At Ignite, we work with a wide range of digestive disorders, with abdominal bloating and distention being one of the most common amongst our clients.
For some people, bloating happens without other noticeable symptoms, while others experience bowel changes, excessive gas production, and/or pain in the abdomen. But perhaps the most frustrating part is the difficulty people face with trying to figure out which (if any) foods are causing their discomfort.
I’m Marlee Coldwell, GI dietitian at Ignite Nutrition. Today we are going to review the ins and outs of bloating and distention; including causes, dietary changes, medications and more!
What is bloating?
Bloating is one of the most commonly reported symptoms associated with functional gut disorders. It is generally described as the feeling of abdominal pressure or feeling tight and swollen in the abdomen. Many people with bloating also note experiencing a more visible symptom called ‘distention’ in which they objectively see an increase in abdominal size in a short period of time.1
What are some other symptoms of bloating?
Bloating is often accompanied by other symptoms such as:
- Abdominal pain
- Gas noises such as rumbling or gurgling
- Frequent flatulence and/or burping
What causes bloating to happen?
The origins of bloating and distention can be quite complicated and tend to vary from person to person. At Ignite we take a 360 approach to your care, looking at all aspects of health and wellness to understand the underlying cause of your bloating, as each case varies.
However, there are a few common things we see as the underlying cause of bloating:
- Constipation – Those that experience constipation also frequently report bloating. About 80% of patients that are constipated describe their bloating as severe.1This is not all that surprising, as a build-up of fecal matter, and additional time for carbohydrates to ferment in the large bowel can mimic the pain and pressure of bloating. In addition to the stool itself being “stuck”, the slow motility and static nature of the colon during constipation causes more gas production and an inability to clear gas from the bowel effectively.
- Intestinal gas build-up – Gas plays a big role in bloating and distention. For starters, bloating can result when we produce more gas than normal during digestion. This occurs when indigestible carbohydrates are poorly broken down and unabsorbed in the small bowel. As a result, fermentation occurs, producing gas as a byproduct. Secondly, we can feel bloated if we are unable to remove the gas that is produced in the bowel. Poor gas clearance times are experienced when intestinal transit is inhibited, such as in those with IBS or chronic constipation.2
- Water content in the small intestine – In some individuals, short-chain carbohydrates have an osmotic pull effect, meaning they draw water into the small intestine. Because these molecules are poorly absorbed in some people, this can result in a much greater volume of water in the digestive tract, resulting in feelings of pressure and fullness.1
- Small intestinal bacterial overgrowth – Occasionally, patients may develop excess bacteria in their small bowel, leading to severe bloating and distension. SIBO is diagnosed through attempts to manage the symptoms with nutrition and medication, followed by appropriate testing and treatment. At Ignite, our dietitians regularly work with physicians and gastroenterologists to advocate for and coordinate SIBO testing when appropriate.
How is bloating diagnosed?
This is where things get a bit tricky. Bloating is not a condition that is diagnosed with a specific test or biomarker. Instead, it is recommended that those that experience fullness, tightness, and pressure in the abdominal region get tested for common gut disorders, such as celiac disease, irritable bowel syndrome or small intestinal bacterial overgrowth.
The testing processes will vary depending on whether the patient is experiencing other symptoms as well. For example, if you also experience lots of diarrhea and urgency along with bloating, your doctor may order stool samples or a colonoscopy to rule out conditions such as crohn’s or colitis.
To sum it up, the first step in diagnosing and treating your bloating is to work with your doctor and/or a dietitian to better understand what may be causing symptoms of bloating. By seeing a dietitian specialized in gut disorders, like our team at Ignite, you can be sure you’re getting the best help possible.
What are the treatment options?
There is no gold-standard or set algorithm for treating bloating and distention. Instead, the goal for treatment is to first identify the contributing factor(s) causing the patient to feel bloated and then manage these factors with an individualized treatment plan.
Treatment strategies for bloating can be categorized as follows: dietary changes, medication management, and lifestyle management. Your dietitian can help you figure out an individualized plan for you.
Several nutrition-related factors are known to impact bloating and distention. Some dietary changes that help reduce symptoms of bloating are:
- Reducing high fat foods in the diet
- Increasing dietary fibre to improve motility and intestinal transit time
- Avoiding gas-producing foods such as carbonated drinks and chewing gum.
- Improving timing of food and meal spacing – eating slower helps us to properly chew our food and means we don’t swallow as much air. It also helps to eat regularly instead of having long gaps between food intake. Waiting too long to eat can often mean eating fast and overeating which can worsen bloating.
