Are you wondering what causes abdominal distension and the treatment options available.
For this article I will base my answers on scientific information on the subject matter to answer some of the questions you may have about abdominal distension.
As a diagnostic radiographer I see many patients who come in x-ray with a distended stomach complaining of bloating and discomfort.
I will delve into the causes, symptoms and available treatments. I draw upon my experience with people who have had abdominal distension and research from medical studies published wide references at the end of the article.
Happy reading!😀and feel free to ask questions in the comments or share your own experience.🙏
Last updated: May, 2025. Written by Juliet Semakula, a diagnostic radiographer.
Overview
Abdominal bloating and distension are two of the most reported gastrointestinal (GI) symptoms in the world.Nearly everyone has experienced occasional symptoms of abdominal bloating or distension, perhaps in the context of a meal.
For many people, bloating and distension are rare, temporary symptoms that do not lead to medical consultation
However, for other people, bloating and distension can be chronic symptoms that are annoying and negatively impact quality of life, particularly among people with disorders of gut-brain interaction (functional GI disorders).
▶️What is the difference between abdominal distension and bloating?
Abdominal distention is a sign of abdominal swelling and bloating is a symptom. both are typically a symptom of an underlying disease or dysfunction in the body rather than an illness in its own.
Abdominal distension is an objective sign of abdominal swelling which is visible in size often due to gas, fat or obesity, constipation, and food intolerances as well as other factors like chronic disease, fluid retention or intestinal obstruction.
Image showing a Massive abdominal distension caused by liver cirrhosis leading to fluid buildup.By James Heilman, MD – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15335623
While Bloating is an uncomfortable feeling of fullness, some people report it as a pressure or tension in the abdomen.
Bloating is a common symptom that can be caused by various factors, including gas, constipation, and food intolerances.
So bloating is one of the symptoms of abdominal distention. People who have a swollen stomach claim to have some kind of bloating as well.
According to most studies, many authors still use the two terms interchangeably.
However, a recent survey of patients who had bloating suggested that only 3 quarters of patients believed their bloating was associated with visible abdominal distension., most of them describing bloating alone.
Thus, the recent suggestion that the term bloating should be restricted to the subjective sensation of abdominal bloating, and distension reserved for an actual increase in abdominal size has some validity (Houghto,2005)
However, there may be some problems with this especially with respect to bloating which may or may not be associated with distension, means different things to different individuals and may not translate or even have the same meaning in different languages.
Symptoms of abdominal bloating and distension frequently coexist but can occur independently in some patients.
This article offers a practical approach for evaluating and treating symptoms of bloating and distension through discussion of 5 common causes or origin of abdominal distention
1️⃣ Diet.
2️⃣Small intestinal bacterial overgrowth
3️⃣Constipation
4️⃣ Visceral hypersensitivity.
5️⃣Abdominal-phrenic dyssynergia
▶️ Understanding abdominal distension and the abdominal wall muscles?
Distension is due to a problem with the muscles in the diaphragm and belly wall muscles.
The diaphragm is a large muscle that separates the belly from the chest. When you do not have distension, the diaphragm normally relaxes.
Then the abdominal wall muscles contract (shorten). This helps to accommodate the contents of the gut when they increase.
This process is called a reflex, as it happens quickly and is not under your direct control.
When you have distension, the opposite occurs. The diaphragm contracts (shortens) and the belly wall muscles relax. This causes the guts contents to be pushed downwards and the belly to bulge outwards.
Malagelada, 2017
The left panel shows a moderately distended abdomen with a discretely increased volume of intraluminal gas. The right panel shows the same patient during a bloating and distension episode.Reproduced by permission (Image from Accarino,2009)
Abdominal protrusion has increased in proportion to the marked accumulation of intraluminal gas with partially compensatory ascent of the diaphragm.
Patients with abdominal distension have been reported to be more likely to have recently gained weight, do very little regular exercise, have weak abdominal muscles and increased size during episodes of distension
Sullivan,1994
▶️What really causes abdominal distension?
Abdominal distension is one of the commonly reported gastrointestinal symptoms, affecting people diagnosed with a broad range of underlying medical and surgical disorders
A distended abdomen can be due to so many things, the most common one is bloating from gas, accumulation of fluid, tissue, or digestive contents. It can be chronic or acute.
▶️Here is a list of possible common organic and pathologic causes for abdominal distention and bloating.
These can include
⚫Celiac disease is an autoimmune disorder which can cause issues with bloating and distention.
⚫Pancreatic insufficiency, prior gastroesophageal surgery (such as fundoplication or bariatric procedures),
⚫Bowel obstruction:This is a blockage in the intestines can lead to a build-up of fluid and gas in the abdomen causing distention gastroparesis,
⚫Ascites, which is a buildup of fluid in the abdominal cavity, or the growth of tumours that enlarge the abdomen. This can also contribute to abdominal swelling.
⚫Gastrointestinal or gynecological malignancy,
⚫Hypothyroidism
⚫Adiposity,
⚫Small intestine diverticulosis.
