Article by Dr Manasa S, B.A.M.S & Dr Raghuram Y.S. MD (Ayu)

Borborygmi, commonly known as stomach growling, are the sounds produced by muscle contractions and gas movement in the digestive system as food travels through the intestines. These noises occur due to the normal process of digestion and are usually heard after eating. While they can be embarrassing in quiet settings, borborygmi are a sign of a functioning digestive system and are generally not a health concern.

However, changes in these sounds can be significant. An exceptionally noisy gut might indicate increased intestinal activity, possibly due to conditions like gas or diarrhoea. Conversely, a completely silent gut may suggest a slowdown in digestive activity, potentially due to constipation or other digestive issues. Monitoring these sounds can help identify if further medical evaluation is needed.

Normal Abdominal Sounds

Normal abdominal sounds, such as gurgles, growls, or rumbles, are typically not a health concern. These sounds occur as your intestines contract to push food and waste through your digestive system. They indicate that your body is digesting food properly.

Bowel sounds can vary in regularity, tone, and volume. While normal bowel sounds are a sign of a functioning digestive system, changes in these sounds can indicate different conditions. For instance, hypoactive bowel sounds are quieter or less frequent and may occur with constipation or as a side effect of certain medications or surgery. Hyperactive bowel sounds, on the other hand, are louder and more frequent, often associated with increased intestinal activity, gas, or diarrhoea.

Hypoactive Bowel Sounds

What Are Hypoactive Bowel Sounds?

Hypoactive bowel sounds are quieter and less frequent than normal bowel noises, indicating a slowdown in intestinal activity. These sounds are often heard when intestinal movements decrease, which can happen during sleep.

Common Causes

Several factors can lead to hypoactive bowel sounds, including:

–        Medications: Drugs such as codeine can slow digestion and elimination.
–        Anaesthesia: Coming off general anaesthesia or spinal anaesthesia (e.g., epidural) can reduce bowel activity
–        Radiation: Exposure to radiation in the abdominal area.
–        Surgery: Abdominal surgery can lead to temporary reduction in bowel sounds.

Implications

Hypoactive bowel sounds may indicate reduced digestive activity, which can lead to constipation. It’s important to monitor these sounds, especially if they persist, as they could signal an underlying issue requiring medical attention.

When to Seek Medical Advice

If hypoactive bowel sounds are accompanied by symptoms such as severe abdominal pain, bloating, or changes in bowel habits, it is advisable to consult a healthcare professional for further evaluation and management.

Causes of Hyperactive Bowel Sounds

Gastroenteritis

Gastroenteritis, an inflammation of the stomach and intestines, often leads to hyperactive bowel sounds. This condition can be caused by viruses, bacteria, parasites, or food poisoning, and is characterized by symptoms such as diarrhoea, abdominal pain, nausea, vomiting, and fever.

Food Allergies and Intolerances

Food allergies, intolerances, or sensitivities can result in hyperactive bowel sounds. Common culprits include lactose intolerance, where the body lacks the enzyme lactase, and gluten intolerance. These conditions cause excess gas and diarrhoea as the body struggles to digest certain foods.

Gut Microbiome Dysbiosis

An imbalance in the gut microbiome, known as dysbiosis, can lead to hyperactive bowel sounds. This imbalance may cause an overgrowth of harmful microorganisms, creating an inflammatory environment in the gut.

Celiac Disease

Celiac disease, an autoimmune disorder triggered by gluten, causes intestinal inflammation and damage. Consuming gluten leads to hyperactive bowel sounds, along with symptoms like nausea, diarrhoea, constipation, stomach pain, and bloating.

Inflammatory Bowel Diseases (IBD)

Inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis, cause chronic inflammation in the GI tract. These conditions can damage the intestines and alter digestion, leading to hyperactive bowel sounds, diarrhoea, abdominal pain, bloody stools, and fatigue.

Bowel Obstruction

A bowel obstruction, which can be caused by medications, scar tissue, hernias, or tumours, leads to high-pitched hyperactive bowel sounds. This condition blocks the normal movement of food and waste, causing severe abdominal pain, nausea, vomiting, constipation, and bloating.

Gastrointestinal (GI) Bleeding

GI bleeding increases the intensity of bowel sounds and can occur anywhere in the digestive tract. It is often accompanied by symptoms such as tarry black stools, vomiting blood, and rectal bleeding. Causes of GI bleeding include haemorrhoids, cancer, polyps, stomach ulcers, infections, and IBD.

Symptoms to Check for in Abnormal Abdominal Sounds

Normal Occurrences

Occasional stomach growling, especially around mealtime or after eating, is a normal sign of a functioning digestive system.

