Why Am I So Bloated? How to Find Relief

Live|Why Am I Bloated All the Time?

https://www.nytimes.com/2022/03/29/well/live/bloating-causes-relief.html

Q: I feel bloated every day. What could be causing it? And is there anything I can do to find relief?

Every week at my gastroenterology practice, my patients complain about their clothes feeling too tight, their bellies feeling squeezed. “It’s like I’m 30 weeks pregnant” is a common refrain, from 65-year-old men and 20-year-old women alike.

It’s no surprise, then, that these patients are suffering from bloating, that unpleasant feeling of pressure in the stomach that affects an estimated one in five adults. (A separate but related phenomenon, called distention, describes the visible increase in abdominal girth that often occurs along with it.)

Yet understanding why bloating happens — and treating it — can be a challenge for patients and providers. “People think, ‘Oh, it’s just bloating,’ so it’s often brushed aside or considered an insignificant complaint,” said Dr. Kimberly Harer, a gastroenterologist and gut motility specialist at the University of Michigan Health. Some of her patients suffer with symptoms for decades before finally seeking help.

But bloating is not only uncomfortable; it can affect “many aspects of our patients’ lives,” Dr. Harer said, leading to embarrassment and body image issues. And getting a proper evaluation is key.

Bloating and distention are common and, for most people, will resolve after a short period of time. But some people are more prone to bloating than others.

Those with certain medical conditions — like lactose intolerance, celiac disease or disorders that affect the way the gut moves contents throughout the body (like gastroparesis) — have more regular bloating as a result of excess gas. In those patients, the gas accumulates in the small intestine and pushes the diaphragm upward and the abdominal wall outward to “make room” for the extra pressure.

If you don’t have those conditions but have bloating that persists for months, you may have something called functional bloating, or bloating with no identifiable cause. Conditions like irritable bowel syndrome or chronic idiopathic constipation fall into this category. In such cases, medical exams generally appear normal, but bloating is a major, recurrent symptom that impinges on daily life.

These cases of bloating often occur not because of skyrocketing gas production, but because of the way the abdomen reacts to the gas. “With bloating, a lot of it is body mechanics,” said Dr. Linda Nguyen, a gastroenterologist and clinical professor of medicine at Stanford Medicine. “If you think about what surrounds the abdominal cavity: You have the diaphragm above, you have the pelvic floor below, you’ve got the spine in the back and then you have the abdominal wall in front.”

One study, published in the journal Gastroenterology in 2009, found that when people with functional disorders were bloated, the diaphragm contracted downward instead of upward, which bulged the abdominal wall muscles (in particular, the internal obliques) forward. At the same time, the amount of gas within their bowels did not increase.

Those abnormal muscle movements — and the bloating that accompanied them — occurred because the nerves of the gut and abdominal wall were overly reactive to otherwise normal amounts of pressure from inside the intestines (called visceral hypersensitivity.)

Thus, even small amounts of gas produced during natural digestion can cause discomfort and distention.

Experts often recommend that patients first try to identify, then eliminate, anything in their diet or lifestyle that might be triggering their bloating — or, as I like to say, “What floats your bloat.” Certain foods, particularly those rich in insoluble fiber like cruciferous vegetables, lentils and beans, are classic offenders.

Other common triggers include fermented drinks like beer and kombucha, the artificial sweetener sucralose, as well as onions and fruits. Occasionally, certain behaviors like drinking carbonated beverages, chewing gum or smoking can raise the risk of bloating by increasing the amount of air you swallow, and cutting back on them can help.

With so many potential triggers, it can be hard — or even harmful — to experiment with identifying and eliminating problematic foods on your own, so seeking the guidance of a nutritionist is recommended, Dr. Harer said.

