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What cause abdominal bloating: Why Is My Stomach Bloated? 15 Causes of Abdominal Bloating


Abdominal Bloating: Pathophysiology and Treatment


Abdominal bloating is a very common and troublesome symptom of all ages, but it has not been fully understood to date. Bloating is usually associated with functional gastrointestinal disorders or organic diseases, but it may also appear alone. The pathophysiology of bloating remains ambiguous, although some evidences support the potential mechanisms, including gut hypersensitivity, impaired gas handling, altered gut microbiota, and abnormal abdominal-phrenic reflexes. Owing to the insufficient understanding of these mechanisms, the available therapeutic options are limited. However, medical treatment with some prokinetics, rifaximin, lubiprostone and linaclotide could be considered in the treatment of bloating. In addition, dietary intervention is important in relieving symptom in patients with bloating.

Keywords: Bloating, Pathophysiology, Rifaximin, Therapy


Bloating is one of the most common gastrointestinal (GI) symptoms, which is a frequent complaint in the patients of all ages. This symptom is very common in patients with irritable bowel syndrome (IBS) and other functional gastrointestinal disorders (FGIDs) as well as in patients with organic disorders. Many clinicians encounter the patients’ complaints such as “too much gas in abdomen,” “heavy and uncomfortable feeling in abdomen” and “full belly.” The severity of bloating is varied from mild discomfort to severe, and it is one of the bothersome symptoms of the patients, affecting their quality of life. Despite being one of the frequent and bothersome complaints, bloating remains incompletely understood of all the symptoms. Therefore clinicians need to be more considerate when evaluating patients with abdominal bloating.

The possible causes of bloating are various and complicated, thus intestinal gas production and transit, gut microflora and hypersensitivity of the patient’s gut might be the factors for the symptom generation. As the underlying mechanism of bloating remains elusive to date, there are few evidences for diagnostic and therapeutic options available. In addition, patients who complain of bloating tend to have IBS or functional dyspepsia (FD), thus most of the therapeutic approaches of abdominal bloating are based on the treatments of IBS and FD.14 However bloating could occur alone without associated diseases and there has been not enough data of randomized controlled trials for treatment of bloating alone. The treatments for bloating have not been standardized and there is no evidence-based algorithm. Although there have been several comprehensive reviews for pathophysiology or treatment of abdominal bloating in FGID (),510 both clinical trials and systematic reviews regarding functional bloating (FB) alone are scarce so far. Only one available pilot study was from Spain, which indicated that sugar intolerance was frequently observed in patients with FB and associated with bloating symptom. Additionally, a malabsorbed sugar-free diet gave rise to clinical improvement in high percentage of patients. 11 Thus, in the clinical setting, rational treatment for bloating is hard and the result of treatment is frequently unsatisfactory. Most treatment options for bloating are similar to treatments for IBS, but as previously mentioned, FB and IBS are in different disease entities.

Table 1

Summary of the Comprehensive Reviews for Abdominal Bloating

Aims and Methods

Our aim was to explain the clinical importance, pathophysiologic mechanisms, and management of abdominal bloating, thus to provide a better understanding of this specific problem. We reviewed the literature of mechanisms and treatment interventions for abdominal bloating based on a PubMed search on the following terms; “abdominal bloating,” “intestinal gas and IBS,” “distension and IBS” and “FGID.” We also quoted important knowledge from a standard textbook, the chapter “intestinal gas.”12


Bloating is defined as subjective discomfort by patient’s sensation of intestinal gas; otherwise, abdominal distension is a visible increase in abdominal girth. In the past, bloating had been considered to be related to abdominal distension directly, but recent studies have suggested that it is not always accompanied by abdominal distension.13 There have been many studies to evaluate the relationship between bloating and abdominal distension. One study has shown that actual abdominal distension only occurred in about half of the patients suffering from bloating.14 In addition, some patients with both visceral hypersensitivity and FGID complained of bloating in the absence of visible distension.15,16 Briefly, abdominal bloating is the subjective symptom and distension is the objective sign, so bloating and distension should be considered as separate disorders with different mechanisms. Although bloating has been considered as a supportive symptom for IBS or FD according to Rome classification, FB is also included as an independent entity in Rome criteria.1719 The diagnosis of FB is made in patients who do not meet the diagnostic criteria of IBS or other FGIDs, but have recurrent symptoms of bloating. According to Rome III, the diagnostic criteria include recurrent feeling of bloating or visible distension at least 3 days a month in the last 3 months with symptom onset at least 6 months prior to diagnosis. Also it should exclude FD, IBS or other FGIDs. The name has been changed from functional abdominal bloating in Rome I and II criteria to functional bloating in Rome III criteria.1719


‘Bloating’ has been first described by Alvarez of the Mayo Clinic in 1949, in a woman patient with psychological problem.20 In USA, 15-30% of general population has been reported to experience bloating.16,21,22 Also in Asia, similar result has been shown (15-23%), suggesting that the prevalence of bloating is not interracially different.23 Though the data for FB alone are relatively little, women typically have higher rates of bloating than men according to the reports of IBS. 16,21,22 This relevance between female gender and bloating has long been suggested and the hormonal effect in connection with menstrual cycle is regarded as one of the possible explanation.24,25 Besides, there are some reports of obese people experiencing more GI symptoms such as abdominal pain or bloating.26,27

Bloating is the second most common reported symptom in patients with IBS following abdominal pain.28 In a study from USA which assessed bloating in 542 IBS patients, 76% of the patients reported that they experienced bloating.29 Other study revealed that more than 90% of patients with IBS suffered from bloating.30 In addition, on comparing constipation dominant IBS (IBS-C) with diarrhea dominant IBS (IBS-D), the prevalence of bloating was higher in IBS-C.31

A survey from the USA suggested that more than 65% of patients with bloating rated their symptom as moderate to severe, and 54% of patients complained of decreased daily activity due to bloating. Furthermore, 43% of patients took medication for bloating or needed medication.22


Abnormal Gut Microbiota

The GI tract microbiota play an important role in host immune system, and there are more than 500 different species of GI microbiota in adult, which mostly are obligate anaerobes.10 Only a fraction of these organisms can be cultured; therefore, the understanding of the functions of various microbes in the GI tract is still limited. However, researches over the past decades have shown that altered colonic flora were found in stool samples of patients with IBS.3234 Parkes et al35 suggested that the GI microbiota can be divided into 2 ecosystems; the luminal bacteria and the mucosa-associated bacteria (). Luminal microbiota form the majority of the GI tract flora, and they play a key role in bloating and flatulence in IBS through carbohydrate fermentation and gas production.35

Luminal and mucosal colonic microbiota and their roles in gut homeostasis. Modified from Parkes et al.35

One comprehensive study of the luminal microbiota in IBS examined the fecal samples of IBS subgroups (diarrhea predominant, constipation predominant and mixed subtype) and the controls using 16S ribosomal RNA (rRNA) sequencing. It has been shown that fecal microbiota are significantly altered in IBS. That is, some patients with IBS seem to have different patterns of colonization with coliforms, such as lactobacillus and bifidobacterium compared to the controls.36 Similar study from Korea using 16S rRNA gene signatures also has demonstrated significant differences in diversity and dominance between IBS and non-IBS fecal samples.37 In addition, these microbial changes altered protein and carbohydrate metabolism in the gut.37 A study from Japan also showed higher counts of Veillonella (P = 0.046) and Lactobacillus (P = 0.031) in IBS patients than in controls. Besides, they expressed significantly higher levels of acetic acid (P = 0.049), propionic acid (P = 0.025) and total organic acids (P = 0.014) than controls, which is related to symptoms such as abdominal pain, bloating and changes in bowel habits.38 Another study demonstrated that the patients with IBS produced more H2 but the total gas excretion was similar in both IBS patients and controls.39 This may be associated with alteration in colonic fermentation by hydrogen-consuming bacteria, which may be an important factor in the pathogenesis of IBS.

Collins et al40 have proposed that disruption of the balance between the host and intestinal microbiota produces changes in the mucosal immune system from microscopic to overt inflammation and this also results in changes in gut sensory-motor function and immune activity. Besides, these altered microflora may produce differences in fermented gas type and volume, which may be the causes of symptom in patients with bloating. 36,40,41

There have been some reports to verify the relationship between the types of gas produced by colonic microflora and bloating. The low producers of methane reported significantly increased bloating and cramping after ingestion of sorbitol and fiber, and the high producers of methane revealed lower prevalence of severe lactulose intolerance than low producers. Hence, the role of methanogenic flora may be important in the pathogenesis of bloating.42,43

Small Intestinal Bacterial Overgrowth

The patients with IBS who specifically complain of bloating have been reported to have increased gas production from bacterial fermentation caused by small intestinal bacterial overgrowth (SIBO). Pimentel and colleagues had established the concept that SIBO might be a major pathogenesis of IBS.44 Moreover, several studies found significant improvement of symptoms such as abdominal pain or bloating, when they were treated with antibiotics. 4446 These findings, however, have not been supported by other studies;4749 they found mildly increased counts of small intestinal bacteria by culture to be more common in IBS, but the breath H2 concentration was not significantly different between IBS patients and controls.48 Also, there was no correlation between bacterial alteration and symptom pattern, and even lactulose breath test was considered as an unreliable method to detect an association between bacterial overgrowth and IBS.47,48 In another study, breath hydrogen concentration was similar in IBS group and control group, and did not correlate with pain ratings in IBS patients, owing to the lack of objective diagnostic measures and inconsistent data.51

It is unclear whether changes in small bowel bacterial flora could contribute to bloating in IBS patients, thus further studies are required to confirm these observations.

Intestinal Gas Accumulation

In the fasting state, the healthy GI tract contains only about 100 mL of gas distributed almost equally among 6 compartments – stomach, small intestine, ascending colon, transverse colon, descending colon and distal (pelvic) colon. Postprandial volume of gas increases by about 65%, primarily in the pelvic colon.12 The excessive volume of intestinal gas has been proposed as the likely cause of bloating and distension, and many researchers have attempted to determine this view. A few studies using plain abdominal radiography demonstrated that intestinal gas volume was greater in patients with IBS than in controls (54% vs. 118%), however, the correlation between intra-abdominal gas contents and bloating was poor.52,53 The vast majority of studies do not support that excessive gas induces bloating or abdominal pain. Lasser et al54 conducted a study using argon washout technique, which demonstrated no differences in the accumulation of intestinal gas between patients with bloating and healthy subjects. More recent studies using CT scans combined with modern imaging analysis software have also shown that excess gas was not associated with abdominal bloating in most patients.3 Thus, these observations suggest that increased volume of gas may not be the main mechanism of bloating, but rather impaired gas transit or distribution are more often the sources of problem.

