BloatingAlso known as Stomach gas, Belching, Flatulence and Abdominal distension
A lot of people complain about gas trouble but don't take it seriously because they think it is embarrassing. But there's a lot you need to know about this common digestive physiological process. Gas is produced as a by-product of the normal digestion process which occurs in the body. Excess gas escapes either through the intestine in the form of a ‘flatus’ (farting/flatulence) or through the windpipe in the form of a ‘belch’ (belching/burping). In some cases, it may also be retained in the digestive tract and lead to abnormal bloating.
Usually, intestinal gas causes no medical problems and is a normal occurrence. But occasionally, it can be a symptom of an underlying medical condition such as irritable bowel syndrome, malabsorption syndrome, Crohn’s disease, inflammatory bowel syndrome, intestinal obstruction, etc.
An excess gas formation can be treated with over-the-counter (OTC) medications and certain prescription drugs that help reduce bloating and improve digestion. Lifestyle changes in the form of a healthy diet and mild exercise are also known to reduce the symptoms.
- All age groups
- Both men & women
- Large intestine
- Small intestine
- General physician
Causes Of Bloating
The normal digestive process that breaks down the food, mainly starch and cellulose containing food, into soluble easy to digest form, releases gas as a by-product.
However, certain conditions may result in excessive gas formation, which may cause troublesome symptoms. For example:
Consuming higher quantities of certain foods that cannot be easily digested in the small intestine, like beans, cabbage, cauliflower, broccoli, cereal, etc.
Eating stale food or undercooked food which leads to over-fermentation in the intestine, resulting in the release of gases with a foul-smelling odor.
In people with lactose intolerance, consumption of milk and dairy products leads to indigestion and the formation of excess gas.
Swallowing a lot of air while eating food. Air enters the stomach via the mouth and gets mixed with the food, and maybe released by burping.
Consuming aerated beverages causes excessive gas to enter the stomach and can be a cause for belching or burping.
Certain protein and multivitamin supplements and artificial sweeteners also cause excessive gas.
Small intestinal bacterial overgrowth is a condition in which the intestinal microbes increase in number and lead to increased breakdown of food, causing gas, bloating, malabsorption of food, and nutrient malnutrition.
Chronic constipation or intestinal obstruction may also lead to excessive gas formation, as the food stays in the bowels for a longer time causing it to degenerate and release a rotten smell.
Risk Factors For Bloating
Following things can increase the chances of excessive gas in the gastrointestinal tract.
Increasing age: With age, the body’s digestive system weakens, and chances of flatulence increase, even with the consumption of simpler meals.
Heavy meals: Eating large meals at a time instead of eating smaller portions throughout the day.
Pregnancy: Pregnancy can lead to excessive gas formation as the uterus grows and presses on the intestines.
Sedentary lifestyle: Leading a sedentary lifestyle can also increase the risk of digestive issues and cause increased gas formation.
Usually, intestinal gas causes no medical problems and is a normal occurrence. However, if there is a formation of excessive gas daily along with other gastrointestinal symptoms, such as heartburn, hyperacidity, etc., medical evaluation is necessary. It will help check for the presence of concurrent medical conditions.
Gas is found to be a common presenting symptom in the following medical conditions:
Lactose intolerance: This condition refers to the body’s inability to digest the lactose present in milk and milk products. Consumption of milk and milk products leads to indigestion, bloating, diarrhea, and flatulence.
GERD (gastroesophageal reflux disease): This is a chronic condition where acid from the stomach regurgitates up the digestive tract and irritates the esophageal lining. Chronic belching could be a symptom of GERD.
IBS (irritable bowel syndrome): Symptoms like bloating, diarrhea, and excessive gas are seen in this condition that affects the large intestine.
Celiac Disease: In this condition, the body abnormally reacts to gluten, a protein found in grains such as wheat and barley. Bloating, diarrhea, and excess gas formation are the symptoms of this disease.
Crohn’s Disease: It is a type of inflammatory bowel disease that presents with symptoms like abdominal cramps, diarrhea, increased passing of wind, etc.
Diagnosis Of Bloating
Passing gas daily, as many as 14-21 times a day, is considered normal. It is not a cause for concern and requires no further evaluation. However, if the flatus is accompanied by other troublesome symptoms and interferes with the person’s daily life and activities, lab investigations and imaging studies may be needed to establish the cause of abnormal flatulence.
Stool test to find out disorders like lactose intolerance, malabsorption syndrome and celiac disease
X-Ray Abdomen helps visualize the internal organs of the abdomen and looks for the presence of gas in the stomach or intestines.
Endoscopy and Colonoscopy are invasive tests in which a probe is inserted via the mouth (endoscopy) or the rectum (colonoscopy) to visualize the inner structures of the digestive tract in real-time.
Laboratory studies have a very limited role in diagnosing conditions that may be associated with flatulence. Certain tests like Allergy, Individual Marker, Gluten can help identify if the patient’s symptoms are due to gluten allergy, also known as celiac disease.
Prevention Of Bloating
Passing gas every day is not considered abnormal. Gas formation in certain health conditions, such as GERD, IBD, lactose intolerance, gluten allergy, etc., can be limited by certain lifestyle modifications.
