The Brick in Your Stomach

 

Imagine eating a big meal, feeling uncomfortably full afterward, and then…nothing changes. For hours or possibly even days your stomach continues to feel full.  As a result, even though you might again have feelings of hunger, your stomach can’t handle anything more substantial going in it. When you try eating just a little, once again that heavy brick feeling is in your stomach. You always feel bloated, and like you have a “food baby”. 

These are the hallmarks of a stomach disorder called Gastroparesis (GP). Here I’m going to explain what Gastroparesis is, some common medical and dietary interventions for it, and how Visceral Manipulation, a technique within Osteopathic Manual Therapy, can help GP in a gentle and natural way.

 

What is Gastroparesis?

Gastroparesis (gastro=stomach paresis=weak) is when the stomach fails to efficiently liquify its contents and pass them along to the small intestine for absorption. A normal, healthy stomach is a robust, muscular organ that squeezes, grinds, and pulverizes food while simultaneously mixing it with hydrochloric acid and enzymes to further break things down.

 

Visceral manipulation for gastroparesis

Left: Weak muscle contractions, leading to delayed stomach emptying.   Right: Normal rhythmic contractions of stomach wall to grind and propel food (chyme) forward

The stomach should stretch when filled, and empty at least 40% of its contents within 2 hours. By 4 hours,it should be 90% emptied. If your stomach isn’t doing this, and its rate of emptying is delayed, that can be due to Gastroparesis (GP).

Common Symptoms

People with gastroparesis typically complain of a bloated, distended belly in the upper abdomen (above the belly button) that happens right after meals. It’s worst toward the end of the day, and best in the morning after the stomach has had time to empty more completely overnight. Usually this over-full feeling comes about quickly and after eating very little. As a result, folks with GP don’t have a big appetite much of the time. They may also have heartburn, nausea, vomiting, or belching associated with bits of under-digested food remaining in the stomach for longer periods of time.

 

Gastroparesis diet

Texture matters a lot for folks with GP. Foods that are softer, more processed or more refined are easier to digest. Think of foods that are broken down to smaller particles such as: 

  • flours versus whole grains 
  • purees versus whole fruits/veggies 
  • cooked veggies versus raw 
  • liquids versus crunchy/chewy solids 

Meals that are high in fat (a steak dinner), or fiber (salads, nuts) are more difficult to tolerate because the stomach needs more time to break them down. The more the food is already mechanically broken down (digested) before reaching the stomach, the easier it is to consume.

 

Prognosis

GP isn’t typically life threatening, but it can be miserable and doesn’t usually resolve on its own.

 

Causes

In many cases, the cause of GP is unknown. Often there is dysfunction of the nerves responsible for the stomach’s digestive motions or motility. These are nerves within the stomach wall that control the pace of the stomach’s muscular contractions, as well as the vagus nerve of the “rest and digest” parasympathetic nervous system that stimulates these “pacemaker” nerve cells. 

This dysfunction can happen following some time following a viral infection. With poor nerve signaling, the muscles don’t contract as well and the food takes longer to grind up before pushing it along to the small intestines. The result: you feel very full and like the food is just sitting there- because that’s largely what’s happening.

Other causes include hypothyroidism, chronically elevated blood sugar (as in diabetes), past history of abdominal surgery, or connective tissue disorders like Ehlers Danlos Syndrome. Physical restrictions are another factor to consider, as I discuss below. In my practice, I find folks with sluggish stomachs (with or without a formal diagnosis of GP) to have several restrictions in the tissues around the stomach. Once these are gently mobilized and the stomach is mechanically more free to do its job, eating tolerance often improves.

