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What Causes Stomach Distension and How Do You Treat It?

Stomach Distension: Natural Treatment Options to Soothe Your Symptoms

Key Takeaways
  • Stomach distension (the physical expansion of the stomach) and bloating (the feeling of pressure) are technically two different conditions. They can occur separately or together.
  • Chronic stomach distension and bloating are common, and even more common in patients with irritable bowel syndrome (IBS).
  • There are numerous underlying causes of distention of the abdomen and bloating, including inflammation, bacterial overgrowth, food sensitivities, and more.
  • Occasional stomach distension and bloating are completely normal, but if they become chronic, painful, and disrupt your daily life they need to be addressed.
  • There are simple, natural ways to relieve both stomach distension and bloating.
Stomach distension: Woman holding her stomach in pain

Have you ever finished a delicious meal, only to experience the uncomfortable feelings of bloating and stomach distension? It can be such a frustrating experience, but you’re not alone. In fact, 16-31% of Americans experience chronic bloating and distention of the abdomen [1].

While each of us has probably experienced both of these at some point in our lives, bloating and stomach distension shouldn’t be an everyday occurrence. If your symptoms have become chronic, cause you abdominal pain, and/or disrupt your daily life, it’s time to address them. 

In this article, we’ll discuss what you need to know about the causes of stomach distension and bloating. We’ll also provide a step-by-step treatment guide for targeting the root causes of your symptoms so you can feel like yourself again.

Step-by-Step Treatment Guide for Stomach Distension

If your stomach distension has become a common occurrence, it’s important to determine the root cause of your symptoms. In our practice, we start with foundational treatments. Using this step-by-step, bottom-to-top approach, we’ve consistently been able to help successfully treat the underlying causes of stomach distension.

Start with step 1 and move on to the next step only if your symptoms persist.

Step 1: Diet and Lifestyle Changes for Stomach Distension

Stomach distension: Fodmap written in chalk surrounded by various fresh ingredients

As I describe in Healthy Gut, Healthy You, diet and lifestyle changes are the foundation for healing most gut issues. While diet needs to be personalized, most people will benefit from getting back to basics when it comes to food. 

Principles of a healthy diet include:

  • A diet low in allergens/intolerances
  • A diet that contains the appropriate amount of bacterial feedings for the individual (prebiotics and FODMAPs)
  • A diet that regulates blood sugar and contains the appropriate amount of carbohydrates
  • A diet that focuses on fresh, whole, and unprocessed foods

A good starting point is often the Paleo diet; if you’re feeling great after a couple of weeks, then stick with it. If you still have some lingering symptoms, you may benefit from a low FODMAP plan

The low FODMAP diet has been shown to improve a variety of gastrointestinal symptoms for people with IBS and other functional gastrointestinal (GI) symptoms:

  • A 2016 systematic review and meta-analysis found that a low FODMAP diet reduced IBS symptom scores, improved quality of life, and eased abdominal pain, bloating, and overall symptoms in people with functional GI symptoms [2].
  • A 2017 systematic review and meta-analysis found IBS patients who maintained a low FODMAP diet had better scores for abdominal pain, discomfort, bloating, and quality of life when compared to IBS patients on a high FODMAP diet [3].

In addition to the dietary changes, here are some important lifestyle considerations:

  • Avoid toxins to the best of your ability
  • Obtain appropriate sun exposure
  • Spend time in nature
  • Get enough exercise (but don’t overdo it)
  • Walk as much as you can; one study found walking for 10-15 minutes after meals was better at reducing bloating than prokinetic drugs in healthy people [4]
  • Get enough sleep
  • Nurture healthy relationships and social connections
  • Mitigate stress, and/or practice stress management
    • While cognitive behavioral therapy and gut-directed hypnotherapy have been shown to improve bloating in IBS patients, yoga and meditation can be helpful as well. One 2016 systematic review of randomized controlled trials found yoga to be more effective than conventional treatment for IBS [5].
    • In addition, a 2013 randomized controlled trial found IBS patients using a mindfulness-based stress-reduction program had clinically significant reductions in IBS symptoms, which were maintained after six months [6].

Step 2: Probiotics for Stomach Distension

If you’ve made the above diet and lifestyle-related changes, but still haven’t achieved your desired results, consider adding probiotics. Probiotics are defined as microorganisms that provide health benefits to their host, and they’ve been shown time after time to be very effective for the treatment of bloating. Let’s look at some of the research on the benefits of probiotics when it comes to bloating and distension:

  • A 2020 systematic review and meta-analysis found multispecies probiotics significantly decreased bloating in adults with functional constipation [7].
  • Several high-quality research studies show that probiotics improve IBS symptoms, including bloating, abdominal pain, gas, diarrhea, and constipation [8, 9, 10, 11, 12, 13, 14].
  • A 2020 randomized controlled trial of IBS patients showed probiotics significantly reduced abdominal pain and abdominal distension in IBS patients [15].

