Abdominal Bloating: Causes and Diagnosis After Surgery

Abdominal bloating

Hello Doctor: I am 47 years old.
I had surgery for intestinal obstruction in the fifth grade.
About two to three years ago, I started experiencing unexplained abdominal bloating that lasts for about a week, and then it gradually returns to normal.
This occurs approximately once every six months.
I have had a fecal occult blood test that came back normal.
The doctor suspects that it may be due to intestinal adhesions, but mentioned that there is no definitive way to confirm this through tests.
Is it common for intestinal adhesions to develop and cause bloating after about thirty years? Is there a medical way to confirm this? Additionally, can a person suspected of having intestinal adhesions undergo a colonoscopy?

Xiao Jie, 40~49 year old female. Ask Date: 2022/03/28

Dr. Chen Shidian reply Gastroenterology and Hepatology

Adhesions can occur at any time.
A colonoscopy can be performed, but it is challenging due to the increased angle, so it should be done with caution.
Clinically, it is often recommended to maintain a low-volume diet and monitor for changes in symptoms.

Reply Date: 2022/03/28

More Info

Abdominal bloating can be a distressing symptom, especially for individuals with a history of abdominal surgery. In your case, having undergone surgery for intestinal obstruction in childhood and experiencing recurrent episodes of bloating over the past few years raises several important considerations regarding the potential causes and diagnostic approaches.

Understanding Abdominal Bloating
Abdominal bloating is often described as a feeling of fullness or swelling in the abdomen, which can be accompanied by discomfort or pain. The causes of bloating can vary widely and may include:
1. Gastrointestinal Motility Disorders: Conditions that affect the movement of the intestines can lead to bloating. This includes conditions like irritable bowel syndrome (IBS) or functional dyspepsia.

2. Food Intolerances: Intolerances to certain foods, such as lactose or gluten, can lead to bloating after consumption.

3. Gas Accumulation: Excessive gas production due to the fermentation of undigested food in the intestines can cause bloating.

4. Intestinal Obstruction or Adhesions: Given your surgical history, adhesions (bands of scar tissue) can form after abdominal surgery and may lead to partial obstructions, causing bloating and discomfort.

5. Infections or Inflammatory Conditions: Gastroenteritis or inflammatory bowel diseases (IBD) can also present with bloating.

Diagnosis of Abdominal Bloating
Diagnosing the cause of abdominal bloating, especially in someone with a surgical history, can be challenging. Here are some diagnostic steps that may be considered:
1. Medical History and Physical Examination: A thorough history, including the pattern of bloating, associated symptoms (like pain, diarrhea, or constipation), and dietary habits, is crucial. A physical examination can help identify any abdominal tenderness or distension.

2. Imaging Studies: While traditional imaging like X-rays or ultrasounds can help identify gross abnormalities, they may not always detect adhesions. A CT scan can provide more detailed information about the abdominal organs and any potential obstructions.

3. Endoscopy: A colonoscopy can be performed to visualize the interior of the colon and rectum. This procedure can help identify any structural abnormalities, such as strictures or lesions, and can also be used to obtain biopsies if necessary.

4. Functional Tests: Tests to assess gastrointestinal motility may be indicated if a motility disorder is suspected.

Adhesions and Their Impact
Regarding your concern about adhesions developing after a long period (30 years), it is indeed possible for adhesions to cause symptoms many years after surgery. Adhesions can form as a result of any abdominal surgery and can lead to chronic pain or bowel obstruction. The likelihood of developing adhesions increases with the number of surgeries and the extent of the surgical procedure.

Can You Have a Colonoscopy with Suspected Adhesions?
Yes, individuals with suspected adhesions can undergo a colonoscopy. However, it is essential to inform your healthcare provider about your history of abdominal surgery and any symptoms you are experiencing. In some cases, if there is a significant risk of obstruction, your doctor may recommend imaging studies first to assess the situation before proceeding with a colonoscopy.

Conclusion
In summary, abdominal bloating after surgery can be attributed to various factors, including adhesions, motility disorders, and dietary issues. Given your history, it is advisable to consult with a gastroenterologist who can guide you through the appropriate diagnostic tests and management strategies. Early identification of the underlying cause is key to alleviating your symptoms and improving your quality of life.

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