Altered Gut Motility and Impaired Gas Handling

Various abnormal motility patterns have been described in IBS patients, but none of those parameters can be used as diagnostic markers.55 Some authors have suggested that slow transit of food representing alteration in gut motility is related to bloating in IBS-C patients.56 Also in a traditional experiment, normal volunteers being made constipated with loperamide, an agent known to slow transit, experienced bloating.57 Recently, IBS-C patients with delayed orocecal and colonic transits have shown abdominal distension rather than bloating. 15 Although delayed gastric emptying and slow intestinal transit in IBS-C patients were reported in many Asian studies, there are still controversies to define these motor disturbances as unique features in Asian IBS patients. Besides, the association between altered gut motility and IBS symptoms is pretty obscure.58 A recent study has also suggested that altered colon transit is of no or minor importance for IBS symptoms such as bloating or pain.59

However, there are some different points with respect to the intestinal gas handling or transit. In a study by Serra et al,60 they have shown that infused gas into the jejunum resulted in distension and abdominal bloating in most of the IBS patients (18 of 20), while only 20% (4 of 20) of control subjects developed symptoms like that. Another study using gas challenge technique has demonstrated that small intestinal gas transit (especially, jejunum) was more prolonged in patients with bloating than in controls, whereas colonic transit was normal. 61 These data support that impaired small intestinal gas handling could be a mechanism of IBS or gas-bloating. Furthermore, a gas challenge test in healthy subjects during blocked rectal gas outflow showed that abdominal distension by girth measurement was similar in the jejunal and rectal infusion experiments, whereas abdominal symptoms including bloating were more significant in jejunal group.62 These data indicate that gas related symptom perception is determined by intraluminal gas distribution, whereas abdominal distension depends on the volume of intestinal gas. Besides, the patients with IBS or FB are considered to evacuate intestinal gas less effectively, so that they are more likely to have symptoms of abdominal distension.63,64 This aspect of bloating’s mechanism has not been considered to be very relevant, but some researchers are interested in this view owing to the observations of anorectal function, especially in patients with constipation. Constipated patients with bloating plus distension exhibited a greater degree of anorectal dysfunction than those without distension. Moreover, self-restrained anal evacuation also increased symptom perception, while impaired gut propulsion caused by intravenous glucagon did not.63,64

Taken together, ineffective anorectal evacuation as well as impaired gas handling may be possible mechanisms of abdominal distension and bloating. However, the data on the link between altered food transit of gut and bloating are not consistent, although they probably account for bloating in some of the IBS patients.56,57

Abnormal Abdominal-diaphragmatic Reflexes

The abdominal cavity is determined by the placement of the walls of abdominal cavity including diaphragm, vertebral column and abdominal wall musculature. Even if there is no increase in intra-abdominal volume, a change of the position of abdominal cavity components may produce abdominal distension. 7 Thus, there have been some efforts to evaluate the relationship between bloating and lumbar lordosis or weakened abdominal muscles. In one classic report, Sullivan suggested that the patients with bloating have weak abdominal muscles and frequently had recently gained weight than controls.65 But another study measuring upper and lower abdominal wall activities using surface electromyography has suggested that there were no differences in abdominal muscle activities between the patients and the controls.66 Moreover, in an early CT study, some IBS patients showed a tendency of lumbar lordosis but not consistent, and a change in lumbar lordosis did not correlate in any way with the changes in abdominal girth. Also, there were no noticeable changes in position of the diaphragm.67

Tremolaterra et al68 reported that intestinal gas load was associated with a significant increment in abdominal wall muscle activity in healthy subjects. In contrast, the response to gas infusion was impaired in patients with bloating, and rather a paradoxical relaxation of the internal oblique muscles was noted.68 Further study using modern CT analysis with electromyography from Barcelona group has provided a novel concept of abnormal abdomino-phrenic reflexes for abdominal bloating and distension. Since then, several studies have demonstrated that abdomino-phrenic dyssynergia is one of main factors for abdominal distension and bloating. In healthy adults, colonic gas infusion increases anterior wall tone and relaxes the diaphragm at the same time. On the contrary, patients with bloating have shown diaphragmatic contraction (descent) and relaxation of the internal oblique muscle with the same gas load.4,69,70

Visceral Hypersensitivity

The sensation of bloating may originate from abdominal viscera in patients with FGIDs, in whom normal stimuli or small variations of gas content within the gut may be perceived as bloating. Indeed, it has been well recognized that the patients with IBS have lower visceral perception threshold than healthy controls,1,71 and it has been speculated that this process might be associated with the sensation of bloating. Kellow et al72 revealed that threshold for perception of small bowel contraction was lower than normal in some patients with IBS. Also, altered rectal perception assessed by phasic balloon distension has been reported in IBS patients.73 In addition, a gas challenge test proved a role of sensory disturbances in IBS patients,60 and recent clinical experiment has demonstrated that bloating without visible distension is associated with visceral hypersensitivity.74

The autonomic nervous system may also contribute to modulation of the visceral sensitivity. Sympathetic activation is known to increase the perception of intestinal distention in FD patients; likewise, autonomic dysfunction could affect the visceral sensitivity in IBS patients. 7577 This mechanism may play a role in bloating. Moreover, it has been proposed that visceral perception may be influenced by cognitive mechanism. That is, IBS patients with bloating pay more attention to their abdominal symptoms, which is a kind of hyper-vigilance.78 Also, a report indicated that female patients with IBS had worsening of abdominal pain and bloating during their peri-menstrual phase, at which time heightened rectal sensitivity might have contributed to bloating, but not to distension.24,79 Taken together, altered sensory threshold combined with altered conscious perception may explain the mechanism of bloating.

Food Intolerance and Carbohydrate Malabsorption

It is well recognized that dietary habits may be responsible for abdominal symptoms, and there have been efforts to prove the relationship between diet and IBS symptoms. Fiber overload has long been regarded as worsening factor of IBS symptoms through decreased small bowel motility or intraluminal bulking. 80,81 In addition, lactose intolerance may contribute to symptom development in IBS patients. In the small intestine, disaccharides are split by intestinal enzymes into monosaccharides which are then absorbed. If this process is not carried out, the disaccharide reaches the colon, in turn is split by bacterial enzymes into short chain carbonic acids and gases. Hence, malabsorption of lactose may produce the symptom of bloating in patients with IBS or FB.11,8284 Additionally, a new hypothesis is proposed, by which excessive delivery of highly fermentable but poorly absorbed short chain carbohydrates and polyols (collectively termed FODMAPs; fermentable oligo-, di- and mono-saccharides and polyols) to the small intestine and colon may contribute to the development of GI symptoms. FODMAPs are small molecules that are osmotically active and very rapidly fermentable compared with long-chain carbohydrates. These molecules induce relatively selective bacterial proliferation, especially of bifidobacterium, and it has been demonstrated indirectly that these can lead to expansion of bacterial populations in distal small intestine.8587 Thus, high FODMAP diet has demonstrated prolonged hydrogen production in the intestine, colonic distension by fermentation, increased colonic fluid delivery by osmotic load within the bowel lumen, and GI symptom generation.88,89

Intraluminal Contents

Levitt et al90 suggested that abdominal bloating might develop without gas retention, but by other gut contents. They had undertaken randomized, double-blind, crossover study of gaseous symptoms by observing the responses of healthy subjects to dietary supplement with lactulose or 2 types of fibers (psyllium or methylcellulose). In lactulose group, gas passages, subjective perception of rectal gas and breath hydrogen excretion were significantly increased, but not in fiber groups. However, the sensation of bloating was increased in all 3 groups. Thus, it has been proposed that increased intra-abdominal bulk, not gaseous filling, might be a cause of abdominal bloating.90 In another study, bran accelerated small bowel transit and ascending colon clearance without causing symptom in controls, but small bowel transit has not further been accelerated in IBS patients with bloating. Thus, they speculated that bran might cause increased bulking effect in the colon, which led to the exacerbation of bloating in IBS patients.91 Francis and Whorwell80 even proposed that use of the bran in IBS should be reconsidered, because excessive consumption of bran might give rise to symptoms such as bloating in IBS patients. Although more studies are needed for further understanding of their relationship, it could be possible that intraluminal bulking aggravates the bloating in some IBS patients.

Hard stool/Constipation

Many constipated patients complain of bloating. 14 Also there is a tendency of its being more common in IBS-C patients than IBS-D patients, though it is not statistically significant in some studies.31,9294 Distension of the rectum by retained feces slows small intestinal transit as well as colonic transit, probably explaining the aggravated bloating in constipated patients.15,56 Thus it seems reasonable that constipation or hard/lumpy stool induces alteration of gut motility and thus maybe increases bacterial fermentation. In addition, constipation may accelerate bloating by intraluminal bulking effect in the same manner as bran.

Psychological Aspects

Bloating is a frequent complaint of women with IBS. Park et al95 proposed that there was a tendency to increase the index of psychological distress when the bloating was more severe. Also, patients with bloating revealed increased anxiety and depression, which allows the hypothesis that psychological distress may contribute to the perceived severity of bloating. 96 Additionally, in large population surveys, bloating was significantly related with psychiatric dysfunction such as major depressive disorder, panic disorder and sleeping difficulties.97,98 Nevertheless, other studies have failed to demonstrate the relationships between psychological distress and either bloating or distension.14,99 However, it is unclear whether or not there is an actual relationship between bloating and psychosocial distress, and further studies are needed to demonstrate it.

Gender and Sex Hormones

In a population based study in USA, female gender was significantly associated with increased symptoms of bloating and distension in IBS, and similar findings have been reported so far.21,100102 Although the question of the gender role in IBS has been raised from many studies, the mechanisms of gender differences in bloating and distension are unclear. Some studies have suggested that bloating is one of the frequent symptoms of menstruation as aforementioned.24,25 Hormonal effect has also been speculated, that is, the variation of reproductive hormones throughout the menstrual cycle and after the menopause may influence the gut motility and visceral perception.24,79,103 Additionally, difference in symptom expression by gender is presented as a potential explanation.31 Although more investigations regarding the underlying mechanisms for these disparities remain to be determined, it seems to be possible to speculate that the hormonal fluctuation may contribute to bloating in female IBS patients.



There has been an increasing acceptance of the use of the antibiotics to treat IBS symptoms, and it is plausible based on the presumption that altered gut flora or SIBO may contribute to gaseous distension or bloating symptom. 44,104,105

Although some questions have been raised regarding the validity of the lactulose breath test in diagnosis of SIBO and the possibility of overdiagnosis,106 much more data support the clinical use of antibiotics in this condition. Specifically, rifaximin, a rifamycin derivative, has largely been studied, and it showed superiority to placebo in relieving bloating in IBS or in patients who were diagnosed as SIBO (). As rifaximin is a non-absorbable antimicrobial agent, the risk of side effects or emergence of resistant organisms is expected to be low; therefore it is suitable for chronic administration.4446,107,108 Recently, a phase 3 multicenter trial proved that rifaximin provided significant improvement of IBS symptoms including abdominal pain and bloating in non-constipated IBS patients.109 Pimentel et al110 also suggested that neomycin normalized lactulose breath test and it contributed to the reduction of bloating in IBS patients. Besides, there have been several retrospective or observational studies, which support the efficacy of rifaximin treatment in IBS patients. Specifically, rifaximin turned the lactulose breath test to negative and significantly reduced the overall symptom scores.111 Also, high dose rifaximin treatment (2,400 mg/day) was proved to be effective in patients who had incomplete response to usual dose of rifaximin.112 Another retrospective study has revealed that rifaximin is superior to other antibiotics, such as neomycin, doxycycline, amoxicillin/clavulanate and ciprofloxacin in patients with IBS.113 Therefore, antibiotics like rifaximin could be considered as a short course therapeutic regimen for bloating, mainly in IBS without constipation. Further studies are needed to determine how long these antibiotics should be given and whether drug resistance will be a problem.

