Why am I bloated all the time?

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Understanding why bloating happens, and treating it, can be a challenge for patients and providers. (Photo: Envato Elements)
Every week at my gastroenterology practice, my patients complain about their clothes feeling too tight, their bellies feeling squeezed. “It’s like I’m 30 weeks pregnant” is a common refrain, from 65-year-old men and 20-year-old women alike.اضافة اعلان

It is no surprise, then, that these patients are suffering from bloating, that unpleasant feeling of pressure in the stomach that affects an estimated 1 in 5 adults. (A separate but related phenomenon, called distention, describes the visible increase in abdominal girth that often occurs along with it.)

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

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

Those with certain medical conditions — like lactose intolerance, celiac disease or disorders that affect the way the gut moves contents throughout the body (like gastroparesis) — have more regular bloating as a result of excess gas.

If you do not have those conditions but have bloating that persists for months, you may have something called functional bloating. Conditions like irritable bowel syndrome or chronic idiopathic constipation fall into this category. In such cases, exams generally appear normal, but bloating is a major, recurrent symptom that impinges on daily life.

These cases of bloating often occur not because of skyrocketing gas production but because of the way the abdomen reacts to the gas. “With bloating, a lot of it is body mechanics,” said Dr. Linda Nguyen, a gastroenterologist and clinical professor of medicine at Stanford Medicine.

Abnormal muscle movements — and the bloating that accompanied them — can occur because the nerves of the gut and abdominal wall are overly reactive to otherwise normal amounts of pressure from inside the intestines (called visceral hypersensitivity.)

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

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

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

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

In some cases, fixing the underlying cause of your bloating may require more than just dietary and lifestyle tweaks. Patients with gastroparesis or significant constipation may benefit from a drug called prucalopride, which helps empty the stomach and expel waste. (Experts do not recommend at-home interventions that empty your gut, like colonic irrigation, because they can cause trauma or tears to the gastrointestinal tract.)

Infrequent stool, straining, or feeling as though you have not ever quite fully “emptied” can also contribute to bloating.

Some causes of bloating are not directly related to your gut at all. Some patients who snore or regularly use CPAP machines for sleep apnea, for instance, might have extra bloating upon waking in the morning, Harer said. Patients with liver disease can have distention. And menstruation and certain types of contraceptives may increase bloating.

Nobody should ever feel ashamed of changes to their midsection, Harer said. “Patients should feel empowered to discuss bloating with their providers and get the help they need.”

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