Bloating

Bloating is a discomfort in the abdomen, characterized by a feeling of fullness or inflated balloon in the abdomen. It is a very common symptom associated with many conditions. In some cases bloating is associated with distention or an increase in the width in the abdominal region.

Bloating and distention may affect the quality of life as they cause considerable discomfort. In many cases, these two are related to other abdominal complaints like burping, belching, swallowing of air, and flatulence.

The bloated feeling is due to the buildup of gas in the abdomen, which otherwise passes out during burping or flatulence. The buildup leads to distention, which is equally uncomfortable. There are multiple causes for bloating.

The causes may range from lactose intolerance to very serious conditions like cancer. Bloating should be considered serious if the accompanying symptoms warrant medical attention.

The warning signs include weight loss, ascites, severe abdominal pain, vaginal bleeding, and high-grade fever. One of the most common causes of bloating is overeating.

Bloating may be related to: 

• Eating fatty foods
• Stress or anxiety
• Having carbonated beverages
• Smoking
• Gastrointestinal infection
• Irritable bowel syndrome (IBS)
• Celiac disease

Bloating caused by overeating, gas, stress, and indigestion may resolve on its own within few hours. Stomach flu cause pain and bloating, but usually go away without any specific treatment.

If the abdominal pain and bloating occur after every meal or occur with painful bowel movement, doctor’s advice is needed. Bloating may also occur if one eats too fast.

Under normal conditions gastrointestinal tract moves the gas effectively, preventing its buildup in the abdomen. Certain habits increase the air swallowed. This includes using straw for drinking, chewing gum, and eating hard candy.

Being anxious or nervous also increases the chances of bloating. Moreover, there are certain foods that increase gas in the abdomen and bloating. Beans and lentils, Brussel sprouts, artificial sweeteners, and certain dairy products are some of them. Whole grains may also cause bloating and gassiness in certain people.

Doctor’s advice is needed when bloating occurs on a regular basis. Physical obstruction in the stomach may also lead to bloating in the abdomen. Medical tests are recommended by the doctor for identifying the underlying cause of bloating.

The type of tests and investigations suggested may depend on the possible cause of distention in the abdomen. Complete blood count, urine analysis, stool analysis, and imaging studies are commonly used to detect the problem.

Treatment for bloating also depends on the underlying cause of the condition. Intestinal obstruction may be treated with medications that improve movement within the intestine, or surgery in case of severe obstruction.

Infections are treated with antibiotics. Home care is the best treatment method for controlling bloating in most of the cases. Drinking plenty of water, having soft and bland food, and over-the-counter medications may be of help in alleviating bloating.

Avoiding foods that trigger bloating is also useful. A healthy diet rich in high-fiber foods is very important in the passing of the gas within the abdomen. Regular exercise is also important.

Other than an underlying medical condition, the most common causes of bloating are: 

• Overeating – this is one of the most probable causes of bloating in the abdomen. Having smaller meals at regular intervals, rather than overeating, helps to reduce the pain.
• Fatty food – having food rich in fats often makes a person feel uncomfortable due to bloating as fat takes a longer time to digest when compared to other nutrients in the diet. Rich fatty foods keep the stomach full for a longer duration.
• Eating fast – it is seen that eating fast triggers bloating and distention. It takes about 20 minutes for the signals of feeling full to reach the brain. The brain responds to these signals by reducing appetite. Eating fast may also lead to overeating, another cause of bloating.

Bloating is also caused by a buildup of gas in the abdomen. Under normal conditions, the gastrointestinal tract moves the air in the abdomen efficiently. When the air is not moved forward, it leads to bloating and distention.

Certain habits also tend to increase bloating. This includes drinking with a straw, chewing gum, drinking carbonated beverages, and having hard candy. Certain foods that are difficult to digest may cause bloating.

Some common foods that increase bloating are:

• Beans and lentils
• Brussels sprout, cabbage, cauliflower, prunes and apricots
• Artificial sweeteners
• Dairy products
• Whole grains

Some medical conditions that have to bloat as one of the symptoms include: 

Digestive disorders – gastrointestinal disorders like ulcerative colitis, celiac disease, and IBS have bloating and distention as symptoms. The majority of the patients with these disorders suffer from bloating.

