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Bloating

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Iqra Mazhar

Overview

Bloating is a symptom where the belly feels full, tight, and painful, usually due to gas, to the extent it negatively affects the individual&rsquo;s quality of life. 
&nbsp;

Abdominal bloating is a common problem characterized by abdominal pressure, trapped gas, and fullness. The abdomen may be distended (swollen) and hard. It can occur in both children and adults.

According to a recent survey, 1 in 7 Americans experience bloating regularly[1]. Additionally, it affects more women than men, with around 75% of women complaining about it before and during menstruation<a href="#accordion">[2]</a>. 
&nbsp;

Generally, nearly 75% of individuals describe their symptoms as moderate to severe, while 50% find it debilitating<a href="#accordion">[4]</a>. Despite its prevalence, 9% of the participants of the survey reportedly felt uncomfortable discussing it with their doctor<a href="#accordion">[3]</a>.

Although earlier studies stated bloating to not be age-related, the survey also observed that the condition became more severe with increasing age up until 59 years; it decreased in people aged 60 or older<a href="#accordion">[3]</a>.

10-25% of otherwise healthy people experience abdominal bloating occasionally<a href="#accordion">[2]</a>.

In Pakistan, the prevalence range of digestive issues is 30-40%, which is higher than the global rate of 20%. The most frequently diagnosed digestive issues in the region include irritable bowel disease (IBS), <a href="https://merisehat.pk/disease/acid-reflux-infants">acid reflux</a>, <a href="https://merisehat.pk/disease/peptic-ulcer">peptic ulcer</a> disease, heartburn or gastroesophageal reflux disease (GERD), and inflammatory bowel disease (IBD)<a href="#accordion">[5]</a>. 
&nbsp;

Signs and Symptoms

Bloating is a type of belly bulge, different from the post-pregnancy belly, menopausal hormonal belly bulge, adrenal stress fat, and beer belly. 
&nbsp;

Symptoms of bloating include:

<ul>
	<li>Abdominal pain or discomfort</li>
	<li>Abdomen feeling bigger than usual</li>
	<li>Abdominal sounds (also known as bowel sounds or borborygmus) 
	&nbsp;</li>
</ul>

Other symptoms that often accompany bloating include:

<ul>
	<li>Swelling</li>
	<li>Cramps</li>
	<li>Constipation</li>
	<li>Diarrhea</li>
	<li>Gas (flatulence)</li>
	<li>Burping frequently 
	&nbsp;</li>
</ul>

Important!

Usually, bloating is not a problem if it does not get worse with time, is associated with food, and/or goes away within a day or two. 
&nbsp;

However, consult a doctor immediately if any of the following are present along with severe bloating:

<ul>
	<li>Nausea</li>
	<li>Vomiting</li>
	<li>Fever due to an infection</li>
	<li>Blood in the stool</li>
	<li>Changes in the frequency or color of the stool</li>
	<li>Unexplained weight loss</li>
	<li>Heartburn</li>
	<li>Persistent or severe abdominal pain</li>
	<li>Loss of appetite</li>
	<li>Vaginal bleeding, which is a cause of concern in case it&rsquo;s between periods or post-menopause 
	&nbsp;</li>
</ul>

Causes

One of the reasons bloating is so common is that it has multifactorial causes, including,

<ul>
	<li>
	<h5>Diet</h5>
	</li>
</ul>

<ol>
	<li>Consuming lots of salt and carbs</li>
	<li>Drinking lots of fizzy drinks</li>
	<li>Certain foods (e.g., cabbage, turnips, Brussels sprouts, beans, and lentils) 
	&nbsp;</li>
</ol>

Note: The quality of nutrients in what you consume can cause changes to the gut microbiome, leading to a buildup of gas in the stomach and gut. 
&nbsp;

