Abdominal bloating is a painful condition in which the abdomen is tight and distended, often from trapped gas. There are many possible causes, such as gas and flatulence, irritable bowel syndrome (IBS), lactose intolerance, gallstones, colic in babies, pregnancy, E. coli infection, H. pylori infection, premenstrual syndrome, indigestion, hyperventilation, ovarian cysts, malabsorption syndrome, giardiasis, colitis, gluten intolerance or celiac disease, congestive heart failure, Crohn’s disease and many more.
After treating the medical cause, physical therapy can reduce the bloating and inflammation by manipulating the visceral structures of the digestive tract. Also, patients benefit greatly from abdominal manual lymph drainage to relieve their symptoms, increase peristalsis, and reduce bloating. By removing the offender, stimulating peristaltic movement, and specific movement exercises, the bloating significantly decreases.
Chronic constipation is a symptom defined as less than 3 bowel movements in a week, and difficultly defecating, which often causes straining, trapped gas and a sensation of incomplete bowel evacuation. The contributing factors related to constipation are intestinal hormones, female hormones, systemic disease, chemical make-up of feces, nervous input to the intestines, emotions, time of eating, and activity level. Some of the causes for constipation are IBS, a poor diet, lack of sufficient fluids, and a decreased activity level. Symptoms include abdominal bloating, pain in the lower abdomen from a chronic stretch on the fascia, no urge to defecate, or obstructed urination. This can cause pelvic floor dysfunction due to pelvic floor muscle incoordination or overactive pelvic floor muscles, as well as a rectal prolapse.
Your physical therapist will release adhesions on nearby scar tissue, instruct in relaxation training to stimulate the parasympathetic nervous system, instruct in breathing exercises, improve pelvic floor coordination, align and regulate the pelvic musculoskeletal system, improve postural alignment related to the pelvis, increase fiber and make other dietary changes, and abdominal massage. A recent patient had a tendency to hold her breath in anxiety-producing situations, lacked vegetables in her diet, and had trigger points in her pelvic floor muscles. By suggesting that she make changes in her diet, improve breathing during stress, instructing in self-abdominal massage, and releasing the pelvic floor trigger points, she was able to achieve daily bowel movements without straining.
Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is a gastrointestinal disorder caused by a disturbance in how the gastrointestinal tract functions, and occurs at least 3 times per month unrelated to any other disease or injury. The symptoms include chronic pain, constipation, and/or diarrhea. The pain improves when you have a bowel movement, the pain begins when the bowel movements become more or less frequent, or the pain begins with a change in the appearance of your stool. Hypothetically, the neurotransmitters in the brain are not sending the proper signals to the gastrointestinal tract, causing a lower threshold of pain in the gut. Stress or any other significant change to the digestive system can disturb the natural balance. In one journal article 17% of women who underwent elective gynecological surgery developed abdominal pain 3-12 months after their surgery1. Treatment consists of: omitting irritating or gas-producing foods, increasing fiber, relaxation and breathing exercises to reduce anxiety, pelvic movement exercises to lengthen and eccentrically strengthen the pelvic floor muscles, and manual lymph drainage to stimulate peristalsis in the digestive system. Patient #6 followed the above treatment program, and in 8 visits was able to reduce her symptoms’ intensity 80%. She found that gluten, dairy, and acidic foods irritated her intestines. She performs breathing exercises when the pain begins in order to relax the sympathetic nervous system. She practices pelvic squats to lengthen and relax her pelvic floor muscles, and each morning performs manual lymph drainage.
1. Sperber AD, Morris CB, Greemberg L, Bangdiwala SI, Goldstein D, Sheiner E, Rusabrov Y, Hu Y, Katz M, Freud T, Neville A, Drossman DA. Development of abdominal pain and IBS following gynecological surgery: A prospective, controlled study. Gastroenterology. 2008;134(1):75-84.