You can prevent excessive gas formation and improve your digestion by making the following lifestyle changes:
- Eat fresh, home-cooked food, which is simple and easy to digest.
- Eat smaller portions throughout the day rather than consuming large meals all at once.
- Limit the consumption of aerated beverages.
- Quit smoking.
- Perform light exercises, such as walking after consuming heavy meals to help with the digestion process.
- Drink plenty of water and fluids throughout the day.
- Do not consume foods to which you are allergic.
- Establish a healthy bowel routine. Go to the loo at the same time every day and try to empty your bowels.
Specialist To Visit
If excessive gas becomes a chronic problem and/or is accompanied by diarrhea, vomiting, blood in the stools, change in the color or frequency of stools, unexplained weight loss, severe abdominal pain, chest pain, etc., medical care must be sought. To seek medical care for excessive gas that causes belching or flatulence, you can visit:
Treatment Of Bloating
The treatment aims to relieve symptoms and treat the underlying causative agent.
Simethicone preparations are prescribed for bloating and abdominal distension. They help break down gas bubbles and allow easy passage of gas. Some studies have shown that activated charcoal when used along with simethicone is more effective in reducing bloating.
Digestive enzymes and probiotics help relieve the symptoms of indigestion and improve the body’s digestive system.
Treatment of underlying cause
If symptoms of gas are due to an underlying cause, it is necessary to treat the causative condition to provide complete relief.
Lactase enzyme preparations are used to treat patients with lactose intolerance.
Mesalazine formulations are used to treat Crohn’s Disease and ulcerative colitis.
Home-Care For Bloating
Most often, symptoms of excess gas, such as flatulence or belching, can be managed at home with simple home remedies and lifestyle changes. Do the following to reduce bloating and gas.
Take OTC preparations containing simethicone to help with faster relief of symptoms.
Perform mild exercise, such as walking, as it helps with the passing of gas and reduces bloating.
Drink liquids with a straw and limit consumption of aerated beverages and smoking to prevent increased swallowing of air through the mouth.
Gently massage the abdomen to help ease the passing of gas and reduce abdominal cramps and bloating.
Change your diet to include fewer fatty foods and ingestion-causing foods. Increase the consumption of fiber-rich foods, such as fresh fruits and vegetables.
Complications Of Bloating
The average human being can pass gas about 20 times a day. It is an ordinary phenomenon, but it may be embarrassing and occasionally painful. If you have excess gas, you may also experience the following:
- Flatus or passing gas through the intestine very frequently. It may have a foul-smelling odor.
- Passing gas through the windpipe by either belching or burping. It may be accompanied by an abnormal taste sensation in the mouth.
- A feeling of fullness or a sensation of bloating in the abdomen
- Abdominal cramps
- Pain along the sides of the stomach
What if bloating is left ignored?
Symptoms like excessive gas, flatulence, and belching do not cause any major complications on their own. The underlying disease, however, may worsen and cause health complications like:
- Ulceration, bleeding in the gastrointestinal tract due to worsening of GERD
- Malnutrition due to the inability of the body to absorb nutrients
- Increased risk of gastrointestinal cancers
- Anal fissures and fistula
- Intestinal obstruction
Alternative Therapies Of Bloating
Apart from prescription medications and OTC preparations, there are alternative therapies that may help provide relief from chronic gas, such as:
Diet modifications: Taking a diet rich in fresh fruits and vegetables and limiting the consumption of spicy foods, fatty foods, and foods that cause allergies help improve the overall health of the digestive system and reduce the formation of excessive gas. In patients without a significant improvement despite exclusion of gas-producing foods, doctors suggest a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (also known as FODMAPs).
Exercise and Yoga: Light exercises such as walking and yoga asanas like Pawanmuktasana help pass gas with ease, provide relief from symptoms, and improve digestion. Pawanmuktasana can be performed by lying flat on the back and slowly bending your knees and bringing them close to your chest. The position should be held for at least 30-45 seconds and then you can ease back into the starting position. Vajrasana is another yogasana that can be performed post meals and it helps with the digestion process. To perform Vajrasana, you must sit on the floor, on your knees in a kneeling position. Put your hands on the thighs and maintain the position as long as comfortable.
Massage therapy: Gentle abdominal massage may help ease abdominal cramps and aid with the easy passing of gas. It also helps provide relief from constipation.
Ayurveda: Ayurveda suggests that gas is caused due to an imbalance of Vatta and Pitta Doshas. Natural herbs and spices, such as cinnamon (dalchini), carom (ajwain) seeds, cumin (jeera) seeds, ginger (adrak), asafoetida (hing), fenugreek (methi), etc., help build a strong digestive system and provide relief from flatulence and belching.
Frequently Asked Questions
- Farting (Flatulence). NHS UK
- Hasler WL. Gas and Bloating. Gastroenterol Hepatol (N Y). 2006 Sep;2(9):654-662.
- Lacy BE, Gabbard SL, Crowell MD. Pathophysiology, evaluation, and treatment of bloating: hope, hype, or hot air? Gastroenterol Hepatol (N Y). 2011 Nov;7(11):729-39
- Foley A, Burgell R, Barrett JS, Gibson PR. Management Strategies for Abdominal Bloating and Distension. Gastroenterol Hepatol (N Y). 2014;10(9):561-571.