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treating bloating and abdominal distension
Abdominal Distension | Image Courtesy of Jonathan Borba via Unsplash

Why a Multi-Disciplinary Team is Best for Treating Bloating and Abdominal Distension

Bloating, abdominal distension, loose stools, constipation, abdominal or pelvic pain, fatigue, brain fog, weakness, nutritional deficiencies… these symptoms may be caused by a variety of gastrointestinal or pelvic conditions. If you are experiencing any of these symptoms, this article is a good place to start when deciding who to have on your care team, and what treatments can help! 

Bloating is the sensation of excess abdominal gas or a feeling of being distended without obvious visible abdominal distension.

Some people have a feeling of fullness or discomfort in the upper abdominal area. Abdominal distension is the visible increase in abdominal girth. A multidisciplinary treatment team of primary care physicians (PCPs), gastroenterologists, dieticians/ nutritionists, and physical therapists is ideal to help manage these symptoms and find the root cause. For example, symptoms of bloating and abdominal distension affect 66 - 90% diagnosed with Irritable Bowel Syndrome (IBS). Getting the proper diagnosis can help direct the best treatment options for you. 

PCPs and gastroenterologists can help diagnose and direct treatment for gastrointestinal conditions that are the common cause of abdominal bloating or distension: slow transit constipation, small intestine bacterial overgrowth (SIBO), irritable bowel syndrome (IBS- and sometimes referred to as visceral hypersensitivity), Irritable bowel disease (IBD-Crohn’s Disease or Celiac’s Disease), hormonal changes during the menstrual cycle or conditions like Polycystic ovarian syndrome (PCOS) or endometriosis, pancreatic insufficiency, abdomino-phrenic dyssynergia, pelvic floor dysfunction, cancer, hypothyroidism, mechanical obstruction, gastroparesis, and food intolerances such as lactose, fructose, gluten or other carbohydrates. If you are interested in learning more about abdomino-phrenic dyssynergia and treatment, see our blog article here: https://feminapt.com/diagnoses/abdominal-phrenic-dyssynergia 

Dieticians and nutritionists can help guide a healthy and safe diet and supplement plan to address symptoms of bloating, abdominal distension, loose stool, constipation, and abdominal pain. 

Pelvic floor physical therapists (PFPTs) have specialized training in treating bloating and abdominal distension and other disorders of the gut and pelvic floor. They play a key role in the treatment of bloating and abdominal distension including:  

  1. Posture Correction: Poor posture can contribute to increased pressure on the abdomen and impair the function of the diaphragm. Physical therapists can assess and correct posture to optimize the alignment of the spine and promote optimal diaphragmatic function.
  2. Breathing Techniques: The diaphragm plays a crucial role in respiration and abdominal pressure regulation. Physical therapists can teach diaphragmatic breathing techniques to promote relaxation, reduce tension, and enhance the coordination between the diaphragm and the abdominal muscles.
  3. Core Strengthening: Strengthening the muscles of the abdominal region and the deep core can improve the stability and support of the digestive organs. Your physical therapist will develop individualized exercise programs that target these muscles to improve their function and reduce bloating and abdominal distension symptoms.
  4. Manual Therapy: Your physical therapist will use hands-on techniques, such as soft tissue mobilization, visceral mobilization, and myofascial release to relieve muscular tension, trigger points, and fascial-visceral restrictions in the abdominal region. These techniques can help improve circulation, reduce pain, reduce inflammation, support the immune system, and enhance overall abdominal function, relieving abdominal distension and bloating.
  5. Your pelvic physical therapist may also use surface EMG biofeedback to correct any muscle coordination or strength deficits affecting pelvic floor muscles, diaphragm and abdominal muscles (specifically the external and internal obliques and intercostal muscles). Biofeedback has been shown to be an effective method to decrease abdominal bloating and abdominal distension by helping patients activate their external and internal obliques, use their diaphragm properly, and decrease overactivity of the intercostal muscles. 
  6. Education and Lifestyle Modification: Your physical therapist will also provide education on dietary modifications, stress management techniques, and appropriate body mechanics (including healthy toileting posture and habits) during daily activities. They will offer guidance on maintaining a healthy lifestyle, including exercise and relaxation techniques, as well as activity modifications to help normalize bowel habits. They will also provide education on appropriate intake of water, soluble and insoluble fiber, and resources on Low FODMAP foods and tracking of bowel and abdominal distension and bloating symptoms. 
  7. Multi-disciplinary team referrals and collaboration: Your physical therapist may also provide referrals to gastroenterologists, a mental health professional, and dieticians/nutritionists if you do not already have a multidisciplinary team managing your symptoms of bloating and abdominal distension. Your physical therapist will collaborate with your care team throughout your treatment to ensure the best possible outcomes.
  8. Additionally, if IBS is the cause of bloating and abdominal distension, gut-directed hypnotherapy has been shown to be a very effective and cost-friendly treatment approach to improve symptoms and decrease medication usage. Nerva is a gut-directed hypnotherapy system in an app-based format that is readily available and user-friendly. Research studies show that after completing 6 weeks of hypnotherapy using Nerva, at least 85% of individuals diagnosed with IBS saw improvement in their symptoms and 82% of individuals reported decreased anxiety, worry, and depression, and increased quality of life. 

Contact us here to schedule with one of our pelvic floor physical therapists @ Femina Physical Therapy.

Resources: 

Barba E, Burri E, Accarino A, et al. Abdominothoracic mechanisms of functional abdominal distension and correction by biofeedback. Gastroenterology. 2015;148(4):732-739. doi:10.1053/j.gastro.2014.12.006. https://pubmed.ncbi.nlm.nih.gov/25500424/

Cangemi DJ, Lacy BE. A Practical Approach to the Diagnosis and Treatment of Abdominal Bloating and Distension. Gastroenterol Hepatol (N Y). 2022;18(2):75-84. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9053509/

Cleveland Clinic. Low FODMAP Diet: Treatment and Procedures.