Ascites – retention of fluid near abdomen lead to bloating. Patients may also complain of temporary gain in body weight. Fluid retention may result from liver disease or even cancer.

Dehydration – dehydration is a common cause of bloating. Electrolyte imbalance and dehydration affect digestion and lead to bloating.

Constipation – in this condition the stool may remain in the intestine giving a full feeling to the stomach. Low amounts of fiber in food, not having enough water and lack of physical activity are some of the reasons for constipation.

Food allergies and sensitivities – food allergies are one of the common causes of bloating. Some dairy products, gluten-containing substances and some carbohydrates are implicated in bloating. Intolerance to a certain food, like lactose intolerance, and sensitivity to some products may also lead to abdominal discomfort.

Small intestinal bacterial overgrowth (SIBO) – SIBO refers to an increase in the number of harmful bacteria in the digestive tract. Inflammation and poor digestion may lead to bacterial overgrowth.

Dysbacteriosis in the bowel, usually after a course of antibiotics, also lead to the accumulation of harmful bacteria, disturbing the normal balance in the gut. This affects the lining of the stomach and causes bloating and distention.

Infections – infections are known to increase the level of inflammation, leading to bloating. Elevated levels of white blood cells during an infection leads to inflammation.

Bowel obstruction – bowel obstruction, usually caused by a scar tissue from a tumor, cause severe bloating. The scar tissue may grow and obstruct the flow of food and fluid in the bowel. This is a very painful condition and requires medical attention.

Hormonal changes – changes in hormonal levels around menstrual periods lead to premenstrual syndrome, a condition characterized by bloating and digestive issues. This is of common occurrence in women unless accompanied by serious or warning symptoms like an irregular menstrual cycle, fibroids, and severe pain during abdominal cramps.

Cancer – uterine and colon cancer has bloating as one of the symptoms. Persistent bloating, pain and digestive issues thus needs medical advice for alleviation.

In most of the cases, bloating and distention represents a benign condition and may resolve on its own. Diagnosis of the underlying cause of bloating begins with a patient history and physical examination.

This will help to list out the probable causes of bloating. Information on serious and warning signs like unexplained weight loss and anemia are also collected. These symptoms are suggestive of malabsorption.

Once this is suspected, the doctor may recommend other tests like complete blood count, celiac serology, upper endoscopy, and duodenal biopsies, if needed. Further evaluations are usually based on the suspected cause of bloating.

Those presenting with nausea, vomiting and bloating may be asked to take a scan of the small intestine, while those having diarrhea as one of the symptoms may have to undergo evaluation through colonoscopy or stool studies. Imaging studies are mostly used in the diagnosis of bowel obstruction and bacterial overgrowth.

There is no common treatment plan for all patients with bloating. The treatment is individualized based on the underlying cause of bloating and distention.

The most common options available are: 

• Diet
• Exercise and posture
• Over-the-counter medications
• Probiotics
• Antibiotics
• Tricyclic antidepressants
• Osmotic laxatives
• Prokinetic agents

Diet – elimination diet consisting of only few food groups are recommended for some patients. Once the body is used to it, other groups are gradually added in the diet. This will help to analyze the groups or foods that help to improve the symptom. For some other patients, the doctor may recommend removing one offending food from the diet. This also helps to identify the causative food.

Exercise and posture – physical exercise helps to clear the abdomen of gas and reduce the symptom of bloating. Retention of gas is more in the supine position and hence patients are advised to be in an upright position after food.

Over-the-counter medications – number of medications are now available to help in clearance of gas and flatulence.

Probiotics – probiotics are thought to confer health benefits by adding beneficial bacteria in the abdomen.

Antibiotics – rifaximin is a commonly recommended antibiotic for the treatment of bloating. This was found to improve the symptoms in patients with IBS.

Tricyclic antidepressants – these prescription medications are used to treat abdominal pain mostly associated with functional dyspepsia.

Osmotic laxatives – these medications are usually recommended for treating constipation. Osmotic laxatives were found to improve symptoms of bloating.

Prokinetic agents – prokinetic agents are commonly suggested in the treatment of pseudo-obstruction in the colon. These medications were found to be useful in improving clearance of gas in these patients.