Abdomino-Phrenic Dyssynergia (APD) 286

or Visible Abdominal Distension

Authors: Elizabeth Barba, M.D., Digestive System Research Unit, University Hospital Vall
d'Hebron; Department of Medicine, Barcelona, Spain and Fernando Azpiroz, M.D.,
Digestive System Research Unit, Hospital General Vall d'Hebron, Barcelona, Spain

International Foundation for Gastrointestinal Disorders ([Link])

Reading time: 7 Minutes © Copyright 2025 by International Foundation for Gastrointestinal Disorders

What is Abdomino-Phrenic Dyssynergia (APD) or Visible Abdominal Distension?

Abdominal distension occurs when the abdominal or belly area visibly expands. In most patients, distension develops
during daily activity and tends to lessen or disappear after a night’s rest. Many people with gastrointestinal (GI)
illnesses experience visible abdominal distension.

Bloating or Distension? What’s the Difference? What causes abdominal distension?

Bloating is described as the feeling of swelling or a Abdominal distension has been researched by a series
build up of pressure in the abdomen. Sometimes it of studies. These studies look at the same person
can be described as the feeling of an inflated balloon when their abdomen is feeling “normal” and when it
in your stomach or intestines. Distension, however, is is distended. These studies used two methods to
the visible increase in the width of your abdominal measure this. First, the amount of contents in the
girth, or the area between your hips and chest. abdomen are measured, including gas in the
Feeling bloated is not always accompanied by the intestines. The structure of the abdominal walls are
physical symptom of distension. measured with CT scan and electromyography (EMG).
A CT scan shows x-ray images of the inside of the
Learn more about bloating and distension with IFFGD body. In this case, the pictures show the abdomen
Fact Sheet No. 262 Understanding Bloating and
Distension wall and the diaphragm. The activity of the muscles in
the abdomen are measured by the EMG. This test
records the electrical impulses the muscles produce
What is considered “normal”? when they move and contract. These studies showed
Over the course of a day, the contents in the the following points:
abdominal cavity will change. The abdomen includes • People with abdominal distension have a
digestive organs (stomach and intestines). The change measurable increase in belly size and an extended
in contents include any food or drink taken in and stomach.
urine or bowel movements that are released. For that • Despite that many people believe abdominal
purpose, the walls of the abdomen actively change to distension is caused by extra intestinal gas, this is
fit what is inside. This is done by tight control of the typically not the case. However, intestinal gas may
muscles that make up the walls. In healthy people, an be the cause in people who have an observed
increase in contents within the abdomen causes the disease such as small intestinal bacterial
diaphragm to relax. The diaphragm is the muscle that overgrowth (SIBO). This condition results from a
separates the chest from the abdomen and helps with high number of bacteria in the small intestine.
breathing. Relaxing this muscle allows the stomach • In the majority of patients, abdominal distension
and other organs to expand into the chest more. The is produced by abnormal activity of the abdominal
GI tract then has room to hold more contents without wall. The diaphragm contracts in a way that
having to expand outward. pushes abdominal contents downwards and
causes the front of the abdomen to expand
outwards. Some people experience
breathlessness during episodes of abdominal
distension which is caused by the diaphragm
contracting this way.
 What triggers abdominal distension? A recent study showed that people are accurately
People typically describe that distension begins recognizing distension after eating leafy greens. It is
quickly once it is triggered. In the studies described not uncommon for people to report bloating after
previously, distension occurred in less than 60 eating salad. Although distension is occurring, often it
seconds in 35% of people, and less than 10 min in is not produced by gas. This study showed that the
another in 26%. Events that can trigger distension true cause may be abdominal muscles not working
may include certain foods and stressors. These together properly.
potential causes are discussed below.
Constipation
Some people with bloating and abdominal distension
Eating Meals
have constipation due to anal dyssynergia. This
Some people who suffer from abdominal distension
condition occurs when muscles of the anus do not
have a more sensitive gut and intestines. This could
contract together properly. The anus is the lower
cause a feeling of bloating to occur even with minor
opening of the GI tract. Normal bowel movements
changes in the gut. In people who regularly respond
occur when the abdominal wall is pushing and is then
like this, a small sensation may trigger the abnormal
followed by a relaxation and opening of the anal
response that produces abdominal distension. In fact,
canal. It has been shown that correction of anal