In some cases, fixing the underlying cause of your bloating may require more than just dietary and lifestyle tweaks. Patients with gastroparesis or significant constipation may benefit from a drug called prucalopride, which helps empty the stomach and expel waste through the colon. (Experts don’t recommend at-home interventions that empty your gut, like colonic irrigation, because they can cause trauma or tears to the gastrointestinal tract.) For those with over-reactive intestines, certain medications can help dampen those heightened responses, making patients less likely to react with bloating.

Infrequent stool, straining or feeling like you haven’t ever quite fully “emptied” can also contribute to bloating. These symptoms may result from improper coordination of the pelvic floor, which can be improved with specialized physical therapy.

Keep in mind that some causes of bloating aren’t directly related to your gut at all. Some patients who snore or regularly use CPAP machines for sleep apnea, for instance, might have extra bloating upon waking in the morning, Dr. Harer said. Patients with liver disease may also have extra fluid in the abdomen, creating distention. And fluctuations in progesterone from menstruation and certain types of contraceptives may increase bloating. Postmenopausal women in particular with new distention should discuss these symptoms promptly with a physician as this could be a sign of ovarian cancer.

“Every person is different, so what causes bloating for your friend or family member is not what might cause bloating for you,” Dr. Harer said.

If at the end of the day you still can’t figure out why you’re bloated all the time, Dr. Harer suggested seeing a gastroenterologist. Nobody should ever feel ashamed of changes to their midsection, she said. “Patients should feel empowered to discuss bloating with their providers and get the help they need. ”

Dr. Trisha Pasricha is a writer and physician at Massachusetts General Hospital. Her work has appeared in The Washington Post, The Los Angeles Times and The Atlantic.

A version of this article appears in print on  , Section D, Page 6 of the New York edition. Order Reprints | Today’s Paper | Subscribe

Bloating – NHS

Bloating is where your tummy feels full and uncomfortable. It’s very common and there are things you can do to ease it. But see a GP if you feel bloated a lot or it does not go away.

Symptoms of bloating

You may be bloated if:

• your tummy feels full or bigger than usual
• you have tummy pain or discomfort
• your tummy is rumbling or making noises
• you’re farting more than usual

Causes of bloating

The most common reason for bloating is having a lot of gas in your gut.

This can be caused by some food and drinks, such as some vegetables and fizzy drinks, or by swallowing air when you eat.

It can also be caused by a problem with your digestion, such as:

• constipation
• a food intolerance
• coeliac disease
• irritable bowel syndrome (IBS)

Some people feel bloated around the time of their period.

Sometimes, bloating that does not go away can be a sign of something more serious such as ovarian cancer.

How to reduce bloating

Do

• exercise regularly to improve your digestion and help prevent bloating – exercise can also help when you’re feeling bloated

• chew with your mouth closed to avoid swallowing air

• drink plenty of water

• eat foods high in fibre if constipated

• eat smaller, more frequent meals instead of large meals

• massage your stomach from right to left to release trapped wind

Don’t

• do not drink lots of fizzy drinks, alcohol or caffeine in coffee and tea

• do not eat lots of foods that are known to cause gas, like cabbage, beans or lentils

• do not eat large meals late at night before bed, or slouch when eating

• do not eat lots of processed, sugary, spicy or fatty foods

• do not eat food you are intolerant to, if you have a food intolerance

A pharmacist can help with bloating

You can ask a pharmacist about:

• laxatives to help treat constipation
• medicines like Buscopan to help ease the bloating

Non-urgent advice: See a GP if:

• you’ve been feeling bloated for 3 weeks or more
• you feel bloated regularly (more than 12 times a month)
• you’ve tried changing your diet but keep feeling bloated
• you have a swelling or lump in your tummy
• you have bloating along with being sick, diarrhoea, constipation, weight loss or blood in your poo
• you find it difficult to move or do daily activities because you’re bloated

Immediate action required: Call 999 or go to A&E if:

• you have a stomach ache that came on very suddenly or is severe
• it hurts when you touch your stomach
• you’re vomiting blood or your vomit looks like ground coffee
• your poo is bloody or black
• you cannot pee, poo or fart
• you cannot breathe
• you have chest pain