Table 2

Studies for Rifaximin Treatment in Irritable Bowel Syndrome Patients


Alteration in gut microbiota may produce or perpetuate the symptoms of bloating or distension, therefore many researchers postulated that modification of the gut microflora could improve gas related symptoms. 39 One placebo-controlled study conducted in IBS patients revealed a beneficial effect of Bifidobacterium infantis and they suggested immune-modulating role of that organism.114 Another multicenter, clinical trial in women with IBS also showed that B. infantis relieved many of the symptoms of IBS, but just at a specific dosage (1 × 108 CFU/mL).115 In addition, more recent experiments have shown that some probiotic strains significantly alleviate the bloating as well as overall symptoms.116,117 One study from Korea has shown that multi-species probiotics given to IBS patients are effective in the relief of bloating, albeit not statistically significant over placebo.118 In the most recent meta-analysis of probiotics for lower GI symptoms, specific probiotics are recommended in the management of bloating in IBS patients as moderate grade of evidence along with 70% level of agreement.119

On the contrary, many other studies have failed to prove favorable effects of the probiotics. Kim et al120 evaluated the effectiveness of VSL#3, a composite probiotic containing Bifidobacterium, Lactobacillus and Streptococcus in IBS patients. VSL#3 reduced flatulence scores and retarded colonic transit without altering bowel function, but there was no significant reduction in bloating score with VSL#3.120 Some experimental studies from Korea showed a trend towards amelioration of bloating, but failed to prove beneficial effect over placebo.121,122 In addition, several other studies using lactobacillus strains reported unfavorable effect on bloating in IBS ().41,123,124 Most of the studies were relatively small and there have been inconsistent results regarding the efficacy of probiotics on bloating. Hence, larger and well-designed trials are needed to prove whether the probiotics are reasonable to treat patients with bloating.

Table 3

Summary of Studies for Probiotics in Irritable Bowel Syndrome


Prokinetics have been used in the treatment of bloating in FD traditionally, in spite of the weak evidence for correlation between symptoms and underlying pathophysiological mechanisms. A number of studies have shown the beneficial effect of prokinetics such as dopamine antagonist, muscarinic antagonist, and serotonergic agents in FD, but studies conducted in IBS patients are relatively rare (). Several studies have suggested that cisapride, a 5-hydroxytryptamine 4 (5-HT4) receptor agonist, significantly improves postprandial bloating in FD patients.125,126 Levosulpiride turned out to be as effective as cisapride in the treatment of FD symptoms, such as bloating.127 Acotiamide, a novel prokinetic agent, also provided relief of bloating in FD patients in a small study.128

Table 4

Summary of Studies for Prokinetics in Irritable Bowel Syndome

Some researchers tried to investigate the efficacy of tegaserod, a selective 5-HT4 partial agonist, in patients with IBS-C whose main symptom was not diarrhea, and they suggested significant relief in bloating with tegaserod.129132 However, tegaserod was withdrawn from the market in 2007 due to possible adverse cardiovascular effects. Additionally, neostigmine, a potent prokinetic drug, also exhibited significant effect in reducing objective abdominal distension as well as bloating in IBS or FB patients.133 On the other hand, some other studies do not agree with the favorable action of prokinetics in IBS. One double-blind trial suggested that cisapride was not superior to placebo in the treatment of bloating and other abdominal symptoms of IBS, but it reduced difficulty of stool passage.134 However, cisapride was also removed from the market due to the side effect. Another study conducted in IBS patients to evaluate the efficacy of domperidone showed no significant improvement of bloating.135 In a small experimental study, pyridostigmine reduced the severity of bloating, but it did not reach the statistical difference across groups.3 Although there are conflicting evidences regarding the effect of prokinetics on bloating, some of the prokinetics could be a treatment option for bloating.


Various types of antispasmodics have been commonly used to relieve the symptoms of IBS, given the presumption that altered GI motility and smooth muscle spasm may give rise to the IBS symptoms.136 Several studies have shown the efficacy of these drugs in IBS symptoms such as bloating, but some do not ().137142 Also data are limited since many of these agents (e.g., mebeverine, otilonium and trimebutine) are not licensed in the USA. There have been several reports that support the beneficial effect of otilonium.141,143 Besides, in a few studies, peppermint oil, considered as a natural spasmolytic agent due to its calcium influx blocking effect, was also superior to placebo in reduction of abdominal distension and bloating.144,145 One systematic review evaluated the efficacy and tolerability of mebeverine. In the meta-analysis, it was effective in the clinical improvement of abdominal pain or distension, but it did not reach a statistical significance. 146 Taken together, antispasmodics have shown some efficacy in the treatment of bloating, but the study results were inconsistent and it is difficult to draw definite conclusion about these conflicting views. Thus, larger studies are needed.

Table 5

Summary of Studies for Spamolytics in Irritable Bowel Syndrome

Dietary Interventions

Food intake may play a key role in perpetuating symptoms in IBS patients, so a careful history taking for diet should be taken. Many retrospective observational studies have shown that the reduced intake of large amounts of highly fermentable, poorly absorbed short chain carbohydrates (FODMAPs) may reduce bloating in IBS patients.147149 Finally, the low FODMAP diet was developed at Monash University in Melbourne,150 and recently, the first prospective study confirming the efficacy of low FODMAP diet for IBS patients was reported. Besides, patients with IBS who had also fructose malabsorption were significantly more likely to respond to the low FODMAP diet than those without fructose malabsorption (). 151

Table 6

Summary of Studies for Dietary Interventions in Irritable Bowel Syndrome

Gas Reducing Substances

One of the earliest pharmachological modalities used in treating distension and bloating was antifoaming agent, and a silicone derivative with surfactant, officially designated as “simethicone” is known as a traditional antifoaming agent, by which gases are evacuated and absorbed from the gut.152 As most of the studies which investigated the therapeutic benefit of those agents were carried out in the subset of patients who have FD, their efficacy in IBS patients seems questionable. Bernstein et al153 reported that simethicone significantly relieved the frequency and severity of gas-related symptoms in patients with FGID. Holtmann154 also conducted a randomized, placebo-controlled trial of simethicone, and suggested that simethicone was significantly better than placebo for overall symptom control in FD patients, in spite of unfavorable effect for bloating. More recently, prospective, multicenter trial to demonstrate a favorable action of activated charcoal-simethicone combination therapy revealed that the severity of fullness and bloating was significantly decreased in the therapy group compared with placebo ().155

Table 7

Summary of Studies for Gas-reducing Substances in Functional Gastrointestinal Disorder

Stimulants of Fluid Secretion

Lubiprostone and linaclotide are novel agents recently approved by the USA Food and Drug Administration, that enhance fluid secretion into the gut lumen and accelerate intestinal transit. These properties are considered to play a role in treatment of constipation, thus a number of clinical trials focusing in the chronic constipation or IBS-C have been conducted (). In 2 phase III trials, lubiprostone significantly improved the overall IBS symptoms including bloating in IBS-C.156,157 Several multicenter, randomized trials of linaclotide in chronic constipation or IBS-C also demonstrated the beneficial effect in relieving abdominal bloating. 158,159 Thus so far, these 2 novel drugs offer a reasonable therapeutic approach for bloating mainly in IBS-C and functional constipation patients.

Table 8

Summary of Studies for Stimulants of Fluid Secrection in Functional Gastrointestinal Disorder


Antidepressants such as selective serotonin reuptake inhibitor (SSRI) or tricyclic antidepressant (TCA) are believed to alleviate symptoms in FGIDs on the basis of their visceral analgesic properties as well as psychological aspects. However, one small study conducted in IBS patients with visceral hypersensitivity revealed that fluoxetine, one of the SSRI, was effective only in abdominal pain, not in other symptoms such as bloating.160 Paroxetine was also evaluated in IBS patients who did not respond to high fiber diet. Overall well-being sensation was improved more with paroxetine than with placebo, but abdominal bloating was not.161 However, there were also some positive results. That is, the SSRI, citalopram significantly improved abdominal bloating compared with placebo, though the therapeutic effect was independent of the effect on anxiety, depression and colonic sensitivity ().162 Taken together, the results for the treatment of bloating and distension with antidepressants are partly contradictory, and there were few studies which explained the effect of TCA on bloating. Hence, larger, well-designed trials with SSRIs and TCAs are warranted to identify the efficacy of these drugs on bloating and distension.

Table 9

Summary of Studies for Antidepressants in Functional Gastointestinal Disorder

Opioid Agents

There have been a few reports that propose the usefulness of opioid agents in IBS patients (). The kappa receptor agonist, fedotozine has been shown to increase the threshold of perception to colonic distension and reduce visceral sensation.163 It has also demonstrated its superiority to placebo in relieving postprandial fullness and bloating in FD patients. 164 In a phase II trial, asimadoline, a novel kappa-opioid agonist, has yielded excellent efficacy results on pain and bloating in IBS-D patients.165 A small study has suggested that naloxone is beneficial in reducing the bloating score in IBS-C or IBS-M patients, but there were no significant differences in the results with naloxone and placebo.166 Though a recent review also makes a suggestion of the use of opioid agonists in IBS-D patients,167 their role in bloating is uncertain to date.

Table 10

Summary of Studies for Opioid Agents in Functional Gastrointestinal Disorder


Abdominal bloating is a frequent and bothersome, but poorly understood clinical problem. The terms of bloating and distension are often confused, but these 2 symptoms should be considered to be separate, as they probably have different pathophysiological mechanisms. The possible mechanisms of bloating are complex and maybe various mechanisms are combined in symptom generation. Important mechanisms of bloating are impaired gas handling and hypersensitivity. Also, recent evidences are beginning to emphasize that patients with bloating may have an altered bacterial flora, SIBO, and abdomino-phrenic dyssynergia. Other less-established factors for bloating are food intolerance, intraluminal bulking and psychological factors ().

Potential mechanisms behind bloating and visible distension in functional gastrointestinal disorders. Modified from Simrén.168 CNS, central nervous system; ENS, enteric nervous system; GI, gastrointestinal.

