Abdominal Distention
“It looks like I’m pregnant!” Marge exclaimed. She has been treated for abdominal distention and bloating for over three years. “Every time I eat anything I immediately get bloating. My abdomen fills up and I can’t eat anymore. It gets so pushed-out that I feel like I’m nine-months pregnant! It’s frustrating… and very uncomfortable – I can’t eat anything!”
I think, “how odd that she has been ‘unable to eat anything
for three years’ and has been on very restrictive diets, but she is overweight
– she is still able to eat too much.” This tells me it isn’t a food
sensitivity, infection, or intestinal problem. People who actually have
intestinal problems lose weight when they can’t eat.
Abdominal bloating affects 10-30% of any population.[i]
At some time in their lives, almost everyone will feel bloated. Many people
experience the same type of bloating again and again. The standard answers from
a gastroenterologist would tell us that bloating is due to one of the following
conditions:[ii]
- · Gas
- · Indigestion
- · Infection
- · Small intestinal bacterial overgrowth (SIBO)
- · Fluid retention
- · Food intolerances
- · Irritable bowel Syndrome (IBS)
- · Inflammatory Bowel Disease (IBD)
- · Gastroparesis
- · Gynecological disorders
- · Constipation
- · dehydration
- · not enough or too much fiber in the diet
- · food intolerance
- · pregnancy
- · nutrient deficiencies, including magnesium
- · certain medicines
- · gallstones or gallbladder disease
- · Ascites
- · Abdominal obesity
Each of these are very different illnesses and would need
their own book to explain. But while each of these can have bloating associated
with them, none of them are the main cause of abdominal distention after
eating. Marge had been treated for many of them, and nothing worked. She went
to multiple doctors, gastroenterologists, acupuncturists, herbalists, and
naturopathic physicians, but was no better. She had been given antibiotics,
vitamins and herbs of all types. One antibiotic for SIBO cost her almost a
thousand dollars! She was so uncomfortable that she was willing to pay for it,
but it didn’t help at all! She also tried many diets. She seemed to have mild
relief from a limited carbohydrate diet called FODMAPS, which is an acronym for
the types of sugars to avoid, but after only a few weeks it came back just as
strong while she was still on the diet.
The mystery solved
The answer to this riddle was found many years ago but has
since gotten lost. It is not taught in medical schools, so gastroenterologists
are not aware of it. In 1962 a general internist reported on 92 patients with
bloating.[iii]
They were all found to have the same problem. They had had many different
treatments and surgeries, but none were improved. One woman was sure she was
going to have a baby. The problem was, she was past menopause, and had no
partner. She told the doctor that she was with child from the Holy Ghost, and
insisted on going into the hospital so she could have the baby. She was very
distressed when x-rays of her abdomen showed that she was not even pregnant. This
is important because the doctor attributed her case of bloating to hysteria,
her mental illness.
Many of these patients with severe bloating were so
uncomfortable they went to the hospital for surgery. In those days there were
no CT scans, so they had to cut the abdomen open to see what was inside, called
an “exploratory laparotomy.” They were sure it must be something terrible. The
surgeons did many of these procedures, but nothing at all was found! There were
no tumors, no gas in the bowel, no obstruction, no distended bowel, everything
was normal! It was all a big mystery. Finally, the anesthesiologist told them
that he noticed that as the patients went to sleep, their abdomens went down to
normal, before the surgeon had even cut. This was the clue to the mystery.
Your Abdominal Canister
Your intestines are contained like a bag of snakes that
allows them to move around freely, except for a couple of places where the
blood vessels are attached. There is a set of muscles that surround the bag,
suspending the contents, called the “abdominal canister.” On the bottom there
are muscles of the pelvic floor which hold them up, in the back is the
multifidus muscles along the spinal column, around the sides are the transversus
abdominis muscles that hold them in from the ribs to the front, and on the top
is the diaphragm, the same muscles that are used to breathe.[iv]
If there is a rupture in any of these muscles, you get a
hernia, where the bag that holds the intestines, fat, and often some
intestines, push outside of the abdomen. Since the food you eat must traverse
every inch of the intestines to get out the other side, hernias can cause
blockage of the intestines, and severe bloating -- associated with vomiting and
pain.
The cause of abdominal distention
In the cases of exploratory laparotomy above, the
anesthesiologist determined that the cause of the distention was muscle spasm,
which relaxed when anesthesia was given. It was the only logical explanation. Interestingly,
there is a normal reflex to maintain pressure in the abdomen by the abdominal canister
muscles when eating. These muscles have specific reflexes during eating to help
move things through the intestines, such as when you push to have a bowel
movement.
