Why am I so bloated all the time?
Most of us will suffer from bloating or distension of our abdomen from time to time but for some people it is persistent or severe and causes significant distress.
Very occasionally, it can signify something serious going on, but more often than not it doesn’t, and a simple change in diet or lifestyle can help.
Here are some things to think about if bloating is a problem for you:
❚ Mostly bloating is caused by gas in our intestine. Some people we know are more sensitive to the presence of gas than others, and will experience pain, bloating, discomfort or even diarrhoea with ‘‘normal’’ amounts of gas – this includes people who suffer from irritable bowel syndrome. We don’t fully understand why these people’s bodies react so strongly to the presence of gas, but it may have something to do with the types of bacteria that have colonised their gut.
❚ Some people get bloating because they swallow too much air – this usually happens when people eat too quickly, and don’t take enough time to chew their food, but it also happens in people who chew a lot of gum or smoke. If you eat a meal, then lie down shortly afterwards, it will also affect the passage of gas through your intestine, and can lead to bloating and wind.
❚ For others, bloating is due to an excessive amount of gas in the bowel – usually because too much gas has been produced during the digestive process, resulting in distension of the bowel, pain and ‘‘wind’’ (either through the upper gut known as burping, or via the back passage known as flatus or farting). People who are intolerant to certain food groups tend to produce more gas – this includes people who are intolerant to gluten (coeliac disease), lactose (the sugar associated with dairy products) or fructose (the sugar associated with fruit). Intolerance to food additives is also common, especially one known as sorbitol – this is found in many artificially sweetened food products, such as chewing gum and ‘‘sugar free’’ sweets.
❚ We know certain food types produce more gas than others, so if you eat a diet rich in beans, broccoli, brussels sprouts, or very starchy foods such as noodles, corn or potatoes, you are likely to get more bloating.
❚ Constipation is a common reason for feeling bloated, and women will often report bloating around the time of their period – this can be due to ‘‘sluggish’’ bowels that happen in the pre-menstrual days, but can also be caused by a bit of fluid retention.
❚ Rarely, bloating can be a sign of an underlying serious medical issue. This can include gut problems such as blockages (known as obstructions), diverticular disease or bowel cancer, as well as other diseases such as ovarian cancer, cysts, liver or kidney disease. Usually these diseases will cause other symptoms that indicate something is going on, but if you have suddenly developed bloating that you haven’t had before, or have noticed weight loss or a change in your bowel habit, it is definitely worth getting a prompt doctor’s assessment.
❚ Occasionally medication can lead to bloating, so it’s worth checking any tablets you are taking to see if it is a recognised side-effect. Really common culprits are metformin (used to treat diabetes) and lactulose (used to treat constipation). Patients report huge relief when they are able to switch these medications to alternatives that don’t have the same sideeffect.
If you have ‘‘simple’’ bloating, and have checked with your doctor to ensure there isn’t anything important underlying it, the following tips might be helpful to alleviate your symptoms:
❚ Diet – it’s really worth ‘‘tracking’’ your diet and figuring out which food groups affect your bloating. Making changes based on that information (for example, eliminating foods containing sorbitol) may be all you need to do to avoid getting symptoms in the future.
❚ Probiotics – the jury is out, but some patients report good results by using probiotics to enhance the bacteria in their gut.
❚ Don’t lie down after eating.
❚ Avoid smoking and chewing gum.
❚ Eat slowly.
❚ Exercise – it is well known that being active reduces your chance of bloating, partly because being upright helps your digestive system to process food effectively.
❚ Peppermint – some people get benefit from peppermint – either in the form of a tea, or a capsule that you can buy in the chemist. Don’t try peppermint in the form of a lolly as it may well contain sorbitol and make your symptoms worse!
❚ Medications – if all else fails, talk to your doctor about whether or not an anti-spasmodic such as mebeverine might help.
❚ Dr Cathy Stephenson is a GP and forensic medical examiner.