Symptoms of Concern

Frequent hyperactive or hypoactive bowel sounds accompanied by other abnormal symptoms may indicate a medical problem. Watch for the following symptoms:

–        High-pitched stomach sounds
–        Excess gas
–        Fever
–        Nausea
–        Vomiting
–        Frequent diarrhoea
–        Constipation
–        Bloody stools
–        Persistent heartburn that doesn’t respond to over-the-counter treatments
–        Unintentional and sudden weight loss
–        Feelings of fullness

Possible Health Conditions

These symptoms, along with abnormal bowel sounds, can indicate several health conditions, including:

–        Crohn’s Disease
–        Food Allergies and Intolerances
–        Gastrointestinal (GI) Bleeding
–        Infectious Enteritis
–        Ulcerative Colitis
–        Irritable Bowel Syndrome (IBS)
–        Dumping Syndrome
–        Paralytic Ileus: A problem with the nerves connected to the intestines.
–        Blocked Blood Vessels: Preventing proper blood flow to the intestines.
–        Bowel Obstruction: Caused by a hernia, tumour, adhesions, or other conditions.

When to Seek Medical Advice?

If you experience frequent abnormal abdominal sounds along with any of the above symptoms, it’s important to consult a healthcare professional for proper diagnosis and treatment.

Preventive Measures for Stomach Growling

Here are some effective strategies to prevent stomach growling:

Drink Water – Drinking water can help fill your stomach and aid digestion, reducing hunger-induced growling. Ensure you drink water consistently throughout the day to avoid a gurgling sound from chugging it all at once.

Eat Slowly – Eating slowly improves digestion and can prevent stomach grumbling. Taking your time during meals helps your body process food more effectively.

Chew Thoroughly – Chewing food slowly and thoroughly reduces the workload on your stomach. It also prevents swallowing air, which can lead to indigestion and gas.

Eat Regularly – Eating smaller, more frequent meals can prevent stomach growling. Aim for four to six small meals a day to maintain consistent digestion and metabolism.

Limit Gas-Producing Foods – Avoid foods that are known to cause gas and indigestion, such as beans, Brussels, sprouts, cabbage, and broccoli. Reducing these in your diet can help minimize stomach noise.

Reduce Acidic Foods – High-acid foods and drinks, including citrus, tomatoes, and coffee, can contribute to stomach grumbling. Opt for alternatives like caffeinated tea to reduce this effect.

Avoid Overeating – Overeating can hinder digestion and increase stomach noise. Focus on smaller portions and eat slowly to give your body time to register fullness.

Take a Walk After Eating – Light exercise, such as a short walk, can help move food through your digestive system more efficiently, reducing post-meal stomach growling.

Manage Anxiety – Anxiety can slow gastric emptying, leading to increased stomach noise. Practice deep breathing exercises to calm your nervous system and reduce these physical side effects.

Reduce Sugar Intake – Excessive sugars, especially fructose and sorbitol, can cause gas and intestinal noise. Limiting these in your diet can help keep your stomach quieter.

Eat When Hungry – Address hunger immediately by eating something light, like crackers or a granola bar, to prevent hunger-induced growling. Avoid greasy foods, which can cause gas and indigestion.

By incorporating these preventive measures into your daily routine, you can effectively reduce stomach growling and improve overall digestive health.

When to Seek Urgent Medical Help for Stomach Growling

While stomach growling is usually harmless and often just a sign of hunger or digestion, there are times when it could indicate a more serious condition. It’s crucial to be aware of the warning signs that necessitate immediate medical attention. If you experience stomach growling accompanied by any of the following symptoms, seek emergency care promptly:

Bloody Stools – The presence of blood in your stools can indicate serious gastrointestinal issues such as infections, ulcers, or even cancer. This symptom requires urgent evaluation to determine the underlying cause and begin appropriate treatment.

Vomiting – Persistent or severe vomiting, especially if it is accompanied by stomach growling, can lead to dehydration and might be a sign of a gastrointestinal obstruction or infection. Immediate medical intervention is necessary to prevent complications.

Fever – A high fever alongside stomach growling may suggest an infection or inflammation within the digestive system, such as gastroenteritis or an abscess. Prompt medical assessment is essential to manage the infection and prevent it from worsening.

Severe Abdominal Pain – Intense, unrelenting abdominal pain paired with stomach growling can be a sign of serious conditions like appendicitis, pancreatitis, or a perforated ulcer. Such symptoms require urgent medical evaluation and treatment to avoid life-threatening complications.