The reason people get bloated every time they eat is not due
to gas, but to spasm[v] of
the pelvic floor and diaphragm muscles, with relaxation of the multifidi in the
back and transversus abdominis in the front, causing the belly to push out,
making the person look and feel bloated. Since this is an abnormal muscle
reflex to eating, it is not related to any specific type of food. Anything that
causes the stomach to stretch could elicit this abnormal response – even plain
water.
Though this abnormal muscle reflex has been known for many
decades, it is still not taught or recognized in the medical system. Even
functional medicine specialists or naturopathic practitioners have never heard
of it. This is why Marge could find no help for her SIBO – she didn’t have
SIBO! She had an abnormal abdominal canister reflex.
The normal reflex is for the pelvic floor and the diaphragm
to relax to allow room for food in the stomach, while the transverse abdominis
and multifidus contract to maintain pressure and hold everything in. What
happens in abdominal bloating is just the opposite, you get spasms of the
diaphragm and the pelvic floor, creating more pressure and pushing the contents
of the abdomen out. You can purposely create this same abdominal distention
when you take a deep breath with your diaphragm; the belly will push out and
look and feel bloated.
How to distinguish abdominal distention from other causes
of bloating.
The other causes of bloating or abdominal distention noted
above, such as SIBO, have different symptoms.[vi]
The characteristics of the abnormal abdominal canister reflex include:
- · Bloating comes almost immediately with eating
- · Can happen even when drinking plain water
- · No passing excessive gas
- · Uncomfortable, but not usually painful or tender
- · Intermittent – it comes with eating, but resolves completely between meals
- · No digestive problems like diarrhea or constipation
- · No fevers
- · No nausea or vomiting
Repairing the abdominal canister reflex
While medical doctors are not aware of this cause of
abdominal distention, physical therapists do know about it. Marge was sent to
physical therapy to help her restore the normal abdominal canister reflex. She
was given exercises to help the muscles respond normally.
- · Diaphragmatic breathing exercises
- · Pelvic floor exercises
- · Abdominal muscle exercises
- · Back exercises
These specific exercises are done to regain control over the
abdominal canister and restore the normal reflex so eating allows the diaphragm
and pelvic floor to relax, while the transverse abdominis and multifidus
muscles maintain support.
Diaphragmatic Breathing [vii]
To breathe from your diaphragm, lie down on your back with your knees bent, and breathe as deeply as you can without letting your chest rise. If you have one hand on your chest, and the other on your abdomen, let the abdominal hand rise while the chest stays stable. Then, let all your air out, push the air out completely, allowing the diaphragm to relax. This can even be done after eating to relieve abdominal distention. A great exercise for both the diaphragm and the transversus abdominus muscles is learning how to sing properly. Singing requires the pressure to come from the abdomen and then up through the diaphragm, providing air from below to move the vocal cords. If you want great control of the abdominal canister, take voice lessons, and sing all day! :)
Pelvic Floor Exercises
Pelvic floor exercises are often recommended for women who
have urinary incontinence, but they are also for men, especially if they have
abdominal distention with eating.
Kegel exercises for strength [viii]
- · Locate your pelvic floor muscles which are the ones you squeeze to stop the flow of urine.
- · Tighten those muscles for three seconds, then relax for three seconds.
- · Repeat this 10 times for a full set.
- · Do one set three times per day.
- · Lie flat on your back
- · Bring your knees toward your chest at a 90-degree angle with your feet straight up
- · Reach up and hold on to your feet. Spread your knees apart.
- · Flex your heels into your hand and gently rock from side-to-side Remain in this position for several breaths, inhaling and exhaling deeply.
Abdominal Exercises[x]
Doing sit-ups is a great exercise for the abdominal muscles.
Try doing them from side-to-side (touching your left knee with your right
elbow, and vice-versa). One exercise that specifically targets the abdominal
canister is the “dead bug.”
Dead Bug
- · Lie on your back with your arms extended up toward the ceiling and your knees bent.
- · Straighten your left leg and lower your right arm to reach behind your head, parallel to the floor. Do not let your arms or legs touch the ground — keep them around 6 inches from the ground.
- · Hold for about 10 seconds, or as long as you can.
- · Return your arm and leg to the starting position and alternate sides.
Back Exercise
Planks
- · Get into “push-up position” with your arms extended.
- · Hold for as long as you can.
After only a few visits with the physical therapist, and
doing her daily exercises at home, Marge was back to normal. She no longer had
any abdominal distention, bloating, or discomfort with eating. And the best
thing, she could eat anything she wanted.
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