What we mean by severe pain

Severe pain:

• always there and so bad it’s hard to think or talk
• you cannot sleep
• it’s very hard to move, get out of bed, go to the bathroom, wash or dress

Moderate pain:

• always there
• makes it hard to concentrate or sleep
• you can manage to get up, wash or dress

Mild pain:

• comes and goes
• is annoying but does not stop you doing daily activities

Treatment for bloating

Treatment for bloating is often not needed. If you need treatment it will depend on the cause.

A GP may:

• refer you to an NHS dietitian if general diet tips, such as cutting down on foods that trigger bloating, are not helping
• refer you to a specialist for tests to find out what may be causing your bloating

Page last reviewed: 03 March 2022
Next review due: 03 March 2025

Why does the stomach get bigger in the evening – the causes of bloating and what to do about it – April 23, 2019

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Sometimes questions about obvious things lead to confusion because of their non-obviousness. Is it normal for your belly to get bigger in the evening? Isn’t it harmful to walk all day with an inflated or tense stomach? And why does the lower abdomen swell after eating? And also, for example, how to explain an upset stomach before an important meeting or interview. The editors of SHE asked the founder of the women’s health school “I’m healthy”, midwife and clinical psychologist Lidia Velichko to talk about the most common problems in this area, which we do not attach much importance to, but in vain.

According to Lydia, several factors can cause damage to the beauty and health of the abdomen.

Perhaps the most obvious is fat.

“How much fat is normal? We measure the waist with a centimeter tape, it should not be more than 80 centimeters. Otherwise, this is already a violation of health and, as a result, excess weight. And it is necessary to fight not with excess weight, but for health, ”the specialist believes.

“A small amount of fat is quite acceptable, thanks to which sex hormones are produced. And this is a stable cycle, good libido, toned skin, no dryness. Yes, and many men like a certain softness of women’s bodies, ”says Lydia.

But diastasis is an unobvious and often undiagnosed problem

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“This stretching of the connective tissue and separation of the rectus abdominis usually occurs after childbirth. It is manifested by the fact that the stomach seems to be like that of a pregnant woman, especially after eating. It is fraught with indigestion and prolapse of organs, ”explains the expert.

“Every third woman we meet after childbirth has diastasis, but there are cases when this diastasis does not cause functional impairment, it is compensated. And there are women in whom it has many side effects: bowel prolapse, pelvic organ prolapse, indigestion, and here it’s not even the presence of diastasis that is more important, but how she lives with it, ”adds Lydia.

The specialist told how to check on your own whether you have diastasis or not. You need to lie down, bend your legs at the knees, raise your head and slightly shoulder blades. The abdomen naturally tightens. No special stress is needed. And now you need to feel with your hands the stomach from the sternum to the pubis. If the fingers fall inward along the midline, this is diastasis. If the stomach sticks out, then this is uncompensated diastasis.

The third variant of the problem is a flaccid stomach, weak muscles.

“This is both ugly and not about health, the problems are the same as those of diastasis. By the way, the lower back will soon hurt, and maybe it will jam. A weak stomach happens even in thin people. How to check? By evening, the stomach becomes larger, especially at the bottom. When trying to draw in the stomach, it is impossible to keep it drawn in for a long time. Tense lower back, ”says Lydia.

According to the expert, slender girls who have exhausted themselves with diets and pumped their stomachs with crunches cannot avoid problems (this exercise is twisting the body, reducing the distance between the chest and pelvis by bending the spine), especially if there is a history of childbirth. In this case, there is a high probability of omission and poor digestion, constipation, cycle failure, reduced libido, painful periods and pain during sex.

“Crunches are dangerous in that there may be omission of organs. With each crunch, intra-abdominal pressure rises. And if there is even the slightest weakness of the pelvic floor, there will be omission. The organs, as it were, get cold – the intestines, the uterus, ”the expert comments.