<ul>
	<li>
	<h5>Underlying Disease</h5>
	</li>
</ul>

<ol>
	<li>Celiac disease</li>
	<li>GERD</li>
	<li>Constipation</li>
	<li>Indigestion (dyspepsia) due to alcohol, eating too much, medications (e.g., ibuprofen), or stomach ulcer</li>
	<li>Gastroparesis due to hypothyroidism</li>
	<li>Irritable bowel syndrome, Crohn&rsquo;s disease, and gut sensitivity</li>
	<li>Pelvic inflammatory disease</li>
	<li>Small intestinal bacterial overgrowth</li>
	<li>Food intolerance, like lactose intolerance or gluten allergy</li>
	<li>Bacterial (e.g., H. pylori and E. coli) and viral (e.g., rotavirus and norovirus) infections</li>
	<li>Gynecological disorders (e.g., endometriosis)</li>
	<li>Eating disorders (e.g., bulimia and anorexia)</li>
	<li>Cancer (e.g., stomach, colon, ovarian, pancreatic, and uterine cancers) 
	&nbsp;</li>
</ol>

Note: Some serious conditions, like diabetes, gallstones, and kidney or liver failure, can cause fluid retention and chronic bloating. Consult a doctor if you have any unusual symptoms! 
&nbsp;

<ul>
	<li>
	<h5>Other</h5>
	</li>
</ul>

<ol>
	<li>Swallowing air while chewing gum, smoking, or eating too fast</li>
	<li>Certain medicines</li>
	<li>Psychological stress &ndash; according to a study, people who experienced bloating were also prone to depression and anxiety<a href="#accordion">[6]</a></li>
	<li>Ileus</li>
	<li>Weight gain</li>
	<li>Hormones, especially before period or after menopause 
	&nbsp;</li>
</ol>

Note: It&rsquo;s important to find the exact cause of bloating so you can get the right treatment and reduce or eliminate the symptoms. There is no one way that bloating presents itself so do bring it to your doctor&rsquo;s attention if you notice any abdominal discomfort or abdominal swelling. 
&nbsp;

Diagnosis

There is no diagnostic test for bloating. Doctors may begin with a thorough clinical history and physical examination. They will need details like the onset and timing of symptoms, diet, use of supplements and medications, surgical history, and bowel movement patterns. 
&nbsp;

They may order some tests to rule out associated disorders or existing underlying problems. These tests include:

<ul>
	<li>Blood workup</li>
	<li>Barium swallow</li>
	<li>Stool analysis</li>
	<li>Gastric emptying tests</li>
	<li>Colonic transit studies</li>
	<li>Small transit follow-through</li>
	<li>Abdominal imaging</li>
	<li>Barium enema</li>
	<li>Esophageal, anorectal, antroduodenal manometry</li>
	<li>Breath test</li>
	<li>Colonoscopy with biopsies</li>
	<li>Upper endoscopy 
	&nbsp;</li>
</ul>

These tests help them examine suspected digestive problems, infection, or bacterial overgrowth. 
&nbsp;

Treatment

Bloating needs medical attention if:

<ul>
	<li>It&rsquo;s lasted for three weeks or more</li>
	<li>If the person feels bloated regularly (more than 12 times a month)</li>
	<li>If bloating is accompanied by constipation, diarrhea, bloody feces, or weight loss</li>
	<li>It&rsquo;s not alleviated despite changes in diet</li>
	<li>It affects daily activities and movement 
	&nbsp;</li>
</ul>

The dos and don&rsquo;ts of treatment include:

<ul>
	<li>Exercise Regularly to improve digestion. Walking around can also relieve gas pressure and constipation.</li>
	<li>Yoga And Meditation are recommended not just to tackle stress but also to encourage the release of excess gas from the gastrointestinal tract.</li>
	<li>Massaging The Abdomen, following the path of the large intestine, can help get a bowel movement. Discontinue it if it causes pain.</li>
	<li>A Warm Bath reduces stress and enables the GI tract to function more effectively, hence reducing bloating and sore abdomen.</li>
	<li>Sometimes, doctors suggest Medicines, like simethicone, or herbal ingredients, like turmeric, peppermint, and fennel to relieve discomfort. 
	&nbsp;</li>
</ul>

Gas buildup is usually not a serious health problem even though the individual may feel discomfort, pain, and embarrassment. However, it feels worrisome as it can mimic the pain of other diseases, like heart attack, appendicitis, or gallstones. It&rsquo;s best to consult a doctor so they can assess these symptoms for underlying causes.

