Bloating - Stomach and bowel under pressure 

Man wring denim shirt lounging on a sofa, suffering from bloating

What is bloating? 

Bloating is one of the most common gastrointestinal symptoms in the world.  

A bloated tummy is not a condition that is easily defined. Patients describe this phenomenon as a feeling of a “stone in the belly” caused by either increased amount of gases in the gastrointestinal tract or by the feeling of too much tension in the abdomen. It should be noted, however, that bloating is usually a subjective feeling, which does not have to be objectively confirmed by the assessment of the volume of intestinal gases or the circumference of the abdomen. When a person describes the feeling of bloating, they may or may not be aware of an increase in abdominal girth. The former is a symptom and the latter is a visible sign, a swelling and feeling of tightness of the skin or clothing combined with discomfort. This visible change in the waistline is what is described as distention, characterized by a relaxation of the abdominal wall.  

We can also differentiate a third symptom, with similar complaints – flatulence. This is frequent discharge of intestinal gases (more than 24 times a day). It is usually perceived as particularly unpleasant when accompanied by symptoms such as bloating and distension.  

Bloating itself lies in a disturbance in the intestinal motility, which may be more excessive, or hypersensitive gastrointestinal nerves, when compared to most healthy people . This is the sphere of the so-called functional gastrointestinal disorders. 

Gases are naturally present in the intestines. Most often they come from air swallowed during meals or speaking, and secondly from the fermentation of food by bacteria in the intestines. The large intestine is physiologically the largest reservoir of bacteria in the gastrointestinal tract.  

Swallowed air contains mainly nitrogen and oxygen. Gases from the bacterial metabolism have a more varied composition. They include carbon dioxide, methane and hydrogen, or – responsible for the specific smell - hydrogen sulphide and other sulphur derivatives. The amount and type of gases from fermentation depend on the type of food consumed and the composition of the intestinal microbiota (the number and variety of species and strains of bacteria living in the intestines). Some intestinal gases are absorbed into the blood and excreted when breathing out, while the rest is removed by the passing of wind. 

The volume of gas in the intestines is usually about 200 ml, and the total daily volume of excreted gases can reach 600 ml. A healthy person passes gas from a dozen to 24 times a day. 

  • An increase in the amount of intestinal gases can be caused by: 
  • Increased swallowing of air, e.g. when smoking, chewing gum or speaking while eating, 
  • the consumption of foods considered to be gas-producing (beans and other legumes), 
  • drinking fizzy drinks, 
  • impairment of digestion and absorption in the small intestine, which causes an increase in the amount of substances and food chyme reaching the large intestine and its fermentation there (e.g. lactase deficiency; fructose malabsorption), 
  • slowed down passage of chyme through the GI tract, caused by organic or functional disorders 
  • bacterial overgrowth of the small intestine (usually, it is relatively sterile in relation to the large intestine). 

How to diagnose bloating? 

As a rule, bloating alone is not diagnosed, as there are no precise methods of evaluating this symptom. The same amount of gas may not cause any symptoms in some people, while others experience it as a significant discomfort. Very often bloating and flatulence are elements of so-called functional disorders of the gastrointestinal tract, such as irritable bowel syndrome or functional dyspepsia. 

Grey haired physician, smiling kindly to blond hair woman, who sits in front of him and talks.

What will the doctor ask about? 

Please consult a doctor if the bloating is too bothersome or painful. You should also see a physician if it is accompanied by other symptoms such as abdominal pain, changes in stool frequency or texture.  

In the case of bloating, your medical professional will usually ask about many of the factors mentioned above, including diet, as well as ask questions about the so-called alarm symptoms, i.e. symptoms that may suggest more serious, non-functional disorders of the gastrointestinal tract. They will also often ask if there was anyone in the family who had a peptic ulcer disease, inflammatory bowel disease (ulcerative colitis or Crohn's disease), coeliac disease, lactose intolerance, since these diseases may affect more than one person in a family. 

What kind of tests can the doctor order? 

If you exhibit any of the so-called alarm symptoms accompanying bloating, i.e. symptoms suggesting more serious organic causes, the doctor may order some auxiliary examinations, such as: 

  • faecal examination (parasites, latent blood, calprotectin), 
  • hydrogen or hydrogen-methane breathing test (assessing lactose intolerance and fructose intolerance), 
  • screening for coeliac disease (genetically determined intolerance of gluten contained in basic cereals) 
  • sometimes radiological and/or abdominal ultrasound, gastroscopy, colonoscopy. 

