Introduction
Bloating is characterised by abdominal fullness, pressure, the sensation of trapped gas, and an increase in abdominal size. In case of a bloated stomach, one may feel severe abdominal pain and constipation. Bloating occurs in almost all patients with Irritable Bowel Syndrome and constipation. However, the history of bloating is yet to be completely understood.
Causes of Stomach bloating
- Fluid within the lumen of the gut
- Faeces
- Inappropriately contracted diaphragm
- Intra-abdominal fat
- Weak or inappropriately relaxed abdominal muscles
- Psychiatric problems
- Small intestinal bacterial overgrowth
- lactose, Fructose and other carbohydrate intolerance
- Pancreatic insufficiency
- Prior gastroesophageal surgery
- Hypothyroidism
- Gastric outlet obstruction
- Ascites
- Gastrointestinal or gynaecological malignancy
- Intra Abdominal gas
Symptoms of Bloating
The five Fs usually refer to causes of abdominal bloating:
- Fat
- Faeces
- Foetus
- Flatus (the air that is passed through the rectal opening)
- Fluid
Diagnosis of Bloating
Symptom-based diagnostic tests for abdominal bloating include the following.
A clear clinical history and physical examination are vital to understanding the cause of bloating and distention.
1. Breath Tests
Breath tests are a safe and non-invasive way to measure carbohydrate malabsorption. Breath tests are of two kinds:
- Lactose Breath Test: This test has excellent sensitivity and specificity.
- Fructose Breath Test
2. Small intestinal bacterial overgrowth (SIBO)
SIBO can cause symptoms like bloating, abdominal pain, gas, and diarrhoea. Though jejunal fluid analysis is the gold standard test for SIBO, The breath test is an inexpensive, non-invasive method that is the best alternative to the jejunal fluid test.
3. Celiac serological examination
Malabsorption of gluten and wheat will lead to bloating, distention, and death in cases of untreated celiac disease. Serological testing using tissue transglutaminase and IgA is suggested for celiac disease.
When a celiac serological test is positive, later, upper endoscopy and small bowel biopsies should be performed to confirm celiac disease.
4. Upper endoscopy
It is recommended when patients show alarming symptoms. Symptoms include recurrent vomiting and nausea, unexplained anaemia, hematemesis, weight loss that is greater than 10% of body weight, and gastric outlet obstruction. The upper endoscopy also allows biopsies of the small intestine and stomach.
5. Abdominal Imaging
This method is used to treat constipation symptoms. Other cases where abdominal imaging is warranted are those with prior abdominal surgery or Crohn’s disease. A CT scan of the abdomen and a CT or magnetic resonance imaging enterography are two abdominal imaging techniques used.
6. Gastrointestinal Function
Bloating is prevalent in patients with gastroparesis (a condition where abdominal muscles do not function normally or spontaneously). A four-hour scintigraphic gastric emptying study is used to test gastroparesis.
7. Anorectal Function Testing
Patients with severe bloating, constipation and a characteristic rectal exam will be advised to undergo an anorectal function test. Anorectal manometry with balloon expulsion is the test used for anorectal disorders.
Remedies for Immediate relief in bloating
- Peppermint Oil: Peppermint oil (180 mg, taken three times daily) consumption has shown a significant decrease in symptoms of bloating and distention.
- Physical exercise improves intestinal gas clearance and also reduces symptoms of bloating.
- A mixture of fennel seeds and rock salt aids in the digestion process. One teaspoon of fennel seeds mixed with one teaspoon of rock salt, when taken, is also used to relieve acidity and heartburn, making it a natural alternative to acidity medicine.
- Traditional Spices: Spices like ginger, garlic, cumin (jeera), and asafoetida (hing), when used during cooking, will help in the digestion process, thereby preventing bloating.
- Activated charcoal tablets help in reducing flatulence.
Treatment for Bloating
Treatment options for bloating include:
- Diet
- Exercise and Posture
- Over-the-counter medicines
- Probiotics
- Antibiotics
- Smooth muscle antispasmodics
- Osmotic laxatives
- Prokinetics
- Chloride channel activators
- Tricyclic Antidepressants
1. Diet
A study has shown that reducing fermentable carbohydrates in the diet significantly reduced bloating and improved irritable bowel syndrome. In severe conditions, a strict diet including water, broth, boiled chicken, and egg whites is recommended. Some patients reported significant improvement after reducing their intake of wheat and carbohydrates.
2. Over-the-counter medicine or immediate relief remedies
Simethicone, an anti-foaming agent, helps reduce bloating; apart from this, alpha-galactosidase helps improve flatus and gas production.
3. Probiotics
Probiotics can be defined as living organisms that have health benefits when given in the recommended amounts. Probiotics like Lactobacillus acidophilus and Bifidobacterium lactis have also shown good effects in improving severe bloating cases.
4. Antibiotics
Rifaximin has been one of the most widely studied antibiotics for bloating and is the most commonly prescribed medication. It is given in a dosage of 400mg/ three times daily.
5. Tricyclic Antidepressants
Tricyclic antidepressants are indicated when there is associated abdominal pain. It also helps in improving bloating conditions.
6. Osmotic Laxatives
Osmotic laxatives like PEG (polyethylene glycol) are best for treating chronic constipation.
7. Prokinetics
Neostigmine is a potent cholinesterase inhibitor used to treat acute colonic obstruction.
8. Other Drugs
The other drugs prescribed selectively and with imitations are domperidone, cisapride, metoclopramide, and Tegaserod.
9. Chloride channel activators
Lubiprostone is the most effective drug indicated to improve the symptoms of bloating.
Linaclotide is effective against abdominal bloating, pain, and strain. It also helps with the frequency of passing stool.
Risk factors for bloating
Patients with surgery in the past for diseases like rheumatoid arthritis show the growth of microorganisms outside the intestine that leads to bloating. Irritable bowel syndrome occurs due to a slightly high accumulation of gas inside the stomach and may also lead to abdominal cramps.
Specialist to visit
Gastroenterologists can treat the underlying cause of the disease which may result in bloating.
Conclusion
Abdominal Bloating is a bothersome and embarrassing disorder. Still, its symptoms and causes are well-defined, making it simple to identify and treat at home or with the help of a doctor. The severity and duration of the disorder determine treatment options. One may try home remedies to treat the disease if symptoms are mild. Do seek consultation from a physician if the symptoms do not go away quickly. Severe bloating conditions are uncommon and need expert treatment from medical professionals. Avail teleconsultation from our expert doctors on our online pharmacy while ordering for medicines or you can also download our Truemeds app to do the same. Get branded as well as generic medicines by uploading your prescription on Truemeds. When placing an order for medicines online, you may save more money by selecting alternative or generic medicine advised by Truemed’s expert doctors. And also, save up to 72% on your purchase and get free home delivery pan India.
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