 

Some Common Tests for GP

There are several tests that your doctor or gastroenterologist might order, but the main one for diagnosing GP is a Gastric Emptying Study (aka Gastric Emptying Scan, Gastric Emptying Scintigraphy). Here you are given a meal with radioactive material mixed in, and over the course of the next 4 (or sometimes 2) hours photographs are taken by a radiologist to determine what percentage of the meal has emptied from the stomach. From this, the diagnosis of gastroparesis can be ruled in or out. If you don’t have access to a place that does a Gastric Emptying Study, there is also a breath test that can be done. Other tests, like using a scope to see inside the stomach – an esophagogastroduodenoscopy (EGD) – can try to rule out anything else that might be obstructing food trying to exit the stomach, such as an ulcer.

visceral manipulation columbia md

 

Medical and Dietary Treatments for GP

Surgical treatments aren’t very common for GP. Medications to help it are referred to as prokinetics, and generally speaking, they improve the motility of the stomach muscle wall. While these can be helpful, there may be side effects.

Making dietary changes is a very important step in feeling better. This is best done under the guidance of a trained professional like a dietician. In general, meals shouldn’t be very large, high fat, or texturally rough. As stated above, the tougher, crunchier, and chewier meals are going to be a lot harder to digest than ones that are cooked, softer, or pureed. And though fiber and fats can cause symptoms, we do still need them to be healthy. Finding solutions to work these into our diets is important. Smaller meals, well-spaced throughout the day usually work better for folks with GP. Instead of 3 meals, try 4 smaller meals with several hours in between each to allow the stomach time to empty afterward, but also not be overloaded by the meal size. 

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Visceral Manipulation for GP

Visceral Manipulation (VM) is a method to gently mobilize the restrictions of organs and their supporting structures. Just like the muscles we exercise at the gym, our organs are prone to becoming tense, restricted, and falling out of their best rhythm. With carefully guided, gentle mobilization techniques from a trained practitioner, organs like the stomach can be stretched and released. This gives them better blood flow, promotes better gut-nervous system communication, and therefore allows them a better ability to do their job. The idea is that an organ with good motion is an organ in good physiologic function.

Visceral Manipulation

Visceral Manipulation Technique for Gastroparesis

Not surprisingly, in folks with GP there is often a problem with the mobility of the stomach, and also the vagus nerve. There may be issues elsewhere in the digestive tract too that are contributing to the stomach’s difficulty, and checking for these is important. Feeling where the stomach is getting hung up, and helping the organ move better is what Visceral Manipulation offers in helping this mechanical GI condition. As a precise, physical intervention, VM promotes health in a unique and powerful way.

It usually takes a few VM sessions for people to start noticing positive changes, particularly in those who have been dealing with GP for a number of years. Most of the time change happens gradually, and many people don’t even notice it until they’re asked and realize that the previous 1-2 weeks “actually hadn’t been that bad”. Or that they may have done surprisingly well with a trigger food (i.e., they are thinking about their GP less and living their lives more!)

 

visceral manipulation columbia md

 

Common reports are a gradual decrease in reflux symptoms (not needing to grab the TUMS as often), not feeling the “brick” sitting as heavily in the stomach after meals, or better tolerance to foods that had been previously tough to digest- like fatty foods, meat, nuts, or roughage. Some folks get all the way back to where they were before they had GP. Others need tune-ups along the way, especially if they have other chronic health issues they are dealing with. The longer the person has had GP, the longer it usually takes to get the maximum benefit. But in most people some measure of progress should be seen within 4-5 sessions.

 

Conclusion

 

Visceral Manipulation is a gentle, natural and holistic way of helping people with gastroparesis and other digestive disorders. By reducing physical restrictions in the stomach and abdomen, VM helps the organs and body as a whole strive toward better function, and better health.

 

CONTACT US TODAY to see what Visceral Manipulation and Osteopathic Manual Therapy can do for you.

About the Author:

 

Tim Newton, PT, DPT, OCS, CFMM is a physical therapist who specializes in Osteopathic Manual Therapy to help people with pain, illness, and stress feel themselves again. His expertise is in Visceral Manipulation, Gentle Spinal Manipulation, and Craniosacral Therapy.  He is the owner of Inspire Movement Physical Therapy in Columbia, MD.

Tim Newton