Raise your hand if you or someone you know has said, “I’m bloated like I’m 3-6-9-months-you-get-the-drill pregnant?” The other day, I even heard from a family member that she felt as bloated as a 10-month pregnant woman. Sometimes, I will say, “I feel and look so bloated,” and others will comment that I’m as flat as I was before, not believing my feeling of fullness and discomfort.

Cases of actual abdominal distension (extension of the abdomen outwards), or that feeling of being bloated but not showing, trouble 10 to 30 percent of our population and upset their quality of life. Abdominal bloating is due to the accumulation of gas or air and is different to weight gain or water retention in the abdominal area. It is oftentimes but not always accompanied by abdominal pain and cramps, gas (flatulence), constipation, sudden diarrhea, repeated burping or belching, and loud or frequent intestinal rumbling.

Abdominal bloating affects people’s everyday life, from their family and social life to their workplace and finances, oftentimes resulting in absenteeism from work and recurrent visits to the doctor in pursuit of a solution to the problem. People admit to trying different medications and techniques, but most of the times feel helpless and desperate.

The gastrointestinal (GI) tract is like a continuous tube that begins at the mouth and ends at the anus. It is surrounded by the wall of the abdomen. When the intestines fill up with gas, liquid stool or hard feces as a result of constipation, the pressure increases. This pressure pushes the front and side muscles of the abdomen in order for the area to expand. Furthermore, the diaphragm that separates the chest area from the abdomen may also be pushed upwards in order to make room for the increased volume in the intestines. All of this adds up to looking or feeling bloated and overall pain and discomfort. 

Which conditions are associated with abdominal bloating?

Abdominal bloating can be a result of a primary cause and an anatomical or structural issue such as an obstruction in the gut or ulcers, but most people complain about bloating when they suffer from a Functional Gastrointestinal Disorder (FGID).

A Bit of Medical Terminology

The term “disease” describes a state where the pathology is visible, i.e. something can be seen on an X-ray or endoscopy or is quantifiably measurable in a blood test or other diagnostic test.

“Illness” is simply when the patient does not feel well.

When the illness is due to a disease that is visible, i.e. a certain pathology or change in the physiology (biochemistry) of the body, then this is called structural. When the patient suffers and has symptoms but there is no apparent sign of disease, then this is called functional. 

Functional GI disorders (also recently transitioning to disorders of brain-gut interactions) occur in more than half of adults and include a big collection of disorders such as: aerophagia (air swallowing), functional dyspepsia (feeling of indigestion, an uncomfortable fullness and nausea after a meal, pain in the upper GI area), irritable bowel syndrome (abdominal pain accompanied by constipation, diarrhea or alternating constipation/diarrhea, with symptoms subsiding after going to the bathroom), functional abdominal bloating or functional constipation.

Non-functional GI disorders that are linked to abdominal bloating are: Lactose Intolerance, Giardiasis (infection of the intestines by parasites), small intestinal bacterial overgrowth (SIBO), celiac disease (an immune response that attacks the small intestine when the patient consumes gluten), and intestinal obstruction.

Females may also experience abdominal bloating during menstruation and this is considered a normal symptom.

Serious non-GI-related conditions associated with abdominal bloating

A number of serious conditions can cause abdominal bloating and these should never be neglected or ignored. You should always consult a physician for further evaluation and to establish a diagnosis when abdominal bloating is severe and sustained, or when it is accompanied by blood in the stool, dark stool, fever, diarrhea, vomiting or sudden and significant weight loss. Some conditions that may be the culprit are:

• Cancer (colon, ovarian or uterine), kidney failure, congestive heart failure or liver disease, which produces fluid that drains and collects in the abdomen.
• Damage of the GI tract, which would allow gas, bacteria and other substances to enter the abdominal area causing irritation or infections.
• Pancreatic insufficiency, which could inhibit the release of important pancreatic digestive enzymes into the gut, thus resulting in inadequate food digestion and the accumulation of food products and gas production in the gut.

What causes abdominal bloating?

So, what are some of the gastrointestinal reasons for this build-up of pressure in the abdomen?

Offenders include swallowing large amounts of air when talking or eating, the stomach not emptying properly or in a timely manner due to dyspepsia, irregular movement of stool due to IBS constipation and formation of gas due to IBS, and other conditions due to fermentation of products by bacteria.

Moreover, visceral hypersensitivity, which is an enhanced perception of sensations that initiate in the gut, plays a role. As a result of this sensitivity, even small changes in volume (stretching) and movement in the gut seem big to the patient and they feel bloated even though there are no visible signs of distension.

8 ways to reduce abdominal bloating

• Avoid foods that are irritating or that you are intolerant to. The most common are: lactose from dairy, increased intake of fructose, artificial sweeteners that contain sugar alcohols, increased intake of dietary fiber, consumption of cruciferous vegetables like broccoli, cauliflower and asparagus, and the ingestion of pulses and lentils, all of which the body has difficulty digesting.
• Avoid drinking carbonated drinks, drinking with a straw, or chewing gum.
• Medication, i.e. in the case of Giardiasis, the use of antibiotics is the easiest solution against the parasite infection.
• Frequent and moderate exercise, especially walking and yoga.
• Psychological therapies such as hypnosis and behavioral treatments that aim to reduce stress in certain patients.
• Relaxation techniques, meditation and the practice of mindfulness (to train the mind to focus on the present moment).
• Intake of probiotics. These are found naturally in yoghurts, kefir and other fermented products or supplements prescribed by a physician. This is still debatable as certain studies confirm the positive impact of probiotic pills and others report no significant effect on reducing bloating and gas production.
• Use of antidepressants prescribed by healthcare professionals. The purpose of using antidepressants is to decrease the nervous system’s awareness of gut movements (which are oftentimes overexaggerated in patients with FGIDs).

Via this blog, the Digestive Nutrition Clinic will touch upon all of the above conditions, offering information on tests and the latest trends in managing abdominal bloating.

References

Understanding Bloating and DistensionUnderstanding Bloating and Distension. International Foundation for Functional Gastrointestinal Disorders.

Thiwan S. Abdominal Bloating: A Mysterious Symptom. UNC Center for Functional GI and Motility Disorders.

Reporter’s Guide to Functional Gastrointestinal Disorders. International Foundation for Functional Gastrointestinal Disorders

Lacy BE, Gabbard SL, Crowell MD. Pathophysiology, Evaluation, and Treatment of Bloating. Hope, Hype or Hot Air? Gastroenterol Hematol (NY). 2011; 7(11):729-739.