⚫Chronic intestinal pseudo-obstruction.
⚫Irritable bowel syndrome (IBS) when you have this syndrome it can cause a variety of digestive symptoms, distention included.
⚫Food intolerances
⚫Constipation.
⚫Small intestinal bacterial overgrowth
⚫Gastroparesis: this is when your stomach is emptying slowly leading to bloating and distention sometimes.
⚫Ovarian cyst.
⚫Cancer: Several types of cancer can cause a distended abdomen, including liver cancer, ovarian cancer, colon cancer, pancreatic cancer, and stomach cancer.
⚫Gynecological malignancy.
⚫Pregnancy
Cangemi, 2022
The list is not definite, so many other things may cause your abdominal distention or bloating. Always consult your doctor for a diagnosis.
However different medical studies are conclusive about some of these causes.
▶️What do medical studies say about causes of abdominal distention?
🟣Gas: Excessive gas is said to be the most obvious cause of distension but evidence in support of this hypothesis is far from conclusive.
Some studies state that if approximately 10 times the normal amount of gas present in the gut is infused into the intestine it can result in a less than 2 cm change in abdominal width (Houghton2005)
Thus, these observations would suggest that increased volumes of gas cannot be the sole cause of distension, although it has been shown that abdominal distension does directly correlate with retained gas volume following experimental infusion
🟣Fluid accumulation: seen as one of the causes of abdominal distention due to impounding of fluid within bowel segments leading to stimulation of mechanoreceptors.
But this is unlikely to be involved in the development of distension, as it is known from observations on ascites that relatively large fluid volumes need to be retained before there is a noticeable change in width (Cattau,1982)
Although it is possible that sequestration of fluid could cause the sensation of bloating.
▶️When should I be concerned about abdominal distension?
While many cases of abdominal distension are benign, it’s important to consult a doctor if:
🟣The distension is severe or persistent.
🟣You have unexplained weight loss.
🟣You are anaemic and you have a very low appetite.
🟣You have concern about the distention or any other issues.
▶️What a some of the abdominal distension symptoms
People who come for x-ray usually complain of these symptoms
🔴They feel an uncomfortable feeling of belly fullness or pressure and a feeling of a trapped gas.
🔴The waist increases in diameter.
🔴Some complain of stomach pain.
🔴A change in bowel habits causing constipation and diarrhoea.
🔴A feeling of bloating with or without distention.
🔴Symptoms usually worsen when getting out of bed.
▶️How do doctors diagnosis abdominal destination
Determining the diagnosis of abdominal bloating and distension can be challenging.
It is important to conduct a thorough clinical history and physical examination.
The doctor will look at a few things that will help him determine the cause of your abdominal distention
♦️You will be asked about your onset symptoms.
♦️ What is your relationship to diet?
♦️What types of medication are you taking
♦️Have you had surgical procedures in the past?
♦️How are your bowel movement habits and patterns?
Then you may have some tests done to confirm your diagnosis which will be written in your medical records, and your doctor will have a discussion with you.
▶️Common tests done to diagnose abdominal distention.
♦️Breath tests to determine whether food intolerance is responsible.
♦️Upper endoscopy will be done if you have for certain conditions such as family history of gastroesophageal malignancy or when gastric outlet obstruction, gastroparesis or if your symptoms such as recurrent nausea and vomiting.
♦️Celiac serologies to help determine if malabsorption of wheat and gluten is occurring.
♦️Complete gastrointestinal transit assessment using scintigraphy or a wireless motility capsule to confirm dysmotility.
♦️Abdominal imaging such as X-RAY, CT and MRI if you have constipation, prior to abdominal surgery, Crohn’s disease or any suspected bowel dysmotility.
These are the common ones done but there are so many other tests your doctor could recommend to diagnose your abdominal distention.
▶️How do you fix abdominal distension? Treatment options:
There is no single protocol for treating abdominal distention, The national health services (NHS) in the United Kingdom does not have a single protocol for treating abdominal distention as the approach depends on the underlying causes.
The treatment you will receive will depend on what caused your distention and the diagnosis you were given.
If your symptoms are not alarming here is a table highlighting how your abdominal distension and bloating will be treated.
Table shows a recommended treatment algorithm for abdominal bloating and distension in the absence of alarm symptoms (Cangemi,2022)
Treatment options for abdominal distension and bloating
1️⃣Diet.
If diet has been diagnosed as the cause of your abdominal distention and bloating. Then specific foods that trigger your symptoms may be stopped to help with the distention and bloating.
For example, artificial sweeteners that contain poorly absorbed sugar alcohols, such as sorbitol, mannitol, and glycerol, can promote intestinal gas production (storey,2007)
Thus, avoidance of products that contain artificial sweeteners, such as certain diet sodas, chewing gum, and coffee sweeteners, may help reduce symptoms of abdominal bloating and distension in some patients.
Deficiency of lactase can lead to lactose mal digestion, causing excess intestinal gas production and diarrhoea.