A frequent accompanying symptom: distension 

If the circumference of the belly increases quite quickly but your body mass remains unchanged, it is very likely you are dealing with distension.  

The following symptoms are considered alarm symptoms. They can accompany a bloated or a distended belly, be disturbing and therefore require medical advice: 

  • weakness, 
  • loss of appetite, 
  • unintentional weight loss, 
  • fever, 
  • the appearance of blood in the stool. 

A serious cause of constant enlargement of the abdomen can also be: 

  • rapid weight gain (the so-called abdominal obesity), 
  • ascites (excessive amount of fluid in the abdomen) 
  • enlargement of the volume of internal organs in the abdominal cavity, such as the liver, spleen or kidneys. 

What are the most common causes of bloating? 

You should keep in mind, however, that excess air in the stomach and intestines is most often caused by completely mundane things, such as too fast and greedy eating, speaking while eating, chewing gum, eating gas-forming foods, such as: beans, cabbage, brussels sprouts, onions, bread, pasta, cereal products, apples, pears, peaches, plums, corn, oats, potatoes, milk, ice cream, mould cheeses, purified bran. 

Probably the most common and usually unconscious cause of flatulence is swallowing excessive amounts of air and often the inability to belch, i.e. to get rid of the swallowed air from the stomach. It is scientifically called aerophagia. 

A natural gas-forming process is also the formation of gases in the large intestine as a result of fermentation (mainly carbohydrates, but not only) carried out by bacteria living there. The production of these gases may intensify when hard to digest and badly absorbed carbohydrates contained in legumes, brassica and onions reach the intestine. 

Excessive fermentation may also be facilitated by lactose intolerance (dairy sugar), fructose (most of it is in fruits, fruit juices, honey), excessive consumption of sorbitol, insoluble fibre, etc.  

Abdominal symptoms may also be caused by the so-called functional disorders of the gastrointestinal tract.  These are disorders that are not based on any organic cause (structural or biochemical). Nevertheless, the symptoms can be very severe. Functional gastrointestinal disorders include: 

  • Irritable bowel syndrome (IBS), 
  • Irritable stomach (Functional Dyspepsia). 

The less common causes to consider are: 

  • deficiency of pancreatic enzymes, 
  • inflammatory bowel diseases (ulcerative colitis, Crohn's disease, microscopic colitis), 
  • celiac disease. 
Deliciously looking green apples.

Can diet and eating help get rid of bloating? 

If you suffer from bloating, both revisiting your diet and lifestyle are recommended. How we eat and what we eat can increase gas production and cause more gas to accumulate in the gastrointestinal tract. 

Most gases are generated by the intestinal bacteria fermenting certain complex carbohydrates and sugars. Fat and proteins are less gas-forming.  

It is also worth noting the way of eating and lifestyle. The formation of gases may be favoured by increased swallowing of air, for example during: 

  • eating in a hurry, 
  • speaking while eating, 
  • smoking cigarettes, 
  • chewing gum. 

In the case of flatulence and gases, it is worth trying a diet based on food products that do not cause excessive gas production. The following list of foods is only a very general recommendation, as each person reacts differently to certain dietary components. The best thing is to listen to your body and avoid foods that cause unwanted symptoms such as bloating, distension and/or flatulence. 

(Mostly) well tolerated: 

  • Meat, poultry and fish, 
  • eggs, 
  • vegetables such as lettuce, tomatoes, zucchini, 
  • fruits such as grapes, berries, cherries, avocados, 
  • olives, 
  • rice, 
  • yogurt, kefir, buttermilk. 

Introduce changes in the diet gradually, observing the reactions of your body so as to be able to exclude products that exacerbate your ailments.  

In general, it helps promote your well-being to eat fresh, unprocessed food, without artificial additives such as dyes or preservatives. 

Herbal treatments against bloating and gas 

Iberogast® is a drug that can be used to relief symptoms like bloating, gases, abdominal pain and cramps, as well as nausea. It has indications for the treatment of irritable bowel syndrome and functional dyspepsia, which can often manifest themselves by chronic bloating and gases. The effectiveness of Iberogast® is due to the unique combination of nine proven extracts from medicinal plants, whose action are synergistic to alleviate various symptoms and underlying causes of gastrointestinal and digestive functional disorders. 

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Disturbances in the gastrointestinal tract are usually not only extremely unpleasant and associated with numerous complaints, they often make a normal everyday life even harder. It’s good that there is Iberogast® : The combination of nine medicinal plants targets both the underlying causes and the annoying symptoms. 

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