Abdominal Distension

Overview

Abdominal distension is the visible increase in abdominal size due to gas, fluid, mass, or altered motility. It may be acute (e.g., bowel obstruction, perforation, ascites) or chronic/recurrent (e.g., functional gastrointestinal disorders, tumors, liver disease). Patients may present with bloating, discomfort, pain, nausea, or changes in bowel habits.

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Treatment Options

1. General & Supportive Measures

• Identify and treat underlying cause (essential step).

• Encourage small, frequent meals and avoidance of foods that increase gas (beans, high-FODMAP foods, carbonated drinks).

• Physical activity to promote gut motility.

• Hydration and fiber optimization (unless obstruction suspected).

2. Pharmacological Therapy (Symptomatic Relief)

• Antiflatulents:

  • Simethicone: 40–125 mg PO after meals and at bedtime as needed.

• Prokinetics (for delayed gastric emptying or motility disorders):

  • Metoclopramide: 5–10 mg PO up to QID before meals/bedtime (max 40 mg/day).

  • Domperidone: 10 mg PO TID before meals.

• Antispasmodics (for functional or IBS-related distension):

  • Hyoscine butylbromide: 10–20 mg PO TID.

  • Dicyclomine: 10–20 mg PO q6–8h.

• Laxatives (if constipation-related):

  • Polyethylene glycol (PEG 3350): 17 g dissolved in water daily.

  • Lactulose: 15–30 mL PO daily, titrated.

• Diuretics (if ascites due to liver disease or heart failure):

  • Spironolactone: 100 mg PO daily (titrate to effect).

  • Furosemide: 40 mg PO daily, often combined with spironolactone.

3. Specific Cause-Directed Therapies

• Ascites due to cirrhosis: Diuretics + salt restriction; paracentesis if severe.

• Bowel obstruction: Nasogastric decompression, IV fluids, surgical evaluation.

• Malignancy-related distension: Oncologic management, paracentesis for palliation.

• Celiac disease: Strict gluten-free diet.

• Lactose intolerance: Lactase enzyme tablets (3000–9000 units PO with first dairy intake).

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Supportive Care

• Probiotics: may reduce bloating in IBS and functional GI disorders.

• Abdominal massage: improves motility in chronic constipation.

• Stress management: relaxation techniques, cognitive behavioral therapy for functional bloating/distension.

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Key Notes

• Always distinguish between functional bloating and organic abdominal distension (e.g., ascites, obstruction, tumor).

• Red flags needing urgent evaluation: severe pain, vomiting, fever, hematemesis, melena, weight loss, or rapidly enlarging abdomen.

• Long-term therapy should always target the underlying pathology, not just symptom relief.