On approaching to the treatment of abdominal bloating, clinicians should consider a heterogeneous condition produced by a combination of various mechanisms. Currently, there is no treatment which has indisputably proven to be effective for bloating. Treatment strategy for bloating may include pharmacologic approach, dietary modification, and psychological therapy. Taken together, 5-HT4 agonists, antibiotics such as rifaximin, some probiotics, and also novel agents, lubiprostone and linaclotide are substantiated to be effective in some degree in the treatment of bloating. Dietary intervention with low FODMAP is also newly qualified treatment option. Though the evidence is weak, antifoaming agents and antidepressants could be considered in some patients. Of course a careful history and physical examination should be the first step and reassurance and education are likewise important.

Though the whole mechanism and treatment strategies are yet to be fully elucidated, this article proposes a framework for assessing and managing the patients with bloating.

Functional Abdominal Bloating with Distention

ISRN Gastroenterol. 2012; 2012: 721820.

Stephen Norman Sullivan

1Department of Medicine, University of British Columbia, Vancouver, BC, Canada V5Z 1M9

2Island Medical Program, University of Victoria, Victoria, BC, Canada V8W 2Y2

1Department of Medicine, University of British Columbia, Vancouver, BC, Canada V5Z 1M9

2Island Medical Program, University of Victoria, Victoria, BC, Canada V8W 2Y2

Academic Editors: S. Mueller-Lissner and A. A. te Velde

Received 2012 Mar 18; Accepted 2012 Apr 18.

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC.


Ten to 25% of healthy persons experience bloating. It is particularly common in persons with the irritable bowel syndrome and constipation. While the cause of bloating remains unknown old explanations such as a excessive intestinal gas, exaggerated lumbar lordosis and psychiatric problems have been disproved. New suggestions include recent weight gain, weak or inappropriately relaxed abdominal muscles, an inappropriately contracted diaphragm and retained fluid in loops of distal small bowel. No treatment is of unequivocal benefit but a low FODMAPs diet, probiotics and the non-absorbable antibiotic rifaximin offer some hope. Treatment by weight loss, abdominal exercise, prokinetics and girdles need more study.

1. Introduction

Bloating is the symptom and distention is the sign. Not a pretty picture! What do we know about this highly prevalent problem and perhaps the most bothersome symptom for persons with the irritable bowel syndrome, especially of the constipated variety?

There have been several recent exhaustive reviews of the topic and important new research [1–15]. This is a brief summary of the relevant science and some of the art. For a historical perspective I highly recommend the classic paper by Alvarez of the Mayo Clinic [16].

Let me begin at the end and say that I believe that most cases of functional abdominal bloating with visible abdominal distention can be explained by some combination of weak or inappropriately relaxed abdominal muscles, a diaphragm that contracts when it should relax; excessive intraabdominal fat; fluid in loops of small intestine and gravity. I will review the evidence for my conclusions and for completeness include some other thoughts.

2. Prevalence

Visible, measurable, uncomfortable distention of the abdomen, “bloating,” may be due to aerophagy, gluttony, gastric outlet or intestinal obstruction, malabsorption, hypomotility of the stomach or intestine, obesity, or intraabdominal masses, and fluid. It may be a symptom of psychiatric conditions such as anorexia nervosa, bulimia, or the somatization disorder. If an organic or psychiatric cause cannot be found, then bloating is usually considered to be “functional” and part of the spectrum of the irritable bowel syndrome, functional dyspepsia, or the premenstrual syndrome. Unexplained abdominal bloating is a very common problem. In surveys of healthy individuals and populations 10–30% experience bloating often, frequently, or greater than a quarter of the time.

3. The Clinical Picture

When a patient comes complaining of bloating make sure that you know what they are talking about. Only about half of patients who complain of bloating actually experience abdominal distention [8].

Functional abdominal bloating is never constant or unremitting. It comes and goes in one of two patterns—shortly after meals or near the end of the day. The former is often considered part of the spectrum of functional dyspepsia. For the purposes of this paper I will address only the latter.

The sufferer, usually a woman, awakens with a flat abdomen that progressively enlarges as the day goes on. Fasting or eating small meals minimizes the problem. Large or heavy meals make it worse as may constipation. It may be worse premenstrually. Loosening of the belt or changing of clothing may be necessary. Minor or temporary relief comes from burping, farting, or defecation.

The distention is visible to the patient, family, friends, and the physician. It is measurable by tape, X-ray, computed tomography, and abdominal inductance plethysmography. With the miracle of digital photography some patients will come with photographic evidence or even post videos on YouTube. The skeptical physician may ask the patient to measure changes in abdominal girth, attend the office when the symptom is present, or email a photograph or video.

Many patients have symptoms of the irritable bowel syndrome, functional dyspepsia, constipation, or the premenstrual syndrome. They may also have psychological or social problems. Recent weight gain, weak abdominal muscles, and lack of exercise are common [17].

4. Etiology

To label a symptom “functional” begs the question, “Why does it occur?” There have been many suggestions (). I still remember the medical school mnemonic-food, fat, flab, fluid, flatus, feces, fetus, factitious, fatal, and fruitcake. The ten “Fs” were the causes of abdominal distention. The “fatal” referred to tumors and the “fruitcake” to patients with psychiatric problems. Which of the “Fs,” if any, might be an explanation for functional abdominal bloating?

Table 1

Suggested causes of functional abdominal bloating.

(1) Intra-abdominal gas
(2) Fluid within the lumen of the gut
(3) Feces
(4) Low or inappropriately contracted diaphragm
(5) Exaggerated lumbar lordosis
(6) Intra-abdominal fat
(7) Weak or inappropriately relaxed abdominal muscles
(8) Psychiatric problems

A visible and measurable increase in abdominal girth implies an increase in intraabdominal volume. Intraabdominal contents increase with swallowed air, ingested food and fluid, retained feces and flatus, secretion of digestive juices, and possibly with increases in intraabdominal vascular volume during digestive and menstrual function. All of these events are normal but in some people cause “dis-ease” in the absence of disease.

Abdominal girth may also increase in the absence of an increase in volume if the abdominal contents are “redistributed” downwards and outwards. More on that later. First let us consider things that might increase volume.

5. Flatus

In veterinary medicine the term “bloat” refers to gaseous distention of the belly, sometimes necessitating treatment with a trocar. Such is not the case in human medicine. It has been repeatedly shown that human bloaters do not have “too much gas.” Farting and belching give only minor or transient relief and “anti-gas pills” are no better than placebo [18]. Bloaters may be excessively sensitive to normal amounts of gas or have trouble handling gas infused into their small intestine [10] or expelling gas infused into their colon [14] but when intestinal gas is measured by sophisticated CT scanning during bloating episodes there are only minor increases [4]. Visceral “hypersensitivity” has been invoked and may be a factor in patients who complain about bloating without abdominal distention as they are more sensitive to rectal distention than the bloaters with distention [7].

6. Food and Fluid

It is easy to understand why bloating might occur after meals. The increase in volume comes from food and fluids and the digestive juices produced in response. This sort of postprandial discomfort is labeled functional dyspepsia but my impression is that it is rarely associated with much abdominal distention. The topic of functional dyspepsia with its other symptoms is beyond the scope of this paper on visible bloating.

This brings me to an idea that has not been adequately addressed, namely, fluid retention within loops of small bowel in the later postprandial period. If bloaters have trouble handing exogenous gas infused into the small intestine [10] could not they also have trouble handling endogenously produced secretions? After all, there are 6–8 liters being produced and absorbed each day. The “mishandling” of only a few liters could explain increased girth at the end of the day. Absorption overnight produces a flat abdomen in the morning.

7. Feces

Many constipated patients complain of bloating [8, 9] indeed difficulty in expelling a balloon from the rectum is predictive of bloating [15]. However the problem is not in the colon. The small volume of retained feces is not sufficient to increase abdominal girth. The problem seems to be “upstream.” Distention of the rectum slows proximal gut motility and some patients with constipation and distention have slow small intestinal transit [6, 19–22]. Even voluntary suppression of defecation slows gastric emptying [23]. Could slow proximal transit increase the volume of fluid within the small intestine?

8. Fat

This is also an area that has not been fully explored. Most studies have not found a correlation between bloating and body mass index although having a BMI > 30 kg/m2 may be related [24, 25]. Bloaters do have a little bit of extra intraabdominal fat [4] but being obese should not cause excessive changes in postprandial or diurnal abdominal girth. However, a few kilos of extra intraabdominal fat might make one more sensitive to the normal fluctuations in intraabdominal volume that we all experience. Approximately 40% of patients with bloating have gained 10 or more pounds in weight in the preceding year [17] and about a quarter feel that their bloating problem began about the time they started to gain weight [9]. A substantial amount of recently gained weight is stored as intraabdominal fat [26] thus reducing space into which the abdominal contents can comfortably expand and perhaps causing the symptom of bloating.

9. Flabby Abdominal Muscles

Many years ago Osler noted that some patients with a bloating condition he called “enteroptosis” had “loss of the normal support of the abdominal wall” [27]. Some years later, Alvarez commented that some bloating patients had “relaxation of the muscles of the anterior abdominal wall” and suggested that some had a “neurosis” of the abdominal wall [16]. He may have been right. A third of patients whose primary symptom is visible abdominal bloating are unable to do even a single sit up [17]! And the most recent research has found that bloaters with distention have “impaired viscerosomatic reflexes and abdominal-wall dystony” with “incoordinated abdominal accommodation” and “abdomino-phrenic dyssynergia” leading to “caudo-ventral redistribution of contents” [4, 12, 13]. Simply stated, the abdominal muscles, especially the “anti-gravity” internal obliques, relax when they should contract and the diaphragm contracts when it should relax thus the abdominal contents sag downwards and outwards. This is nicely illustrated by the diagrams in [3, 4].

Redistribution of abdominal contents also occurs in women with severe vertebral osteoporosis and loss of abdominal vertical height. The rib cage rests on the pelvis and the abdomen protrudes because its contents have nowhere else to go.

10. Psychological Factors

The largest case series of functional abdominal bloating is still Alvarez’s unfortunately titled “hysterical type of nongaseous abdominal bloating” [16]. His article began thus, “In 1911, I saw a psychopathic woman, past the menopause, who, with her protuberant abdomen, was sure she was pregnant by the Holy Spirit… I learned then that a bloated abdomen can be produced purely by nervous means.” Perhaps we can forgive his generalization, considering that it was the age of psychosomatic explanations for peptic ulcers and ulcerative colitis.

Unfortunately it has too often been the habit of physicians to blame the patient’s psyche for symptoms the physician cannot explain. Let us state categorically that the average functional bloater is not crazy or faking it! Some years ago my colleagues and I found that patients who had a consultation with a gastroenterologist for the primary complaint of unexplained visible abdominal bloating had the same degree of anxiety or depression and even a greater tolerance to pain as patients with quiescent Crohn’s disease [28, 29]. And as for faking it, voluntary protrusion of the abdomen has a different CT appearance than spontaneous bloating and CT scans and lateral abdominal films have shown that women with IBS and abdominal bloating have a normal degree of lordosis and a normally positioned diaphragm [30]. Although recently the involuntary position of the diaphragm has been readdressed, it appears that as the abdominal contents sag downward and outward the diaphragm contracts rather than relaxes into a lower position, so-called abdomino-phrenic dyssynergia [4, 13]. The ancient observation that general anesthesia almost instantly relieves distention may now have an explanation—the diaphragm relaxes.