An assessment of lactose malabsorption can be performed with a hydrogen breath test using lactose as a substrate.
Gluten, a storage protein found in certain grains, is another dietary source that can cause symptoms of bloating and distension in some patients (especially those with celiac disease),
Although the potential for gluten to cause bloating in patients without celiac disease is debated (Cangemi,2022)
2️⃣Small intestinal bacterial overgrowth
This is characterized by the presence of excess bacteria within the small intestine, combined with characteristic gastrointestinal symptoms such as bloating. Leading to abdominal bloating or distension
Recommendations regarding management of small intestinal bacterial overgrowth have also been somewhat limited by controversies surrounding its diagnosis.
However, the first step will be to identify the potential causes and then correct, if possible, the small bowel stricture as the first step of management.
Medication such as antibiotic treatment for small intestinal bacterial overgrowth is used to help with the symptoms.
3️⃣Constipation
Chronic constipation has been estimated to affect approximately 15% of adults.
Patients with primary chronic constipation (constipation not attributable to another disease) can be classified based on assessment of colonic transit and anorectal function.
Different tests such as radio-opaque-marker radiograph study, scintigraphy, and wireless motility capsule may be used to diagnose.
Cangemi,2022
4️⃣Visceral hypersensitivity.
some studies have also identified a significant association between visceral hypersensitivity and the severity of bloating symptoms among IBS patients
Agents such as antidepressants and gabapentin, may be a reasonable treatment option in a select group of patients with bloating.
As there is growing evidence these agents improve symptoms of bloating.
5️⃣Abdominal-phrenic dyssynergia
Some patients with abdominal distension develop a paradoxical abdominal-phrenic response to increased intraluminal gas, which is termed abdominal-phrenic dyssynergia
Although there is currently no available test to assess for abdominal-phrenic dyssynergia clinically, this maladaptive response has been shown to improve with biofeedback therapy (Cangemi,2022)
An image showing pathophysiology of gas and bloating image from clinical gastroenterology and hepatology, 2021
Image from Lacy ,2021
▶️How to get rid of a distended stomach as soon as possible?
The truth is there is no miracle quick approach that will dissolve abdominal distention.You need to get treatment and be patient with the healing process.
Some of the treatment approaches used to get rid of a distended stomach.
Diet changes
🟠Avoid foods that trigger bloating and distension.
🟠Limit high fibre foods to reduce gas in the stomach
🟠Avoid artificial sweeteners, sugar and alcohol which cause gas in the stomach
Change your lifestyle if you can.
🟠Try to exercise every day to keep in shape especially of you are overweight.
🟠Avoid stress because it is known to worsen digestive symptoms which can cause symptoms.
🟠Biofeedback therapy is known to help certain individuals to learn to control their gut muscles and reduce spasms.
Medications.
🟠Your doctor will recommend certain medication based on your diagnosis to help with abdominal distension and bloating.
Physiotherapy
🟠You may need therapies such as biofeedback and hypnotherapy to help address the emotional and psychological components of certain conditions causing abdominal distension and bloating.
There so many different treatments of abdominal distension and bloating and this will depend on the cause., you may need surgery for some cancer causes, or a biopsy, drainage to reduce the fluid in your stomach.
Remember if your diagnosis is chronic, treatment will be individualised based on the cause, if it is not chronic, symptoms are getting worse or you are worried it is very important to see a doctor.
We have come to the end of this article. Wishing a quick recovery!🙋
📚Sources:
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Accarino A, Perez F, Azpiroz F, Quiroga S, Malagelada JR. Abdominal distention results from caudo-ventral redistribution of contents. Gastroenterology. 2009 May;136(5):1544-51. doi: 10.1053/j.gastro.2009.01.067. Epub 2009 Feb 4. PMID: 19208364.
Houghton LA, Whorwell PJ. Towards a better understanding of abdominal bloating and distension in functional gastrointestinal disorders. Neurogastroenterol Motil. 2005 Aug;17(4):500-11. doi: 10.1111/j.1365-2982.2005.00666.x. PMID: 16078938.
Cattau EL Jr, Benjamin SB, Knuff TE, Castell DO. The accuracy of the physical examination in the diagnosis of suspected ascites. JAMA. 1982 Feb 26;247(8):1164-6. PMID: 7057606.
Abraham P, Pratap N. Dysbiosis in Irritable Bowel Syndrome. J Assoc Physicians India. 2023 Sep;71(9):75-81. doi: 10.59556/japi.71.0353. PMID: 38700306.
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Storey D, Lee A, Bornet F, Brouns F. Gastrointestinal tolerance of erythritol and xylitol ingested in a liquid. Eur J Clin Nutr. 2007 Mar;61(3):349-54. doi: 10.1038/sj.ejcn.1602532. Epub 2006 Sep 20. PMID: 16988647.
Lacy B E, Cangemi D,Vazquez-Roque,M. Management of Chronic Abdominal Distension and Bloating ,Volume 19, Issue 2p219-231.e1 February 2021. 10.1016/j.cgh.2020.03.056