Constant abdominal bloating could be gas or illness; see tips

In my gastroenterology office, every week I see patients who complain that their clothes are too tight, that their abdomen feels tight.

“It’s like I’m 30 weeks pregnant” is something I’m often told by patients ranging from 65-year-old men to 20-year-old women.

So it’s not surprising that these patients all suffer from bloating — an unpleasant feeling of pressure in the stomach that is estimated to affect 1 in 5 adults. (A distinct but related phenomenon called bloating describes the visible increase in abdominal circumference that often accompanies the problem.)

But understanding why the swelling occurs and treating it can be challenging for both patients and doctors. “People think, ‘Oh, it’s just bloating,’ and the problem is often downplayed or seen as insignificant,” said gastroenterologist Kimberly Harer, an expert in gut motility at the University of Michigan Health in the US.

For most people, the swelling and distension resolves after a short period of time. But some people are more likely than others to have swelling.

People with certain medical conditions — such as lactose intolerance, celiac disease, or disorders that affect the way the intestine moves contents around the body (such as gastroparesis) — experience bloating more often, due to excess gas.

If you don’t have these conditions but the swelling persists for months, it’s possible you have something called functional swelling. Conditions like irritable bowel syndrome and chronic idiopathic constipation fall into this category. In these cases, medical tests usually give normal results, but swelling is an important and recurring symptom that gets in the way of everyday life.

These cases of bloating often occur not because of too much gas production, but because of the way the abdomen reacts to them. “When bloating occurs, a lot of the problem is in the mechanics of the body,” said gastroenterologist Linda Nguyen, clinical professor of medicine at Stanford Medicine (USA).

Abnormal muscle movements – and the swelling that accompanies them – can occur when the nerves in the intestine and abdominal wall are overreactive to otherwise normal levels of pressure coming from inside the intestine. It’s called visceral hypersensitivity.

Thus, even small volumes of gases produced in natural digestion can cause discomfort and distension.

Experts often recommend that patients first seek to identify and then eliminate anything in their diet or lifestyle that may be causing the swelling. Certain foods are classic bloating triggers, especially foods rich in insoluble fiber like cruciferous vegetables, lentils, and beans.

Other common triggers include fermented beverages like beer and kombucha, the artificial sweetener sucralose, onions and fruit. Sometimes behaviors like drinking carbonated drinks, chewing gum, or smoking can increase your risk of bloating by increasing the amount of air you swallow.

With so many potential triggers, it can be difficult or even harmful to experiment with eliminating problem foods on your own. Therefore, said Harer, the recommendation is to seek the guidance of a nutritionist.

In some cases, addressing the underlying cause of the swelling may require more than just modifying your eating and lifestyle habits. Patients with gastroparesis or significant constipation may benefit from a medication called prucalopride, which helps to empty the stomach and expel waste. (Experts do not recommend at-home interventions to empty the colon, such as colonic irrigation, because of the risk of causing trauma or injury to the gastrointestinal tract.)

Some causes of bloating are not directly related to the intestines. According to Harer, some patients who snore or who use CPAP (continuous positive airway pressure) devices to combat sleep apnea, for example, may experience additional swelling when they wake up in the morning.

Patients who have liver disease may experience abdominal distention. And menstruation and some types of birth control can increase bloating.

Harer stressed that no one should feel embarrassed or embarrassed by changes in their abdominal area. “Patients should feel free to discuss the swelling with their doctors and get the help they need.”

Translation by Clara Allain