Step 3: Specialized Digestive Support

If you’re still struggling with distention of the abdomen and bloating after implementing steps 1 and 2, you may consider specialized digestive support in the form of an elemental diet, antimicrobials, antibiotics, digestive enzymes, and/or supplemental acid.

These therapeutics shouldn’t be added all at once. You should consider working with a practitioner to help you determine which digestive aid(s) are most likely to be helpful for you. 

  • Elemental diets: An elemental diet is an anti-inflammatory, antibacterial reparative liquid diet. The contents of the liquid are completely broken down into easily absorbable components. Liquid-elemental and semi-elemental diets have shown impressive results for IBS and SIBO. While elemental diets are very safe, it’s best to use them under the care of a qualified healthcare provider [16].
  • Antimicrobials and antibiotics: These treatments can help to rebalance the ecosystem living in your gut by reducing or removing the microbes that shouldn’t be present, thus allowing your resident microbes the chance to thrive [17, 18, 19, 20].
  • Digestive enzymes and supplemental acid: In order to properly digest your food and prevent malabsorption, your stomach must release enough stomach acid, your gallbladder must release bile, and your pancreas must make enough pancreatic enzymes. If any of these are disrupted, digestion is negatively affected and symptoms such as bloating and distension can result. The good news is, all of these can be replaced with simple dietary supplements before meals. One 2011 randomized controlled trial found the inclusion of digestive enzymes helped to significantly improve bloating and flatulence in IBS patients [21].

Step 4: Consider a Pelvic Floor Therapist

Pelvic floor dysfunction can be a culprit in bloating and distension of the abdomen. If you have ruled out any other medical cause, worked through the first three steps, and still struggle with these symptoms, it may be worth it to consult with a pelvic floor therapist. 

A non-randomized clinical trial found manual therapy to break up scar tissue in the abdomen and pelvic floor improved bloating and stomach distension for people with small bowel obstructions. In addition, an observational study where patients were taught exercises to strengthen their pelvic floor muscles relieved bloating [22, 23].

Are Stomach Distension and Bloating the Same Thing?

These two terms are often used interchangeably, but they refer to two different conditions. While stomach distension is the physical expansion of the abdomen (think “pregnant belly”), bloating refers to the feeling of abdominal fullness or discomfort [1].

People can experience them separately, but bloating and stomach distension can occur together. One study found 50-60% of patients with bloating also have distension [1].

Most people have experienced some digestive symptoms at one point or another, especially after eating a large meal. Stomach distension, abdominal bloating, gas, cramping, and indigestion can be normal every now and then. But if you’ve been taking care to improve your gut health, yet notice an uptick in these symptoms, it’s probably time to look for and target root causes.

What Causes Stomach Distension?

While the occasional large meal can be the culprit when it comes to stomach distension, there are a myriad of possible underlying causes for chronic abdominal distension. 

But the most common causes of bloating and chronic stomach distension we see in the clinic are: 

  • Irritable bowel syndrome (IBS): Much of the research on bloating and stomach distension has been completed in the context of IBS. Interestingly, research shows excessive intestinal gas may not contribute much to bloating and abdominal distension in IBS patients, rather it could be a hypersensitivity to gas pressure from abnormal abdominal wall reflexes [24].
  • Small intestinal bacterial overgrowth (SIBO): When bacteria travel to your small intestine, the increased gas production and gas pressure seen in SIBO may create feelings of bloating and stomach distension [1].
  • Gut dysbiosis: When the balance of bacteria in your gut is altered, inflammation increases, which can make you more sensitive to the pressure and feeling of distension.
  • Food intolerances: Intolerances to certain foods like lactose (dairy products), fructose, gluten, those high in histamines, and/or FODMAPs (fermentable carbohydrates) may cause bloating and distension related to increased fluid retention and fermentation in your colon [1, 25, 26, 27].
  • Obesity: If you’ve gained weight in a short period of time, especially in your belly, you may experience bloating since abdominal fat can alter the intestinal nerve impulses of the gut-brain axis [24].
  • Chronic constipation: When stool remains in the colon or rectum, it may allow for gas formation and slow your colonic motility. When people with chronic constipation take prokinetic agents, they have less bloating [7, 24].
  • Pelvic floor dysfunction: Your pelvic floor muscles are important for supporting several organs (anus, rectum, and abdominal organs), they help with bowel and bladder control, and they contribute to sexual function. When the muscle tone is too high or low in your pelvic floor muscles, changes in your anatomy result in constipation, which can cause bloating [1, 28].

