Splenic Flexure Syndrome: Exploring the Underlying Causes and Optimal Treatment Options

Splenic flexure syndrome occurs as a result of muscle spasms and abdominal distention leading to pain and discomfort in the upper abdomen. The exact location of the pain is at the splenic flexure, which is in the part of the colon between the transverse and descending segments.

Pain can be a result of air trapped in this part of the large intestine and may also be identified as irritable bowel syndrome.

Where is the splenic flexure?

The splenic flexure is a critical anatomical structure within our digestive system, specifically within the large intestine or colon. To understand its location, we need to comprehend the basic anatomy of the colon. The colon is divided into four parts: the ascending, transverse, descending, and sigmoid colon.

The splenic flexure, also known as the left colic flexure, is the sharp bend between the transverse and descending parts of the colon. It’s situated close to the spleen, where it gets its name. The splenic flexure resides in the upper left part of the abdomen, just under the rib cage.

Why is the splenic flexure important?

Although it may not be a well-known structure compared to other organs, the splenic flexure plays a pivotal role in the digestive system. As a junction between the transverse and descending colon, it’s a key part of the passage through which digested food material travels.

Its specific position and angulation can make it susceptible to certain problems, notably splenic flexure syndrome. Because of its close proximity to other organs, such as the spleen and the stomach, issues affecting the splenic flexure can sometimes mimic symptoms of conditions related to these adjacent organs, making diagnosis challenging. Therefore, understanding its relevance is crucial in diagnosing and managing conditions such as splenic flexure syndrome.

Causes of splenic flexure syndrome

Pain or discomfort in the gastrointestinal tract has a lot of potential causes, and splenic flexure pain is no different. The following are some causes for the condition:

• Gas accumulation: This is thought to be the most common cause of splenic flexure syndrome, and it occurs due to trapped air in the gastrointestinal tract. The trapped air pushes on the inner lining of the gastric mucosa, putting pressure on the surrounding structures, leading to pain and discomfort. Relief of gas accumulation can be achieved by simply passing gas, but unfortunately, those with splenic flexure syndrome have difficulty doing so.
• Abdominal distention: This can occur when too much space accumulates in the gastric area, leading to feelings of discomfort. This may be caused by fatty foods and gas production, leading to abdominal distention. Undigested food in the digestive tract commonly produces excessive amounts of gas. Swallowing too much air—called aerophagia—during times of eating, chewing, mouth breathing, and hyperventilation can also lead to abdominal discomfort due to splenic flexure syndrome.
• GI disorders: Inflammatory bowel conditions such as Crohn’s disease and ulcerative colitis can affect the lining of the large intestine, leading to abdominal discomfort. Other disorders that affect the movement of the gut may result in small air pockets leading to discomfort. Eating contaminated food items that have bacteria on them can also result in diarrhea and gas production.
• Abdominal adhesions: This is a complication of previous abdominal surgery, whereby abnormal healing of the tissues near the digestive tract can lead to restriction of food or gas passage through the intestines.
• Infections: Examples include amebiasis, tuberculosis, and other infections that may cause irritation to the intestinal lining.
• Diet: The consumption of certain foods can lead to feelings of abdominal discomfort. Short-chained carbohydrates—legumes, apples, and prunes—can pull water from the vessels of the intestine to the lumens after ingestion, leading to diarrhea and abdominal bloating. Complex carbohydrates composed of raffinose and fructose can increase the likelihood of developing splenic flexure syndrome. Other gas-forming foods include potatoes, sodas, soybeans, peas, and lactose. Alcohol may also increase gas formation.
• Food poisoning: Food poisoning is another potential cause of splenic flexure syndrome. Eating contaminated food can lead to an infection in your digestive tract. The bacteria, viruses, or parasites causing food poisoning can inflame the gastrointestinal tract, resulting in gas buildup, particularly in the bend of the colon known as the splenic flexure. This could result in severe abdominal pain and discomfort, typical symptoms of splenic flexure syndrome.
• Air entrapment: Air entrapment can also contribute to splenic flexure syndrome. Sometimes, gas can get trapped at the sharp bend of the colon at the splenic flexure. Because this part of the colon has a sharp bend, it may be challenging for the gas to move past it, causing abdominal pain, bloating, and other related symptoms.

Symptoms of splenic flexure syndrome

Discomfort in the upper abdominal area is the main presenting symptom of splenic flexure syndrome. The following signs and symptoms may accompany the syndrome:

• Abdominal pain: The most common presenting symptom of splenic flexure syndrome, abdominal pain is usually located in the upper left abdominal quadrant. This pain has the potential to radiate up toward the left side of the chest. This pain can often be mistaken as a heart attack. Splenic flexure abdominal pain has been described as being severe and lasting for a few minutes, recurring many times for weeks or months.
• Abdominal distension: This is mainly due to over-accumulation of gas in the splenic flexure. Increased gas production may present as bloating and could be triggered by gas-forming foods and fatty meals. A condition called Liddle’s syndrome may also be a causative factor.
• Abdominal spasm: A common manifestation and a source of discomfort in people with splenic flexure syndrome. It is most likely caused by trapped gas in the gastrointestinal system.
• Constipation and diarrhea: While not occurring simultaneously, these two conditions can be the result of uncontrolled episodes of splenic flexure syndrome
• Flatulence: Excessive flatulence or farting is another symptom that may be associated with splenic flexure syndrome. Flatulence results from the buildup of gas in the digestive system, and if this gas becomes trapped at the splenic flexure, it can cause discomfort and other symptoms associated with this condition.
• Increased heart rate: An increased heart rate or tachycardia might be observed in individuals suffering from splenic flexure syndrome. This may be a response to pain or discomfort or due to anxiety related to the condition.

