Ever got to the end of the day and you feel like you’re six months pregnant? Do you often get a sensation of heaviness or air in your belly that lasts hours?
Bloating is a very common occurrence that many people experience. Often, bloating is nothing to worry about, it’s simply a sign of your body undergoing a normal digestive process after eating a meal. However, for some, bloating can be uncomfortable, embarrassing and even painful.
In this article we’re looking at what can cause bloating, how to reduce it and when to seek medical advice or support.
What is bloating?
Most people have felt bloated at some point in their lives. For some, it resolves itself in a short time, whereas for others it can last longer and have a significant negative impact on their quality of life. It was previously thought that bloating was caused by the excess gas trapped in the gastrointestinal (GI) tract and due to the pressure building up. However, we now know that bloating is a feeling or sensation that results from increased nerve signals from the GI tract and/or ineffective regulation of the sensation by the brain.
In some people bloating can also trigger visible abdominal distension via the miscommunication of the brain-gut axis. When we eat a large meal, this may stretch the stomach and cause the bloating sensation. This sends a message to the brain that will ‘respond’ by moving the diaphragm down into the abdomen and relax the abdominal wall muscles. This increases the pressure within the abdomen leading to distension. Please note that bloating doesn’t always lead to distension and some people with distension may not feel bloated.
Causes of bloating
Bloating can occur for many reasons including when we swallow air, are constipated, and eat large meals. Bloating is common in women during certain times of the menstrual cycle such as during ovulation, just before and during menstruation.
Bloating commonly occurs as a symptom of functional gastrointestinal (GI) conditions such as Irritable Bowel Syndrome (IBS), functional dyspepsia and Small Intestinal Bacterial Overgrowth (SIBO). Other medical conditions can also be associated with bloating including, liver disease, cancer, and many others.
On top of these reasons, bloating is thought to be triggered mostly by certain foods we eat. One culprit are FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), which are short-chain carbohydrates that are poorly absorbed in our bodies. This group of sugars found in some common foods, passes through the small intestine undigested and goes to the large intestine where the bacteria ferment on these sugars and use them as energy to survive. The fermentation process creates gas and attracts water to the intestines causing them to expand. The pressure can also trigger nerves lining the gut. People with IBS and sensitive intestines can find this to be very painful.
How to manage mild bloating?
For those with mild symptoms of bloating there are certain behaviour changes that can help reduce the symptoms. Simple things like avoiding chewing gum and the use of straws as these can increase the amount of air that travels to the gut. Carbonated drinks cause a build-up of gas in the stomach and should be also minimised or avoided. Eating slower and not overeating so as to not overload the GI tract. Increasing fluids (mostly water) and regular physical exercise also help prevent and manage this condition. Smoking and alcohol, can also irritate the gut and aggravate symptom, as is the case with most illnesses.
How to manage chronic bloating?
In some cases, bloating can cause serious discomfort and have an impact on everyday life. In these chronic cases, and to add to the above recommendations, changes in the diet might also be required. Eating high fibre foods can aid with constipation as it keeps things moving and prevents food from being in the GI tract for too long. This may help decrease fermentation and the consequent gas. Fibre can be found in plant foods and the recommendation is to eat more vegetables, legumes, fruits, and whole grains to at least, reach the recommended intake of 25 to 30g a day.
FODMAPs can also exacerbate the issue given they are poorly absorbed in many people with IBS. As such a low FODMAP diet can be trialled (as directed by your dietitian) in order to understand which sugars and foods are triggering the discomfort. The goal is to, with time, add back the FODMAP foods that can be tolerated, without causing symptoms of bloating, rather than eliminate these foods permanently.
One other factor that can play a part in worsening this condition is high levels of stress. In today’s world sometimes it can be hard to simply enjoy a meal without any feeling of stress, anxiety or rushing to go somewhere. However, this ‘simple’ change can relax the digestion process which can potentially help with bloating and/or constipation.
When to see a doctor?
Bloating can sometimes mean something else more serious is going on. When symptoms like, diarrhoea, blood in the stools, change in bowel motion, rapid weight loss, loss of appetite, vomiting, rapid swelling of the abdomen or continuous abdominal pain for long periods it is advised that medical attention should be sought immediately. Regardless of the severity of the symptoms it is always advised to seek professional help from doctors, dietitians and/or a university-qualified nutritionist to diagnose the issue and before making any major changes to the diet.
Written by Joao Cruz – Nutrition Masters Student
Reviewed by Rebecca Ponsford, APD
Lacy, B, et al. Management of Chronic Abdominal Distension and Bloating. Clin Gastroenterol Hepatol. 2021 Feb;19(2):219-231. doi: 10.1016/j.cgh.2020.03.056
The Rome Foundation- Bloating and Distention: What’s the Difference – https://theromefoundation.org/bloating-and-distension-whats-the-difference/
Accarino, Anna, et al. “Abdominal Distention Results From Caudo-Ventral Redistribution of Contents.” Gastroenterology, vol. 136, no. 5, 2009, pp. 1544–1551., doi:10.1053/j.gastro.2009.01.067.