Article by Dr Manasa S, B.A.M.S & Dr Raghuram Y.S. MD (Ay)
Meteorism, also known as tympanites, is characterized by the accumulation of gas within the gastrointestinal (GI) tract, leading to bloating and abdominal distension.
This condition often results in discomfort and can interfere with daily activities. Improper eating habits are a significant contributor to meteorism, with the ingestion of certain foods and beverages exacerbating gas production. Common dietary triggers include high-fibre foods, carbonated drinks, and dairy products in individuals with lactose intolerance. Effective management of meteorism typically involves modifying eating behaviours, such as eating slowly, avoiding gum chewing, and identifying specific dietary triggers. Additionally, incorporating regular physical activity and over-the-counter remedies like simethicone may provide relief. For persistent or severe symptoms, consulting a healthcare professional is advised to rule out underlying conditions such as irritable bowel syndrome (IBS) or small intestinal bacterial overgrowth (SIBO).
Epidemiology
Meteorism, or the accumulation of gas in the gastrointestinal tract leading to bloating and abdominal distension, is a widespread condition affecting individuals across all age groups. It is equally prevalent among different races and can impact anyone from infants to the elderly. The majority of cases are reported in individuals during their third decade of life. Epidemiological data indicate that approximately 15-23% of Asians and 15-30% of Americans experience symptoms of flatulence. This prevalence highlights the common nature of meteorism and the importance of recognizing and addressing this condition in diverse populations.
Causes of Meteorism
– Excessive fermentation caused due to bacteria of the intestinal flora
– Swallowing too much air while eating
– Obstruction in bowel
– Overeating
– Renal stones
– Overgrowth of bacteria
– Blunt trauma to kidney
– Bowel inflammation
– Peritonitis|
– Functional disorder
Symptoms
Bloated sensation
– Bloated sensation may be associated with abdominal discomfort
– It might last a few minutes or for prolonged period of time
– Some individuals may also complain of distended stomach
– Some complain of excessive belching and or passage of flatus.
Abdominal pain – may be dull or sharp and might cause cramping
On examination –
– On palpation – there may be signs of abdominal distension and marked tympany.
– On auscultation – there might be rumbling bowel sounds or tinkling sounds.
– Rectal examination – might not reveal anything significant.
Diagnosis: How is a patient evaluated for meteorism?
The first step involved in evaluation of meteorism is to rule out an organic disorder like bowel obstruction, bowel disease, strangulated hernia, or volvulus and colon cancer.
Lab investigations are done to rule out other pathologies.
Most of the time, no imaging technique is required to make the diagnosis but if the patient has pain or tenderness while doing abiding examination, then plain X-ray is required to look for dilated bowel loops, air-fluid levels, or free air.
Prognosis
Temporary bloating is generally a mild annoyance that can be effectively managed through dietary changes and lifestyle adjustments. Most individuals experience significant relief by identifying and avoiding specific food triggers and adopting healthier eating habits.
However, persistent bloating and gassiness may indicate an underlying organic cause that requires medical evaluation. In such cases, it is crucial for healthcare providers to conduct thorough assessments to rule out serious conditions like irritable bowel syndrome (IBS), small intestinal bacterial overgrowth (SIBO), or other gastrointestinal disorders. With appropriate diagnosis and treatment, most patients can manage their symptoms effectively and maintain a good quality of life.
Treatment and Management of Meteorism
Principles of management
– For functional bloating, supportive treatment is recommended.
– Maintain a food diary to track symptoms and identify triggers.
– Eliminate foods that produce a bloating sensation.
Dietary Modifications
– Avoid overeating; consume 4 to 7 small meals a day instead of 3 large meals.
– Limit intake of high-fat and simple carbohydrate foods as fats prolong digestion and bloating.
– Adopt a low FODMAP diet to reduce bloating symptoms.
– Eat slowly to avoid swallowing air and to reduce the desire to overeat.
– Chew food thoroughly.
– Avoid drinking beverages while eating or immediately after meals; consume beverages, vegetables, and fruits at least 1-hour post-meal.
Beneficial Additions
– Include ginger, cumin, and herbs like dill, parsley, and basil to help reduce flatulence.
Habits to Avoid
– Do not chew gum.
– Avoid drinking through a straw.
– Refrain from consuming carbonated sodas.
– Do not suck on candy.
Stress Management
– Reduce anxiety and stress to avoid swallowing air.
– Practice relaxation techniques such as breathing exercises, yoga, or tai chi.
Supplements and Alternative Therapies
– Vitamin D supplements have been shown to improve quality of life by reducing bloating.
– Moxibustion and acupuncture may help alleviate bloating sensations.
– Psychotherapy can benefit patients with functional dyspepsia.
Foods to Avoid
– Lentils and beans, which contain indigestible sugars.
– Certain fruits and vegetables like carrots, cabbage, Brussels sprouts, prunes, and apricots.
– Artificial sweeteners like sorbitol.
– Dairy products, especially for those with lactose intolerance.
– Wheat, due to gluten, which can cause bloating in sensitive individuals.
Physical Activity
– Engage in regular physical activity to enhance peristalsis and facilitate the expulsion of gas from the intestine.
Meteorism: Ayurveda Understanding
Adhmana – By explanation of meteorism, it can be compared to a condition mentioned in the context of Vata Vyadhi called Adhmana. It is a condition which is caused due to obstruction of vata in the abdomen, colon – pakvashaya to be precise.
Modern medicine says that this condition is caused due to accumulation of gases within the gastrointestinal tract. The foods which cause gases are those which also increase vayu and akasha bhavas (qualities) in the body. When vayu and akasha increase in the gastrointestinal tract, with special reference to pakvashaya – which is the main seat of vata, they tend to increase vata. This is because vata is also predominantly made up of vayu and akasha mahabhutas. This condition is marked by bloating and abdominal distension – which precisely means adhmana.
Adhmana is defined as ‘vata purna charma putaka’ i.e. the abdomen feels like a leather bag completely filled with air.
Master Sushruta counts atopa – gurgling sounds in the abdomen and ati ugra ruja – severe pain in the abdomen along with admata udara i.e. distended abdomen amongst the symptoms of adhmana. The word ghora – indicates that it is a dreadful condition. But such intensity and severe colic has not been highlighted in meteorism. Adhmana indicates a severe progressive or complicated stage of meteorism which needs immediate emergency attention.
Treatment principles of adhmana include management on the lines of treating vata vyadhi. Master Sushruta advocates fasting (apatarpana), fomentation by palm (pani tapa), carminative powders (dipana churna), phala varti (suppositories) and basti / vasti (enemas) for comprehensively treating adhmana. The same can be administered in meteorism.