However, bloating is an extremely common symptom in apparently psychiatric conditions like anorexia nervosa, bulimia, and the somatization disorder. It is also true that persons who have experienced and survived extreme stresses such as the Nazi Holocaust frequently suffer from bloating [31]. Bloating, stress, anxiety, and depression may coexist with or aggravate functional disturbances such as the irritable bowel syndrome or functional dyspepsia. In two large population surveys bloating correlated with psychiatric dysfunction: depression, sleeping difficulties, problems of coping, panic disorder, and agoraphobia [32, 33]. However bloating is also a common symptom in healthy and normally noncomplaining persons, even runners and athletes [34, 35]. So even though many patients find that their bloating is worse when they are anxious or it correlates with depression, insomnia, difficulty in coping, or alcohol abuse, I do not think we should “reflexly” blame the psyche. A symptom may cause psychic distress. Psychic distress may take the patient to the physician but we should not assume that the psyche is the cause of the symptom.

11. Management

The diagnosis of functional abdominal bloating can usually be safely made from history and physical examination alone. If a disease of sufficient likelihood to cause the problem cannot be excluded by history and physical then it should be excluded by selective investigation. Always a good idea is to rule out coeliac disease.

Once an organic cause for the bloating has not been found and the patient has been reassured, science and tradition provide little proven course of action (). This topic has recently been reviewed [36]. There are no 101% proven treatments. The role of exclusion diets is uncertain. The patient has usually tried diet manipulation and is dissatisfied with the results. Certainly lactose, fructose, and sorbitol should be considered and some patients, even without coeliac disease, benefit from exclusion of wheat and rye [37] or going on a gluten-free diet. A FODMAP exclusion diet may be worth trying [38]. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are small molecules that are rapidly fermentable and osmotically active and could cause luminal distention. Probiotics and even nonabsorbable antibiotics like rifaximin are being studied [39, 40]. Weight loss may help but is unproven, as are girdles and abdominal exercises. Physical activity seems to help bloaters [41] and even runners and other athletes bloat less when exercising regularly [35, 36]. Perhaps walking or jogging will help the bloater. Laxatives help constipation and maybe the associated bloating. None of the “anti-gas” remedies are better than placebo although peppermint oil has some promise. If the problem is slow transit or extra fluid in loops of small intestine maybe a whole-gut prokinetic like cisapride, erythromycin or pyridostigmine will help [11]. Some believe psycho- or hypnotherapy are of benefit [42, 43].

Table 2

Management of functional abdominal bloating.

(1) Exclude an organic cause
(2) Explanation and reassurance
(3) Diet manipulation
(4) Weight loss?
(5) Sit-ups?
(6) Exercise?
(7) A girdle?
(8) A laxative?
(9) A prokinetic?
(10) Probiotics?
(11) Non-absorbable antibiotics?
(12) Psycho- or hypnotherapy?

Personally I recommend smaller meals, weight loss where appropriate, laxatives when needed, physical activity, abdominal exercises, and yoghurt. I used to try cisapride and tegaserod but they are no longer readily available. I might try erythromycin or pyridostigmine. I also recommend abdominal binders such as Slim Away seen on YouTube. As Osler noted, “I know of no single simple measure which affords relief to distressing symptoms in so many cases as the abdominal bandage” [27].


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What Causes Abdominal Bloating?: Health One Family Medicine: Family Medicine

Abdominal bloating is a painful condition that usually occurs due to the accumulation of gas in the abdomen. Your stomach tends to feel tight and will protrude outwards. A bloated stomach is fairly uncomfortable and embarrassing to deal with and it can have a direct impact on the quality of your life.

There are several causes of abdominal bloating as well and in some cases, a bloated stomach may be a sign of a more serious medical condition.

Some of the most common causes of abdominal bloating include:


Bloating often occurs due to constipation. Irregular bowel movements allow the bacteria in your colon to carry out fermentation on your stool. This produces gas and can result in bloating.  


Diet is one of the main causes of bloating as well. Many foods that you eat produce an excessive amount of gas which can lead to bloating. Drinking carbonated beverages also causes a buildup of gas in your abdomen.

If you are lactose intolerant, then your body cannot digest dairy products such as milk and ice cream. This leads to the production of gas, abdominal pain, and bloating.

Eating Habits

Besides your diet, the manner in which you consume your food is also a cause of bloating. If you eat too quickly, then you end up swallowing a lot of air. This can lead to bloating. Eating very fast also causes you to consume more food. This is because it takes your stomach 20 minutes to let your brain know that it is full. Overeating also leads to bloating.

Irritable Bowel Syndrome (IBS)

Bloating is among the signs and symptoms of irritable bowel syndrome. Other symptoms include diarrhea, abdominal pain, and constipation. There is no cure available for this condition, but it is not associated with any serious diseases.

Small Intestinal Bacterial Overgrowth (SIBO)

As the name suggests, small intestinal bacterial overgrowth is a condition where there is an excess amount of bacteria in your small intestine. This can result in increased flatulence, bloating, constipation, diarrhea, nausea, abdominal pain, and fatigue.


Gastroparesis is also one of the causes of abdominal bloating. This is a condition in which the stomach is unable to empty itself of food or there is a delay in emptying. The cause of gastroparesis is hard to detect. In some cases, it happens because the vagus nerve becomes damaged. This never is responsible for controlling the muscles in your stomach and intestine. When it gets damaged, food is unable to move through the digestive system in a normal manner. Other symptoms of gastroparesis include nausea, heartburn, weight loss, poor appetite, vomiting improperly digested food, and poor blood sugar control.

There are several causes of bloating. As far as treatment and prevention are concerned, understanding the cause is the first step. If you suffer from bloating due to your diet, then avoiding foods that produce gas can help treat your condition. You can also consult a physician for a full diagnosis of your condition.

If you’re seeking further advice on the treatment and prevention of abdominal bloating, we suggest you make an appointment with a physician at Health One Family Medicine, visit https://www.healthonemedicine.com/or call (469)262-5762.


Health One Family Medicine

Abdominal Bloating | Gastroenterology | JAMA

Abdominal bloating is not a disease but rather a condition with many possible causes.

Common Causes of Bloating

Bloating can be caused by gaining weight; overeating; constipation; functional dyspepsia, indigestion not caused by an obvious disease; irritable bowel syndrome, a disorder that may cause abdominal pain, cramps, diarrhea, and constipation; lactose intolerance, an inability of the small intestine to digest milk products; small bowel bacterial overgrowth, an abnormally large number of bacteria growing in the small intestine; medications; acarbose; artificial sweeteners; menstruation; and menopause.

Disorders That May Cause Bloating

More serious conditions that may cause bloating include ascites, a buildup of fluid between the lining and the abdominal organs, usually caused by such diseases as congestive heart failure or cirrhosis of the liver; celiac disease (sprue), an intolerance of gluten; ovarian cancer; giardiasis, an intestinal parasite infection; diverticulosis or diverticulitis, pouches on the wall of the digestive tract; and bowel obstruction.

Abdominal bloating can be curbed by making such changes in your eating habits as avoiding swallowing too much air, which can occur while chewing gum, drinking carbonated beverages, smoking, using a straw, or eating too fast. Foods that cause gas include cabbage; legumes; onions; artichokes; mushrooms; turnips; some fruit such as pears, apples, and peaches; whole grains; sugar-free candy; juice; high-fructose corn syrup drinks; fatty foods; and sweets. Avoiding milk and dairy products may help determine whether you are lactose intolerant. Eliminating gluten from your diet may also help you determine whether you have celiac disease. Some over-the-counter medications to reduce gas may help with bloating, as may probiotics.

You should see your doctor when you have abdominal pain; find blood in your stools or on toilet paper after wiping; or experience diarrhea, vomiting, or weight loss.

Box Section Ref ID

For more information

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at jama.com. Many are published in English and Spanish.

Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Sources: Gas – flatulence. A.D.A.M. Inc. https://ssl.adam.com/content.aspx?productId=105&pid=1&gid=003124&site=welldynerx.adam.com&login=well1815. Reviewed April 17, 2012. Accessed September 24, 2013.

Azpiroz F, Malagelada J-R. Gastroenterology. 2005;129(3):1060-1078.

Topic: Gastroenterology

Abdominal Fullness or Bloating | Michigan Medicine

Topic Overview

Abdominal fullness or bloating occurs when excess gas builds up in the digestive tract.

Common causes of gas include:

  • Swallowed air. If swallowed air is not burped up, it passes through the digestive tract and is released through the anus as gas (flatus). Excessive air swallowing may cause hiccups.
  • Gas-producing foods and drinks, such as beans, broccoli, carbonated drinks, and beer. The amount of gas that different foods cause varies from person to person.
  • Constipation. This can cause bloating but generally does not increase gas.
  • The side effects of medicines or supplements, such as opioid pain medications, vitamins, iron supplements, and many medications that are used to treat constipation.
  • Changing hormone levels. Many women feel bloated right before their periods because their bodies retain fluid.
  • Pregnancy.
  • Weakened abdominal muscles caused by pregnancy or abdominal surgery.
  • Obesity.

Occasionally, excess gas and bloating may be caused by a more serious medical problem, such as a bowel obstruction, liver problems, gallbladder disease, or cancer.

Treatment depends on what is causing the problem. Call your doctor for a checkup if you have abdominal fullness or bloating that has not gotten better or gone away with home treatment.


Current as of: February 26, 2020

Author: Healthwise Staff
Medical Review: William H. Blahd Jr. MD, FACEP – Emergency Medicine
Adam Husney MD – Family Medicine
Kathleen Romito MD – Family Medicine
Kathleen Romito MD – Family Medicine

Current as of: February 26, 2020

Healthwise Staff

Medical Review:William H. Blahd Jr. MD, FACEP – Emergency Medicine & Adam Husney MD – Family Medicine & Kathleen Romito MD – Family Medicine & Kathleen Romito MD – Family Medicine

Abdominal Swelling | Reasons For a Swollen Stomach

Ovarian cyst

During her reproductive years, a woman’s ovaries release a single egg cell each month. But sometimes the egg remains on the surface of the ovary, where the follicle that enclosed it continues to grow. It then becomes a fluid-filled ovarian cyst.

Ovarian cysts may be caused by hormonal imbalances; by endometriosis tissue, if it attaches to the ovary; and by severe pelvic infections that spread to the ovaries. Cysts may also form during pregnancy.

Small ovarian cysts often cause no symptoms. Larger cysts may cause pelvic pain, backache, unexplained weight gain, abnormal vaginal bleeding, and/or pain during sex. Ovarian cysts are almost never a form of cancer.