Lidia specifies that a beautiful and healthy belly cannot be separate from the body. Signs that determine the absence of cause for concern are good posture, lightness and mobility in the body, beautiful tightened skin, regular stools – once a day, and, of course, high libido, a stable cycle, painless periods

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Separately, it is worth mentioning about the stomach after pregnancy and childbirth.

“We need to improve nutrition and digestion so that our own collagen and elastin are produced, which will help restore tissue a little. You need a local massage, at least just rub it red-hot with salt: 5 minutes every two days for a month. Most stretch marks can be made inconspicuous, discreet, they will not disappear, but they will become much neater, ”recommends Lydia.

The expert advises pregnant women to use natural corsetry, which is when the lower abdomen is pulled up and supports the stomach like a corset. Pregnant women should not walk with a completely relaxed stomach, because then the load on the lower back increases many times, the position of the pelvis changes and the abdominal tissues are stretched. A pregnant woman needs to keep her posture, stretch her spine vertically, otherwise she reduces the house for the child, “presses on the roof” and eventually squeezes out the pelvic floor.

Normally, the abdomen is slightly tucked up. He certainly does not hang relaxed, but he is not tense either. Ideally, the stomach from below is pulled up a little more. We have a slight tone of the muscles of the pelvic floor and abdomen while walking, standing and sitting. If we lie relaxed, then we relax the stomach. If we walk fast, run, go in for sports, we draw in the stomach more.

Another feature is that the internal organs of the abdomen easily react to stress.

“From the point of view of body psychotherapy, the stomach is a warehouse of unnamed and unlived emotions. Something happens to me, I ignore it, and this stress goes into my stomach. The work of the digestive system is disrupted. And here, diets will definitely not help, diets can become a crutch, against their background, the condition of the gastrointestinal tract improves, but the problem is not solved. So you have to sit on a diet all your life, and every year it is getting stricter. By solving a mental conflict, problems with the gastrointestinal tract are solved by themselves, ”the psychologist believes.

According to the expert, a healthy belly starts with good posture. Lydia advises doing this simple routine every day.

“We need to build a pelvis. It must not be turned back. The spine must be directed upwards, straight out, then you will immediately feel how the energy is running through it, and there will be more strength. And now the stomach: the navel is slightly inward and upward, ”says the expert.

“A popular vacuum, it’s not about a flat stomach. The abdominal muscles do not participate in the exercise at all, but its slimming secret is that the internal edema, lymph stagnation disappears and the intestines slightly rise, so the stomach becomes smaller, which is good. But this is not a panacea and not a solution to stomach issues, this is just one of the tools of the whole integrated approach, ”Lydia notes.

A comprehensive approach, according to a specialist, is:

— Healthy digestion, as a result, an ideal chair.

— Eat a balanced diet so that you have enough vitamins and minerals, and at the same time your intestines do not suffer.

– Posture, posture and again posture.

– Exercises that tone the abdominal muscles: something close to planks and vacuum.
– Self-massage of the skin of the abdomen: brush or salt.

Have you noticed any of the problems listed in the article? Have you thought before that this is not the norm? How were they treated? Share your opinions in the comments below the article.

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Why GlaxoSmi thKline divides a single research building into many smaller ones

Reuters

Kevin Lee, British neuroscientist , busy with new research at GlaxoSmithKline, wears a fleece jacket with the EpiNova logo, little known in the pharmaceutical industry. It’s not a competitor to Glaxo, but the name of a 60-person division led by Dr. Lee that is part of a multi-thousand-strong new research structure at a British pharmaceutical company.

Dr. Lee, who founded and sold two biotech companies before joining Glaxo, says the new name for his division was meant to show, “We’re more like biotechnologists than pharmaceuticals.”

