Bloating can be described as the feeling that there is an inflated balloon in the abdomen. It is a commonly reported symptom and is sometimes associated with distension, or the visible increase in the width of the area between your hips and chest (abdominal girth).

Both bloating and distension cause discomfort and sometimes pain. They have a negative impact on the quality of life for some individuals. The symptoms may be linked with other gas related complaints, such as burping or belching, swallowing air, and passing intestinal gas.

Some people with functional gastrointestinal disorders (FGIDs) and motility disorders frequently experience bloating, distension, or both as symptoms of their conditions. Examples of frequencies of abdominal bloating reporting include:

Irritable bowel syndrome (IBS): 23–96%
Functional dyspepsia: 50%
Chronic constipation: 56%
There is also something called functional bloating, which is fullness and or/distension of the abdomen, not associated with changes in bowel movements.

Causes

While researchers have proposed different explanations for bloating and distension, there is no conclusive answer as to why the 2 symptoms occur.

Possible reasons for bloating and distension include:

Too much gas in the intestine
Abnormal levels of bacteria in the small intestine (Small Intestinal Bacterial Overgrowth – SIBO)
Imbalance of microorganisms that usually live in the bowel; sometimes the result of taking antibiotics
Food intolerance
Difficulty absorbing carbohydrates from food, such as FODMAPs
Increased perception and sensitivity to what is happening in the digestive tract
Increased curvature of the lumbar region of the spine, which decreases the capacity of the abdomen to hold gas.

Treatment

There is no universally effective treatment for bloating and distension. However, there are things that people can do with the help of their physicians to try and alleviate the symptoms.

Working with a Doctor

It is important to speak openly with your physician to express a clear picture of your experiences and symptoms. FGIDs present special challenges when communicating, specifically because of their vague symptoms and sensitive subject matter.

In Spanish and some other languages, there is not word for “bloating.” People use the words “swelling” and “inflammation,” or describe it as “feeling pregnant.” Using the balloon analogy can be the most helpful. Let your doctor know exactly whether you have the sensation of having a balloon in your abdomen (bloating), the truly visible increase in your abdominal girth (distension), or both.

There isn’t a diagnostic test for bloating or distension, but your doctor may run some tests to rule out underlying problems or associated disorders.

You can help your doctor by describing your symptoms as accurately and concisely as possible. With regard to bloating and distension, here are some important questions to ask and details to tell your health care provider (keeping track of the things that trigger your symptoms is a good way to discover the answers):

Things to Ask your Doctor:

Am I bloated?
Am I distended?
Am I both bloated and distended?

Things to Tell your Doctor:

Where you feel your symptom is located
If your bloating or distension is associated with burping
If you experience nausea or vomiting
If the symptom is associated with pain in your abdomen and where the pain is located
If your symptom relates to passing gas or a change in your bowel habits (diarrhea, constipation, or alternation of both)
If your symptoms are related to food, and which ones
If your symptoms occur right after eating
If your symptoms increase during the day or improve during night hours
Medicines and Other Therapies
Some treatments have been found to help ease the symptoms of bloating and distension. Your doctor may talk to you about some of these options, depending on your symptoms and other health related considerations.

Antispasmodics: These can relax the muscles of the bowel and provide relief. Examples include:

In the United States – dicyclomine (Bentyl) and hyoscyamine (Levsin)
In Latin America and some countries in Europe and Asia – otilonium bromide or pinaverium bromide
In some Latin America countries – a combination of pinaverium bromide with simethicone (Alevian Duo)
Probiotics: These dietary supplements contain live bacteria that, when taken in adequate amounts, help balance out the existing bacteria of the intestines. Some that include a relatively low level of probiotic bacteria are available over the counter or in yogurt varieties.

Other options include Bifidobacterium infantis 35624 for individuals with IBS in general, and Bifidobacterium animalis DN-173 010 for patients with IBS with constipation (IBS-C).

Rifaximin: This antibiotic is only slightly absorbed and can be used for short periods of time. Usually it is used (off-label) to lessen bloating in people with IBS whose symptoms do not include constipation, or in those with small intestinal bacterial overgrowth.

Prokinetics: These are medications that improve the time it takes for food to travel through the digestive tract. Some prokinetics have been shown to improve bloating. A person’s age, health, and other considerations must be taken into account for these therapies. Availabilities of prokinetics vary from country to country.

Antidepressants: These drugs affect receptors in the gut and in the brain. Given in lower dosages than what is used to treat depression, they have been shown to help alleviate bloating and distension.

Examples include:

Citalopram (Celexa), an SSRI (Selective Serotonin Reuptake Inhibitor). It has been shown to help improve bloating in individuals with IBS.
Amitriptyline (Elavil), a tricyclic antidepressant, is commonly used to treat pain and discomfort, as well as diarrhoea, and may be helpful for bloating.
Newer options: In people with chronic constipation or IBS with constipation (IBS-C), medications that may improve multiple symptoms including bloating, pain or discomfort, and bowel function may also be used. Examples include lubiprostone (Amitiza) or linaclotide (Linzess).

Psychological therapies: Treatments including hypnotherapy and cognitive-behavioral therapy can be useful and help with symptoms and mood.

Low FODMAP diet: FODMAPs are types of carbohydrates that are rapidly fermented by bacteria in the gut. Working with a doctor or registered dietitian to determine a diet low in FODMAPs is an option for alleviating bloating and distension symptoms. Foods that are rich in FODMAPs include:

Fruits such as mangoes, apples, pears, avocados, blackberries, and plums
Dairy products like milk (cow, sheep, and goat), yogurt, ice cream, and soft cheeses (cottage cheese, cream cheese and mascarpone)
Honey
Vegetables and legumes such as asparagus, bell peppers, broccoli, Brussels sprouts, cabbage, cauliflower, eggplant, onion, garlic, baked beans, kidney beans, and lentils
Sweeteners like sorbitol and maltitol (frequently used in gum and other candies)

Conclusion
Bloating and distension are both very common. Either of the 2 may be very bothersome to people that are experiencing the symptoms. They are also challenging to those trying to treat them. There is not a conclusive cause for bloating or distension, and there is no universally effective treatment. But with the help of a physician, individuals can find different treatment options that may help ease their symptoms.

©2014 IFFGD

Adapted from IFFGD publication 262, Understanding Bloating and Distension, by Max Schmulson, MD