoform dysfunction of the ANS).

Also abdominal distension and pain in the intestines are included in the list of symptoms:

• dysbacteriosis  (including after the use of systemic antibiotics),
• excess bacterial growth syndrome in the intestines,
• long-term inflammation of the large intestine or  chronic non-ulcerative colitis,
• malignant ovarian or uterine tumors.

Abdominal pain can spread to adjacent anatomical structures - radiating. Thus, abdominal distension and lower back pain can be felt in acute pancreatitis and pancreatic adenocarcinoma, in patients with  gastric ptosis. Acute cholecystitis, cholelithiasis, inflammation of the appendages in women, ectopic (ectopic) pregnancy is accompanied by back pain and bloating. And among the symptoms of hiatal hernia, that is, hernia of the esophageal opening of the diaphragm, abdominal distension and chest pain (in the chest) are noted.

[11], [12], [13], [14], [15]

Risk factors

Taking into account that flatulence and abdominal pain are symptoms, the risk factors for their occurrence are intestinal infections and helminth infections, the development (or presence) of the gastrointestinal diseases listed above, metabolic disorders and fermentopathies.

And, of course, increase the risk of digestive disorders and gastrointestinal disorders, unhealthy diet, overeating, low-fiber diet, alcohol, food poisoning, long-term antibiotics, stress.

[16], [17], [18]

Diagnostics of the bloating and abdominal pain

In gastroenterological practice, diagnostics is based on an integrated approach to ascertaining the causes of abdominal pain and flatulence and identifying a specific disease or pathology causing these symptoms - taking into account the history and individual characteristics of each patient.

Detailed information on what tests and tests are assigned, how instrumental diagnostics are used - x-ray, endoscopic, ultrasound, computed tomography, magnetic resonance; What is the purpose of differential diagnosis, read in the materials:

• Abdominal examination
• Diagnosis of abdominal pain
• Diagnosis of functional dyspepsia
• Diagnosis of chronic gastritis and gastroduodenitis
• Diagnosis of the pancreas

[19], [20], [21], [22], [23], [24], [25], [26], [27]

Treatment of the bloating and abdominal pain

For almost all of the above diseases and pathologies, the  treatment of abdominal pain  can be both etiological and symptomatic.

We remind you that the etiological treatment is directed to the cause. That is, for tumors, diverticula, adhesions, gallstones, surgical treatment is necessary (in cases of oncology, in combination with chemotherapy).

What to do with a strong bloating? Read -  Treatment of flatulence

Gastroenterologists recommend taking pills for bloating and abdominal pain: for food errors - absorbents (enterosorbents); with the increased formation of gases in the intestine - the so-called "defoaming agents" (Simethicone, Espumizan, etc.); with dyspepsia and deficiency of digestive enzymes - Pancreatin (Festal, Creon and other trade names). Dosage, contraindications, possible side effects in detail in the articles:

• Pills for bloating and heaviness in the stomach
• Remedies for flatulence

Pay special attention to the  pills for abdominal pain, because not all analgesics can be used in gastroenterology, and with gastrointestinal symptoms medications of antispasmodic action are shown (No-shpa, Bellastezin, Mebeverin).

In case of infectious enteritis, other drugs are prescribed, which are described in the article -  Treatment of an intestinal infection.

In cases of violation of the intestinal microbiota, probiotics (preparations with bifidobacteria) are used to restore it, which ones read: -  List of probiotics

Home abdominal distention is treated in cases not associated with acute conditions (intestinal infection, exacerbation of gastritis, ulcers or pancreatitis). At the same time, the remedies used by homeopathy for relieving spasms of the gastrointestinal tract are applied: Magnesia phosphorica and Magnezia carbonica, Nux vomica, Carbo vegetabilis, Caullophylum, Bryonia alba, Asafoetida (it helps more in stomach pains and meteorism). The dosage is determined by the homeopath individually.

Alternative treatment offers to deal with these symptoms of herbal teas and decoctions of medicinal plants. To reduce the formation of gases, it is recommended to take a decoction of dill, fennel or cumin seeds; Chamomile flowers.

In addition, herbal treatment can be carried out using a tributary of medicinal, double-leaved, gryzhnik naked, large plantain (seeds), dandelion roots or chicory. In case of constipation, broths of wheatgrass, mountaineer, and mothwort are helping; with helminthiases - the grass of the centaury umbrella and elecampus.

Complications and consequences

Experts say that over the past few decades there has been an increase in the incidence of most gastrointestinal diseases, which have serious consequences and complications that affect the general health of people, and in terms of symptoms, they reduce their quality of life and level of daily activity.

[28], [29], [30], [31], [32], [33], [34], [35], [36]

Prevention

In order to preserve the health of the intestines, prophylaxis should be aimed at changing the diet and nutritional principles that preclude increased gas formation: eating high fiber foods and consuming enough water. And in the presence of diseases of the digestive organs and the digestive tract - to diet:

• Diet with flatulence
• Diet for dysbacteriosis

Medical advice: do not lie down after eating, move more, be less nervous, do yoga (in particular, learn diaphragmatic breathing), and  massage the bowel.

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Forecast

With dietary causes of bloating and abdominal pain, the prognosis is always positive. In other cases, it all depends on the specific disease (pathology), the degree of its severity and the success of treatment.

[41], [42], [43]