Sudden, severe abdominal pain could indicate a ruptured cyst. This is a medical emergency and the patient should go to an emergency room or call 9-1-1.

Diagnosis is made through ultrasound.

Hormonal birth control, such as the pill, injection, or patch, prevents ovulation and therefore prevents the formation of cysts. Surgery to remove the cyst may be necessary in some cases.

Rarity: Rare

Top Symptoms: stomach bloating, vaginal bleeding, pelvis pain, lower abdominal pain, lower back pain

Urgency: Primary care doctor

Uterine fibroids

Uterine fibroids are benign growths in the wall of the uterus and most often appear during childbearing years. Fibroids are almost never associated with cancer.

Those at higher risk include black women and women who started their periods at a young age. Other risk factors are vitamin D deficiency, poor diet, obesity, drinking alcohol, and family history of fibroids.

Fibroids can cause pelvic pressure and pain, severe menstrual cramping, and heavy menstrual bleeding that leads to anemia. Quality of life is diminished due to the chronic pain and discomfort. Though fibroids don’t always make it impossible to become pregnant, infertility and pregnancy loss may occur as well as pre-term delivery.

Fibroids can be diagnosed through a routine pelvic exam or ultrasound in a doctor’s office.

A gynecologist can prescribe various medications to ease the symptoms and regulate the menstrual cycle. There are also a number of surgical techniques, some minimally invasive, to shrink or remove the fibroids while leaving the uterus in place. Hysterectomy, or removal of the uterus, is an option in some cases.

Rarity: Common

Top Symptoms: vaginal bleeding, pelvis pain, abdominal cramps (stomach cramps), painful periods, irregular period

Urgency: Primary care doctor


Cirrhosis is scarring of the liver. Scar tissue forms because of injury or long-term disease. In the United States, alcoholism and Hepatitis C are the most common causes. Scar tissue cannot do what healthy liver tissue does – make protein, help fight infections, clean the blood, help digest food and store energy.

Rarity: Common

Top Symptoms:

Urgency: Primary care doctor

Ovarian cancer

Ovarian cancer is an abnormal growth of cells in the ovaries, the reproductive organ in women responsible for producing eggs. Risk factors for developing ovarian cancer include familial genetic syndromes, increasing age, obesity or weight gain, starting menses at an early age, undergoing menopa…

Liver failure

The liver is a large and important organ in the right side of your belly, just under your lower ribs. It is responsible for countless functions from clearing toxins to processing nutrients to producing vital blood proteins. As a result, liver failure can cause a wide array of symptoms, but the mos…

Compartment syndrome

Acute compartment syndrome describes the damage done to certain muscle groups of the arms or legs after a traumatic injury.

All of the long muscles are bundled into sections – “compartments” – by the white sheets of strong, tough connective tissue called fascia. If something interferes with circulation so that blood flow is trapped within the compartment, pressure rises because the fascia cannot stretch. This causes serious damage to the muscles and other tissues within the compartment.

Acute compartment syndrome is caused by a broken bone; a crush injury; burns, due to scarred and tightened skin; and bandages or casts applied before an injury has stopped swelling.

Symptoms can rapidly intensify. They include severe pain and tightness in the muscle; tingling or burning sensation; and sometimes numbness and weakness.

Acute compartment syndrome is a medical emergency which can result in loss of the limb. Take the patient to the emergency room or call 9-1-1.

Diagnosis is made through patient history and physical examination.

Treatment involves hospitalization for emergency surgery and, in some cases, skin graft.

Rarity: Rare

Top Symptoms: arm numbness, hand numbness, foot numbness, pain in one leg, thigh numbness

Urgency: Hospital emergency room

Small bowel obstruction

The small bowel, or small intestine, is a long, coiled, tube-like structure that connects the stomach to the large intestine (the large bowel, or colon.) If the small bowel is blocked for any reason, food and liquid cannot pass through. This is a medical emergency.

There a number of possible causes. Scar tissue called adhesions can form after any abdominal surgery (including Caesarean section.) Inflammation from Crohn’s disease or diverticulitis causes the intestinal wall to thicken and narrow. Hernias or tumors can also cause blockage.

Symptoms include inability to have a bowel movement or pass gas; abdominal cramping and swelling; loss of appetite; and vomiting.

If not treated, a small bowel obstruction can cut off the blood supply to the small intestine. This leads to tissue death, which can then tear and cause an infection in the abdominal cavity called peritonitis. Both of these are medical emergencies.

Diagnosis is made through physical examination, x-ray, CT scan, and/or ultrasound.

Once diagnosed, most patients are hospitalized. Surgery may be necessary to clear the obstruction.

Rarity: Uncommon

Top Symptoms: abdominal pain (stomach ache), nausea, stomach bloating, being severely ill, abdominal cramps (stomach cramps)

Symptoms that always occur with small bowel obstruction: being severely ill

Urgency: Hospital emergency room

Other causes of abdominal swelling

Other causes of abdominal swelling include the following.

  • Skin infection: If the swelling is limited to one section of the abdomen, it may be due to an infection in the skin. Typically, skin infections cause localized redness, swelling, and tenderness. Skin infections are typically caused by bacteria and treated with antibiotics.
  • Obesity: Increased abdominal girth over time can be due to weight gain or obesity.

Bloating and Distension: What’s the Difference?

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 swelling and feeling of tightness of their skin or clothing along with discomfort. Often, patients will describe this as if a balloon has blown up in their abdomen and women often say that they look like they are several months pregnant. While bloating and distension often go together, they have different origins and possible treatments. Therefore, it is important to understand the differences.

Bloating vs. Distension

Bloating is a sensation, not a visible change in the waistline.  It can occur for many different reasons: related to constipation, getting full after eating, or having disorders like functional dyspepsia or IBS.  Bloating, like pain, is related to a combination of increased nerve signals arriving from the GI tract (i.e., due to visceral hypersensitivity) and/or ineffective regulation or control of the sensation by the brain. Changes in this brain-gut regulation, with the conditions noted above, can lead to more intense discomfort.  As noted bloating can have different causes and treatment of the underlying condition can obtain relieve. For example using medications to improve constipation or antibiotics to reduce bacterial overgrowth or dysbiosis or neuromodulators to reduce visceral hypersensitivity in IBS can reduce this sensation.


For some people, this intense discomfort described as bloating or abdominal pain that often occurs after eating, can also trigger visible abdominal distension. The change in abdominal girth can be measured and seen by others as a swelling and change in belt size.  Previously, this occurrence was frequently attributed to an increase of gas in the abdominal cavity with providers suggesting patients avoid swallowing air. However, several recent studies have used imaging to determine that gaseous distension such as from bowel obstruction or pseudo-obstruction occurs infrequently relative to most of the distension which actually is not due to increased gas. Instead the distension is called a visceral (gut) somatic (abdominal muscles) reflex that is triggered by the bloating sensation via the dysregulation of the brain-gut axis.

Dr. Drossman explains what abdomino phrenic dyssynergia is and shares treatment options via FaceBook live.

So, for example when eating a meal, food is eaten and it may stretch the stomach or intestines causing the bloating sensation.  The sensation goes to the brain which has a reflex response to paradoxically move the diaphragm down into the abdomen and relax the abdominal wall muscles.  This increases the pressure within abdominal cavity which pushes out through the relaxed abdominal wall leading to abdominal distention (see diagram). This is called Abdomino-phrenic dyssynergia. Abdomino-phrenic dyssynergia is a brain-gut reflex typified by bloating as a symptom and distension as a sign. It should be noted that bloating and distention can occur independently of one another. Not all people who experience bloating become distended and not all people with distension feel bloated.

Three treatment options can be utilized to treat Abdomino-phrenic dyssynergia including rebreathing techniques, central neuromodulators, and less commonly biofeedback with esophageal probes. The technique that our practice most often employs is to use central neuromodulators to reduce visceral hypersensitivity and improve brain regulation of the sensation which in effect raises the patient’s threshold for sensations like bloating and pain. By treating the brain-gut dysregulation, the sensation of bloating can be reduced and therefore the trigger resulting in distension does not occur or occurs to a lesser degree.

The above figure is taken from a paper in Gastroenterology demonstrates anterior abdominal wall protrusion and diaphragmatic descent during bloating compared with basal with only a small increase (by 22 mL) in gas content.1


  1. Accarino, Anna, et al. “Abdominal Distention Results From Caudo-Ventral Redistribution of Contents.” Gastroenterology, vol. 136, no. 5, 2009, pp. 1544–1551., doi:10.1053/j.gastro.2009.01.067.

Where does bloating come from and how to get rid of it

When you need to see a doctor as soon as possible

Schedule an urgent visit to a gastroenterologist or therapist if you have a bursting feeling in your stomach regularly, almost every day. And especially if there are additional symptoms :

  • blood in the stool;
  • prolonged constipation or diarrhea;
  • Any changes in the frequency of bowel movements;
  • weight loss despite the fact that you have not changed anything either in nutrition or in physical activity;
  • persistent or intermittent nausea and vomiting.

Immediately call an ambulance (103, 112) or go to the nearest emergency room if bloating is accompanied by:

  • persistent abdominal pain;
  • Burning pain in the chest.

All these can be symptoms of a life-threatening condition up to intestinal tumors or heart attacks.

However, really dangerous causes of bloating are very rare . If there are no threatening signs, chances are you are okay.

And so that the bursting sensation does not appear in the future, it is enough to understand its causes and slightly change your eating habits and lifestyle.

Where does bloating come from and what to do about it

Here are the most common causes of and how to fix them.

1. You overeat

The stomach is a rather small organ. According to various sources , in a stretched state, it can hold from 1 to 4 liters of food – food and drinks. If you overeat, the stomach lining is stretched beyond measure.And you feel the heaviness, the belly is bursting.

What to do

Try to keep your portion sizes smaller. If you are not full, eat more often – up to 5-6 times a day. But don’t push more into your stomach than it can hold.

2. You swallow air while eating or drinking

Those who like to chat during lunch often suffer from this. When you talk and eat at the same time, a portion of air enters your esophagus with each bite. The same thing happens when you chew gum, suck lollipop, drink through a straw.

What to do

Observe the rule “when I eat, I am deaf and dumb.” Avoid foods and habits that make you swallow air.

3. You chew poorly or eat too fast

This leads to the fact that you swallow large pieces. They expand the esophagus, and therefore air enters the stomach.

What to do

Make sure your food is well chewed. By the way, many people eat too fast, in large chunks, when they are under stress.Try to learn how to manage your emotions.

4. You eat fatty foods

Fat takes longer to digest than proteins or carbohydrates. Therefore, the stomach does not empty for a long time.

What to do

Try limiting fat in your diet.

