Abdominal Distension (Distended Abdomen)

A distended abdomen is abnormally swollen outward. You can see and measure the difference,
and sometimes you can feel it. A distended abdomen can be due to bloating from gas, or it can
be due to accumulated fluid, tissue, or digestive contents. It can be chronic or acute.

What is abdominal distension?

A distended abdomen is measurably swollen beyond its normal size. It’s often accompanied by
the feeling of being bloated with trapped gas or digestive contents. However, abdominal
distension isn’t always from digestive processes. Healthcare providers diagnose a distended
abdomen in terms of the “five ‘f’s”: flatus (gas), fetus (pregnancy), feces (trapped poop), fluid
(from several causes) or fat.

A distended abdomen may be very uncomfortable, or it may simply be a symptom that you and
your healthcare provider observe visually. It may be acute — a sudden, unusual occurrence —
or chronic — something that occurs and resolves itself repeatedly in a predictable way. Chronic
abdominal distension accompanied by an uncomfortable bloated feeling is often related to a
digestive problem.

POSSIBLE CAUSES
What does abdominal distension indicate?
A distended abdomen is either an organic or a functional problem. An organic problem can be
explained by physical evidence, like a disease. Functional problems are observable but
unexplained.

Organic causes
Organic causes of abdominal distension might include:

Pregnancy.
Menstruation, which causes water retention.
Significant recent weight gain, which tends to be stored as intra-abdominal fat and may restrict
digestion.
An obstruction of the small or large bowel, causing a build-up of gas and waste matter.
Partial paralysis of the stomach (gastroparesis) causing a build-up of digestive contents.
Certain gastrointestinal diseases cause gas and bloating, including small intestinal bacterial
overgrowth (SIBO), celiac disease, exocrine pancreatic insufficiency (EPI) and inflammatory
bowel diseases (IBD).
Inflammation of the abdominal lining (peritonitis).
A build-up of fluid in the abdomen caused by liver disease (ascites).
Organ enlargement from inflammation or a growth.
Internal bleeding (intra-abdominal hemorrhage).
Functional causes
Functional reasons for a distended abdomen tend to involve digestive problems that cause gas
and/or digestive contents to accumulate. Causes might include:
Gas from functional indigestion, food intolerances or irritable bowel syndrome (IBS).
Constipation causing a build-up of feces and back-up of digestive contents.
Urinary retention causing a build-up of urine.
A disorder of the muscle contractions involved in digestion (intestinal pseudo-obstruction),
causing digestive contents to back up.
Abdominal muscle weakness, which causes the abdominal contents to sag outwards and
downwards (enteroptosis).
CARE AND TREATMENT
How do healthcare providers treat abdominal distension?
If you seek medical care for your distended abdomen, your healthcare provider will work to
isolate the cause. They’ll start by asking you questions about your symptoms and examining
your abdomen to see where it's distended. The location of the outward curve, whether it's
uniform across your abdominal cavity or more pronounced in a particular region, helps them
determine which organs are involved and narrow down the list of likely causes. They may also
feel the area with their hands or tap it and listen to the sound it makes to determine the
presence of fluids, gasses or solids.

The internal organs of the abdomen can be classified as either solid or hollow. Solid organs
include the liver, spleen, kidneys, adrenals, pancreas, ovaries and uterus. These can become
enlarged due to inflammation or growths such as a tumor, abscess or cyst. Your healthcare
provider might be able to feel that they are enlarged, or they might need to look at an image of
the internal organs to tell. A large growth might be palpable through the skin. Your healthcare
provider will confirm your condition with imaging tests, then follow up with additional testing and
treatment depending on the condition.

The hollow organs of the abdomen include the stomach, small intestine, colon, gallbladder, bile
ducts, fallopian tubes, uterus and bladder. These organs are only palpable if they are distended.
If your healthcare provider can feel any of them, they’ll know immediately where the problem is.
Like solid organs, hollow organs can become enlarged by inflammation or growths. But they can
also become swollen with the products of digestion —gas, digestive juices, poop and urine — or
with pregnancy, in the case of the uterus — or, rarely, with internal bleeding. Imaging tests will
clarify this.