Updated and medically reviewed by Cleveland Clinic medical professional Feb. 2022. https://my.clevelandclinic.org/health/treatments/22466-low-fodmap-diet 

Davidson C. Measuring Symptom Improvement in Nerva. MindSet Health. Sept. 7, 2022. https://www.mindsethealth.com/resource/nerva-symptom-improvement#:~:text=Improvement%20in%20gastrointestinal%20symptoms,%2C%20bloating%2C%20and%20abdominal%20pain.

Rao SSC, Bhagatwala J. Small Intestinal Bacterial Overgrowth: Clinical Features and Therapeutic Management. Clin Transl Gastroenterol. 2019;10(10):e00078. doi:10.14309/ctg.0000000000000078.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6884350/ 

Sorathia SJ, Chippa V, Rivas JM. Small Intestinal Bacterial Overgrowth. [Updated 2023 Apr 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546634/ 

Vasant DH, Whorwell PJ. Gut-focused hypnotherapy for Functional Gastrointestinal Disorders: Evidence-base, practical aspects, and the Manchester Protocol. Neurogastroenterol Motil. 2019;31(8):e13573. doi:10.1111/nmo.13573. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850508/

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Testimonial by R.D., age 38

"I had a severe tear during childbirth that was not stitched together correctly and therefore healed poorly. Even after having a surgery a year later to remove the scar tissue, I was still having pain, and no one could explain why -- there was no overt 'reason' to explain the pain. I had tried other 'specialists' and even saw another physical therapist who had me do hip / leg stretches -- what a joke! I was about to give up and just 'live with it' until thankfully I kept searching online and found Heather.

Read more: Testimonial by R.D., age 38

Testimonial by A.B.

Before I was referred to Heather Jeffcoat I was living in a nightmare. I had been married to my husband for three years and I was suffering from Vaginismus. That all changed when I visited my OBGYN and she said she knew of someone with a great success rate. To be honest I was hesitant at first because my first doctor had already told me that all I needed to do was order dilators from the internet and I should overcome my problem. She was wrong because I had followed the book on how to use the dilators with absolutely no advancements in my condition. However, that all changed when I went in for my first visit and Heather took the time to explain my condition and how we were going to work together to overcome it.

I remember leaving her office with a glimmer of hope that I could live a normal life. As my sessions continued I began to see immediate results. With only four sessions and a strict dedication to my home programs I was cured of Vaginismus. In the beginning of this process I was made aware that my health insurance company might not cover the costs, which was disappointing but today I can say one hundred percent that it was the best money I ever spent. Now thanks to Heather I am finally enjoying my life to the fullest with my husband. Thank you Heather, I can’t begin to tell you how much I appreciate all that you have done for me. I will never forget it. Those who are suffering from these types of conditions don’t be afraid because she makes you feel so comfortable and the end result is worth it. Good luck to you all and I hope you experience the success I have.
-- A.B.

Testimonial by Jamie M.

I have been going to see Heather for a while now, and I can't tell you enough how much she has improved my quality of life. Heather specializes in issues like pelvic floor, but I see her for other orthopedic issues.

I have a lot of chronic joint pain and dysfunction issues (back, hips, neck) that require that have ongoing physical therapy maintenance. The effects of my problem joints/areas overlap and interconnect with each other in complex ways, so helping me requires really having a complete understanding of the entire skeletal and muscular system. Pain does not always appear where the problem actually is, the human body is a twisty, many-layered puzzle. I have an exercise program I do at home and I am very functional, but there are just something things I need a PT to help me out with.

Read more: Testimonial by Jamie M.

Testimonial by S.H., age 24

I just wanted to thank you for everything you've done for me for the past 19 months. I literally could not have reached my goals without you and your practice. You gave me the courage to keep moving forth with my treatment no matter how afraid and anxious I was. You were always there to answer questions and made this whole process so much easier than I expected it to be.

It's because of you that my marriage is on the right track, that I can get pregnant and that this part of my life is finally over. I really feel that Fusion Wellness is a team of people you can call family and are there to root for you and cheer you on until you reach your goals. There is nothing better than knowing I accomplished this with you guys by my side and as calmly and patiently as I needed. Thank you from the bottom of my heart for always being there and helping me reach my goals.

S.H., age 24

Testimonial by S.H., age 24

I just wanted to thank you for everything you've done for me for the past 19 months. I literally could not have reached my goals without you and your practice. You gave me the courage to keep moving forth with my treatment no matter how afraid and anxious I was. You were always there to answer questions and made this whole process so much easier than I expected it to be.

It's because of you that my marriage is on the right track, that I can get pregnant and that this part of my life is finally over. I really feel that Fusion Wellness is a team of people you can call family and are there to root for you and cheer you on until you reach your goals. There is nothing better than knowing I accomplished this with you guys by my side and as calmly and patiently as I needed. Thank you from the bottom of my heart for always being there and helping me reach my goals.

S.H., age 24

Testimonial by Carolina J.

I had tried Pelvic Floor Physical Therapy before (with another PT) and I had a really bad (painful) experience. A friend of mine and fellow patient, told me about Heather, Laureen and Femina PT (née Fusion Wellness & Physical Therapy) and I decided to try again. I am so happy I did! Femina PT have, literally, changed my life. I was able to do again things I couldn't do for over 10 years!! Their bedside manners are impeccable, their knowledge and understanding make me feel comfortable to recommend this place to anyone in pain. Specially if you have Endometriosis. 100% recommended!!

-- Carolina J., 12/28/16 via Yelp!

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