Other signs to look for

–        Rapid pulse rate
–        Fatigue
–        Constipation or inability to pass gas
–        Rectal bleeding

Tests and diagnosis

–        Taking proper medical history
–        Hearing to stomach sounds with or without stethoscope
–        Imaging tests like CT scan or X-ray
–        Blood tests
–        Enterostomy

Treatment and management

Borborygmi, commonly referred to as stomach growling, is a natural phenomenon that occurs when gas and fluids move through the stomach and intestines. It is a normal part of the digestive process and typically does not require any medical treatment. However, if excessive growling is causing discomfort or embarrassment, certain preventive measures and home remedies can be beneficial.

Home Remedies Using Naturally Available Herbs

Ginger: Ginger has anti-inflammatory properties and can aid digestion. Drinking ginger tea or chewing a small piece of ginger can help reduce stomach noises.

Ajwain (Carom Seeds): Ajwain is known for its digestive benefits. Consuming a teaspoon of ajwain seeds with a pinch of salt and warm water can alleviate digestive issues and reduce borborygmi.

Cinnamon: Cinnamon helps in soothing the digestive tract. Adding a teaspoon of cinnamon powder to warm water and drinking it can help manage stomach growling.

Jeera (Cumin): Cumin seeds are effective in reducing gas and bloating. Boiling a teaspoon of cumin seeds in water and drinking it after meals can be beneficial.

These home remedies, along with preventive lifestyle and dietary adjustments, can effectively manage and reduce the occurrence of borborygmi. Remember, while stomach growling is usually harmless, persistent or severe symptoms should be discussed with a healthcare provider to rule out any underlying conditions.

Study – An unusual cause ‘Intractable positional borborygmi’ was diagnosed by barium contrast study. It showed that borborygmi that are related to respiration are likely to be caused by diaphragmatic compression.

Study (veterinary) – In a study ‘The effects of bit chewing on borborygmi, duodenal motility and gastrointestinal transmit time in clinically normal horses’ showed that bit chewing was safe, inexpensive and well tolerated. It shortened GI TTT (Gastrointestinal Total Transit Time) and might be an adjunct therapy to augment GI TTT. It may be a simple and inexpensive way to augment progressive GI motility.

Notes – Even in human beings, quick and hurried food intake, swallowing without chewing food might lead to many gastrointestinal conditions leading to Borborygmi.

Borborygmi: Ayurveda Understanding

Though not from one, the concept of Borborygmi as per Ayurveda can be understood from various contexts.

From dosha perspective, vata dosha which is made up of air and ether elements is causal of normal bowel sounds when in a state of balance as well as hyperactive and hypoactive bowel sounds when it is in a state of abnormal increase or decrease respectively.

Prana Vata, Udana Vata, Samana Vata, Apana Vata, Pachaka Pitta, Ranjaka Pitta and Bodhaka Kapha imbalances and the disturbance of their relative chemistry can also lead to borborygmi.

Since imbalances in digestive activities is the basic foundation for causation of pathological bowel or abdominal sounds i.e. borborygmi, agnimandya, and types of agni disturbances like vishamagni, tikshnagni and mandagni are responsible for borborygmi while samagni will produce normal and healthy bowel sounds.

Different kinds of ajirna i.e. vishtabdajirna, vidagdhajirna and amajirna can cause borborygmi.

Borborygmi may be a secondary manifestation of many kinds of systemic and gastrointestinal disorders and doshic conditions described in Ayurveda which include – Vata Vriddhi (Sanchaya and Prakopa), Udavarta, Adhmana, Atopa, Anaha, Visuchika, Vilambika, Alasaka, Atisara, Pravahika, Grahani, Udara Roga, Gulma, Koshtagata Vata, Gudagata Vata, Pakvashayagata Vata, Vidavrita Vata and Krimi.

Causes of borborygmi, apart from the above said doshic conditions and diseases include, viruddha ahara – mutually incompatible or antagonistic foods, asatmya ahara – unsuitable or incompatible foods, adhyashana – eating food in presence of indigestion of previously consumed food, ati ashana – excessive eating of foods, ahita ahara – foods taken without considering quality and quantity, not following ahara vidhi vishesha ayatana i.e. etiquities and general rules and regulations of food consumption, avyayama – sedentary life activities devoid of exercise and manasika nidanas i.e. different abnormal states of mind including jealousy, anger, fear, greed, helplessness, aversion or hatred for food, over thinking or stress, grief etc.

Ayurveda treatment principles of Borborygmi include avoidance of etiological factors, treatment of causal doshas and diseases, meaningful eating of food, sattvavajaya chikitsa – psychotherapy, panchakarma measures including vamana, virechana and vasti, special treatments like nabhi lepa and vatanulomana.

Related Reading – ‘Borborygmi – Ayurveda Understanding’