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"Tight-pants syndrome." (cause of abdominal pressure)

It's really just a new name for an old and frequent problem, but a letter in the Archives of Internal Medicine in June 1993, followed by a response in the Journal of the American Medical Association (JAMA), May 25, 1994, shed new light on the subject.

The earlier letter of Dr. Octavio Bessa, a Connecticut internist, referred to 200 or so of his patients during the previous 20 years whose abdominal complaints had defied diagnosis by endoscopy, x-ray, or CT scans. He had observed two things common to the group. First, all had similar complaints, including bloating and upper abdominal discomfort, sometimes radiating into the chest. Second, all were overweight men whose waist measurements exceeded their pants sizes by three inches or more. When they took his advice to wear suspenders and pants that matched their waist measurements, the symptoms disappeared.

Curious why so many men wear tight pants, Dr. Bessa theorized that it has to do with the known aversion of many men to shopping. When their wives ask them their pants sizes before heading to the department store, they usually give their waist sizes--or what they remember as their waist sizes of 20 years before. So when the wife returns from the men's department with a pair of size-32 slacks, size-42 husband tries stuffing himself into them. Or it may be just a case of pride in not wanting to admit to an over-expanded waistline.

When Dr. Bessa later wrote a letter to JAMA asking if such a condition had previously been described, Dr. Deborah Allen of the Indiana University School of Medicine suggested that the underlying problem is likely to be a silent hiatus (or diaphragmatic) hernia. When pressure in the abdomen increases (e.g., from too-tight clothing), it can force the upper end of the stomach through the weak spot (hernia) in the diaphragm where the esophagus joins the upper end of the stomach. Such hernias are often extremely difficult to detect by x-ray or other such means.

Dr. Allen also pointed out that she and many of her colleagues have observed similar symptoms in their female patients after childbirth, which often causes temporary hiatus hernias, aggravated whenever the patient attempts to get back into too-tight clothing after delivery.

Now that suspenders are in again with the younger set, older men can now feel comfortable in avoiding tight-pants syndrome.

RELATED ARTICLE: When Down Is Better Than Up

Persons whose breathing is so severely restricted by chronic obstructive lung disease (emphysema) that they must rely on oxygen tanks may find relief by moving to a lower altitude.

An Israeli study reported in the Annals of Internal Medicine, November 1994, found that patients with severely impaired breathing living in Jerusalem (altitude (2,600 feet) got along much better when they spent a week in a resort on the Dead Sea (1,300 feet below sea level). The 4,000-foot difference in altitude improved significantly their arterial oxygenation, sleep patterns, exercise performance, and general quality of life.

Although living below sea level is not feasible for many, there are situations in the United States where significant differences in altitude exist in the same geographic area. In Arizona, for example, Phoenix is 4,000 feet lower than Flagstaff--and even lesser differences in altitude may prove beneficial.
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Author:Brown, Edwin W.
Publication:Medical Update
Date:Jul 1, 1995
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