Potential complications of bloating include:

<ul>
	<li>
	Gastrointestinal Distress
	</li>
</ul>

Bloating accompanies other gastrointestinal symptoms, like abdominal pain, gas, and changes in bowel movements. All of these issues together can affect digestive health. 
&nbsp;

<ul>
	<li>
	Anxiety And Psychological Distress
	</li>
</ul>

Chronic bloating affects mental health due to persistent concerns about the impact of bloating on appearance. Low self-esteem and negative body image cause people to withdraw from social activities or avoid certain situations. Individuals are also worried about its underlying cause. 
&nbsp;

<ul>
	<li>
	Nutritional Issues
	</li>
</ul>

Bloating due to certain conditions, like chronic pancreatitis and celiac disease, can affect nutrient absorption leading to malabsorption and nutritional deficiencies. Further, it causes some people to change their eating habits &ndash; reducing food intake or avoiding certain foods &ndash; which leads to inadequate calorie intake. 
&nbsp;

<ul>
	<li>
	Obstruction
	</li>
</ul>

In rare cases, severe bloating due to conditions like intestinal obstruction can cause intestinal blockage, which requires immediate medical attention. 
&nbsp;

<ul>
	<li>
	Reduced Quality Of Life
	</li>
</ul>

Bloating can cause significant discomfort and interfere with daily activities. 
&nbsp;

Some people are more prone to experiencing bloating, including: 
&nbsp;

<ul>
	<li>Gender &ndash; Women have a higher risk than men, especially due to hormonal fluctuations during premenstrual syndrome.</li>
	<li>Age &ndash; Older people have a higher risk because digestive function slows down with age.</li>
	<li>Lifestyle &ndash; Lack of physical activity slows down digestion; also includes diet (e.g., foods high in fiber and fat, carbonated drinks), eating too quickly, eating large meals, certain habits (e.g., talking while eating, chewing gum, drinking through straws), and smoking.</li>
	<li>Stress &ndash; High levels of stress affect digestion.</li>
	<li>Medical Conditions &ndash; Gastrointestinal infections, liver disease, gluten sensitivity, lactose intolerance, and ovarian cysts are some of the conditions that increase the risk of bloating.</li>
	<li>Medications &ndash; Some medications, especially those that affect the gastrointestinal system, cause bloating as a side effect. 
	&nbsp;</li>
</ul>

The following lifestyle changes can help prevent bloating in the long term: 
&nbsp;

<ul>
	<li>Stay Hydrated. However, increase the intake of water rather than drinking carbonated drinks.</li>
	<li>Eliminate Artificial Sweeteners and carbs from the diet.</li>
	<li>Eat More Fiber. The recommended daily intake for females is 25 g; for males, it&rsquo;s 38 g. However, increasing the intake too quickly or eating too much fiber can cause more bloating.</li>
	<li>Avoid A&nbsp;Sedentary Lifestyle. Physical activity helps release extra sodium from the body, relieving water retention. Additionally, it makes bowel movements more regular and helps get the gas out of the colon.</li>
	<li>Eat At Regular Intervals. A big meal or unnecessary snacking often induces bloating. Avoid eating quickly or drinking from straws as air may enter into the digestive tract. Also, avoid chewing gums.</li>
	<li>Cut down On Salt and try probiotics, such as yogurt. Salt causes water retention. Probiotics, on the other hand, regulate the colon bacteria that produce gas and cause bloating.</li>
	<li>Keep A&nbsp;Food Diary to identify triggers. Certain foods, like lactose in dairy products or gluten, may trigger the condition. 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Bloating is a common condition that refers to a feeling of fullness or tightness in the abdomen, often accompanied by visible distension.</li>
	<li>Symptoms of bloating include flatulence, burping, rumbling noises in the stomach, feeling full even after eating small amounts, and swollen abdomen.</li>
	<li>Causes of bloating include eating too quickly or overeating, constipation, gastrointestinal disorders (e.g., IBS, IBD, and GERD), food intolerances, and certain foods that lead to excessive gas production.</li>
	<li>Risk factors of bloating include excess water retention due to hormonal changes or high sodium intake, serious medical conditions (e.g., liver disease, uterine fibroids, ovarian cysts)</li>
	<li>Treatment includes avoiding trigger foods, consuming probiotic-rich foods or supplements, eating smaller or more frequent meals, staying hydrated, and exercising regularly.</li>
	<li>It&rsquo;s important to consult a healthcare provider in case of chronic or severe bloating as it can be a symptom of an underlying health issue. 
	&nbsp;</li>
</ul>