How to tell the difference between a normal bloated stomach and something more serious

Because sometimes bloating just happens.

Feeling like you have a bloated stomach is normal. There’s nothing wrong with experiencing minor bloating after, say, having a meal. Even if it’s uncomfortable, it’s usually temporary. Let’s all thank evolving fashion technology for elastic waistbands and not make ourselves feel bad about having a bloated stomach. With that said, persistent bloating can sometimes be an indication that something’s going on with your health, which might be worth getting checked out.

“I think it’s important to differentiate the sensation of bloating from the physical change of what we call distension,” says Dr Simon Hong a gastroenterologist specialising in inflammatory bowel disorders (IBD) and clinical assistant professor at NYU Grossman School of Medicine. “They often go together, but bloating is that feeling of feeling full, which most people attribute to gas.” Distension, he explains, is a noticeable difference in the size of your abdomen.

Feeling bloated for a few hours can be normal for many reasons. Experiencing distension alongside that sensation can be normal too. But if your abdomen is physically distended and doesn’t return to where it was before, that’s concerning.

Look for food-related patterns in your bloating

“The sort of bloating that may be less dangerous, so to speak, is the kind that seems to have a regular pattern,” says Dr Hong. That is especially relevant to your diet. If you’ve noticed that you’re regularly getting unusually bloated – relative to what you’re used to – after eating, consider what was on the menu, especially anything new. There are a few common dietary culprits that cause bloating in many people. Lactose is one example from a group of food substances called FODMAPS to look out for when tracking your diet and bloating. Take a deep breath before reading what that stands for: fermentable oligosaccharides, polyols, disaccharides and monosaccharides. These are carbohydrates that your body struggles to digest and absorb, which can lead to bloating and distension. As well as in dairy products, FODMAPS are present in certain fruits and vegetables – including onions, cauliflower, apples,

and watermelon — as well as legumes, processed meats, wheat, rye, highfructose golden syrup, and nuts like cashews and pistachios. FODMAPS don’t affect everyone equally, so while certain FODMAPS may make you feel bloated, you may be able to process others just fine. The intention isn’t to permanently stop eating every kind of FODMAP because you think some may be behind your bloating – it’s best to check with someone like a doctor or registered dietician before trying any kind of elimination diet for health purposes. Fibre is another food substance that our bodies aren’t good at digesting, with potentially bloating consequences. You mainly break down fibre in your colon, where it produces gases including carbon dioxide, hydrogen, and methane. These cause bloating until you literally “break wind”. The US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says that doing this 13 to 21 times a day is considered normal – so let it rip. As the Mayo Clinic explains, eating adequate amounts of fibre helps your digestive system function more smoothly.

Consider if your bloating is lining up with your menstrual cycle

If you’re someone who has periods, that’s another factor to track when you’re looking for patterns in your bloating. A 2014 study in BMC Women’s Health asked 156 women about their gastrointestinal symptoms before and during their periods. The results showed that bloating was the most common Gi-related symptom pre-menstruation and the second most common (behind abdominal pain) during menstruation. Unlike bloating due to digestive issues, bloating related to your period could happen because of fluid retention rather than gas. Bloating that’s connected to your menstrual cycle is pretty normal. But that doesn’t make it much fun.

If you’ve also noticed that certain foods make you feel bloated, consider limiting them in the days leading up to your period (within reason – as we mentioned, the idea is not to just cut out every food group you think could be behind your bloating). To help reduce water retention, the Mayo Clinic recommends steps like curbing your salt intake if sodium is a factor.

Talk to a doctor if you think a gastrointestinal disorder is causing your bloating and distension

If your bloating doesn’t follow a neat pattern, you can’t pinpoint a factor behind it such as hormonal changes or lactose intolerance, and you experience additional bothersome symptoms, you could have a gastrointestinal condition such as ulcerative colitis or Crohn’s disease. These both fall under the umbrella of inflammatory bowel disease (IBD), which describes conditions that cause inflammation of various parts of the bowel. Centres for Disease Control and Prevention explains that ulcerative colitis affects consistent stretches of the large intestine and rectum, while Crohn’s disease can affect any part of the digestive system, with inflammation usually occurring in patches. In addition to bloating, here are symptoms that may indicate IBD: abdominal pain, diarrhoea, blood and/or pus in your stools, fever, unexplained weight loss and fatigue. People with Crohn’s or ulcerative colitis can go for long periods with no symptoms. But these are serious, chronic conditions that require treatment. Left untreated, ulcerative colitis can lead to rectal bleeding, joint inflammation, and inflammation in deep tissue layers of the large intestine, while Crohn’s can lead to ulcers, intestinal obstructions, fissures, and abscesses. Other medical conditions can cause persistent, painful bloating, including irritable bowel syndrome (also known as IBS, this describes a wide range of symptoms with no observable physical cause) and celiac disease (a chronic disease in which the immune system attacks the small intestine when it detects the presence of gluten). If you’re regularly experiencing any uncomfortable symptoms in addition to your bloating, including pain and/or diarrhoea, talk to your doctor. They may recommend investigating with blood tests such as a C-reactive protein (CRP) test, which can show whether you have

“If your abdomen is physically distended and doesn’t return to where it was before, that’s concerning”

inflammation that may indicate a health condition, and a faecal calprotectin (CALPR) test, which specifically tests for active GI inflammation, Dr Hong says. They can also offer guidance on other diagnostic tests you may need, like an endoscopy, in which a doctor uses a flexible tube to examine your digestive system. Based on the issue in question, treatment follows from there. Most of the time, bloating indicates nothing more than your digestive system doing its job. And now that you know how to determine if it’s potentially serious, you can tell the difference between when you may need to see a doctor – and when it’s time to change out of your uncomfortable jeans.