Glaxo’s experiment is a response to one of the industry’s most pressing challenges, the failure of the giant R&D divisions that emerged from mega-mergers. The mergers helped the company build strong sales and marketing capabilities, but R&D found itself stifled by a bureaucracy that was alien to innovation. Over the past 10 years, the big pharmaceutical business has brought few new drugs to market. SanofiAventis CEO Chris Wichbacher dubbed this period the “lost decade.”

Bad habits

The scientists in Glaxo’s new biotechnology groups (called discovery performance units, DPUs) have already spent half of their three-year budgets in 2008. “If they fail, there will be consequences all the way to liquidation,” says Moncef Sloughy, Head of R&D at Glaxo.

Glaxo’s big pharmaceutical habits are hard to change. Scholars say the company’s bloated bureaucracy and old-fashioned thinking are hindering innovation. “People come to me every day and say, ‘What should I do?’ And I answer daily: “It is your decision. What do you want to do?” says Perry Nisen, chief cancer researcher at Glaxo, spreading his arms.

Dr. Lee recently complained to Glaxo CEO Andrew Witty that he was having difficulty getting a signature from the finance department on an application for additional funding. Vitti argues that a certain level of bureaucracy is inevitable in a large company, but the strategy works: “You can be a successful, entrepreneurial innovator within a large corporation.”

“The problem with large companies that try to act like biotech firms is that people who like the entrepreneurial culture of biotech go to work for biotech,” says Denise Anderson, a healthcare analyst at Sit Investment Associates in Minneapolis, Minnesota). Gbola Amusa, a pharmaceutical market analyst at UBS London, says: “People respond to incentives, and incentives that encourage cutting-edge innovation, whether financial or non-financial, are much more visible in smaller companies.”

Leading by example

Glaxo now has 36 DPUs in the UK and US, each focused on a specific disease. For example, Dr. Li’s group is pursuing a new science called epigenetics, looking for treatments for autoimmune diseases, and investing part of the budget in third-party research.

The group sits in the labs at the gigantic Glaxo complex an hour from London, in a building that looks more like a military bunker than a start-up headquarters. It was built in the 80s and designed for chemists and biologists to work separately, reflecting the point of view of that time: the creation of a drug should be a production process with groups of scientists, each of which does its own operation. And the leaders, far from the laboratories, decide which drugs should be funded.

Top executives in the pharmaceutical business were enamored with this approach, but it failed. Meanwhile, small startups like Genentech and Gilead Sciences have invented drugs that have made billions. They had passionate, driven founders, often straight from academia. Small groups of scientists worked, focusing on a small number of projects.

Glaxo decided to take a cue from the biotech industry by dividing thousands of researchers into groups of about 400 and giving them budgets, but scientists still felt the divisions were too big. Vitti, when he became CEO, divided the employees into groups of 20 to 60 people. And he created a supervisory board, in which, for greater impartiality, a venture capitalist and a biotechnologist were hired.

When Li was asked to lead EpiNova in 2008, he received a three-year budget, the right to hire half of the 60 full-time employees from within the company, and the rest from academia and the biotechnology field.

Dr. Wilson, a chemist, says talking to EpiNova scientists leads to interesting brainstorming sessions and quick decision making. For example, he says, they needed a crystallograph for research. Scientists decided that Glaxo did not have the necessary specialists, and they found one outside the company. It took a couple of days to get funding from Lee, which used to be impossible when it was necessary to “approve the budget”.

Even EpiNova almost immediately brought in leading epigeneticist Sasha Tarakhovsky from the Rockefeller University in New York to provide advice. Glaxo funds this collaboration in exchange for certain intellectual property rights and pays the doctor for consulting services. The idea is to imitate the “founding scientist” that most biotech companies revolve around.

Pool of money

The research divisions of large pharmaceutical companies, including EpiNova, have a serious recruiting disadvantage: they cannot offer employees powerful financial incentives like biotech companies, such as stocks that can skyrocket in price overnight in the event of a breakthrough in research.