Sometimes chronic abdominal distention is related to medical conditions such as:

  • Ovarian cysts
  • Celiac disease (gluten allergy)
  • Bowel obstruction
  • Acute gastroenteritis 
  • Inflammatory bowel disease (IBD) (Crohn’s disease and ulcerative colitis)
  • Gastroparesis (delayed gastric emptying)
  • Exocrine pancreatic insufficiency (EPI) (insufficient production of pancreatic digestive enzymes leading to malabsorption)
  • Autoimmune gastritis (chronic inflammation of the stomach lining)
  • Gastrointestinal or ovarian cancer
  • Cirrhosis (a liver disease characterized by ascites or fluid in the abdomen)

If you’ve worked through the step-by-step protocol, but still struggle with symptoms, you may consider some specific testing options such as: 

  • Breath tests to diagnose SIBO
  • Upper endoscopy for serious symptoms
  • Abdominal X-rays to determine the level of stool retention in those who are constipated
  • Gastric emptying studies

Can Stress Cause Distension of the Abdomen?

Stressed man trying to accommodate everyone

Have you ever noticed changes to your gastrointestinal function when you’re nervous or stressed? It’s no coincidence since your gut and brain communicate with each other via the gut-brain axis, including the vagus nerve.

When it comes to stomach distension and bloating, stress can both physically change the landscape of your gut and also change your perception. 

  • Stress can disrupt the balance of the microbes in your gut microbiome. These changes can lead to inflammation, immune system dysfunction, and an increase in digestive symptoms like bloating [24, 29].
  • Stress can create hypersensitivity to gut sensations. Some of our patients develop bloating and distension of the abdomen due to a heightened awareness and attention to their gastrointestinal system, which is common in IBS. In this case, the gut-brain axis may generate feelings of stomach distension and bloating despite normal intestinal contents [24].

Bloating and Distension Treatments

Beyond our stepwise, holistic treatment approach, there are a number of conventional and alternative treatments that have been found to be beneficial for bloating and distension. Here’s an overview of each treatment, their beneficial effects, and any common side effects.

TreatmentBeneficial Effect in StudiesCommon Side Effects in Studies
MA = meta-analysis
RCT = randomized controlled trial
Antispasmodic [24]relieved bloating symptoms [30]dry mouth, dizziness, blurred vision (MA of 22 RCTs) [30]
Simethicone (anti-bloating ingredient in Gas-X ®) [24]reduced frequency and severity of gas, distension, bloating [31]none (RCT) [31]
Peppermint oil [24]reduced distension [30]none (MA of 4 RCTs) [30]
Low FODMAP diet [24]reduced functional GI symptoms, including bloating, pain, and flatulence [32, 33]none (2 MAs) [32, 33]
Lubiprostone (prokinetic drug, brand name Amitiza) [24]improved bloating [30]nausea [30]
Prucalopride (prokinetic drug, brand name Resolor/Motegrity) [24]improved constipation and reduced bloating [30]diarrhea, cramping, heart problems [30]
Linaclotide (prokinetic drug, brand name Linzess) [24]improved constipation and reduced abdominal pain and bloating [30]diarrhea [30]
Rifaximin [24]improved bloating and flatulence [30]none (MA of 5 RCTs) [30]
Probiotics [24]improved bloating [7, 34]none in people with non-compromised immune systems (MA) [34]
Abdominal biofeedback [24]reduced the abnormal muscular contractions that lead to bloating, which reduced subjective bloating and distension girth [35]none [35]
Gut-brain axis modulators [24]
• antidepressants
• hypnotherapy
• cognitive behavioral therapy (CBT)
• antidepressants: reduced bloating frequency and severity, possibly by making neurotransmitters more available [30]
• hypnotherapy: improved IBS symptoms [36]
• CBT: reduced depression and anxiety, which can contribute to bloating [36]
• antidepressants: dry mouth, drowsiness (MA of 17 RCTs) [30]
• hypnotherapy: none [36]
• CBT: none [36]
Pelvic floor biofeedback [1]relieved bloatingnone [23]

The Bottom Line on Stomach Distension

Occasional stomach distension is completely normal. If it becomes a chronic issue for you, follow the simple foundations-up approach above to help relieve your symptoms.

If you complete the protocol but still struggle, you may benefit from working with a healthcare provider who can order certain tests to determine the root cause of your lingering symptoms. 

For a more personalized treatment plan, reach out to become a patient.

➕ References
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