Bloating

Bloating is the protrusion of the abdomen, usually caused by gas (and sometimes fluid), and it generally ebbs and flows—many individuals experience a flat abdomen in the morning and by evening, the abdomen is protruding and hard to the touch. Others will have days without bloating and then several days following where bloating is a problem.

• Go for a walk after meals to encourage peristalsis 
• Limit your consumption of fatty foods, which will make you feel fuller Bloating is the protrusion of the abdomen, usually caused by gas (and sometimes fluid), and it generally ebbs and flows—many individuals experience a flat abdomen in the morning and by evening, their abdomen is protruding and hard to the touch. Others will have days without bloating and then several days in a row where bloating is a problem. Bloating is never a “normal” occurrence and is always a sign that something isn’t quite right in the gut. It is one of the earliest and most common indications that there may be a problem.

SYMPTOMS

• Protruding abdomen
• Abdomen that is hard to the touch
• Abdominal pain
• Gas, flatulence and/or burping
• Puffy, swollen appearance

Conditions associated with bloating are:

• Adhesions from previous abdominal or pelvic surgery
• Aerophagia (air swallowing)
• Anatomical variations in the female colon and pelvis
• Clostridium difficile
• Celiac disease
• Constipation
• Diastasis recti
• Diverticulosis/diverticulitis
• Dysbiosis
• Fructose malabsorption
• Gallbladder dysfunction or removal
• Gallstones
• Gastroparesis
• Gluten intolerance
• Hernia
• Hormone imbalances, such as estrogen dominance
• Inflammatory bowel disease (IBD – Crohn’s  and ulcerative colitis)
• Irritable bowel syndrome (IBS)
• Lactose intolerance
• Leaky gut
• Malabsorption
• Microscopic colitis
• Parasites
• Poor lymphatic flow
• Radiation
• Tumors or other masses (endometriosis, uterine fibroids, or ovarian cysts)
• Volvulus
• Yeast overgrowth

CAUSES

The causes of bloating vary tremendously, from common benign conditions to rare life-threatening illnesses. Below are some lifestyle factors that may cause bloating:

• Acid-suppressing medications
• Chugging water after exercise
• Bloat-causing liquids (dairy, soda, sports drinks, fruit juices, alcohol, soy milk, caffeine, carbonated drinks, and kombucha)
• Drinking too much liquid during meals
• Eating large meals at night
• Eating too much fat or too much fiber in one sitting
• Excessive salt intake
• Excessive sugar intake
• Lack of exercise
• Lack of water
• Low calorie sweeteners
• Poor diet

DIAGNOSIS

Symptoms like bloating are non-specific, which makes it challenging to arrive at an accurate diagnosis. To help diagnose your bloating, pay close attention to the feedback your GI system gives you —what makes it feel good and what aggravates it. Over time, the adjustments you need to make to keep your gut functioning without feeling bloated and uncomfortable will become more and more apparent. 

If you have bloating and a change in bowel habits and are having a colonoscopy, it’s important that biopsies be taken from throughout your colon, including the top, bottom, and middle parts. Inflammation from conditions like microscopic colitis that can cause bloating and diarrhea isn’t always visible to the naked eye, and it can be patchy and missed if enough areas aren’t sampled.

Sometimes bloating is confused for other conditions. Occasionally a solid mass in the uterus, ovaries, or colon presents as bloating and causes constant, if not increasing, protrusion of the abdomen. Belly fat can also be mistaken for bloating. If you’re not sure whether your expanding waistline is due to bloat or belly fat, measure your waist several days in a row. If it’s bloat, your waist measurement will vary by more than an inch; if it’s belly fat, there’ll be little variation.

TREATMENT

Because bloating can be a symptom of many different diseases, conditions, and lifestyle choices, the treatments vary greatly. Consuming more water is one of the fundamental concepts for improving bloating: it improves motility, lymphatic flow, stool consistency, and regularity. 

If you think you could have gastroparesis, a hernia, volvulus, scar tissue, a tumor, bowel obstruction, or some other serious condition that’s causing your bloating, a thorough evaluation by a medical practitioner and clear diagnosis is paramount. For those with milder symptoms whose bloating may be caused by lifestyle choices, here are some tips that can help alleviate symptoms:

• Eat smaller meals
• Split a meal into two smaller meals a few hours apart
• Eat your largest meal early in the day and your smallest meal at night
• Wait at least 3-4 hours after eating to exercise or lie down
• Split up your fiber consumption in smaller portions throughout the day
• Sip your fluids instead of gulping them to reduce air swallowing which can bloat you