Understanding Bloating vs. Distention: TCM and Scientific Insights
by Gavin Larsen
Abdominal bloating is a widespread issue that can affect anyone, regardless of age or gender. It is often linked to conditions like irritable bowel syndrome (IBS) and can be both distressing for patients and challenging for clinicians due to the limited and inconsistent effectiveness of treatments. While people often use the terms bloating and distention interchangeably, they refer to different experiences and likely have different underlying causes.
Understanding Bloating and Distention
Bloating, according to the Rome III criteria, is a subjective feeling of abdominal fullness or pressure without a visible increase in abdominal size. In contrast, distention refers to an actual, measurable increase in abdominal girth. Bloating affects 15-30% of the general population, but its prevalence is much higher in IBS patients, ranging from 66-90%, especially among those with constipation-predominant IBS.
Functional Abdominal Bloating and Distension (FABD)
Functional abdominal bloating and distension (FABD) are common gastrointestinal complaints encountered daily by healthcare providers. FABD may be diagnosed as a single entity or may overlap with other functional gastrointestinal disorders such as functional constipation, irritable bowel syndrome, and functional dyspepsia. The pathophysiology of FABD is not completely understood from a biomedical perspective, with proposed mechanisms including visceral hypersensitivity, abnormal abdominal wall-phrenic reflexes, the effect of poorly absorbed fermentable carbohydrates, and microbiome alterations.
What causes Bloating?
The causes of bloating are complex, involving gut microflora, gas production, intestinal transit, gas propulsion, and sensory functions within the gastrointestinal (GI) tract. In Traditional Chinese Medicine (TCM), bloating and distention are usually linked to imbalances in the Spleen and Stomach meridians, which play key roles in digestion and the transformation and transportation of food and fluids. According to TCM, if the Spleen's function is weakened (often termed as "Spleen Qi deficiency"), it can lead to poor digestion and the accumulation of dampness and phlegm, manifesting as bloating and abdominal distention. Additionally, stagnation of Liver Qi, often exacerbated by stress and emotional disturbances, can impede the flow of Qi and result in digestive discomfort and bloating.
Gut Microbiome
Your gut is home to about 500 different types of bacteria that help with digestion and overall health. Factors like diet, antibiotic use, and how you were fed as a baby can change the makeup of these bacteria. When this balance is disturbed, it can lead to more gas and digestive issues, causing bloating.
Aberrant constitution or alteration in colonic microbacteria may lead to increased production of colonic gas by fermentation or decreased gas consumption, leading to increased colonic gas content and bloating. Recent studies indicate that an imbalance in gut microbiota can significantly affect bloating and distention.
Normal and Abnormal Intestinal Gas
On average, the GI tract contains 100-200 cc of gas, predominantly produced in the colon through bacterial fermentation of undigested food components. While the overall gas volume may not significantly differ among individuals, the composition (methane, hydrogen, or carbon dioxide) can vary, influencing symptoms of bloating. Theories such as increased gas production, impaired gas transit, and abnormal sensory perception have been proposed to explain bloating. However, studies show no significant difference in gas production between IBS patients and healthy individuals. Instead, factors like impaired gas transit, particularly in those with constipation, and abnormal viscerosomatic reflexes, where the abdominal muscles relax instead of contracting in response to distention, are more plausible contributors.
Psychosocial Aspects
Psychological factors, including anxiety and depression, may exacerbate symptoms, suggesting that addressing these comorbidities can improve outcomes. TCM posits that emotions such as stress, anxiety, and depression cause imbalances in the body's organ systems.
For instance, excessive worry and pensiveness weaken the Spleen, leading to digestive issues like bloating. Similarly, anger and frustration can cause Liver Qi stagnation, which can further affect digestion.
How to Diagnose Bloating
Diagnosing bloating involves a detailed patient history and physical examination to exclude organic causes. Alarm features like anemia and unintentional weight loss warrant further investigation. Breath tests and empirical antibiotic trials can help diagnose conditions like small intestinal bacterial overgrowth (SIBO), which might contribute to bloating. In TCM, diagnosis also involves a comprehensive assessment but takes a different approach. TCM practitioners use techniques such as pulse diagnosis, tongue examination, and palpation to understand the underlying imbalances in the body. They look for patterns of disharmony, such as Qi stagnation, Dampness accumulation, or Spleen deficiency, that could be contributing to bloating. These patterns are determined through detailed questioning about the patient's lifestyle, emotions, diet, and other symptoms. By identifying the root cause of the imbalance, TCM practitioners can tailor treatments to address both the symptoms and the underlying issues.
TCM Treatments for Bloating
Effective management of bloating requires a personalized approach. TCM treatments for bloating often aim to strengthen the Spleen, harmonize the Stomach, and ensure the smooth flow of Liver Qi through acupuncture, herbal remedies, and dietary adjustments.
1. Acupuncture
Specific points such as Zhongwan (CV12), Zusanli (ST36), and Sanyinjiao (SP6) can help regulate the digestive system and relieve bloating.
2. Herbal Medicine
Formulas like Xiang Sha Liu Jun Zi Tang, containing ingredients like Saussurea (Mu Xiang) and Amomum (Sha Ren), support digestion and reduce dampness.
3. Dietary Therapy
Emphasizing warm, easily digestible foods and avoiding cold, raw, or greasy foods aligns with TCM principles to support digestive health.
Dietary Modifications
TCM dietary recommendations are based on individual constitution and patterns of disharmony. TCM practitioners may advise avoiding foods that create Dampness in the body, such as dairy, greasy foods, and processed sugars. Instead, they may recommend easily digestible foods like cooked grains, soups, and steamed vegetables to support Spleen function and promote digestive harmony. Additionally, specific herbs and herbal formulas tailored to the patient's condition may be prescribed to address underlying imbalances contributing to bloating.
Exercise and Posture
Physical activity can aid in clearing gas from the intestines, alleviating bloating. Patients are encouraged to engage in regular exercise and avoid extended periods in a supine position to reduce gas retention. Specific exercises like qigong or tai chi are often recommended to enhance circulation, addressing digestive stagnation associated with bloating. Additionally, it’s advised to avoid certain prolonged postures that compress the abdominal organs, such as slouching or sitting with crossed legs. Practicing mindfulness of posture and incorporating gentle stretching exercises into daily routines can support optimal gastrointestinal function and minimize bloating discomfort.
Integrating TCM and Western Medicine
Combining TCM with Western approaches can provide a holistic strategy for managing bloating. For example, dietary recommendations from both traditions can be synergistic: a low FODMAP diet can complement TCM dietary principles. Acupuncture and herbal treatments can be integrated with conventional therapies to enhance overall efficacy.
Combat Bloating with Acupuncture & TCM in Vancouver
Bloating and abdominal distention are complex symptoms with multifactorial origins. A comprehensive approach, integrating TCM principles and modern scientific knowledge, offers the best chance for effective management. Personalized treatment plans, combining dietary modifications, exercise, psychosocial support, and both TCM and Western medical therapies, can significantly improve patient outcomes. By addressing the underlying pathophysiological mechanisms and considering the holistic needs of the patient, clinicians can offer patients effective and enduring relief.
About Gavin
Gavin Larsen, a Registered Acupuncture & Traditional Chinese Medicine (R.Ac., R.TCM.P.) brings over a decade of expertise in holistic health to his practice. Leveraging various techniques, including orthopedic and electro-acupuncture, Five Elements Acupuncture, and channel palpation, Gavin’s develops treatment plans tailored to address diverse conditions including pain management, reproductive issues, digestive disorders, and skin conditions, among others.