5. You have food allergies or intolerances to certain foods

These two conditions are sometimes similar, but have different mechanisms of development. An allergy is a powerful reaction of the immune system to an irritant, an allergen.Food intolerance, on the other hand, has genetic causes: the body simply does not perceive this or that product and reacts to its appearance with the development of chronic inflammation.

However, in the context of bloating, the body’s response to “inappropriate” foods is the same: they can cause excess gas in the intestines.

Here are the foods and their ingredients that can be dangerous:

  • Lactose . This is the name of the main carbohydrate in dairy products.
  • Fructose .These are sugars, which are especially rich in sweet fruits (bananas, grapes) and honey.
  • Eggs. Excess gas and bloating are the main symptoms of egg allergy.
  • Gluten. This is a protein contained in cereal seeds, especially in wheat, rye, barley. Excessive consumption can lead to a variety of digestive symptoms, including bloating.
What to Do

Try to track what you ate before you have a bloating feeling in the stomach and intestines.Perhaps we are really talking about food intolerances.

Nicola Shubrook

Nutritionist in an interview with NetDoctor

If you suspect that you have a food intolerance, stop completely for at least 21 days and see if your symptoms improve .

6. You consume foods that cause excessive gas formation

Such foods include :

  • carbonated drinks, including beer;
  • products containing artificial sweeteners – aspartame, sucralose, sorbitol, xylitol;
  • some vegetables and fruits with a high fiber content – legumes (beans, peas, lentils), cabbage (white cabbage, Brussels sprouts, cauliflower), carrots, apples, apricots, prunes;
  • Food supplements containing fiber.
What to do

Try for a while to give up food that stimulates gas formation, and observe how you feel. If you manage to find a product that provokes bloating, you don’t have to give it up – just limit its use.

You can try supplementing the diet with foods that, on the contrary, reduce gas production.

Elena Kalen


To eliminate bloating, you can use fermented milk products: natural yogurt, kefir, fermented baked milk.They contain beneficial bacteria that help food digest. When bloating, it is worth eating porridge. Oatmeal helps to normalize digestion, and buckwheat porridge improves intestinal motility. The most popular home remedy for flatulence is dill. You can add it to salads to prevent bloating, or you can brew a decoction of dill seed.

7. You are constipated

Normally, there is gas in the digestive system. When there are too many of them, they retreat through the anus.But with constipation, the passage of gases is difficult. They accumulate in the intestines and cause bloating.

What to do

Understand the causes of constipation. When you normalize your bowel movements, the bloating problem will go away on its own.

8. You smoke

Smoking affects the activity of the digestive tract and may well cause gas formation.

What to do

Stop smoking. Or at least reach for your cigarette less often.

9.You have problems with the digestive system

Gas production is often increased in cases of bowel problems such as diverticulitis, ulcerative colitis or Crohn’s disease.

What to do

If bloating often bothers you, see a gastroenterologist, even if there are no other warning signs. This is necessary to exclude possible diseases of the gastrointestinal tract.

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5 causes of bloating and 5 foods

First you need to understand that gas formation is a normal phenomenon for the human body.The gases are involved in the digestion process and help the food move through the intestines. If the stomach is healthy and there are enough beneficial bacteria in it, gas formation does not bring a pronounced pronounced discomfort. But when you notice an unpleasant smell, heartburn appears, and your stomach turns stone, pay attention to your daily diet and eating habits.

In this article, we will consider in detail the dishes, products and products that not only do not cause bloating, but can also eliminate it. But first, it is important to know why such unpleasant symptoms appear.

Several causes of gas and bloating:

1. You ate a food or drink that triggered the gas formation

You may be using different foods in your meals that do not mix well and are difficult to digest. Or, certain foods cause these symptoms because of the individual characteristics of the body. If you are prone to gas formation, be careful with frequent consumption of beans, potatoes, sauerkraut, black bread.

Caffeine can cause irritable bowel syndrome and gas production.

Sweet carbonated drinks, kvass and kefir can also cause bloating. In addition, the experts of the European working group IBiS Club have determined that caffeine increases the sensitivity of the stomach, therefore, in some people, symptoms of irritable bowel syndrome appear precisely because of its use.

2. The body lacks enzymes for normal digestion of food

You may have noticed how heaviness in the stomach arises after eating a meat dish.The fact is that meat is a protein-rich product, and the proper amount of enzymes is necessary for its digestion. If there are not enough of them in the digestive tract, the meat is poorly absorbed and the stomach swells.

3. You overeat fatty foods

Fatty foods take longer to digest, and the body needs enzymes to digest them. If there are not enough of them, then bloating after fried potatoes is inevitable.

4. You talked while eating and air got into your stomach

When you talk while eating, air gets into your stomach and can cause flatulence.

Sometimes in a restaurant or just at lunch we have lively conversations, quickly swallow food and do not always chew it enough. All this impairs the digestion process. Also, when we talk while eating, air enters the stomach and provokes gas formation. No wonder the proverb says: “When I eat – I am deaf and dumb.”

5. You do not move much

Bloating can occur due to an inactive lifestyle. When blood circulation in the intestines is impaired, the digestive system suffers.Therefore, physical activity, walking and yoga are beneficial not only for the figure, but also for the internal organs.


Most often, foods that are unsuitable for the body cause bloating and flatulence. There are several ways to deal with unpleasant symptoms – take medicine, adjust your diet, or try folk remedies.

5 products that can eliminate gassing

Certain foods and natural remedies help with bloating and gas.

There are many fruits, vegetables and herbs that can help you get rid of gas without pills.Typically, these foods contain certain substances that are necessary for digestion. So remember.


This fruit contains a lot of potassium. It stimulates blood flow, regulates the amount of water in the body and the level of electrolytes in the colon. Resistant starch (a type of fiber in bananas) is an excellent prebiotic. Australian scientists talk about this in a study on the role of resistant starch and insoluble polysaccharides.

Banana electrolytes eliminate the negative effects of sweets, chips and burgers.And pectin, which is most abundant in green bananas, may help fight colon cancer, according to the University of Reading School of Nutritional Biological Sciences.

If for some reason you do not want or are uncomfortable to eat bananas in their pure form, try making kiwi and banana marmalade according to this recipe. Instead of sugar, it contains agar-agar and honey.


Pineapple contains a lot of bromelain, which is essential for normal digestion.

Bromelain is an essential enzyme necessary for normal digestion.It is found in pineapple and breaks down protein that sometimes makes it difficult to digest food.

This juicy fruit can reduce inflammation of the colon, which means you won’t get bloating after a pineapple smoothie. You can cook pork in sweet and sour sauce according to our recipe and add pineapples – they will help to digest the meat better.


A vegetable is 96% water and flushes its excess from the body. Toxins are removed along with the water. Therefore, the hydration of the body is improved and food is digested better.To prevent flatulence from finding you in an awkward situation, be sure to eat a couple of slices of fresh cucumber at a hearty dinner. Or make “broken” Chinese cucumbers using this recipe.


Greens, like cucumbers, expel excess water from the body. And cilantro contains enzymes and phytonutrients that are beneficial for digestion. These greens can be eaten neat or added to salads to reduce bloating, gas, and heartburn.


Most often, the benefits of the fruit are discussed with an emphasis on the high content of omega-3 in it.That being said, all the healthy fats in avocados not only have a beneficial effect on the health of the skin, hair and eyes, but also prevent bloating. The fruit is high in potassium, which helps the body eliminate sodium and excess water. Therefore, we advise you to definitely prepare a hearty and healthy breakfast with avocado and eggs according to our recipe.

5 natural remedies for flatulence

There are also natural remedies that can relieve unpleasant stomach symptoms.

In addition to products that eliminate bloating and gas formation, there are natural remedies that have the same effect.But you need to be careful with them – although they have therapeutic properties, they can cause side effects.


This herb is known to many to relieve anxiety and improve sleep quality, because it relaxes and soothes. But chamomile tea can also reduce indigestion, help get rid of gas in the intestines, and reduce stomach rumbling.

The recipe is simple: make yourself chamomile tea and drink it before meals or before bed.


To prevent flatulence by surprise, you can add a little cinnamon to your dishes.

The spice contains many antioxidants, which are especially needed by humans during the assimilation of food. A study by the University of Hong Kong compared the antioxidant activity of cinnamon to other spices and was the clear winner in preventing oxidation. But very often cinnamon is faked and cassia is sold instead. In this article, we will tell you how to recognize a harmful fake.

Also, cinnamon reduces pressure on the walls of the abdomen and acts as an excellent carminative. You can add a dash of cinnamon to baked goods or drinks to aid digestion.

The spice is used both in sweet dishes and in sauces. For example, in our recipe, beef stew is cooked with a tomato and cinnamon sauce.

Apple cider vinegar

The digestive system functions properly thanks to a sufficient amount of trace elements and vitamins such as beta-carotene, pectin, zinc, iron, potassium.Apple cider vinegar contains all of these nutrients, so it can help relieve intestinal discomfort. And pantothenic and lactic acids in it lower the alkalinity of gastric juice and accelerate digestion.

The easiest natural remedy for bloating: One teaspoon of 6% apple cider vinegar in a glass of water. The solution should be drunk every 2 hours during the day, 2-4 tablespoons.

Remember, this vinegar-based product must not be overused.

Dill and fennel

Infusion of dill or fennel seeds will help to better remove metabolic products.

You can use these plants to relax your digestive muscles. They contain anethole, estragole and fenchone, which will help relieve spasms of the intestinal muscles. Dill and fennel also dilate blood vessels. Therefore, if you add a little of their seeds to a dish or make dill water, the absorption of nutrients will accelerate, and this will contribute to a better elimination of metabolic products.

To prepare the infusion, put 1 tablespoon of dill seeds in a 200 ml glass and cover with boiling water. Let the broth infuse for about 20 minutes, strain it and take in small amounts 6 times a day.


This aromatic herb works in much the same way as chamomile – it relaxes the intestinal muscles, improves bile flow and helps food digest better.

Recipe for natural remedy with mint for bloating: Tear the leaves of the plant, pour boiling water over them and let it brew for 20 minutes. Drink the broth 3 times a day after meals.

Pay attention to what and how you eat

If you are experiencing gas and bloating, you are most likely lacking certain chemicals or enzymes needed to digest food.Also, unpleasant symptoms can be caused by poor diet.

Before taking medications, review your diet, understand which foods are causing bloating and try not to eat them. Add foods to your daily menu that, on the contrary, can relieve flatulence and try natural remedies.

Watch your health and eat right!

How to eat fruits and not be afraid of bloating

Almost all experts advise eating fruits every day, but what if they cause flatulence and bloating? Nela Berlanga, a pharmacist and nutritionist at Spain’s KilosOut, is ready to talk about which fruits are more likely to cause bloating and what to do to avoid digestive problems.Spoiler alert: you don’t have to give up your favorite fruits, you can just work on their negative properties.

