What is Abdominal Phrenic Dyssynergia?

Abdominal Phrenic Dyssynergia (APD) is a functional gastrointestinal disorder (FGID). This condition occurs when the brain cannot coordinate the correct movement of the diaphragm in relation to the fullness of the abdomen (abdominal muscles) via the phrenic nerve, causing uncomfortable abdominal distension and bloating.

The diaphragm is a dome-shaped muscle that divides the chest and abdomen, our bodies use this muscle to help us breathe. Normally when the stomach is full of food or gas, the diaphragm will relax and release upward, in order to give the organs in the abdomen extra room.

With Abdominal Phrenic Dyssynergia, this coordination is dysfunctional and the diaphragm contracts instead of relaxing when there is abdominal fullness. When the diaphragm contracts the muscle moves downward, taking up space in the abdomen. This action forces the abdominal organs to move down and out, causing abdominal distention and bloating.

Symptoms

• Abdominal bloating that does not resolve with changes in diet nor exercise
• Distended belly that does not resolve with changes in diet nor exercise
• Abdominal pain
• Constipation

Often presents with pelvic floor dyssynergia (read more about dyssynergia in my previous blog post)

• Constipation
• Pelvic pain
• Pain with sex

How Pelvic Floor Therapy Can Help

A trained pelvic floor therapist will conduct a comprehensive exam of the spine, pelvis, lower extremities, nerve function, viscera (organs) of the abdomen and pelvis, and also assess the tone and function of the pelvic floor and abdominal muscles. After the therapist gathers all the pertinent information, they will work with the client to create a treatment plan and goals. Read my previous blog post on what to expect at your first appointment for more information.

Treatment for Abdominal Phrenic Dyssynergia can include:

• Manual therapy of the structures surrounding the diaphragm, improving movement
• Manual therapy of the spine and pelvic girdle
• Nerve Flossing
• Visceral Manipulation
• Exercises to improve respiratory diaphragm and abdominal wall function and coordination
• Pelvic floor manual therapy
• Mindfulness and breathing exercises
• Intestinal and abdominal massage
• Biofeedback
• Surface EMG biofeedback
• Neuromuscular re-training of the diaphragm, abdominal wall, and pelvic floor

Our team at Femina PT is specially trained in all these techniques, let us hep you! Give us a call to schedule a visit today.

Resources

Villoria, A., Azpiroz, F., Burri, E., Cisternas, D., Soldevilla, A., & Malagelada, J.-R. (2011). Abdominal Phrenic Dyssynergia in Patients With Abdominal Bloating and Distension. The American Journal of Gastroenterology, 106(5), 815–819. doi:10.1038/ajg.2010.408

Malagelada, J. R., Accarino, A., & Azpiroz, F. (2017). Bloating and Abdominal Distension: Old Misconceptions and Current Knowledge. The American Journal of Gastroenterology, 112(8), 1221–1231. doi:10.1038/ajg.2017.129

Sanders, L. (2013). Think Like a Doctor: The Gymnast's Big Belly Solved. New York Times Website: https://well.blogs.nytimes.com/2013/09/06/think-like-a-doctor-the-gymnasts-big-belly-solved/