At Ignite, one of the most common complaints we see from our clients is abdominal bloating and distention. Bloating is typically described as a feeling of increased pressure in the abdomen. Many people with bloating also experience distention, which is a visible increase in abdominal size or girth.
There are many potential causes of bloating and distention, including visceral hypersensitivity, chronic constipation, abdominal air build-up, food intolerances, small intestinal bacterial overgrowth, and abnormal coordination of the diaphragm and abdominal wall muscles.
Today we’re going to focus on the abnormal coordination of the diaphragm and abdominal wall muscles.
This abnormal coordination of the diaphragm and abdominal wall muscles is called abdomino-phrenic dyssynergia (APD). APD is a behavioural condition seen in functional gut disorders in which the brain is unable to coordinate correct movement of the diaphragm and abdominal muscles, causing uncomfortable pain, bloating, distention and in some cases, constipation. Today we will be looking at what APD is, how it’s diagnosed, and different treatment options.
What is Abdomino-Phrenic Dyssynergia?
To understand APD, we first need to understand how the abdominal cavity normally functions. Studies show that the abdominal wall is able to actively adapt to its contents. In other words, when we eat, the muscles in the abdominal cavity shift to increase the size of the abdominal cavity and accommodate the volume of food. Normally, this results in contraction of the abdominal walls and relaxation of the diaphragm, which allows the diaphragm to move up and away from the abdomen.
In APD, the diaphragm and abdominal cavity are not properly coordinated. Instead of relaxing the diaphragm and contracting the abdominal walls, eating a meal leads to relaxation of the abdominal walls, and the diaphragm moves down and closer to the abdomen. This leads to an increase in pressure in the abdominal cavity, which can lead to abdominal bloating, distention, pain, and in some cases, constipation. APD is often seen in conjunction with pelvic floor muscle dyssynergia (when the muscles of the pelvic floor are not properly coordinated).
What are the key symptoms of Abdomino-Phrenic Dyssynergia?
- Bloating and distension immediately after a meal
- Abdominal pain immediately after a meal
- Improvement of symptoms away from mealtimes
- Chronic constipation (when APD presents in conjunction with pelvic floor dyssynergia)
How is Abdomino-Phrenic Dyssynergia Diagnosed?
When a patient presents with bloating and distention, their family doctor will need to ensure other causes of bloating and distention are ruled out. Other conditions that can cause bloating and distention include visceral hypersensitivity, chronic constipation, abdominal air build-up, food intolerances and small intestinal bacterial overgrowth. If these conditions have been ruled out, referral to a physiotherapist with experience diagnosing pelvic floor/diaphragmatic dysfunction should be considered.
A trained pelvic floor physiotherapist can assess the function of abdominal and pelvic muscles. This may include an internal examination of the pelvic floor muscles to assess for muscle tone, weakness or tightness, and coordination of movements.
What are the Treatment Options for Abdomino-Phrenic Dyssynergia?
Most of the treatment options for APD involve retraining the muscles of the pelvic floor and abdominal cavity to improve coordination.
This is typically done with a physiotherapist and may include:
- Manual release of muscle tension
- Pelvic floor retraining exercises
- Biofeedback therapy
- Mindfulness and diaphragmatic breathing exercises
Dietary Strategies for Abdomino-Phrenic Dyssynergia
While there is no specific diet for APD, there are several dietary and lifestyle strategies that can be used to help reduce the amount of gas introduced into the stomach, thereby relieving some of the pain, bloating and distention associated with APD. Dietary strategies can also be used to help the stomach empty more quickly, which may allow for better symptom relief.
Dietary strategies to manage APD include:
- Eating more slowly and chewing with the mouth closed to reduce introduction of air into the stomach
- Eating smaller meals and snacks rather than large meals to reduce the amount stomach stretch
- Eating lower fat meals to allow the stomach to empty more quickly – avoid fatty, fried or chewy meats like steak, pork and bacon. Avoid full-fat dairy products
- Eating a moderate fibre diet to allow the stomach to empty more quickly – choose cooked vegetables rather than raw vegetables. Avoid gas-causing vegetables like broccoli, cauliflower, mushrooms, cabbage and brussels sprouts. Choose fruits with the skin removed and avoid fruits with large seeds, tough skins, or membranes. Avoid whole nuts and seeds. Avoid really bulking fibrous foods, like large amounts of leafy greens
- Choose liquid foods like soups and smoothies, as these move out of the stomach more quickly
If you experience bloating and distention and other conditions have been ruled out, and the bloating you experience occurs immediately after eating, you may want to discuss the possibility of assessment for APD and referral to a pelvic floor physiotherapist with your family doctor.
While dietary strategies are not a cure for APD, they may be useful for symptom management. As dietary strategies for APD can often be quite restrictive, it’s recommended to work with a registered dietitian to ensure that you are only avoiding the foods you absolutely need to. Our registered dietitians can help you customize a nutrition plan that works for YOU.