Though regarded as a non-dangerous (benign) symptom, bloating can cause embarrassment when you can least afford it: like a loudly rumbling stomach during a sombre business meeting, or the inability to contain gas from shooting out from wherever it can from the body, or your tummy making you look six months pregnant. Bad.
Bloating affects nearly one third of all people, though it is more common in women. Being a common symptom, this is more often associated with Functional Gastro-Intestinal Disorders (FGIDs). For example, 60 to 90 per cent of patients with irritable bowel syndrome are found to have bloating.
Gas Storage and Transportation
Symptoms of bloating may overlap with each other in the same patient, often giving a confusing clinical picture:
- Feeling full: The feeling of a full stomach need not be very pleasant always. The abdomen could feel unpleasantly full or distended; ‘bloating’ is a frequently used term to describe the condition.
- Excessive gas (flatulence): The involuntary release of gas from the anus.
- Frequent burping (eructation): Here, gas is expelled in the reverse way – from the mouth.
- Abdominal rumbling (borborygmi): The rumbling that embarrasses you is not the sound of worms twisting and turning in your stomach; it’s the movement of gas through the stomach and intestines – if that’s any consolation.
The Usual Suspects
FGIDs are mostly found responsible for bloating, though some anatomical or structural abnormalities could also be involved. These are caused by abnormalities in the abdominal wall and gastrointestinal tract motility. Abnormal perception of gut sensations (visceral hypersensitivity) could also be responsible, than structural causes. Bloating gives credit to these causes:
- Air swallowing (aerophagia).
- Slow gas transport in the intestines, leading to gas accumulation.
- Irritable Bowel Syndrome.
- Retention of stools due to functional constipation.
- Delayed emptying of the stomach due to autonomic dysfunction.
- Functional dyspepsia or stomach upset, with or without heartburn and nausea.
6 Organic Causes of Bloating
- Lactose intolerance.
- Intestine infection through contaminated food and water.
- Bacterial overgrowth.
- Malabsorptive conditions like coeliac disease, where the person has intolerance to wheat protein.
- Some surgical procedures (with exotic names like Nissen fundoplication), which are used to treat gastro oesophageal reflux disease or hiatus hernia.
- Intestinal obstruction can also happen due to increased gas production or obstructed gas transport.
Management of gas and bloating depends on the cause of symptoms. Organic causes may be best treated with specific medications or by surgical intervention. Functional disorders meanwhile, may respond to other measures, as described here.
Several common food substances are known to cause bloating, especially when they are not normally digested. This causes bacterial degradation of these food substances, thereby producing more gas. Try to avoid a daily intake of:
- Dietary fibre, though it might be beneficial for constipation.
- Artificial sweeteners.
- Carbonated beverages.
- Vegetables like beans and broccoli.
- Alpha D Galactosidase, a digestive enzyme supplement, assists in the digestion of some complex carbohydrates in vegetables and may reduce flatulence, but may not be helpful in relieving bloating.
- Other over-the-counter preparations containing Simethicone and activated charcoal are still being used for gas and bloating symptoms, although their usefulness is questionable.
Probiotics are beneficial bacteria found in the intestinal tract of healthy mammals. Preparations containing bacterial species, especially Lactobacillus and Bifidobacterium, have been associated with improvement in bloating and flatulence.
- Prokinetics are a type of drug, which enhances movements of the digestive system and the transit of the contents within, by increasing the frequency of contractions in the small intestine or making them stronger, but without disrupting their rhythm.
- Recent trials with Tegaserod, a drug which stimulates serotonin receptors in the gut, have been shown to improve bloating in patients with IBS and chronic constipation.
- Low doses of tricyclic antidepressants (Amytriptyline or Desipramine, if you’re a drug name junkie) are found to act by modifying the perception of gut sensations.
When no apparent bloating cause is found, treatment usually includes avoidance of the offending food items, empirical use of drugs, and occasionally, psychological therapies in selected patients.
- Hypnosis has been shown to improve bloating in patients with irritable bowel syndrome.
- Behavioural treatment by a psychologist may be necessary for patients who swallow a lot of air.