Breaking Down Bloat
This article was written by Gutivate Team Dietitian, Brittany Durant RDN.
Bloating and abdominal distention are two of the most common gastrointestinal (GI) symptoms, especially among IBS patients and those with other functional gut disorders. If you fall under either of these categories, you have likely experienced bloating at some point in your life. It can be uncomfortable, painful, and an overall undesirable feeling.
The term “bloating” is frequently used among those with GI concerns, but what does the word actually mean? What exactly is bloat? Why does it happen? What triggers it? If any of these questions piqued your interest, continue reading.
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What is Bloating?
Individuals who experience bloating often have some form of digestion issue, like IBS or functional dyspepsia (indigestion), but it is possible for bloating to occur on its own without an associated medical condition. Since bloating is often a symptom of an existing condition, it can be difficult to define.
Some describe bloating as feeling excessively full after eating, even if they only ate a small amount. Others describe their bloat as a distended abdomen that looks like a “pregnant belly”. Varying factors of bloat include gas (whether it be burping or flatulence), pain associated with the gas, a distended abdomen, relief when going to the bathroom, timing of the bloat, etc.
Previously, it was thought that bloating was directly related to abdominal distention. However, recent research suggests that this may not always be the case. While the two symptoms frequently present together, it is possible to experience signs of bloating in absence of the visible distention.
Why Does Bloating Occur?
As previously mentioned, bloating is most commonly seen as a symptom of a functional GI disorder. The exact pathophysiology of bloat is not yet clear, though researchers do have some evidence supporting possible mechanisms of it. Potential mechanisms include:
Gut hypersensitivity due to the gut-brain axis (read more on the gut-brain connection here!)
Changes in the gut microbiota, aka the collection of bacteria and other organisms coexisting in the GI tract
Increased gas production and/or issues releasing the gas
Increased water pulled into the digestive tract
Abdomino-phrenic dyssynergia (ADP). ADP is an abnormal coordination of the nerve signals and muscle movements associated with digestion. Normally when you eat a meal, your stomach begins to expand and the diaphragm muscle moves up to make room for the stomach. The abdominal wall muscles also slightly relax to make room for the stretching stomach. However, in ADP, the diaphragm does not rise and the abdominal wall muscles relax to an extreme extent, creating the distended abdomen appearance often seen with bloating.
Altered gut motility
Some of the conditions often associated with bloating include:
IBS
Constipation/FOS (full of stool)
SIBO - an overgrowth of bacteria in the small intestine (read more about SIBO here).The small intestine is more narrow than the colon, which means the gas can be more uncomfortable and potentially painful when it is produced here.
IMO - an overgrowth of methanogens in the small or large intestine, which can contribute to more fermentation and gas production, as well as constipation.
Aerophagia - excessive swallowing of air
Carbohydrate intolerances - most common ones include lactose intolerance, fructose malabsorption, and sucrase isomaltase deficiency
Celiac disease - a chronic autoimmune disease that causes damage to the digestive system and can affect multiple other systems of the body too. This damage is triggered by the consumption of gluten, a protein found in wheat, rye, and barley.
Pancreatic insufficiency
Gastroparesis - delayed stomach emptying
Indigestion - which is often a symptom of acid reflux, ulcers, a hiatal hernia, irritation of the stomach lining, etc.
Bloating can also be triggered by the way in which we eat. Many experience bloating as a result of eating a large portion size or eating too quickly. If you think this might be you, eating smaller, more frequent meals and taking time to slow down during your meals may help. Try taking a few deep breaths before you begin eating. Focus on slowly progressing through the meal and chewing your food thoroughly. Take pauses throughout the meal and set your utensils down. Check in with yourself - are you full yet? Tuning in to the body’s cues may to help avoid getting uncomfortably full.
Can We Treat Bloat?
Since bloating is such an individualized, non-uniform experience, there is not one perfect solution or treatment that works for every case. A lot of times, the therapies used to treat bloat are based on treating the underlying IBS or other digestive condition, if present.
Treatment for these conditions is multifaceted and tailored to the specific patient and their symptoms. It may involve different approaches including dietary adjustments, pelvic floor physical therapy, working to better manage stress, increasing movement, and other lifestyle changes. In some cases, medications are prescribed or taken over the counter to help manage the underlying conditions associated with bloating. These could include:
Prokinetics - medications used to stimulate motility of the stomach so that it empties more frequently
Indigestion and acid reflux medications such as TUMS, MiraLax, Pepto Bismol, etc.
Laxatives/stool softeners
Antidepressants - can aid regulating hormone levels involved in the pain response
Simethicone - main ingredient found in products such as Phazyme, Gas-X, Alka-Seltzer Anti-Gas, Mylanta Gas, etc. Note: Some of these medications contain FODMAPs (such as sorbitol). Be sure to check ingredient labels. Phazyme is FODMAP-free.
IBgard - a peppermint oil capsule supported by research
Digestive enzymes
Fiber supplements
Next Steps
If you experience frequent and uncomfortable bloating, it is best to work with a registered dietitian or other medical provider to identify and address the root cause of your bloating. There are several tests that can be performed to identify potential digestive system issues. A trained registered dietitian can help you identify which tests might be worth pursuing based upon your individual symptoms. If you’re interested in working with a dietitian at Gutivate, schedule a consult call here.
Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3816178/
https://www.hopkinsmedicine.org/health/wellness-and-prevention/bloating-causes-and-prevention-tips
https://pubmed.ncbi.nlm.nih.gov/32246999/
Book: “The Bloated Belly Whisperer” by Tamara Duker Freuman, MS, RD, CDN
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