Bloating is common, but when is it time to seek help, and how is it managed
If you have to unbutton your pants after dinner, take comfort in knowing you are far from alone. While bloating may feel embarrassing, it’s actually a common condition that affects nearly one in seven Americans every week, according to a study published in the November 2022 Clinical Gastroenterology and Hepatology.
The study looked at nearly 90,000 survey results from patients who sought medical help for gastrointestinal (GI) issues.
Researchers found that bloating is highly prevalent, affects women more frequently than men, and is a common side effect in people who deal with other digestive conditions like inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), or chronic constipation. And yet, nearly 60 percent of people who had recent bloating did not seek medical care for it.
“That suggests that there are a lot more people frequently experiencing bloating and not mentioning it to their doctor,” says Janice Oh, MD, a physician at Cedars-Sinai in Los Angeles and the lead author of the study. “However, it is important to bring up, because there may be an underlying condition that your doctor could help treat.”
According to Dr. Oh, not only can bloating manifest in different ways, from abdominal discomfort to an abnormally swollen belly, but it also has various causes that can be tricky to pinpoint.
“There’s no standardized way to treat bloating,” she says. “That’s why it is important to share your story with your doctor so they can put the pieces together.”
Reasons Why You Might Feel Bloated
Some causes of bloating include changes to the gut microbiome, where trillions of bacteria, viruses, and fungi populate our intestines; abnormal movement of the diaphragm (think involuntary contractions in the muscle under your lungs and above your abdomen); gas; and constipation. Bloating is highly prevalent in eating disorders like anorexia and bulimia. It can also stem from a liver problem such as ascites that builds up fluid, which may be a precursor to cirrhosis in some severe cases.
And bloating can also build up fluid because of blockages in the lymphatic system from various cancers, including ovarian, stomach, or colon cancer. Belly pain from IBS-constipation can trigger bloating.
If you experience bloating on a regular basis, Oh says it’s time to take control of diet and exercise, and seek help for general bowel movements if it becomes a pervasive issue. “When you feel day-to-day bloating, take note of what you eat and try to identify what’s causing it. Also try to walk more, hydrate, and slowly increase your fiber intake.”
Barbara Olendzki, RD, MPH, a dietitian at the University of Massachusetss Chan Medical School in Worcester, often sees bloating in patients who lack certain enzymes that help with digestion. For example, lactose intolerance, which is an inability to fully digest the sugar lactose in cow’s milk, is caused by a deficiency in lactase. “A lot of the time patients will confuse an enzyme deficiency for IBS,” she says.
Olendzki also notes that bloating may be correlated with anxiety and stress, since stress can contribute to a range digestive issues, according to a study in the Journal of Physiology and Pharmacology. But the exact way that anxiety and stress affects our digestive system is not fully understood.
A study in the March 2019 Advances in Therapy noted that stress may contribute to bloating, and people who experienced bloating were more likely to feel anxious and depressed. One theory is that stress slows digestion, which could lead to bloating. Olendzki recommends relaxing activities, like meditation, and exercises like walking and yoga, to help reduce stress.
“When we see significant bloating and medicine or dietary interventions are not helping, we want to provide reassurance to our patients that we will find strategies to cope with it,” says Megan Riehl, PsyD, a GI psychologist at Michigan Medicine in Ann Arbor.
Dr. Riehl teaches her patients several techniques to cope with bloating, including abdominal self-massage, diaphragmatic breathing or deep-breathing exercises into the abdomen rather than the lungs, and GI-directed relaxation that steers relaxing thoughts to the abdomen.
“When bloating starts to get in the way of your day-to-day functioning and you find yourself using heat pads or avoiding work and social situations, it’s time to talk to your provider,” she says.
