What is Splenic Flexure Syndrome & How is it Treated?

Splenic flexure syndrome is a medical disorder characterised by gas entrapment inside the flexures located within the colon. In terms of anatomy, splenic flexure is the normal structure of the colon (also known as large intestine) and it is located adjacent to the spleen. It is a sharp bend between the descending colon of the abdomen and the transverse colon. Splenic flexure syndrome is characterised by extreme pain over the abdomen due to excessive gas entrapment. It is also known as chronic digestive disorder and is often classified as a sub-type of IBS or irritable bowel syndrome.

The most classic symptom of splenic flexure syndrome is excessive pain and tenderness over the upper left side of the abdomen. It is often mistaken as a heart attack as the location of the pain is quiet close to the heart. Other symptoms associated with splenic flexure syndrome are:

• Involuntary spasms of the colon associated with pain, generalized discomfort and frequent contraction of the lower digestive tract
• Air and gas entrapment in the colon flexure causing excessive pain
• Abdominal bloating with cramps
• Abdominal pain which are usually several, recurrent and last for several minutes. Sometimes this may recur over weeks and even months
• Frequent episodes of diarrhea and constipation can be a symptom of splenic flexure syndrome
• Fever and generalized weakness
• Increased heart rate
• Change is appearance of the stool in terms of colours, consistency, shape and frequency can also be a symptom of splenic flexure syndrome
• Tapping of the upper abdomen may elicit a drum like sound
• Upper portion of the abdomen is usually tender to touch and often distended
• Belching, flatulence and burping
• Palpable mass in the abdomen.

Splenic flexure syndrome can be caused by different reasons. In most of the cases, it is caused by the food consumed and in some cases it is caused in association with other medical conditions. The most common causes of splenic flexure syndrome are listed below:

Certain food items can causes abdominal issues in certain individuals. It has been seen that under certain conditions, bacteria that help in breakdown of food, can release excess amount of gas in the gastrointestinal system. This may be due to allergic reaction of the body to some specific food, consumptions of food products that are not tolerated by the individual, or presence on short chained carbohydrate which are capable of dragging water molecules with them leading to bloating. This in turn leads to excessive gas accumulation caused abdominal pain.

Food poisoning caused by bacteria (such as Salmonella and E.coli) can often lead to splenic flexure syndrome. This may lead to gas development secondary to bacterial infection causing splenic flexure syndrome.

Eating too fast can lead to swallowing of air into the digestive tract. If this air does not escape and get trapped within the splenic flexure, it can lead to abdominal discomfort and pain. More air may accumulate over a period of time leading to more pain and discomfort. It is advised to eat slowly to avoid entrapment of air and for facilitating digestion.

In some cases, splenic flexure syndrome is present in association with ulcerative colitis. The disease may begin in the rectal area and over a period of time it may involve the entire colon. Other gastrointestinal disorder such as Crohn’s disease can also cause splenic flexure syndrome.

Other causes of splenic flexure syndrome includes, recent history of abdominal surgery, obstruction in the digestive system, twisting of the colon, alcohol consumption etc.

Splenic flexure syndrome is diagnosed and treated by an experienced physician or a gastroenterologist. A detailed case history is obtained followed by a physical examination. There are no specific diagnostic test for pin pointing splenic flexure syndrome; however, few general diagnostic tests are carried out to rule out other causes of pain. An x-ray of the large intestine may be done after a barium enema. Quite often, CT scan and abdominal MRI are also done to reach a conclusion.

In most of the cases, release of the trapped gas through the rectum or through the mouth (in the form of burp) subsides the pain associated with splenic flexure syndrome. In some cases, a bowel movement provides relief. However, in some cases, the gas does not escape the digestive tract and may require certain medications prescribed by the physician. Most of these medications are similar to those prescribed for IBS. Besides these, it is important to keep a close watch over the diet, as it is a main cause of splenic flexure syndrome. Treatment modalities of splenic flexure syndrome are discussed below:

In most of the cases, the individuals with frequent episodes of splenic flexure syndrome are advised to follow a special diet which excludes food items that are known to trigger the condition. Some of these foods include: Prunes, Brussels sprouts, cabbage, broccoli, beans, dairy products, apples, potatoes, peas, corn, bread, processed cereals etc. It is also important to cut on sodium intake and increase potassium intake. Adequate intake of water is very important. It is also recommended to increase the intake of fibre in diet and cut down on spicy food. Frequent meal should be encouraged instead of large 3 meals. Eating slowly, maintaining a good posture, and avoiding a straw while drinking prevents air entrapment in the digestive tract.

Medications such as Gas-X and Beano can help in alleviating the gaseous and bloated feeling associated with splenic flexure syndrome. A large number of over the counter medications are available that helps in inducing bowel movement which in turn helps in controlling the condition. Stool softeners can be taken in case of constipation. One of the most common drugs that are prescribed to ease abdominal discomfort associated with splenic flexure syndrome is metoclopramide. Anti-spasmodic drugs help management of abdominal cramps and pain. Antacids (which contain simethicone and activated charcoal) also help in providing relief; examples include Maalox and Di-Gel.

Splenic flexure syndrome is a gastro-intestinal condition that is caused due to entrapment of air or gas in the splenic flexure causing pain and tenderness particularly over the upper left portion of the abdomen. It is characterised by excessive pain, abdominal spasms, bloating, change in bowel movement etc. In most of the cases, the spasms are episodic and can last from few days to months. It has been noted that in large number of cases of splenic flexure syndrome, the condition improves on its own particularly after burping or farting. Bowel movement often provides adequate relief. Treatment for splenic flexure syndrome includes diet modification and medications. It is recommended to follow a diet which is rich in fibre, and it is advised to avoid food items that are known to be ‘gassy-food’.