What causes bloating—and how to relieve it

bVomiting is an uncomfortable feeling of fullness or pressure in the abdomen. Like an overstretched balloon, a distended abdomen can feel filled with air and in some cases can be markedly enlarged or distended.

Bloating is a common problem. By some estimates, up to 30% of Americans experience the condition from time to time. In most cases, this feeling is temporary and tolerable. It can be uncomfortable, but by itself it’s usually not a serious concern. However, bloating can also be a symptom of an underlying digestive problem or disorder, including some that need a medical provider’s urgent attention.

“If bloating negatively affects a patient’s quality of life, we should investigate,” said Dr. Kimberly Harer, a gastroenterologist and clinician at the University of Michigan Health System. and treat it. That’s especially true if a person’s bloating is accompanied by additional red flag symptoms, which could indicate a serious underlying medical condition.

Here, Harer and other experts explain common causes of bloating, including food triggers and GI disturbances. They describe some of the more mysterious aspects of this condition and detail the most effective treatment options.

What causes bloating?

The list of potential causes is long. At the top of that list is anything that causes a build-up of gas in the intestinal tract, which can cause a feeling of bloating throughout the stomach and abdomen.

“There are two main causes of this gas,” says Dr. Scott Gabbard, a gastroenterologist at the Cleveland Clinic. The first is the diet. “You may be eating foods that are fermenting in the gut and producing a lot of gas,” he explains. While many foods can cause gas buildup, he highlights a group known as FODMAPs, which are acronyms for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are short-chain carbohydrates that are difficult for the intestines to digest and are therefore more likely to travel down the large intestine or colon, where they are usually broken down into gaseous by-products. Beans and other legumes, as well as cruciferous vegetables like broccoli, are examples of foods high in FODMAPs.

The second major cause of gas, says Gabbard, is some kind of imbalance in the gut microbiome, or gut microbiome. “You might have too much or too little of certain bacteria, or you might have the wrong bacteria,” he explains. For example, some of his recent studies have found that patients with small bowel disorders may have higher levels of a group of gut bacteria called methanogens, which produce methane. “They can also slow down the entire digestive system and cause constipation, which contributes to bloating,” he says.

Another type of microbiome imbalance is called SIBO, which stands for Small intestine bacteria overgrowth. “Normally, very few bacteria live in the small intestine,” says Dr. Brian Lacy, GI specialist and professor of medicine at the Mayo Clinic. “Patients with intestinal bacterial overgrowth have too many bacteria living in the small intestine.” These bacteria process food earlier than usual, which can cause symptoms of gas and bloating.

Gastrointestinal disturbances—problems with the way food, mucus, and other substances move through the digestive tract—can also be a factor. “Two of the most common disorders associated with gas and bloating are chronic constipation and irritable bowel syndrome with constipation,” says Lacy. Whenever the contents of the intestines don’t move through it properly, gas can get trapped, causing bloating.

Bloating and bloating often go hand in hand, but not always. In fact, Gabbard says many people with bloating don’t have unusually high amounts of gas. “When investigators look at intestinal gas and compare healthy volunteers with patients with bloating, they often find no difference in gas production,” he said. “Many patients come to us complaining of bloating because the nerves in the intestines are too sensitive, so the amount of gas stays the same but they feel more.” This is sometimes called visceral hypersensitivity, and it is typical of irritable bowel syndrome (IBS).

Many medical problems can also cause bloating, including problems with how the stomach muscles stretch and relax to hold food. “When someone tells me their upper stomach feels full and bloated right after a meal, and they can’t eat as much as before, this suggests a disorder called functional dyspepsia, ie the stomach is not relaxed.” Gabbard said. It is also possible that the intestinal muscles relax or stretch improperly during digestion, which can lead to gas and bloating.

Many times, GI experts stress that bloating is a complex problem with many (potentially overlapping) triggers. Determining the exact cause or cause of a person’s bloating—a necessary step in determining the appropriate treatment—is best done with the help of a healthcare provider.

Read more: Best and worst foods for flatulence

bloating can become a serious health problem?

Bloating itself can be so severe that it makes life difficult. “Unfortunately, bloating is not always considered a significant complaint by health care providers, and it is brushed aside,” says Harer. “People suffer in silence.” That said, bloating itself is usually not a symptom of a life-threatening medical condition. “When it is accompanied by red flags—vomiting, blood in the stools, unexplained weight loss, yellowing of the eyes or skin—those are signs of an urgent and serious disorder,” she says. more serious. Liver disease or a gastrointestinal obstruction can cause bloating along with some of these red flags.