bloating and distension may be related to food intake.
dyssynergia can relieve distension and bloating. This
A large number of people with bloating, describe that
can be done through biofeedback, the use of electrical
it develops or worsens shortly after meals. Some
stimulation to help train muscles.
people express that they are unable to complete a full
meal because of bloating. This effect is more obvious
Learn more about constipation with IFFGD Fact Sheet
when eating large and especially fatty meals. Bloating
No. 170 What is Constipation Anyway?
after meals is a typical trait in specific groups of
people. This can include those with dyspepsia and
people who binge eat. High fiber foods or fiber Diagnosing Abdomino-Phrenic Dyssynergia (APD)
supplements are often believed to worsen bloating. Testing for Abdomino-Phrenic Dyssynergia (APD) or
Fiber increases the volume of intestinal content, visible abdominal distension is typically not required
leading to a feeling of bloating. given the previously discussed symptoms and data. If
needed, a CT scan and electromyography (EMG) can
Learn more about dyspepsia with IFFGD Fact Sheet No. be done. Due to the abnormal movement of the
514 Upper Abdominal or Stomach Pain (Indigestion)
diaphragm, which can be associated with APD, an
ultrasound can be done to help identify these
movements. An ultrasound is a noninvasive test that
Food Intolerances
uses sound waves to produce images of inside the
Specific food intolerances have also been connected
body.
with bloating and distension. One example is dairy
products, however it has been shown that only a
Managing APD
fraction of these cases are truly due to lactose
Unfortunately, there are no standardized treatments
intolerance. This intolerance occurs when the lactase
for APD presently, however there are multiple
enzyme is not present in the GI tract, preventing dairy
management strategies that can be explored with
from being broken down properly by the body. If
your healthcare provider.
symptoms occur with a low amount of dairy, it is
unlikely to be caused by an intolerance. Fatty foods
Lifestyle and Dietary Modifications
and carbonated drinks are other examples and are
The initial line of treatment in patients with
frequently reported as a cause. Some people say that
abdominal distension would be to target triggers, such
eating lettuce and other green leafy vegetables cause
as increased content in the intestines. Specifically, it is
them gas and abdominal distension.
wise to avoid diets rich in fermentable foods, such as
yogurt, kimchi, and kefir, as well as fiber supplements.
 Treating Underlying Constipation About IFFGD
If present, constipation should be treated to help with The International Foundation for Gastrointestinal Disorders
(IFFGD) is a 501(c)(3) nonprofit education and research
symptoms. Some common treatments for organization. We work to promote awareness, scientific
constipation are also known for causing bloating. It is advancement, and improved care for people affected by chronic
best to always ask your healthcare provider before digestive conditions. Our mission is to inform, assist, and support
people affected by gastrointestinal disorders. Founded in 1991,
starting treatment. Treating constipation also varies we rely on donors to carry out our mission. Visit our websites at:
depending on severity. Some known treatments for [Link] or [Link]
constipation are listed below:
IFFGD
• Increased hydration and exercise 537 Long Point Road, Unit 101
• Biofeedback Mt Pleasant, SC 29464
• Laxatives
About the Publication
• Medications Opinions expressed are an author’s own and not necessarily
• Bowel retraining those of the International Foundation for Gastrointestinal
Disorders (IFFGD). IFFGD does not guarantee or endorse any
product in this publication or any claim made by an author and
Learn more about treating constipation by visiting IFFGD’s website: disclaims all liability relating thereto. This article is in no way
[Link] intended to replace the knowledge or diagnosis of your doctor.
We advise seeing a physician whenever a health problem
arises requiring an expert’s care.
Prokinetics and Spasmolytics For more information, or permission to reprint this article,
contact IFFGD by phone at 414-964-1799 or by email at
How each person experiences symptoms, particularly iffgd@[Link]
bloating, is a key factor often associated with
distension. As a result, treatment with prokinetics or
spasmolytics may relieve abdominal symptoms.
Prokinetics are drugs that increase the frequency of
contractions in the GI tract. This may improve
movement of contents through the GI tract and
stomach emptying. Spasmolytics are drugs that help
reduce smooth muscle spasms. Smooth muscles make
up the lining of the GI tract and other organs.

Biofeedback
As mentioned previously, biofeedback is the use of
electrical stimulation to help train muscles.
Biofeedback has been proven useful to correct muscle
tone and resolve distension. The use of this
treatment, however, is limited as it can be complex
and costly. A new standardized biofeedback technique
has been developed in Spain. Unfortunately, it is not
widely available but can be found in some specialized
medical centers.