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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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I wanted to thank you so much for helping me get through something I thought I may never be able to. We have achieved pain-free intercourse and this has really solidified our marriage. We are so grateful to you for all the work you do! Thank you!!

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Testimonial by M.M.

My husband and I were married for 5 years and unable to have intercourse, but I never knew why. After numerous awful experiences at doctor’s offices (where many doctors told me I “just needed to relax”), a surgery that didn’t fix the problem, and a year of owning dilators that didn’t get me anywhere, someone finally referred me to Heather for Physical Therapy. I finally had answers and information from someone who knew exactly what I was dealing with!

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Testimonial by R.M., Age 40

I can’t speak highly enough of the theapists at Femina Physical Therapy and how much they have helped me grow, discover, and love my body. I had had painful sex for my entire life, and didn’t know that there was anything that could be done about it. It was at the point where my husband and I were not having sex for MONTHs, because it was just too frustrating, and I hated feeling like I was the ONLY woman out there who had this problem, especially at my age. I finally brought it up to my doctor because I was turning 40 and my husband and I were barely having enough sex to conceive. And she brought up pelvic floor, PT. I didn’t even know this was a “thing”.

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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!

Testimonial by R.H.

No one could tell me why I was having pain during sex--sharp pain, not just uncomfortable, pain. I was referred to Heather Jeffcoat after researching several different options. I had seen a specialist who told me physical therapy would not help and my only option was surgery. I really didn't want to go that route, so when we got a referral, I decided to try it--it can't hurt, I thought. I am so glad I did. She diagnosed the problem right away, which was a relief in itself.

To know why I was having pain eased my mind immensely. And to hear that she could fix it without surgery was another relief. She said she could fix the problem in 6 weeks. I think it was actually 4 for me. She was very methodical, and treated me as an intelligent human being capable of participating in my own recovery. I would absolutely recommend her to anyone. She did not try to prolong my session numbers, she worked hard to accommodate my schedule (and the fact that I had to bring a baby to sessions), and she was completely honest the entire time. It is so hard to find someone with these characteristics, much less a professional who is so good at what she does. She has my highest respect.

-- R.H.

Testimonial by R.M., Age 40

I can’t speak highly enough of the theapists at Femina Physical Therapy and how much they have helped me grow, discover, and love my body. I had had painful sex for my entire life, and didn’t know that there was anything that could be done about it. It was at the point where my husband and I were not having sex for MONTHs, because it was just too frustrating, and I hated feeling like I was the ONLY woman out there who had this problem, especially at my age. I finally brought it up to my doctor because I was turning 40 and my husband and I were barely having enough sex to conceive. And she brought up pelvic floor, PT. I didn’t even know this was a “thing”.

Read more: Testimonial by R.M., Age 40

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