Bowel sounds are an expression of the peristalsis of the stomach and intestines. Based on the presence and intensity of bowel sounds, a doctor can assess the likelihood of diseases such as diarrhea or intestinal obstruction. However, further testing is always necessary for detection.
What are bowel sounds?
When peristalsis now mixes and transports heavy, still insufficiently comminuted food components and thin fluids, the bubbling sounds known as bowel sounds occur. The detection of bowel sounds is part of every medical examination of the abdomen. With the stethoscope, the examiner can determine whether bowel sounds are present at all, whether they sound normal “bubbling” or whether they may sound different in individual areas of the abdomen, for example, whether an intestinal obstruction is present. Even without a stethoscope, you can hear bowel sounds with your ear on or – if your stomach is growling – even a few meters away.
Causes
In order for the gastrointestinal tract to do its daily job of transporting and absorbing fluids and nutrients, it must be very active. The word peristalsis describes the ability of the intestinal wall to contract in a wave-like manner, moving the contents of the intestinal tube further toward the bowel outlet. Peristalsis is present along the entire length of the gastrointestinal tract and is thus responsible, among other things, for the fact that it is possible to eat and swallow while standing on one’s head without the contents of the stomach and esophagus falling out of one’s mouth again. When peristalsis now mixes and transports heavy, still insufficiently comminuted food components and thin liquids, the bubbling sounds known as bowel sounds occur. The growling of the stomach is one example, the gurgling of the abdomen after eating or during diarrhea another. Flatulence is also noticeable as intestinal sounds when air bubbles are moved through the intestinal contents.
Diseases with this symptom
- Three-month colic
- Food poisoning
- Ulcerative colitis
- Gastric rupture
- Gastritis
- Irritable bowel
- Gastrointestinal flu
- Crohn’s disease
- Intestinal obstruction (ileus)
- Malnutrition
- Celiac disease
- Cholangitis
- Inflammation of the intestine
- Food intolerance
- Lactose intolerance
Diagnosis and course
While these intestinal sounds can be heard well with the ear by placing it on the abdominal wall or even at a distance of a few meters, a doctor uses his stethoscope as an “extended ear” for hygienic reasons. With this, the sounds are well filtered and the examiner can fully concentrate on what he wants to hear. The examination of the abdomen with the stethoscope, also called auscultation, always includes listening to all four quadrants of the abdominal wall, i.e. all four fields on the right and left, each above and below an imaginary line at the level of the belly button, since different diseases can be present at the different locations. At least half a minute of listening per quadrant is often necessary to detect the intestinal sounds. If the bowel is very active, a shorter auscultation time is often sufficient. The physician describes normal bowel sounds as “brisk” or “brisk” and “over all four quadrants.” If the bubbling and gurgling is noticeably violent, this may indicate a diarrheal illness, such as an infection caused by viruses and bacteria. Vigorous bowel sounds may also be heard in cases of food intolerance, such as lactose intolerance. However, due to the presence of other symptoms, auscultation of bowel sounds is of little importance in these cases. This is different if the opposite is true: If no bowel sounds are heard over the entire abdominal wall, this may indicate bowel obstruction (ileus) due to bowel wall paralysis, a so-called paralytic ileus. In the presence of abdominal pain and absence of bowel movements or bloody stools, the lack of evidence of bowel sounds can thus be an important part of the medical diagnosis and treatment decision. There is a second variant of intestinal obstruction: If the ileus is mechanical, the intestinal wall tries to work against the obstruction site, and the bowel sounds then sound amplified; the physician describes them as “high-pitched” or “ringing.”Through the stethoscope, this sounds as if someone were hitting a heating pipe with an iron. The cause of such a mechanical ileus can be a foreign body or a cancerous ulcer that obstructs the intestinal passage. Rarer occasions when auscultation of bowel sounds is of immediate importance are malformations in infancy, for example, when bowel sounds can be detected in the chest due to patency of the diaphragm.
Complications
Bowel sounds are a transient symptom, but they can cause various complications. These include skin diseases and disorders of the nerves, which can occur as a result of malnutrition, and rheumatic inflammation of the joints, which occurs as a result of typical allergies that cause bowel sounds. Affected persons who change their diet as a result of the flatulence often suffer from deficiency symptoms, and children may develop failure to thrive. If the bowel sounds are additionally accompanied by severe abdominal pain and shock symptoms, there is a risk of acute abdomen. Intestinal obstruction, appendicitis or gastric rupture are also possible complications. Bowel sounds are thus usually related to gastric discomfort and may indicate aerocolysis or aerogastria in the intestinal tract. However, bowel sounds are usually harmless and indicate unproblematic upset of the gastrointestinal tract. Diarrhea, stomach pain and constipation are usually the result, and there is also often a reduction in the quality of life, as the accompanying symptoms can sometimes severely restrict the mobility of those affected. Irritable bowel syndrome in particular can have a negative impact on well-being due to the secondary symptoms that occur. Due to the sensitive bacterial cultures in the gastrointestinal tract, the treatment itself, especially through medication, a change in diet or the use of home remedies, can also initially worsen the intestinal symptoms. However, professionally supervised treatment usually leads to resolution of symptoms without long-term complications.
