Bloated Stomach: Why Your Belly Looks Distended

Authored by Bodyful Physical Therapy and Wellness

Do You Feel Bloated or Notice a Distended Stomach?

Do you often feel bloated after meals?
Does your stomach look distended after eating or during times of stress?
Do you experience chronic constipation along with stomach pain and bloating?

If you have been dealing with these symptoms and have repeatedly been told it is “just your diet,” yet nothing seems to change, it may be time to look at other possible contributing factors.

In pelvic health, we are trained to be core specialists. The pelvic floor is part of the core, and so are the abdominal wall and the respiratory diaphragm. Because of this relationship, digestion, bloating, and abdominal distention often overlap with pelvic floor function—and fall well within the scope of pelvic floor physical therapy.

How Are Bloating and a Distended Stomach Connected to the Core?

Emerging research shows that bloating and abdominal distention are not always digestive or dietary issues alone. They can also have biomechanical and nervous system components.

To understand stomach pain and bloating more clearly, it helps to first distinguish between bloating and distention, which are often used interchangeably but are not the same.

Bloating vs. Distention: What’s the Difference?

Bloating is the sensation of pressure, fullness, or discomfort in the abdomen.
Importantly, studies show that in many people who report bloating, imaging does not reveal increased gas volume.

This suggests that bloating is often related to visceral hypersensitivity—meaning the nervous system becomes more reactive to normal changes in gas or fluid. This sensitivity may develop after inflammation, surgery, illness, or trauma, and reflects how closely the nervous system and gut function are connected.

In the absence of impacted stool and IBS, people who complain of bloating tend to avoid fully exhaling when they perceive or anticipate bloating, and this can make the symptoms worse.

Distention, on the other hand, is a visible and physical change in the abdominal wall.
The stomach appears larger, stretched taut, or protruded.

Bloating and distention frequently occur together. When the brain perceives discomfort in the gut, it may respond by changing breath patterns—allowing the abdominal wall to reciprocally soften and move away from the source of sensation in an attempt to reduce discomfort.

Abdomino-Phrenic Dyssynergia and a Distended Stomach

This abdominal wall response can lead to a pattern known as abdomino-phrenic dyssynergia.

In this pattern:

• The abdominal wall weakens

• The respiratory diaphragm increases tension to compensate

• Other tissues in the low back become stiff, making it harder for the abdominal muscles to support your posture

When this happens, several things are affected:

• Gas movement through the digestive tract becomes less efficient

• The diaphragm loses its ability to assist digestion through pressure changes

• Coordination between the diaphragm and pelvic floor is disrupted

This can contribute not only to ongoing stomach bloating and distention, but also to pelvic floor symptoms, constipation, and difficulty fully evacuating bowel movements.

Why Breathing and Abdominal Coordination and Strength Reduce Bloating

When the diaphragm is no longer fully relaxing and fully contracting:

• Digestive motility can slow

• Pressure regulation through the abdomen becomes insufficient

• Pelvic floor muscles may struggle to lengthen and relax for bowel movements

This can create a cycle where stomach pain, bloating, and constipation reinforce one another.

How Pelvic Floor Physical Therapy Can Help Bloating and Distention

Treatment for abdomino-phrenic dyssynergia focuses on restoring coordination, as the precursor to proper strengthening and functional relaxation.

At Bodyful, we address this through:

• Skilled hands-on fascial work to the diaphragm and abdominal tissues

• Nervous system–informed manual therapy to improve tissue adaptability

• Individualized movement and breathing practices

These approaches stimulate mechanoreceptors that help retrain how the diaphragm and abdominal wall respond to pressure.

The key components include:

True diaphragmatic breathing to restore respiratory function

• Coordinated transverse abdominis and internal obliques activation to support abdominal tone and functional strength

• Integration with pelvic floor relaxation and bowel mechanics

This combination allows the digestive system to move more efficiently while reducing the sensation of bloating and the appearance of a distended stomach.

When Diet Isn’t the Whole Story

While nutrition often plays a role, persistent stomach bloating, abdominal distention, and constipation often require addressing movement patterns, breathing mechanics, and nervous system regulation.

If you have already tried dietary changes without meaningful improvement, you are certain you do not have impacted stool, and you are not diagnosed with IBS, exploring these underlying contributors may offer a very successful direction forward.

Interested in Learning More?

If your stomach feels bloated, your abdomen looks distended, or you experience ongoing stomach pain and bloating alongside constipation or pelvic floor symptoms, pelvic floor physical therapy may be a helpful next step.

Book with us to learn more about working together and exploring whether this approach is right for you.

Reference

Damianos JA, Tomar SK, Azpiroz F, Barba E. Abdominophrenic Dyssynergia: A Narrative Review. Am J Gastroenterol. 2023 Jan 1;118(1):41-45. doi: 10.14309/ajg.0000000000002044. Epub 2022 Sep 30. PMID: 36191283; PMCID: PMC9810002.