One of the most prevalent dietary factors associated with bloating is poor absorption of a group of short-chain carbohydrates called FODMAPs. Consumption of foods that contain these small molecules may result in excess water in the bowel, fermentation leading to gas production, and poor gas clearance.
A low FODMAP diet, in which FODMAP-containing foods are avoided for a period of time may be recommended to reduce bloating and gas build-up. Talk to your doctor or dietitian before initiating a FODMAP elimination diet, as it is quite restrictive and is best done under supervision.
Exercise – Getting your body moving is a great way to naturally promote movement in the gut. Exercise improves gas clearance from the bowel. If you sit often, consider taking short breaks to get up and move and also include regular fitness into your weekly routine.
Stress – At Ignite Nutrition, we take a holistic approach to health and therefore consider non-food causes of digestive issues, with one of the biggest being stress! Reducing stress with mindfulness-based therapy is a key component in the big picture of reducing symptoms such as bloating.
Comfortable clothing – wearing tight or uncomfortable clothing can make even the most subtle bloating really noticeable. Consider sizing up or wearing something with more stretch if you are noticing pressure from your clothing. There is nothing wrong with buying larger clothing!
At Ignite, we prioritize a food-first approach and believe that bloating can be significantly reduced with dietary and lifestyle interventions in most patients. However, medications are often necessary as an adjunct therapy to other lifestyle changes or an emergency remedy.
With medications, there are side effects and risk factors to consider. Some common medications used in the management of bloating are:
- Laxatives– The use of laxatives may be warranted if a patient’s bloating is stemming from constipation. However, not all laxatives are created equal and may be habit forming. It is recommended to speak with a medical professional prior to starting a laxative to manage your symptoms.
- Antibiotics– Antibiotics MAY be appropriate if SIBO is suspected. Our philosophy at Ignite is to be sure all other gut issues are ruled out, and to test for SIBO prior to treatment. The most common antibiotic in the treatment of SIBO is called Rifaximin. It is a non-systemic antibiotic, meaning it remains in the gut without spreading to other areas of the body. Sometimes, a combination of antibiotics or other treatment options are considered. Your doctor may recommend this treatment if bloating appears to result from an altered gut microbiota.1
- Antidepressants – While antidepressants are shown to improve quality of life in many patients, it is not yet clear what effect they have on bloating. Existing studies have shown contradicting results, with some patients having a reduction in bloating and others having no significant changes. It is noted, however, that selective serotonin receptor inhibitors (SSRIs) are favourable over tricyclic antidepressants (TCAs), as they have fewer side effects.1
- Enzymes – if you are having trouble breaking down specific carbohydrates, such as lactose or galacto-oligosaccarides (found in beans!), your doctor or dietitian may recommend an enzyme to help you break down that specific type of carbohydrate. It is best to work with a dietitian first to identify which foods may be causing you to bloat.
Bloating & Body Image
Bloating and distention is normal and everyone experiences it to some extent. However, the pain, gas, distress, and changes in bowel habits because of distension and bloating is not normal.
We’re starting to notice that ‘I feel bloated’ is the new way to say ‘I feel fat’. This is concerning, because far too many people are being put on restrictive diets, when in fact, fermentation and bloating is a part of normal healthy digestion – it often means the bacteria in your gut are being well fed!
The reality is, our stomachs will expand throughout the day as we eat and our bodies digest. However, if there is significant distension or pain associated with the bloating, nutrition management may help.
If you notice your self worth or body image is severely affected by your bloating it may be important to consider working on your food relationship too. Luckily, our dietitians are here to help. Of course, this can be hard to determine, so properly screening for body image and disordered eating behaviour is key before making any dietary changes for bloating.
If you have consistent discomfort from bloating, it is best to discuss this with your doctor to identify next steps and determine the underlying cause of your bloating prior to attempting interventions. Remember, bloating can result from a variety of different cofactors so treatment will vary from individual to individual.
Working with a dietitian is also recommended – dietitians can help you to make safe and effective changes to reduce bloating. At Ignite, we will listen to your health story and come up with a personalized diet and lifestyle plan that works for you and your busy life!
- Foley et al. (2014). Management strategies for abdominal bloating and distention. Gastroenterology & Hepatology, 10(9): 561-571
- Lacy et al. (2011). Pathophysiology, evaluation, and treatment of bloating: hope, hype, or hot air? Gastroenterology & Hepatology, 7(11): 729-739