In rare cases, bloating can also be a symptom of ovarian cancer. “But we need to put that statement in perspective,” Lacy said. Tens of millions of people experience bloating each year, and most—more than 99%—do not get ovarian cancer. “Blood is a nonspecific symptom”—meaning it has many causes—“and I wouldn’t consider it a warning sign of ovarian cancer if it were the only symptom,” he says. (Other symptoms include weight loss, fatigue, feeling full quickly when eating, frequent urination, and discomfort in the pelvic area.)

What is the relationship? between bloating and menstruation?

“Many women, especially in the week before or during their menstrual cycle, will notice increased bloating and often relief in the week following their period,” says Harer. Why this happens is still not well understood, but she says hormonal factors may be involved.

Changes in reproductive hormones during a woman’s cycle can affect both bowel movements (the movement of substances through the digestive tract) and bowel sensitivity, which can lead to bloating. Hormonal fluctuations (specifically, changes in estrogen and progesterone levels) can also lead to water retention, causing feelings of fullness and bloating. Lacy says about 70 percent of women report bloating during their menstrual cycle, and many can actually distinguish the feeling of bloating during their cycle: some can tell which symptom is due to the regimen. eating and what symptoms are caused by constipation, for example. He added: “This again highlights the complexity of flatulence.

What is the best and worst food for flatulence?

Experts once again emphasize FODMAP, those short-chain carbohydrates, are typical gas triggers. “As a group, these foods generally produce more gas than other foods,” says Lacy. Some examples of foods high in FODMAPs are dried fruits, apples, mangoes, pears, plums, honey, onions, peppers, garlic, cruciferous vegetables (broccoli, cauliflower), assorted vegetables. beans and anything that contains artificial sweeteners, such as “sugar-free” candies, gum, and mints.

Lacy says that lactose (a sugar found in dairy foods) and fructose (a sugar found in fruit and sweets) can also cause gas and bloating. “Common offenders are high-fructose corn syrup or fructose-containing liquids, including juices, sports drinks, energy drinks and soft drinks,” he said.

If a person’s bloating seems to be caused by dietary factors, the health care provider may recommend a special diet. “The diet has two phases — a restriction phase and a reintroduction phase,” explains Harer. The restriction period may involve cutting out all high-FODMAP foods and possibly dairy products, wheat products, and carbonated beverages (which can produce gas and alcohol). flatulence). Ideally, avoiding all of these foods will reduce bloating for a person. At that point, each food can be added back, one at a time, so that the person can find the source of their bloating symptoms. “The goal isn’t to keep someone on that strict diet indefinitely,” says Harer. “The goal is to identify which foods and which quantities are triggers, so that they have the ability to determine how much food they want to eat.”

She strongly recommends that people try this method only with the support of a registered dietitian. Restrictive diets are complicated and easy to mess up, and cutting out these foods can lead to dangerous nutrient deficiencies. Harer adds that if the diet relieves a person’s bloating, this doesn’t mean the person has a food allergy. Flatulence and bloating are not inherently harmful, she said, and eating the foods that cause them is not harmful to a person’s health. HOLD system. She adds: “You won’t harm yourself if you eat foods that make you gassy or bloated.

The list of foods that reduce bloating is much shorter. Green kiwifruit is one of the very few foods that research has shown to be associated with improved symptoms. “I’ve fed some patients with bloating and constipation two green kiwifruit a day,” says Gabbard, “and the effect has been amazing. Green kiwifruit contains a compound called actinidin that can enhance digestion and soothe intestinal inflammation.

There is great interest in using beneficial foods or prebiotics to treat bloating. “You hear a lot about kimchi and sauerkraut, as well as foods like yogurt that contain bacteria,” says Harer. But so far, research on their usefulness in treating flatulence has been mixed.

Read more: 5 sneaky causes of bloating and how to avoid them

What relieves bloating?

In addition to identifying and avoiding food triggers, other remedies may be helpful. These include over-the-counter supplements (such as peppermint oil and magnesium) and prescription drugs.

Relax and stress relief techniques It has also been shown to reduce many intestinal symptoms, including bloating. Stress can cause inflammation and increased immune system activity, so it makes sense that targeting stress (and the thoughts that cause it) could help with pain. Gabbard mentions diaphragmatic breathing (belly breathing), cognitive behavioral therapy, and acupuncture as three helpful treatments. “Some of these therapies have been shown to be more effective than most medications for irritable bowel syndrome,” he said.

The right treatment plan will depend on a person’s specific bloating. “There are usually many contributing factors,” says Harer. “It may take some trial and error to determine the cause and the best remedy.”

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