When we digest food, naturally occurring bacteria in the gut emits various gases, including methane and hydrogen (Image 1). In an optimally functioning GI track, we react to the gas production by contracting our anterior abdominal muscles and relaxing the diaphragm. If the gut is full of food or gas, the dome-shaped diaphragm should automatically relax upward, giving the abdomen more room to expand (Image 2). However, when efficient gut-brain neural coordination is lost, the diaphragm contracts rather than relaxes when it senses abdominal fullness, and the gas is forced down and out instead of moving upward. To add to the discomfort, if the pelvic floor muscles are unable to relax properly, the gas is then pushed back up into the abdominal cavity, causing a visceral (gut) somatic (abdominal muscle) reflex that triggers the bloating sensation.
Thankfully, most people have enough musculofascial elasticity in pelvic floor muscles such as the levator ani, coccygeus, and piriformis to accommodate the bloat by expanding up, down, side-to-side, and front-to-back. But in those with a chronically contracted pelvic floor, much of the pressure will be pushed out through the belly, resulting in that uncomfortable belly bulge (Image 3). It’s not uncommon for bloated clients to complain of heartburn symptoms as well, which can be related to pressure from gasses pushing up and compressing the lower abdominal sphincter muscles that separate the stomach from the esophagus.
In Images 4 and 5, I demonstrate a couple of my favorite myoskeletal techniques for relieving these uncomfortable sensations caused by abdominal and pelvic floor rigidity. The goal of all belly bloat techniques is to help establish a balanced functional relationship between the pelvic and respiratory diaphragms by way of the brain-gut axis.
The brain – belly relationship
On account of the large number of neurotransmitters it helps produce, the human gut acts like a “second brain.” Any alteration in brain-gut signaling can create hormonal imbalances that stress the system, leading to increased visceral hypersensitivity. Similar to pain, bloating is related to a combination of increased noxious nerve signals arriving from the GI tract and ineffective regulation of the signaling by the brain. Changes in brain-gut regulation combined with gut hypersensitivity can cause more intense discomfort. In addition, bloating may be further aggravated by abnormal lumbosacral and pelvic relationships, such as tight hip flexors and weak core muscles. This is primarily due to lack of variety in daily movement patterns and prolonged desk-occupied postures.
It’s interesting to note that brain-gut alterations can worsen with troublesome breathing habits, such as sleep apnea, due to the inappropriate use of the abdominal and breathing muscles. The technical term for this condition is abdominal phrenic dyssynergia, which describes the loss of synergy between muscles of the abdomen (the diaphragm and abdominal wall muscles) and the phrenic nerve that transmits sensation and movement to the diaphragm.
Bloating and distension are highly prevalent symptoms with a marked effect on health status and quality of life. In the last few years, considerable progress has been made in understanding the pathogenesis of these symptoms, and emerging evidence indicates that targeting colonic motility, gut flora, visceral sensitivity, and dietary intake is helpful in controlling such symptoms.2
The primary goal of digestion is to get food from one end to the other as quickly as possible with maximum absorption. Massage techniques that manually teach overworked abdominal muscles how to relax and efficiently move gasses through the system will improve gut motility and strengthen peristaltic action. Though few studies exist in which bloating is a primary endpoint, I’ve personally found that musculoskeletal pelvic alignment coupled with breathing exercises to stimulate the parasympathetic nervous system help improve the symptoms of belly bloat among my clientele.
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