We’ve all had that uncomfortable “belly-bloat” feeling at some point in our lives. In most cases, it’s perfectly normal and not a cause for concern (Image 1). Functional gastrointestinal (GI) disorders, such as belly bloat, are extremely common, affecting up to 30 percent of the population and accounting for 40 percent of GI problems patients present to their doctors.1
Most cases of functional belly bloat are accompanied by visible belly distension and can be explained by some combination of weak or inappropriately relaxed abdominal muscles, a diaphragm that contracts when it should relax, inability of the small intestine’s villi to assimilate and transport nutrients into the bloodstream, and excessive gas produced by lactose and carbohydrate fermentation in the large intestine. Fortunately, touch therapy may help ease these frequently seen nonpathologic belly-bloat symptoms.
Gut Gases
When we digest food, naturally occurring bacteria in the gut emits various gases, including methane and hydrogen. In an optimally functioning GI track, we react to the gas production by contracting our anterior abdominal muscles and relaxing the diaphragm. If the gut is full of food or gas, the dome-shaped diaphragm should automatically relax upward, giving the abdomen more room to expand (Image 2). However, when efficient gut-brain neural coordination is lost, the diaphragm contracts rather than relaxes when it senses abdominal fullness, and the gas is forced down and out instead of moving upward. To add to the discomfort, if the pelvic floor muscles are unable to relax properly, the gas is then pushed back up into the abdominal cavity, causing a visceral (gut) somatic (abdominal muscle) reflex that triggers the bloating sensation.
Thankfully, most people have enough musculofascial elasticity in pelvic floor muscles like the levator ani, coccygeus, and piriformis to accommodate the bloat by expanding up, down, side to side, and front to back. But in those with a chronically contracted pelvic floor, much of the pressure will be pushed out through the belly, resulting in that uncomfortable belly bulge (Image 3). It’s not uncommon for bloated clients to complain of heartburn symptoms as well, which can be related to pressure from gases pushing up and compressing the lower abdominal sphincter muscles that separate the stomach from the esophagus. In Images 4 and 5, I demonstrate a couple of my favorite myoskeletal techniques for relieving these uncomfortable sensations caused by abdominal and pelvic floor rigidity. The goal of all belly bloat techniques is to help establish a balanced functional relationship between the pelvic and respiratory diaphragms by way of the brain-gut axis.
Brain-Gut Axis
On account of the large number of neurotransmitters it helps produce, the human gut acts like a “second brain.” Any alteration in brain-gut signaling can create hormonal imbalances that stress the system and lead to increased visceral hypersensitivity. Similar to pain, bloating is related to a combination of increased noxious nerve signals arriving from the GI tract and ineffective regulation of the signaling by the brain. Changes in brain-gut regulation combined with gut hypersensitivity can cause more intense discomfort. In addition, bloating may be further aggravated by abnormal lumbosacral and pelvic relationships, such as tight hip flexors and weak core muscles. This is primarily due to lack of variety in daily movement patterns and prolonged desk-occupied postures.
It’s interesting to note that brain-gut alterations can worsen with troublesome breathing habits, such as sleep apnea, due to the inappropriate use of the abdominal and breathing muscles. The technical term for this condition is abdominal phrenic dyssynergia, which describes the loss of synergy between muscles of the abdomen (the diaphragm and abdominal wall muscles) and the phrenic nerve that transmits sensation and movement to the diaphragm.
Summary
Bloating and distension are highly prevalent symptoms with a marked effect on health status and quality of life. In the past few years, considerable progress has been made in understanding the pathogenesis of these symptoms, and emerging evidence indicates that targeting colonic motility, gut flora, visceral sensitivity, and dietary intake are helpful in controlling such symptoms.2
The primary goal of digestion is to get food from one end to the other as quickly as possible with maximum absorption. Massage techniques that manually teach overworked abdominal muscles how to relax and efficiently move gases through the system will improve gut motility and strengthen peristaltic action. Though few studies exist in which bloating is a primary endpoint, I’ve personally found that musculoskeletal pelvic alignment coupled with breathing exercises to stimulate the parasympathetic nervous system help improve the symptoms of belly bloat among my clientele.
To improve gut motility and relieve built-up gas in the client’s pelvic floor, the therapist’s thenar eminence hooks the tissues attaching to the pubic symphysis and gently scoops headward.
To help relax and/or to stimulate tone in the client’s pelvic floor muscles, the therapist’s forearm traverses up the adductors and contacts the tissues attaching to the pubic ramus and gently rocks back and forth. To enhance this technique, the client is asked to perform slow pelvic tilts while the therapist’s forearm gently resists this effort.
Notes
1. Nicholas J. Talley, Philip Boyce, and Michael P. Jones, “Identification of Distinct Upper and Lower Gastrointestinal Symptom Groupings in an Urban Population,” Gut 42, no. 5 (June 1998): 690–95, https://doi.org/10.1136/gut.42.5.690.
2. Max Schmulson and L. Chang, “The Treatment of Functional Abdominal Bloating and Distension,” Alimentary Pharmacology and Therapeutics 33, no. 10 (May 2011): 1,071–86, https://doi.org/10.1111/j.1365-2036.2011.04637.x.
Erik Dalton, PhD, is the executive director of the Freedom from Pain Institute. Educated in massage, osteopathy, and Rolfing, he has maintained a practice in Oklahoma City, Oklahoma, for more than three decades. For more information, visit www.erikdalton.com.