Functional gastrointestinal disorders (FGID) are the most common gastrointestinal disorders in the general population, accounting for about 40% of GI problems seen by doctors and therapists. FGID are disorders of gut-brain interaction, meaning the normal motility of the intestines or the sensitivity of the nerves that innervate the intestines are impaired. However, upon imaging, there are no structural abnormalities of the GI system. These disorders are thus diagnosed by the characteristics of the symptoms which can vary widely, and include abdominal bloating and distension. Sudden onset of these symptoms, particularly in the young, female, athletic population has become increasingly more common though often misdiagnosed and widely misunderstood. This particular disorder is called Abdomino Phrenic Dyssynergia (APD) and the diagnosis can be frustrating, taking months or even years to come by, often after a battery of expensive tests which return with “unremarkable” findings.
What is APD?
Abdomino phrenic dyssynergia falls under the category of functional GI disorders due to the inability of the brain to coordinate the correct movement of the diaphragm in response to the fullness of the abdomen via the phrenic nerve. This leads to uncomfortable abdominal bloating and distension as the diaphragm contracts instead of relaxes when there is abdominal fullness. The diaphragm is a large muscle that lies underneath the ribs and helps with breathing. When the diaphragm contracts, it moves in a downward motion, reducing the space in the abdomen and pushing the organs down and out. Further, as the intraabdominal contents are pushed outward, the abdominal muscles are unable to compensate for the pressure and weaken resulting in bloating and distension.
APD often coincides with pelvic floor dysfunction as the diaphragm and pelvic floor muscles have a functional relationship modulating intraabdominal pressure. When the synergy is off, the pelvic floor muscles also suffer from impaired nervous innervation and become tense and contracted, pulling up into the pelvis further contributing to the bloating and distension.
How can physical therapy help?
APD is a complex neuromuscular disorder that takes a unique skill set to assess and treat. A physical therapist with a background in both orthopedics and pelvic health can examine the tissues, reduce symptoms, and restore proper coordination of the diaphragm, abdominal muscles, and the pelvic floor. Manual techniques are utilized to reduce the tension in these muscle groups, including soft tissue mobilization, visceral mobilization, muscle energy techniques, and trigger point dry needling to the appropriate muscle groups. Neuromuscular reeducation is a therapeutic technique that can restore the mind-body connection and retrain neurological pathways. Multiple forms of biofeedback are used including manual, visual, and surface EMG in which electrodes are placed on the surface of the skin which read the activity of the underlying muscle; the patient learns to relax and contract the targeted muscles appropriately which helps restore the normal piston-like motion of the pelvic floor muscles and the diaphragm. Therapeutic exercise provides stability of the spine and pelvis to ensure maintenance of restored, normalized muscle patterns. To schedule with our physical therapists who specialize in treatment of FGID and pelvic floor dysfunction, click here! Our pelvic health specialists at Mend in Boulder, Colorado would love to answer your questions and resolve your functional gastrointestinal problems.
References:
Talley NJ. Functional gastrointestinal disorders as a public health problem. Neurogastroenterol Motil. 2008 May;1:121-129.
Villoria A Abdomino-phrenic dyssynergia in patients with abdominal bloating and distension. Am J Gastroenterol. 2011 May;106(5):815-9.