BLOATED TUMMY IS A VERY COMMON COMPLAINT. MOST CASES ARE HARMLESS and self-limiting, usually caused by gas or food indiscretion, but some are serious and dangerous because of bowel blockages (intestinal obstruction), abnormal fluid collections (ascites) or cancer. The challenge is to identify the few dangerous cases out of the many harmless ones.
What exactly is a bloated tummy indeed lies in the eye of the beholder; from a young female patient with a flat belly insisting that it is so bloated and big, to a postmiddle aged man with a protuberant eight-month pregnant tummy equally adamant that it is not big but his alarmed wife is desperately worried that it is getting bigger. A practical approach to assessing bloated tummy is to categorise it anatomically to upper abdomen and the rest which could be central, lower or the whole abdomen.
Bloatedness of the upper abdomen is often due to alcohol and food indiscretion. There is swelling of the upper abdomen, discomfort and belching. This may last for one to two days only, and can be relieved by simple antacids or acid reducing medications like Omeprazole. If the bloatedness keeps coming back, endoscopy is indicated to exclude underlying gastritis, Helicobacter pylori (a bacteria commonly found in the stomach), ulcer, reflux oesophagitis and hiatus hernia. If present, specific treatment is required.
If endoscopy is normal, the bloatedness could be due to gallstone disease which is diagnosed by an ultrasound scan and treated by key-hole surgery. When bloatedness is persistent and not relieved by medication, it can be due to blockage of the lower part of the stomach by chronic ulcers, stomach or pancreatic cancer. Fortunately, these causes are rare.
Central and lower abdominal bloatedness is most commonly due to gas in the intestines. Common causes are fizzy drinks, swallowed air when talking or eating, excessive dietary fibres including beans, constipation, intestinal infection and Irritable Bowel Syndrome. |
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Such bloatedness is neither serious nor dangerous but can be uncomfortable and embarrassing. Steps can be taken to reduce intestinal gas and specific conditions like constipation need to be identified and treated.
Diverticular disease or pocket formation in the wall of the colon is now very common among Singaporeans. The main symptom when present is a bloated tummy. It is often diagnosed by colonoscopy and treated by reducing pressure inside the colon or spasm.
The most common cause of serious bloated tummy is intestinal obstruction. Small bowel obstruction is caused by adhesions while that of the large bowel is due to colorectal cancer. Adhesion is a form of scarring in the abdomen occurring after abdominal surgery, injury or infection.
Most adhesions do not cause problems but in some instances the small intestine can get caught and twisted up causing obstruction. Surgery is mandatory in serious cases as the affected intestine may become ischaemic or gangrenous (die off) became of interrupted blood supply.
The most important cause of serious large bowel obstruction is colorectal cancer. Patients present with progressive bloated tummy with cramps and increasing constipation. When diagnosed with colorectal cancer, surgical treatment has to be prompt to avoid complications.
Apart from gas, fluid in the abdomen (ascites) is another serious cause of bloated tummy. Abnormal fluid can be due to heart, kidney, liver failure, or cancer cells in the abdominal cavity. When such cancer cells are present, it indicates advanced cancer. The commonly associated cancers are colorectal, appendiceal, ovarian, stomach and pancreatic.
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