Never heard of this one, right? A real mouthful to pronounce, too. ‘Abdomino’ is easy. ‘Phrenic’ is the nerve from your spinal cord attached to your diaphragm, the large muscle that separates your lungs from your abdomen. Your phrenic nerve controls breathing. ‘Dyssynergy’ simply means things are functioning out-of-whack.
More and more gastroenterologists have come to realize that Abdominophrenic Dyssynergy (let me abbreviate APD) can be a main culprit in BLOATING.
Let’s say you’re one of those many people, usually female (90%!) who eat a meal (or sometimes just have a few sips of water) and within a few minutes you’re aware of that really uncomfortable feeling of “bloat”. The gender predominance has several theories, none proven.
When you’re a victim of APD, almost minutes to an hour after a meal, you’ll see your tummy swelling right before your eyes. Standing in front of a full-length mirror, you might even say, “I look pregnant!”, but fortunately a few hours later, the swelling’s gone down. Very likely, before halfway decent pregnancy tests were invented in the 1960’s, many young women got married for being bloated.
Over the years as your bloating worsened, you tried eliminating certain foods but doing this wasn’t really helpful. Your Breath Test for Small Intestine Bacterial Overgrowth (SIBO) was “positive” but the treatment with the antibiotic used for this condition (Xifaxan) only gave temporary relief and your symptoms were back in a couple of months. You tried the low FODMAP diet but weren’t impressed, only deprived.
Some aspects of your bloating you discovered by yourself. If you ate too quickly, your bloating was worse so you deliberately slowed down for every meal. You avoided carbonated beverages. Both helped.
Stress made your bloating worse. When they announced layoffs at work, which turned out not to affect you, you remember your bloating went into high gear. So you enrolled in a Yoga class, and you’re really not sure if it helped your bloating but overall you do feel better.
You have discovered there’s a definite hormonal component to your bloating. You’ve picked up that your bloating is definitely worse at the midpoint between your periods (ovulation) and in the week before your period starts (PMS). Your best week is the week after your period.
So like any sensible proactive patient you went online and read about the brain gut connection. You discovered how the longest nerve in the body, the vagus nerve, connects the two, and how a large muscle, the diaphragm, which separates the lungs and the abdomen, can be thrown out of kilter, setting the stage for an impossible to pronounce condition called ABDOMINOPHRENIC DYSSYNERGY whose main symptom is BLOATING. We’ve agreed to call it APD for short. APD is a ‘dysfunction’, not a ‘disease’. It doesn’t lead to a ‘disease’, like ulcerative colitis, Crohn’s, or cancer. It has never been nor ever will be a line item on anyone’s death certificate. That APD is profoundly annoying is an understatement.
Here’s what goes wrong with APD:
When you eat anything (or even that sip of water), there’s supposed to be a wondrous coordination of muscles in swallowing, breathing, your diaphragm, and the muscles of your abdominal wall sending your food into your intestines to absorb the nutrients.
“Dyssynergia” is defined as any disturbance in muscular coordination that causes abrupt and uncoordinated movements. Many women see Pelvic Floor Therapists to treat the chronic pelvic pain of pelvic muscle dyssynergia. They want to have sex, but it’s too painful.
APD is a lack of coordination between your diaphragm and your abdominal wall muscles. The end result of every meal is that you swell like a balloon, that’s the ‘bloat’.
Here’s what I suggest you do:
Schedule an appointment at WholeHealth Chicago. Although there is no specific diagnostic test for APD, you want to make sure you don’t have SIBO. Have your practitioner order a breath test for this.
Watch this YouTube video as a physical therapist teaches Diaphragmatic Breathing. This will slowly reverse the APD. A referral to pelvic floor therapist and an acupuncturist would be very helpful as well.
There have been very few clinical trials of medications used for APD.
Gastroenterologists generally prescribe medications like Lyrica (for symptom control), antidepressants, and the prokinetic Reglan (to help with intestinal motility). The best prokinetic can be ordered from Canadian pharmacies is Domperidone. We can order it for you (easy to remember because of the champagne Dom Perignon).
Recommended supplements:
- Motility Activator (Integrative Therapeutics), twice a day;
- AM/MD (Amy Myers), twice a day;
- ProBioMax DF (Xymogen), once a day;
- If you have significant PMS, add Vitex (Vitanica), once a day.
There are some features of APD that suggest an imbalance of pain receptors along the intestinal tract (“visceral hypersensitivity”). I think it is worth trying Low Dose Naltrexone available from compounding pharmacies for at least three months. It is inexpensive and virtually free from side effects.
Be well,
David Edelberg, MD