When should you see a doctor?
Bowel sounds should be clarified by a doctor if they occur together with other complaints, do not improve with a change in diet or even develop into a chronic problem. If intestinal gas escapes excessively frequently and in large quantities, which sometimes also has an unpleasant odor, this is an indication of food intolerance, which should in any case be examined by a specialist (e.g. gastroenterologist) in order to prevent the development of secondary diseases. If there is accompanying vomiting, nausea or abdominal cramps, or if a feeling of fullness occurs even when the stomach is empty, there may be a serious underlying cause that requires clarification. The same applies if appetite decreases for no apparent reason or if excessive weight loss occurs with a normal diet. If the bowel sounds are accompanied by flatulence or even diarrhea, there may be a disorder in the gastrointestinal tract – a medical examination provides clarity about its cause and can provide important information for rapid treatment. Indicators of a disorder of the gastrointestinal tract include sudden changes in stool characteristics, severe flatulence or pain in the area of the stomach. Bowel sounds are not problematic if they occur in irregular episodes and without accompanying symptoms. However, the physician should also determine in this case whether there is possibly a food intolerance or whether another disease is causative for the bowel sounds.
Treatment and therapy
Almost always, however, further instrumental diagnostics follow in order to track down the exact causes of the altered bowel sounds and to substantiate or refute any suspected disease. Depending on the intestinal disease, medicinal or surgical procedures may be considered for therapy. A paralytic ileus can often be observed for a certain period of time as long as it is not underlying an intestinal infarction; in the case of mechanical ileus, for example caused by a growing tumor, there is no way around surgery.
Outlook and prognosis
Bowel sounds can bother people or be uncomfortable in certain situations. However, they need not immediately indicate a malfunction. Bowel sounds are usually a sign of a well-functioning bowel.The treatment is usually not done by a doctor, because in this case the patient himself can control the development of these noises. They do not necessarily lead to further problems and often represent natural noises that occur during digestion. However, if they are associated with pain or with nausea, a doctor should be consulted for treatment and eating habits should be changed. Changing the diet to one that is light and easy for the stomach to digest can cause the bowel sounds to disappear. Often they only occur with certain foods, so that these can be avoided. In such cases, targeted treatment is possible and often leads to success. Treatment with medications is optional. These calm the intestines and thus prevent the intestinal noises from developing. However, they do not correct the cause of the problem and can only be used temporarily. In most cases, bowel sounds result in a positive course of the disease.
Prevention
Those who want to prevent intestinal diseases in general should pay attention to a healthy diet in moderation with sufficient fiber. For prophylaxis of gastrointestinal infections, good hygiene is crucial: wash food or keep it cool overnight, do not eat anything that may be spoiled, wash or disinfect hands when in contact with others suffering from diarrhea. Malformations or food intolerances, meanwhile, cannot be prevented, of course.
Here’s what you can do yourself
Bowel sounds are usually harmless, but always embarrassing. Patients who suffer from this, however, can do a lot themselves to prevent this disorder from occurring in the first place. During hectic eating, a lot of air gets into the gastrointestinal tract. Patients should therefore eat slowly and chew well. In addition to how we eat, what we eat also plays a major role in digestive disorders. Hard-to-digest foods such as animal fats and red meat should be avoided. Also flatulent vegetables and legumes, especially onions, all types of cabbage as well as beans and lentils, are at best well cooked and tolerated in small portions. Alcohol, acidic drinks such as fruit juices or coffee can irritate the stomach and aggravate already existing digestive disorders. Many sweeteners such as lactose, fructose or sorbitol can also irritate the digestion. If the intestinal noises are accompanied by flatulence, simple home remedies quickly provide relief. Fennel tea soothes, relaxes the stomach and is effective against flatulence. The same applies to caraway and peppermint oil. Gentle massages in a clockwise direction relax the stomach and thus help to alleviate stomach gurgling. Applying a hot water bottle often has the same effect. Regular exercise combats indigestion and constipation, two of the most common causes of bowel sounds.
