What causes intermittent abdominal bloating/distention?
Excessive production of gas by bacteria is a common cause of intermittent abdominal distention and bloating. Theoretically bacteria can produce too much gas in three ways.
- First, the amount of gas that bacteria produce may vary 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 that involve poor digestion and absorption include lactose intolerance, pancreatic insufficiency, and untreated 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 back 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 colonic-type bacteria that have moved into 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 or small intestinal bacterial overgrowth (SIBO).
Excessive production of gas by bacteria usually is accompanied by flatulence. Increased flatulence may not always occur; however, gas can be eliminated in other ways such as absorption into the body, utilization by other bacteria, or possibly, by elimination at night without the awareness of the gas passer.
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 (scarring that kinks the intestines) 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) also can obstruct the flow of the intestinal contents and result in distention. In this case, however, the bloating or distention usually is constant and progressive, and is relieved by bowel movements or removal of the impacted stool.
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:
- Gastroparesis (paralysis of the stomach) of diabetes
- Chronic intestinal pseudo-obstruction, an unusual condition in which the muscles of the small intestine do not work normally
- Hirschsprung’s disease, mostly seen in infants, in which a small stretch of colonic muscle does not contract normally due to missing nerves
Accumulating evidence shows 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. Some believe that this sensation of bloating (and possibly even distention) is caused by high-fiber foods, which slow the passage of gas through the intestine. Of course, some types of fiber may lead to increased production of gas because they are digested to some extent by the colonic bacteria.
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 become aggravated or even progress to distention if the meal contains substantial amounts of fat, perhaps because fat slows the transit of gas and digestion of food out of the stomach and small intestine.