Persistent Abdominal Distension: Seeking Solutions for Gas Retention

Q: Persistent Abdominal Distension: Seeking Solutions for Gas Retention

Hello： There are many causes of abdominal bloating, such as neurogenic, organic, infectious, and electrolyte imbalances. <br>It is recommended to consult a gastroenterologist for diagnosis and treatment. <br>Wishing you peace and happiness.

Bloating with inability to pass gas?

My father has complete paralysis below the neck due to a spinal cord injury, but he is conscious and able to eat normally.
He can urinate on his own, but there is residual urine, so he requires catheterization three times a day.
For bowel movements, he needs assistance to manually evacuate.
He has been bedridden for over ten years and has frequently been hospitalized in the past year due to issues with abdominal distension.
Each time his abdomen swells, inserting a rectal tube usually allows for the expulsion of most of the gas, and with a period of fasting for one to two days, the gas shown on abdominal X-rays can typically be expelled within three days.
However, during this recent hospitalization for distension, after inserting the rectal tube, the swollen abdomen decreased, but X-rays still indicated the presence of gas.
Therefore, he was kept for observation.
After one day of fasting, he resumed a liquid diet, and the rectal tube was removed.
Within less than a day, his abdomen became distended again, prompting the re-insertion of the rectal tube to relieve the gas.
He continued fasting and was restricted from water for three days (during which he only received 5-10% dextrose), and antibiotics were administered.
X-rays still showed gas retention, leading the doctor to decide to insert a nasogastric tube while continuing the fasting and providing nutritional support via injections and dextrose IV.
However, after three days, the X-rays showed no improvement.
Given that my father is over seventy years old and has not eaten for more than seven days, his immune system is significantly compromised, and he has developed oral ulcers and poor color.
The attending physician did not specifically mention "intestinal obstruction" or "volvulus," only noting that the X-rays showed gas throughout the small and large intestines.
His abdomen has become so flat that the hip bones are visible, and when he takes deep breaths, the rectal tube bag visibly rises and falls.
We are truly puzzled as to why the gas in his intestines cannot be expelled.

We are very concerned about these symptoms persisting for several days without resolution.
What further assistance can we seek? Thank you for your patience in reading this.

Wang Ting, 30~39 year old female. Ask Date: 2012/10/18

Dr. Cai Jinji reply Gastroenterology and Hepatology

Hello: There are many causes of abdominal bloating, such as neurogenic, organic, infectious, and electrolyte imbalances.
It is recommended to consult a gastroenterologist for diagnosis and treatment.
Wishing you peace and happiness.

Reply Date: 2012/10/18

More Info

Persistent abdominal distension, especially in patients with long-term immobility, can be a complex issue that requires a multifaceted approach. In your father's case, given his spinal injury and the associated complications, it is crucial to understand the underlying mechanisms contributing to his symptoms.

Firstly, the inability to move can significantly affect gastrointestinal motility. The intestines rely on physical movement to help propel contents through the digestive tract. In patients who are bedridden, this natural peristalsis can be severely impaired, leading to gas retention and abdominal distension. Additionally, the use of medications, especially opioids for pain management, can further slow down gut motility, exacerbating the problem.

In your father's situation, the repeated interventions such as the insertion of a rectal tube to relieve gas and the use of a nasogastric tube indicate that there is a significant issue with gas accumulation. While these methods can provide temporary relief, they do not address the root cause of the problem. The fact that X-rays continue to show gas retention suggests that there may be an underlying issue that needs to be identified and treated.

Here are some potential strategies and considerations that could help manage your father's condition:
1. Dietary Adjustments: Since your father is able to eat, it may be beneficial to consult with a dietitian who specializes in gastrointestinal issues. A diet low in fermentable carbohydrates (often referred to as a low-FODMAP diet) may help reduce gas production. Additionally, ensuring that he is adequately hydrated can help maintain bowel function.

2. Physical Therapy: Engaging a physical therapist who specializes in working with patients with spinal injuries could be beneficial. They may be able to implement passive range-of-motion exercises that can stimulate intestinal activity and help reduce gas retention.

3. Medications: While you mentioned concerns about medication side effects, there are options available that may help with gas relief. Simethicone is an over-the-counter medication that can help reduce gas buildup. Additionally, prokinetic agents may be prescribed to enhance gut motility.

4. Regular Monitoring: Given your father's age and the complexity of his condition, regular follow-ups with a gastroenterologist are essential. They may recommend further imaging studies or endoscopic evaluations to rule out any obstructions or other gastrointestinal issues that could be contributing to the gas retention.

5. Consideration of Advanced Interventions: If conservative measures fail, it may be necessary to consider more invasive options. This could include surgical interventions if there is evidence of bowel obstruction or other anatomical issues that are not resolving with conservative management.

6. Psychological Support: Long-term hospitalization and chronic health issues can take a toll on mental health. Ensuring that your father has access to psychological support can help him cope with the stress of his condition.

In conclusion, managing persistent abdominal distension in a patient with long-term immobility requires a comprehensive approach that includes dietary management, physical therapy, medication, and regular medical oversight. It is essential to work closely with healthcare providers to tailor a plan that addresses your father's specific needs and to remain vigilant for any changes in his condition that may require immediate attention.

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