Q: I feel bloated every day. What could be the cause? Is there anything I can do to find relief?
Every week in my gastroenterology practice, my patients complain that their clothing feels too tight and their abdomen feels pinched. “It’s like I’m 30 weeks pregnant” is a common saying for 65-year-old men and 20-year-old women.
It is therefore not surprising that these patients suffer from bloating, an unpleasant feeling of pressure in the stomach that affects estimates one in five adults(A separate but related phenomenon called bloating, which describes a marked increase in abdominal girth, usually accompanies it.)
However, understanding why bloating occurs and treating it can be challenging for both patients and providers. “People think, ‘Oh, it’s just bloating,’ so it’s often overlooked or considered a trivial complaint,” says Dr. Kimberly Haller, a gastroenterologist and bowel movement specialist at the University of Michigan Health. Some of her patients suffered from symptoms for decades before finally seeking help.
But bloating isn’t just uncomfortable; it affects “many aspects of our patients’ lives,” Dr. Harer said, leading to embarrassment and body image issues. Getting a proper assessment is key.
What causes bloating?
Bloating and bloating are common and, for most people, subside within a short period of time. But some people are more prone to bloating than others.
People with certain medical conditions—such as lactose intolerance, celiac disease, or conditions that affect the way the gut moves contents throughout the body (such as gastroparesis) — more regular bloating due to excess gas. In these patients, gas builds up in the small intestine, pushing the diaphragm up and the abdominal wall outward to “make room” for the extra pressure.
If you don’t have these conditions, but bloating persists for several months, you may have functional bloating, or bloating without an identifiable cause.irritable bowel syndrome or chronic idiopathic constipation fall into this category. In this case, the physical exam usually looks normal, but bloating is the main recurring symptom that affects daily life.
These cases of bloating are usually not because of a surge in gas production, but because of the way the abdomen responds to gas. “Bloating, a lot of it is body mechanics,” said Dr. Linda Nguyen, a gastroenterologist and professor of clinical medicine at Stanford Medicine. “If you think about what’s around the abdominal cavity: the diaphragm on top, the pelvic floor below, the spine in the back, the abdominal wall in front.”
a studyResearch published in the journal Gastroenterology in 2009 found that when a dysfunctional person experiences bloating, the diaphragm contracts downward instead of upward, allowing the abdominal wall muscles, especially the internal oblique, to move forward. bulge. At the same time, the amount of gas in their intestines did not increase.
These abnormal muscle movements — and the bloating that goes with it — occur because the nerves in the gut and abdominal wall overreact to normal pressure from within the gut (called visceral hypersensitivity).
Therefore, even a small amount of gas produced during natural digestion can cause discomfort and bloating.
What can I do to alleviate it?
Experts often advise patients to first try to identify and then eliminate anything in their diet or lifestyle that might be triggering bloating — or, as I like to say, “what’s bringing your bloating to the surface.” Certain foods, especially those high in insoluble fiber, such as cruciferous vegetables, lentils, and beans, are classic offenders.
Other common triggers include fermented beverages such as beer and kombucha, the artificial sweetener sucralose, and onions and fruit. Sometimes certain behaviors, such as drinking carbonated beverages, chewing gum, or smoking, increase the risk of bloating by increasing the amount of air you swallow, and reducing these behaviors can help.
With so many potential triggers, trying to identify and eliminate problem foods on your own can be difficult or even harmful, so seeking guidance from a nutritionist is recommended, Dr. Haller said.
In some cases, addressing the underlying cause of bloating may require more than just diet and lifestyle adjustments. Patients with gastroparesis or severe constipation may benefit from a drug called prucalopride, which helps empty the stomach and pass waste through the colon. (Experts do not recommend at-home bowel-emptying interventions, such as colonic lavages, because they can traumatize or tear the gastrointestinal tract.) For those with an overreactive gut, certain medications can help curb these overreactions , making the patient less likely to respond to bloating.
Infrequent bowel movements, straining, or feeling like you’ve never completely “emptied” can also cause bloating. These symptoms can be caused by poor pelvic floor coordination and can be improved with specialized physical therapy.
Remember, some causes of bloating are not directly related to your gut at all. For example, some patients who snore or regularly use a CPAP machine for sleep apnea may experience additional bloating when they wake up in the morning, Dr. Harer said. People with liver disease may also have excess fluid in the abdomen, causing bloating. Progesterone fluctuations caused by menstruation and some types of birth control pills may increase bloating. Postmenopausal women, especially new-onset bloating, should promptly discuss these symptoms with their doctor, as this may be a sign of ovarian cancer.
“Everyone is different, so what’s causing your friend or family member’s bloating isn’t what could be causing yours,” says Dr. Haller.
If at the end of the day you still can’t figure out why you keep bloating, Dr. Harer recommends seeing a gastroenterologist. She said no one should be ashamed of the changes in their belly. “Patients should feel empowered to discuss bloating with their providers and get the help they need.”
Dr. Trisha Pasricha is a writer and physician at Massachusetts General Hospital. Her work has appeared in The Washington Post, Los Angeles Times, and The Atlantic.