Let’s talk a bit about bloating. There is “normal bloating” which can occur in anyone after eating a particularly large meal or one high in fat (think a fried fish platter!) or even after eating a big bowl of chili. Bloating isn’t always a sign that something is not working right in the body. Bloating can simply reveal that we are feeding the gut microbes that live in our gut. These resident intestinal microbes keep our immune system working, create several vitamins and help our body digest fibers. Unfortunately, in people with irritable bowel syndrome (IBS), bloating often comes hand in hand with significant belly pain.
When bloating is associated with pain, as is common in IBS, therapeutic interventions can be helpful, such as a low FODMAP diet. FODMAPs are a group of small carbohydrates that pull water into the gut and are rapidly consumed by our gut microbes resulting in gas. FODMAPs are found in many everyday foods such as in apples, pears, wheat, garlic, onion, milk, watermelon and more. A low FODMAP diet is a nutritional intervention that has been shown to scientifically reduce IBS symptoms, particularly pain and bloating, in up to 86% of those who have this condition. Fortunately, there are several certified low FODMAP foods and snacks, such as BelliWelli snack bars to help make the low FODMAP diet easier to follow.
When bloating leads to pain or interferes with life, it is essential to seek guidance from a doctor. Bloating may simply be due to diet choices or can reflect other conditions that warrant a medical evaluation such as: inflammatory bowel disease, celiac disease, irritable bowel syndrome or in rare cases, cancer. As always, do not self-diagnose.
Bloating versus abdominal distention
It’s common for people to think that when their belly expands, they are experiencing bloating. But bloating refers to the sensation of fullness in the gut, not the expansion of the gut. The term abdominal distention is the term used to describe the physical change of an expanded belly. Okay, now that we have the terminology covered, let’s discuss a bit more about bloating and abdominal distention in IBS and how we may treat it.
What causes of bloating and abdominal distention?
A few factors can contribute to the feeling of bloating or the reshaping of the gut, leading to abdominal distention. The perception or feeling of bloating can occur in IBS, as the gut and brain communications are escalated and a small amount of gas in the belly may trigger the brain to over-exaggerate the feeling of gas. In IBS, the gut and brain tend to over-share or over-dramatize, resulting in the perception that the gut is really overfilled with gas, even it is not.
We may feel bloated and experience increased gas production in the gut due to our diet. We all feel a bit over-full of gas if we eat a bowl of chili. Bloating can occur due to the type of microbes in our gut and how they interact with our food. Some individuals have gut microbes that are very efficient at breaking down dietary fiber into copious amounts of gas. IBS is a motility disorder in which gas can become trapped, leading to the sensation of bloating and distention. When a belly experiences significant distention (or growth), this may be a sign of small intestinal bacterial overgrowth (SIBO), a condition in which microbes over-grow in the small intestine (an area of the gut where there should few microbes). Too many microbes are in the small bowel, leads to gas in the small intestine as these microbes can interact and consume the food we eat before it even has had a chance to be digested. This upper gastrointestinal gas is harder to expel as it is far up in the gut. Another condition associated with expansion of the belly, is abdomino-phrenic dyssynergia (APD). APD describes the failure of the abdominal wall muscle to contract and the diaphragm to relax after a meal. Instead, the anterior abdominal wall relaxes and the diaphragm contracts and this redistributes gas which can lead to the sensation of bloating and visible belly distention. Why this happens in some people is poorly understood.
Treatment consideration for those with IBS experiencing bloating and abdominal distention
Depending on the cause of the bloating and/or distention treatments may vary.
When bloating is associated with:
- Eating-speak with your dietitian or gastroenterologist to see if you are a good candidate for a low FODMAP diet or a breath test for small intestinal bacterial overgrowth.
- Belching-consider diaphragmatic breathing or cognitive behavioral therapy, two behavioral therapies that may help manage these symptoms.
- Constipation-consider working with a gastroenterologist to help provide a good “bowel program” such as a trial of a laxative or fiber supplement, or try a “squatty potty, that encourages better posturing while pooping. Your healthcare provider may encourage an evaluation for dyssynergic defecation, a condition linked to constipation, that is treated with pelvic floor physical therapy or biofeedback.