Abdominal discomfort and pain caused by bloating or distension can be very distressing. We need to try to understand the cause. 

Is the patient new to enteral feeding?

If Yes - Sometimes it takes a while to adapt to being fed this way. Discuss with the community dietitian and see if the feeding regimen can be reduced for a short while to allow adaptation.

If No - Has anything else changed about the patients' routine? E.g., new medication, other new treatments?

Does the abdominal pain coincide with when these changes were made?

Check medication. Drugs such as morphine and dopamine can reduce gastric emptying causing bloating and distension.

Is the patient opening their bowels regularly?  Constipation is a common cause of abdominal pain. Ensure adequate fluid and fibre content of feed. Investigate and treat cause of constipation.

Keep a feed and symptom diary showing when the patient has abdominal pain and when they have their feeds. Ideally this should be for about 7 days. Look for patterns.  Discuss with community dietitian.

Is the patient swallowing air to cause bloating? 

Some people naturally swallow more air than others, but this can cause more issues with enterally fed patients, especially if the patient does not burp easily.  Some things can cause increased air gulping, e.g. anxiety, stress.

Consider venting the gastrostomy tube by attaching a 60ml syringe barrel to the feeding tube (or extension tube) and opening the clamp.  If air is present, a whoosh sound will be heard.

Contamination of feed: Check the expiry date and temperature of the feed being given. Ensure good hygiene practices are being always followed.
 
Bolus feeding Continuous pump feeding

Consider if symptoms coincide with feeds being given in a regular pattern.

Smaller volumes may be needed to help ease this.

Try to slow the rate of feeding to see if this improves symptoms.  Remember not to slow feeding rate so much that the patient does not receive what they need.

A different type of feed could be trialled, e.g. peptide based, soya based.

Consider changing feed to a different type of feed.  Discuss with your community dietitian.

Consider changing to more continuous pump feeding. 

If caused by slow gastric emptying a prokinetic drug (e.g. metoclopramide) could be considered. 

 

Please contact the Community Home Enteral Feeding Dietitian to discuss options and ways to address this concern.

If you would like this information in another format, for example large print or easy read, or if you need help communicating with us, please contact:

First Community (Head Office)

Call: 01737 775450 Email:    fchc.enquiries@nhs.net    Text: 07814 639034

Address: First Community Health and Care, Consort House, 5-7 Queensway, Redhill, Surrey, RH1 1YB.

For office use only: Version 4 GU_TS003 Publication date: May 2026