Other possible symptoms include:

• Fever
• Bloating
• Belching
• Colon spasm
• Rapid heartbeats
• Abdominal cramps
• Presence of a palpable mass
• Presence of excessive amounts of gas
• Drum-like sounds while tapping the upper abdominal area

Diagnosing splenic flexure syndrome

Your doctor will take a full history of presenting symptoms to help rule out the most common causes first. This will often include taking a full medical history of previously diagnosed illnesses as well as reviewing all past and recent dietary habits. Remembering everything you ate in the past 24 hours will also help your doctor make a more informed decision about your current condition.

Next, your doctor will perform a physical exam, which will require you to lie down and expose your stomach area. The doctor will then lightly press on different areas of the stomach and ask you specifically where you feel the pain.

If your doctor feels further testing is needed, a barium enema test may be prescribed. This allows for a more detailed examination of the lower GI tract and can help diagnose abnormalities affecting the large intestine. This test requires the insertion of contrast material (barium) through the anus and an x-ray of the abdomen. If necessary, you may need more detailed imaging tests, such as a CT scan or MRI.

Treating splenic flexure syndrome

The following methods can be used to treat splenic flexure syndrome. However, no definite treatment exists for splenic flexure syndrome, with most remedies focusing on symptom relief.

Diet modification: This is usually the first treatment recommended to patients and involves avoidance of eating gas-forming foods such as carbonated drinks, foods high in fat content, and high in sugar to prevent bloating. Avoidance of spicy foods can also reduce symptoms. Incorporating more fiber in the diet has been known to aid in the digestive process, as has eating smaller, more frequent meals.

Passing stool/gas: While this may be difficult for splenic flexure syndrome patients, doing so can help relieve abdominal pain.

Avoid air swallowing: This will help keep excess air out of the GI tract. By chewing food with your mouth closed instead of open, you can reduce excess air consumption.

Medicines:

• Antacids: Great at relieving bloating and discomfort, this is a commonly used class of medication to relieve stomach pain. They work by neutralizing stomach acid, reducing the amount of gas production. Examples include Maalox and Tums.
• Antispasmodic drugs: help reduce abdominal pain
• Anticholinergic drugs: help relieve abdominal spasms. Dicyclomine is one such medication that also aids in managing pain and fecal urgency.
• Metoclopramide: Can help stimulate gastrointestinal movement, leading to the relief of GI pain.

Splenic flexure syndrome diet and nutrition guidelines

Managing splenic flexure syndrome through diet involves both avoiding certain foods that could exacerbate the condition and including foods that can alleviate symptoms.

It’s crucial for those with chronic conditions of splenic flexure syndrome to avoid foods that lead to excessive gas buildup in the intestinal tract. Here are some foods you should consider minimizing or eliminating from your diet:

• Beans
• Prunes
• Brussels sprouts
• Cabbage
• Broccoli
• Dairy products (especially for those with lactose intolerance)
• Apples
• Corn
• Peas
• Processed cereals and bread
• Potatoes

These foods are known to increase gas production and could potentially worsen the symptoms of splenic flexure syndrome. If you suspect an intolerance to lactose is causing excessive gas production, try excluding dairy products from your diet for a week to assess whether your condition improves.

In addition to this, it would be beneficial to limit foods high in sodium as they may attract water to the cells to exchange for potassium. You could replace this lost potassium by consuming foods rich in it, such as bananas and various root vegetables.

On the other hand, certain additions to your diet can alleviate symptoms of splenic flexure syndrome:

• Probiotics: Foods like yogurt, kefir, and sauerkraut can introduce beneficial bacteria to your gut, improving digestion and reducing gas production.
• Ginger and peppermint: These herbs can aid digestion and soothe the gastrointestinal tract.
• High-fiber fruits and vegetables: Promoting healthy bowel movements and preventing constipation.
• Adequate hydration: Drinking plenty of water can aid digestion and prevent constipation.
  Lean proteins: Foods such as chicken, fish, and tofu can maintain gut health without leading to excessive gas.

As a general rule, it’s beneficial to increase fluid consumption and include food high in fiber in your diet to promote digestive health. This can help improve the signs and symptoms of GI discomfort and has even been shown to reduce cholesterol levels.

However, remember that everyone’s body responds differently to dietary changes. It may take a bit of trial and error to determine what works best for you. Always consult a healthcare professional or a registered dietitian before making significant changes to your diet. It’s crucial to tailor your diet plan to your personal needs, ensuring it’s balanced, nutritious, and supportive of your overall health while managing the symptoms of splenic flexure syndrome.