From the Guidelines
Several medications and treatments in this list could contribute to abdominal bloating and distension, primarily due to their effects on intestinal motility and gas production. The medications that could contribute to abdominal bloating and distension include:
- Codeine phosphate, which is an opioid that can slow intestinal motility, leading to constipation and bloating 1
- Loperamide hydrochloride, which can also slow gut transit and cause distension when overused 1
- Hyoscine butylbromide, which can cause paradoxical bloating due to its anticholinergic effects that slow gut motility
- PEG feeding (Vital 1.5), which can contribute to bloating if administered too quickly or if there are absorption issues
- Glycerine suppositories and macrogol, which are used for constipation management and are often associated with bloating
- Gastric decompression, which is ordered four times daily and further confirms that gas accumulation is a significant issue for this patient These medications and treatments can exacerbate abdominal bloating and distension, particularly in patients with limited mobility, such as those requiring ventilator support and muscle tone management with baclofen. It is essential to monitor and manage these medications carefully to minimize their contribution to abdominal bloating and distension, and to prioritize treatments that improve intestinal motility and reduce gas production, as recommended by recent guidelines on the management of irritable bowel syndrome 1.
From the FDA Drug Label
The adverse events with an incidence of 1. 0% or greater, which were reported at least as often in patients on loperamide hydrochloride as on placebo, are presented in the table below. Gastrointestinal AE% Constipation 2.6% 0.8% The adverse events with an incidence of 1. 0% or greater, which were reported at least as often in patients on loperamide hydrochloride as on placebo, are presented below in the table below. Gastrointestinal AE% Constipation 5.3% 0.0% Gastrointestinal disorders Dry mouth, abdominal pain, distention or discomfort, nausea, vomiting, flatulence, dyspepsia, constipation, paralytic ileus, megacolon; including toxic megacolon
Abdominal bloating and distension could be contributed by:
- Loperamide, as it may cause abdominal distention or discomfort, constipation.
- Codeine phosphate, as opioids can cause constipation, which may lead to abdominal bloating and distension.
- Macrogl, as it is used to treat constipation, which may cause abdominal bloating and distension if not effective.
- Gastric decompression, as it is used to relieve abdominal distention.
- Flatus tube decompression, as it is used to relieve abdominal bloating. 2 2
From the Research
Potential Causes of Abdominal Bloating and Distension
The following medications and treatments could contribute to abdominal bloating and distension:
- Hyoscine butylbromide: as an antispasmodic, it can affect bowel motility and potentially contribute to bloating and distension 3, 4, 5
- Loperamide hydrochloride: can cause constipation, which may lead to bloating and distension
- Macrogl: an osmotic laxative that can cause gas and bloating
- Glycerine suppositories: can cause gas and bloating
- Codeine phosphate: an opioid that can cause constipation and contribute to bloating and distension
Underlying Mechanisms
Abdominal bloating and distension can be caused by various factors, including:
- Food intolerances
- Abnormal intestinal microbiota
- Disordered visceral sensation
- Delayed intestinal transit
- Abnormal viscero-somatic reflux 6, 7
- Visceral hypersensitivity
- Behavioral induced abnormal abdominal wall-phrenic reflexes
- The effect of poorly absorbed fermentable carbohydrates
- Microbiome alterations 7
Diagnostic and Therapeutic Considerations
- Abdominal girth measurement: can be used to monitor abdominal distension
- Flatus tube decompression: can be used to relieve abdominal bloating and distension
- Gastric decompression: can be used to relieve abdominal bloating and distension
- Dietary changes, probiotics, antibiotics, prokinetic agents, antispasmodics, neuromodulators, and biofeedback may be used to treat abdominal bloating and distension 6, 7