Dear doctor;

What can I do to relieve stomach distension (not really bloating), which is keeping me awake at night? Distension seems to occur as soon as I eat or drink anything and I seem to have gained some weight, although my eating habits have not changed.

Sam, 29.

Dear Sam,

You have not specified when this problem started. Is the distension increasing gradually or it is same, do you have to keep awake because of abdominal discomfort associated with breathing trouble?

Abdominal distension usually occurs due to accumulation of fluid or gas in the abdomen causing the girth to expand beyond the normal measurements. The upward pressure caused on the diaphragm causes breathing difficulty. The distension is accompanied by pain, belching, nausea, etc.

Fluid can collect in abdominal cavity due to systemic diseases like chronic heart failure, liver or kidney failure. Deficient functioning of thyroid gland can also cause this problem. Local infection like tuberculosis or a tumour can manifest as accumulation of fluid in abdominal cavity. In all these conditions, the fluid starts to accumulate slowly and as the disease progresses, the distension also increases. Often, the belly button becomes everted and bowels may herniate through umbilicus.

Diagnosis is made clinically and by ultrasound examination. If it is huge and causing discomfort to the individual, therapeutic removal of the fluid by inserting a needle is useful.

Accumulation of gas in the stomach, intestine or large bowel also causes distension. It can occur due to functional dyspepsia, chronic constipation, over eating or eating fatty food. One can have abdominal distension due to lactose intolerance or consuming much of milk. It can be a sequel to surgery done on stomach or intestines.

Eating a fiber rich diet, avoiding fatty food, drinking much water helps to prevent abdominal distension due to flatulence or gas. In case of a pathological underlying cause, treatment of underlying cause cures the problem as well.