That tight, swollen feeling in your stomach — we’ve all felt it. Maybe after a heavy meal, during a stressful week, or for no obvious reason at all. This sensation is called abdominal distension, and while it’s often harmless, it can also be a sign that something more serious is going on inside your body.
Let’s explore what abdominal distension really is, what causes it, and when to worry.
What is Abdominal Distension?
Abdominal distension is the visible swelling or enlargement of the abdomen. It may come with a feeling of pressure, discomfort, or even pain. Many people describe it simply as “bloating,” but distension specifically refers to a physical expansion of the belly — not just a sensation.
How common is it?
- Up to 30% of healthy individuals report bloating or distension occasionally.
- Among people with digestive disorders like Irritable Bowel Syndrome (IBS), up to 90% experience it regularly.
How Does It Happen?
Imagine your abdomen as a balloon. When something inside it increases — like gas, fluid, stool, or swelling — it stretches outwards. That’s abdominal distension.
This can happen due to:
- Trapped air or gas,
- A build-up of stool or fluid,
- Slowed digestion,
- Or more serious causes like a blocked intestine or infection.
Common Causes of Abdominal Distension
Let’s break this down into mild and serious causes:
✅ Benign or Functional Causes
These are often temporary and not dangerous:
- Gas and bloating from fizzy drinks, chewing gum, or fast eating.
- Constipation, causing stool and gas build-up.
- Food intolerance, especially lactose or gluten.
- Irritable Bowel Syndrome (IBS).
- Premenstrual hormonal changes.
- Swallowed air (aerophagia).
⚠️ Serious Medical Causes
These need medical attention and can be life-threatening if untreated:
1. Intestinal Obstruction (Bowel Blockage)
A mechanical blockage in the small or large intestine that prevents food, fluid, and gas from passing through.
Causes include:
- Hernias,
- Tumours,
- Adhesions from previous surgery,
- Severe constipation,
- Twisting of the intestines (volvulus).
Symptoms:
- Sudden, severe abdominal distension,
- Crampy abdominal pain,
- Inability to pass gas or stool,
- Nausea and vomiting,
- Loud or absent bowel sounds.
Why it matters:
If untreated, obstruction can cut off blood supply to the intestines, leading to tissue death and perforation (hole in the bowel wall).
2. Bowel Perforation (Hole in the Intestine)
This is when a hole forms in the wall of the intestine, allowing its contents (stool, bacteria, air) to leak into the abdominal cavity.
Common causes:
- Untreated obstruction,
- Diverticulitis,
- Inflammatory bowel disease (IBD),
- Trauma or injury,
- Cancer,
- Ulcers (in the stomach or intestine).
Symptoms:
- Sudden, severe abdominal pain,
- Fever and chills,
- Rigid or hard abdomen,
- Rapid heartbeat,
- Nausea, vomiting, and confusion.
3. Peritonitis (Infection of the Abdominal Lining)
When the intestines leak or rupture, bacteria enter the peritoneal cavity, causing widespread inflammation known as peritonitis.
Peritonitis can be deadly if not treated quickly. It may occur after:
- Bowel perforation,
- Burst appendix,
- Ruptured ovarian cyst,
- Complication of peritoneal dialysis.
Symptoms:
- Extreme abdominal pain and distension,
- Tender, firm, or “board-like” abdomen,
- High fever,
- Fatigue or confusion,
- Low blood pressure and shock.
Who Is at Risk for Distension and Its Complications?
You’re more likely to develop abdominal distension if you:
- Have a history of abdominal surgery (risk of adhesions),
- Suffer from chronic constipation or IBS,
- Eat a high-FODMAP diet (fermentable carbs),
- Have liver disease (risk of fluid build-up or ascites),
- Are over 60 or have diverticular disease.
Other Associated Symptoms
With abdominal distension, you may also experience:
- Gas and bloating,
- Cramping or sharp pain,
- Nausea or loss of appetite,
- Change in bowel habits (constipation or diarrhoea),
- Weight loss (especially in chronic or cancer-related causes).
Seek urgent care if you also have:
- Persistent vomiting,
- Blood in stool or vomit,
- High fever or chills,
- Yellowing of the eyes (jaundice),
- No bowel movements or gas for 24–48 hours.
How Is It Diagnosed?
Doctors use a combination of history, physical exam, and tests to pinpoint the cause.
Examinations and tests may include:
- Physical exam — checking for tenderness, swelling, or masses.
- Blood tests — to detect infection, inflammation, or organ failure.
- Abdominal X-ray — to check for gas patterns, fluid levels, or perforation.
- Ultrasound or CT scan — to evaluate for obstruction, ascites, tumours, or organ damage.
- Endoscopy or colonoscopy — to look inside the digestive tract if needed.
Treatment: From Simple Remedies to Emergency Care
Mild Causes (Gas, Constipation, Food Intolerance)
- Eat slowly, avoid carbonated drinks,
- Try a low FODMAP diet,
- Use gentle laxatives or fibre supplements,
- Probiotics may help some individuals.
Serious Causes (Obstruction, Perforation, Peritonitis)
These require immediate medical care.
- Bowel obstruction may need:
- Hospital admission,
- IV fluids and bowel rest (no eating),
- Surgery if the blockage doesn’t clear.
- Perforation and peritonitis require:
- Emergency surgery to repair the leak,
- Strong intravenous antibiotics,
- Sometimes ICU support.
Final Thoughts: Listen to Your Belly
A bloated belly can be annoying — or it can be your body’s emergency signal.
If your abdominal distension:
- Comes on suddenly,
- Doesn’t go away,
- Is painful or accompanied by fever, vomiting, or constipation…
Don’t wait. Get it checked.
In most cases, it’s just bloating or constipation. But in some cases, it could save your life to recognise that something deeper is wrong.
References
- Abdominal Bloating and Distension: Pathophysiology and Treatment. Gastroenterology & Hepatology, NCBI, 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4198919/
- Acute Abdominal Pain and Surgical Emergencies. BMJ Clinical Review, 2020. https://www.bmj.com/content/371/bmj.m3801
- Peritonitis: Symptoms, Causes and Treatments. Mayo Clinic, 2023. https://www.mayoclinic.org/diseases-conditions/peritonitis/
- Intestinal Obstruction. American College of Surgeons, 2022. https://www.facs.org/patient-education/patient-resources/conditions/intestinal-obstruction/