Borborygmus are peristaltic sounds audible without a stethoscope due to the mobilization or agitation of a mixture of air and liquid within the intestine, caused by increased peristaltic movements. They are also called "gut noises", "hydro-air noises" or "roars".
Patients refer to it as "my guts are ringing" or "my stomach is ringing." That is, the patient hears the intestinal sound or noise and refers to it as a nuisance. These noises resemble the sound that a water pipe filled with air makes when the liquid begins to flow inside.
Borborigmos (Image by Анастасия Гепп at www.pixabay.com)
When listening to the abdominal wall with a stethoscope, the movement of large amounts of air and fluid in the small intestine produces noise. These sounds are heard with a slightly higher pitch if they come from the small intestine and lower pitch when they come from the colon.
Some authors point out that rumbling can normally originate in the colon, however, if there is increased mobility in the small intestine and excessive accumulation of gas, for example, in abdominal distention, then rumbling from the small intestine is generated.
Various pathological processes can produce rumbling, but all of them have a common condition that is the presence of an excess of gas and liquid in a segment of the digestive tract, with a consequent increase in motility related or not to abdominal pain.
Causes
All alterations that originate as changes in the tone of the wall of a segment of the intestine produce changes in the adjacent areas.
Thus, if the tone of an intestinal zone increases, the pressure in the adjacent segments will determine the tension exerted on the wall and the speed, and the character of the passage of the liquid content through the lumen of the corresponding intestinal loop.
Disease, vascular contracture, or vascular compression from increased tension can deprive the intestinal wall of its ability to contract, secrete, or absorb. Unabsorbed waste or excessively large volumes of secretions attract more fluid.
Components of the human digestive system (Source: BruceBlaus. When using this image in external sources it can be cited as: Blausen.com staff (2014). «Medical gallery of Blausen Medical 2014». WikiJournal of Medicine 1 (2). DOI: 10.15347 / wjm / 2014.010. ISSN 2002-4436. Via Wikimedia Commons)
The concomitant increase in fluid in the intestinal lumen causes further distention and, if swallowed air masses do not pass rapidly into the cecum as they usually do, then the movements of the air-fluid mixture are loud enough to be perceived by the patient or his environment.
These noises perceived and referred by the patient are known as rumbling. They are generally produced by the passage of the mixture with the aforementioned characteristics through the colon or small intestine.
Evaluation
The evaluation is done by auscultation. On auscultation of the abdominal wall, regular gurgling is usually heard with a frequency of about 7 to 8 sounds every minute. This regular gurgling is caused by the mobilization of gas and / or liquid as it moves within a hollow viscus.
In the process, special emphasis is placed on the tone of these noises or on the presence of more pronounced noises that some authors define as “roars”, which are prolonged and audible gurgling characteristic of hyperperistalsis called rumbling.
Rumble may be slightly higher in pitch if it comes from the small intestine or lower when it occurs in the colon.
The human small intestine (Source: Illu_small_intestine_català.png: ToNToNi / * derivative work: Ortisa via Wikimedia Commons)
Although noises can be evaluated by auscultation, the evaluation of rumbling involves evaluating the pathology that causes it. In these cases, a general medical evaluation is required and, if necessary, a more specialized clinical and paraclinical evaluation.
Related diseases
Many pathologies can be accompanied by rumbling, for example, in some diarrhea in which liquid and gas accumulates in the digestive tract and increases peristalsis. In the processes of mechanical distention due to an increase in intraluminal pressure before an obstruction, while the intestine is gradually distended in the area proximal to the obstruction.
In the processes of functional distention in which the intestine is unable to maintain its normal motor functions. In psychoneurotic patients sometimes there are distension due to aerophagia (swallowing air) which generates rumbling.
In the cases of organic obstructions in a normally functioning intestine, it will generate a violent peristalsis above the obstruction zone and rumbling of increasing volume is perceived, related to the painful spasms and that increase with these until a maximum.
Then, as the pain decreases, the intensity of the noises also decreases, reducing the volume of the rumbling.
Syndromes of poor intestinal absorption and bacterial overpopulation are examples of diseases that, in addition to other associated symptoms, present rumbling.
In some tumor processes that cause suboclusive conditions, the triad of pain, meteorism and rumbling occurs. In this case, the pain is of the "cramping" type with variable intensity and frequency according to the degree of obstruction, and is accompanied by the desire to defecate and expel gas.
The meteorism accompanies the distension that occurs in the path that precedes the semi-obstructed sector. The rumbling accompany the periods of pain and when they occur the pain and distension decrease.
Treatment
The main treatment consists of treating the disease that causes it, since it is the treatment of the cause that immediately corrects the symptoms. However, some palliative measures can be taken to reduce distention and thus the volume of fluid and gas.
Regarding the treatment of the primary cause, for example, if it is diarrhea, the treatment will consist of treating the origin of that diarrhea. When normal transit is restored and the diarrhea disappears, the rumbling disappears.
In the case of intestinal obstructions or subocclusions, the obstruction must be treated, thereby reducing distention, fluid accumulation, and rumbling. For this, sometimes these patients require emergency surgeries.
In these cases, the intestine must remain at rest, so oral feeding is suspended and fluids are supplied parenterally while the problem is resolved surgically. Stopping oral feeding reduces bowel movements and rumbling.
Among the palliative treatments, one of the most innocuous is the use of activated carbon as a gas adsorbent. This reduces gas within the intestine and colon, thereby reducing distention and slightly reducing the volume of rumbling.
References
- Borstnar, CR, & Cardellach, F. (Eds.). (2013). Farreras-Rozman. Internal Medicine. Diseases of the digestive system. Gastroenterology and hepatology. Elsevier Health Sciences.
- Riquelme, A., Arrese, M., Espino, A., Ivanovic-Zuvic, D., & Latorre, G. (2015). Manual of clinical gastroenterology. Faculty of Medicine, Pontificia Universidad Católica. Chile.
- Svedlund, J., Sjödin, I., & Dotevall, G. (1988). GSRS-a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Digestive diseases and sciences, 33 (2), 129-134.
- Weinstein, L., & Swartz, MN (1974). Pathogenetic properties of invading microorganisms. Dalam: Sodeman WA Jr. Sodeman WA, eds. Pathologic physiology: Mechanism of diseases.
- Wiener, CM, Brown, CD, Hemnes, AR, & Longo, DL (Eds.). (2012). Harrison's principles of internal medicine. McGraw-Hill Medical.