Although Berlanga notes that there are no universal rules in nutritional matters – “what works great for one person can lead to indigestion in another” – the specialist admits that some fruits cause flatulence more often than others. “Fruits contain a lot of sugars like fructose and sorbitol, which can cause irritation and gas,” explains Nela.“They also have a lot of fiber. It is absolutely necessary for healthy bowel function, but when in excess it inhibits the digestion process, causes swelling and gas formation. ”

According to the expert, there are no fruits in the world that should be avoided, but if you have something to worry about, take on board her advice – they will help to minimize negative consequences.

Note which fruits are causing bloating.

It’s important to remember that fruits don’t affect everyone in the same way.Try watching your body’s response to what you eat. Also, keep in mind that some fruits are more likely to cause irritation. “Fructose is especially abundant in apples, bananas, grapes and figs. Not all of this sugar can be digested by the intestines, which can lead to irritation, ”explains Berlanga, adding that seasonal fruits are best eaten at their peak of ripeness.

Check what time of day discomfort occurs most often

As we have already determined, the reaction to fruits depends on the individual characteristics of the organism.For example, the rule that prohibits eating fruit after lunch and dinner is not universal. “Eating or not eating fruit after a full meal is a personal choice,” says Nela. – If you have a slow digestion, then fruits stay in the intestines longer, provoking irritation and flatulence. It all depends on how balanced its flora is and whether you have any digestive pathologies. ” The specialist advises to eat fruit at breakfast to start the intestines, but he also does not discourage fruit after a daytime meal or in the evening: “There is a theory that it is better not to eat fruit after two o’clock in the afternoon, but there is no conclusive evidence that sugar is perceived by the body worse or that the body does not have time to stabilize its level.By banning fruit in the evenings, many people start eating unhealthy snacks and gain weight. Fruit is a great choice if you need to suppress hunger and not get better. ”

Choose Bananas

Bananas are on the list of bloating fruits, and some health experts advise not to eat them at all if you are trying to lose weight – but they are the ones that a Spanish expert advises to pay attention to. “Banana is a real superstar in the fruit world,” says Berlanga.- Yes, compared to others, it contains more sugar, but this is not industrial sugar, it is useful. We not only do not prohibit bananas, but we advise you to eat at least one a day. This fruit is rich in potassium and contains tryptophan, a precursor substance for serotonin, the hormone of happiness. Bananas are also very easy to carry with you, because they are already in their natural “packaging”. And of course they are just delicious. ”

Combine fruits with kefir

If your body does not want to cope with some fruits, you can try combining them with probiotics.For example, with fermented dairy products, which Nela says help regulate intestinal flora. Try adding kefir or yogurt without sugar or other additives to your fruit.

Drink warm infusions

Some spices like oregano, cinnamon, fennel, mint, ginger, bay leaf and sage stimulate the production of digestive juices and, as a result, improve digestion. To reduce the likelihood of bloating, you can try drinking the fruit with these infusions or adding them to warm tea.

Eat slowly

This golden rule should never be forgotten, and even more so in the case of bloating foods. It is important to chew the fruit thoroughly to help the intestines cope with the shock of fructose. “You should eat slowly, drink enough water, and watch what other gas-stimulating foods you eat,” Berlanga advises.

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Top 5 dangerous foods that cause bloating are named (PHOTOS)

YEREVAN, August 22. News-Armenia . These five foods can trigger bloating.


Any grape is a heavy product for digestion. Fructose, abundant in grapes, causes gas production and inevitably leads to bloating. The thing is that for its digestion the stomach requires certain enzymes, which are not always produced in the right amount.This also applies to apples, peaches, melons and pears. In addition, grapes are quite high in calories, so it is rarely recommended to eat it and only as a dessert.


Cabbage itself is an extremely useful vegetable: it is rich in fiber, various minerals and vitamin K, but it is better to refuse it before putting on a tight-fitting dress. Important: this only applies to raw vegetables, since heat treatment destroys coarse fiber, which is the main cause of bloating.Braised or baked cabbage can be eaten at any time.

Bread and pastries

Bread and any baked goods (especially hot) made from white flour, in principle, should be limited, since it will not bring anything but an extra carbohydrate load to the body. The yeast and sugar used in making bread trigger gas and fermentation in the stomach and can cause bloating and a host of other uncomfortable sensations. If giving up bread doesn’t work at all, opt for the yeast-free options made from whole grain flour.

Cottage cheese with jam

Lactose and lactose bacteria contained in all dairy products themselves can cause bloating and difficulty in digestion, but if they are used with fruits and sugar (and jams and preserves contain both , and more), the situation can worsen dramatically. For digestion, such a mixture is extremely difficult: proteins are broken down for a long time, and the jam, in the meantime, begins to ferment. By the way, this also applies to coffee with milk – if you do not drink the drink in its pure form, try replacing cow’s milk with vegetable milk.

Carbonated water

Here everything is more than logical: both sweet carbonated drinks (they generally do not recommend to use nutritionists), and ordinary mineral water contain air bubbles, which inevitably lead to an increase in stomach volume. Bloating can last up to 3-4 hours and be accompanied by heaviness and discomfort. This is not a reason to give up mineral water altogether – it is very useful – but its use should be treated with caution. -0-

8 products that will relieve bloating

Here’s what the author of Essential Sports Nutrition, sports nutritionist Marnie Sambel, advises to deal with this problem.

Bloating is an unpleasant sensation. You just felt great, and suddenly you feel that you are swelling like a fish-ball.

This is one of the most common stomach troubles. Bloating occurs when fluid or gas builds up in the abdomen. Sometimes bloating is accompanied by pain and discomfort.Certain types of food, constipation and overeating, irritable bowel syndrome (IBS), and swallowing air when drinking or eating too quickly can all trigger this condition.

Fortunately, there are products to help you.


At times, increased gas formation and bloating occurs due to the fact that the bacterial balance in the digestive tract is out of order. Probiotics from some fermented foods like kefir come to the rescue.(Kefir must be fresh, no older than yesterday)

Yogurt is also a reliable source of probiotics, but kefir contains 3 times more nutrients than yogurt. In addition, kefir is practically free of lactose, which some people cannot tolerate.

If you don’t like drinking kefir just like that, you can make a smoothie out of it, add it to muesli instead of milk ..


Cyclists need to include sodium in their diet to compensate for the loss of salt that is excreted along with sweat during riding, but excessive amounts of salty food retains water in the body.Treat yourself to plenty of potassium-rich foods like avocados to help flush out water.

“Sodium sucks water into cells and potassium pumps it out, which can help get rid of bloating,” says Sambel.

The norm for an adult is 4,700 milligrams of potassium per day, but most people don’t get that much. Potassium champions: Avocados, potatoes, bananas (of course!), Beans, spinach and pumpkin. Avocado is good to include at least in breakfast, at least at lunch and dinner.It contains healthy fats that make you feel full.


Ginger, one of the oldest home remedies for everything from muscle aches to sore throat, can work wonders when you feel like Michelin-starred after a hearty meal.

“Ginger stimulates the production of intestinal fluid, which is involved in digestion and helps reduce bloating caused by indigestion,” explains Sambel.

Boil several small pieces of fresh ginger in hot water and drink after meals instead of tea. Fresh ginger can also be added to smoothies and salad dressings, and ground dried ginger can be used as a spice.

Oranges & Company

Fiber is essential for bowel function, but sometimes increased gas production and bloating becomes a side effect of its consumption. Water is needed to stimulate the movement of fiber through the digestive system.In addition to drinking water, you must add foods rich in water: oranges, melons, berries, cucumbers. An additional plus – after these products, swelling does not occur.


Asparagus is a natural diuretic. In addition, asparagus contains prebiotics (not to be confused with probiotics), which are not processed in the stomach, but serve as food for the microflora in the large intestine, thus improving digestion.


If you feel bloated after eating, have a mug of mint tea.

“The oils in peppermint help relax the muscles in the gastrointestinal tract and reduce the spasms that caused discomfort and bloating,” says Sambel.

Brew fresh mint leaves , as oils against swelling evaporate during drying and grinding of leaves. Fresh mint leaves can also be added to salads or mixed with fruits.

Beans and cabbage

This sounds counterintuitive at first glance, but if after legumes or cruciferous vegetables, such as broccoli, you get the feeling that you’ve swallowed a volleyball, you should eat them more often.

So if you only eat beans or kale once a year and get bloating, try adding them to your diet regularly.

“Frequent eating of poorly tolerated cooked vegetables rather than raw vegetables can make them easier to digest as you train your body to eat them,” explains Sambel.

Dill and fennel seeds

There is a long tradition of using these seeds to reduce digestive problems such as bloating and cramps.It looks like fennel and dill seeds contain compounds that ease gastrointestinal spasms.

When you want your stomach to behave well, you can chew the seeds or steep with hot water and drink like tea. You can use them as a seasoning in cooking: soups, spaghetti, etc.

Flatulence: how to avoid unpleasant situations – VIDEO

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19 March 2016 11:30
Editorial staff

The formation of gases in the gastrointestinal tract is a normal physiological phenomenon.And what to do when excess gas builds up? Do foods cause bloating? All the answers are known by the nutritionist of the Snidanok z 1 + 1 program Galina Nezgovorova.

So, flatulence is often accompanied by general weakness, interruptions in the work of the heart, headache and sleep disturbance.

Causes of bloating:

  • Stressful situations
  • Parasites
  • Diseases of the gastrointestinal tract, pancreas
  • Intolerance to cereals, milk and fiber.

What foods cause bloating?

  • Legumes, cabbage, green onions, radishes, bell peppers, mushrooms
  • Apples, grapes
  • Dairy products, yeast products
  • Wine and carbonated drinks.

How to avoid bloating?

  • Remember which foods cause flatulence in you, limit them or eliminate them altogether. Try to eat less fatty, fried, sweet foods.Eat slowly and move more.
  • To eliminate flatulence, drugs are most often used that reduce gas formation in the intestines. However, it is best to see your doctor to determine the cause. The sooner the diagnosis is made, the sooner you will get rid of the discomfort.

Watch the story on how to avoid bloating:

90,000 6 culprits for bloated abdomen – RU.DELFI


Bloating may be related to the foods we eat.Although we can eat a healthy diet, certain foods such as broccoli and milk can cause flatulence, stomach pain and bloating, which are extremely uncomfortable.

  1. Broccoli. Although it is full of fiber and vitamins, broccoli can also
    cause gas and bloating. Try to eat your broccoli very slowly to
    reduce this negative effect.
  2. Sweeteners
    (artificial sweeteners) Although they will help you “save” on
    calories, but artificial sweeteners contain sugar alcohols,
    which can cause bloating. Minimize usage
    artificial sweeteners or eliminate altogether to reduce
    unpleasant gas formation.
  3. Cabbage. Delicious and healthy food that is great
    a source of vitamins. Plus we can enjoy it all year round. But
    this leafy vegetable can also stimulate gas and cause
    painful bloatingAvoid it if you have “problems with
    belly “.
  4. Carbonated drinks. While some popular sodas
    were formulated to aid digestion, they can also cause bloating