Abdominal bloating is a common issue affecting millions of people worldwide. It can significantly impact daily life and often points to underlying digestive problems that need attention (1). Research shows that approximately 20% of people, particularly women, experience this type of gastrointestinal discomfort (2).

What is Bloating?

Bloating refers to a feeling of fullness, pressure, or swelling in your abdomen. While many people associate these sensations with intestinal gas, feelings of bloating are often unrelated to excessive gas production (3).

Visible belly swelling happens because of poor coordination between your diaphragm (breathing muscle) and abdominal wall muscles (4). After eating, how your diaphragm moves can make bloating feelings worse (5). This is many people feel more bloated after meals.

Fact
How your belly looks (distention) and how you feel (bloating) can vary greatly. Some people feel very uncomfortable with little visible swelling, while others have a noticeably expanded belly but feel less discomfort.

Causes and Risk Factors

Many different factors can contribute to bloating, like your gut bacteria, the foods you eat, and certain medications. Understanding these causes can help you find the right solution for your symptoms.

Swallowing Air (Aerophagia)

One of the most common but often overlooked causes of bloating is swallowing too much air (aerophagia) (6). This happens during normal eating and drinking but can be excessive for some people. Common habits that increase air swallowing include:

  • Eating or drinking too quickly
  • Drinking through straws
  • Chewing gum or sucking on hard candies
  • Talking while eating
  • Drinking carbonated beverages
  • Smoking
  • Wearing poorly fitted dentures

Research shows that people with aerophagia as a comorbidity experience significantly more impairment from gas-related symptoms (like bloating and flatulence) compared to those without this condition (7). Treatment approaches that reduce air pressure, such as adjusting CPAP settings in sleep apnea patients, can significantly decrease bloating and other symptoms in those who experience aerophagia (8).

Tip
To reduce air swallowing, eat slowly and mindfully in a relaxed environment. Avoid drinking through straws, chewing gum, and consuming carbonated beverages. Try taking smaller bites and completely swallow your food before taking another bite or speaking.

Gut Microbiome Disruption

Small intestinal bacterial overgrowth (SIBO) occurs when too many bacteria grow in your small intestine, leading to excess gas and bloating (9). This condition is very common in people with inflammatory bowel disease. SIBO can also develop after weight loss surgery, affecting about 29% of patients within the first 3 years of surgery and increasing to 53% after 3 years (10).

An imbalance in gut bacteria (called gut microbiome dysbiosis) is a major cause of abdominal gas, bloating, and distension (11). Research has shown that changes in gut bacteria may play a significant role in causing irritable bowel syndrome and related bloating symptoms (12, 13).

Fact
Changes in the intestinal barrier (the lining of your gut) are also linked to bloating. When this barrier is weakened, bacterial components may trigger inflammatory responses that contribute to bloating symptoms.

Common Underlying Conditions

Several digestive disorders commonly cause bloating, and understanding which one might be affecting you can help guide treatment.

Irritable bowel syndrome (IBS) is the most common disorder of dysfunctional gut-brain interactions— conditions that affect 20-40% of the population (14). IBS is characterized by recurring abdominal pain, bloating, and changes in bowel habits (15). Certain conditions, like chronic idiopathic constipation, are often accompanied by significant bloating symptoms (16).

Aerophagia (air swallowing) is a condition where excessive amounts of air are swallowed, leading to significant bloating and gas-related symptoms. This can occur as a standalone issue or as a comorbidity with other conditions, like gastroesophageal reflux disease (GERD). Research shows that people with aerophagia experience more severe bloating, flatulence, and postprandial fullness compared to those without this condition (7). People with sleep apnea who use breathing machines (CPAP therapy) may also experience aerophagia, with symptoms of bloating, flatulence, and belching (8).

Functional dyspepsia commonly involves symptoms after eating (called postprandial distress syndrome). About 80% of affected people experience meal-related symptoms: upper abdominal bloating, feeling full quickly, and increased fullness after meals (17, 18).

Lactose intolerance can cause persistent digestive symptoms, even during a lactose-free diet, which probiotics may help alleviate (19). Research shows that probiotics can effectively reduce symptoms in people with lactose intolerance, including significant reductions in abdominal pain, diarrhea, and flatulence (20).

Non-celiac gluten sensitivity is a condition where people experience digestive symptoms in response to gluten without having celiac disease. Studies show that even small amounts of gluten can increase bloating, abdominal pain, and other symptoms in sensitive individuals (21). The prevalence of this condition is still being studied, but research indicates it affects a significant proportion of people who report gluten-related symptoms (22).

Retrograde cricopharyngeal dysfunction (RCPD) is a fairly recently described condition where people can’t belch due to a muscle dysfunction in the throat. This leads to bloating, gurgling noises, and excessive gas (23).

Pancreatic insufficiency is a serious condition where the pancreas doesn’t produce enough digestive enzymes. This can cause significant bloating and other digestive symptoms. Research shows that it’s particularly common in people with diabetes, with wide prevalence rates ranging from 14% to 77.5% in type 1 diabetes and 16.8% to 49.2% in type 2 diabetes (24). Pancreatic insufficiency can also develop after surgical stomach removal (gastrectomy) to treat cancer, causing nutritional deficiencies and gastrointestinal symptoms, like bloating and diarrhea (25).

Dietary Factors

What you eat can have a significant impact on bloating symptoms, with some foods being more likely to cause problems than others.

Certain foods are more likely to cause bloating, especially those containing poorly digested, fermentable carbohydrates (26). These carbohydrates, often called FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), can trigger gut symptoms due to problems with the gut-brain connection (27).

High-fiber diets, while generally beneficial for health, can sometimes worsen bloating symptoms. Research shows that high-fiber diets with different macronutrient compositions can all increase bloating compared to participants’ regular diets. Interestingly, high-protein, high-fiber diets caused 40% more bloating than high-carbohydrate, high-fiber diets (28).

Specific dietary triggers:

  • Lactose: Found in dairy products, lactose causes symptoms in about 30% of adults due to insufficient enzyme to digest it (29).
  • Fructose: Found in fruits and some sweeteners, fructose malabsorption (the inability to properly absorb this sugar) frequently causes bloating and other abdominal symptoms (30).
  • Fructans: Found in wheat, onions, and garlic, these can trigger symptoms in sensitive individuals (31).

Medications and Medical Conditions

Some medications and medical treatments can cause bloating as a side effect, which is important to recognize so you can discuss alternatives with your healthcare provider if needed.

Some medications can cause bloating as a side effect:

  • Opioids: These pain medications commonly cause constipation, incomplete bowel emptying, bloating, and reflux (32, 33).
  • Metformin: This diabetes medication causes digestive side effects in about 2-13% of patients, with symptoms including bloating, which can be reduced with probiotic supplementation (34). Certain forms of metformin (extended-release versus immediate-release) usually cause less bloating and diarrhea (67).
  • Cholesterol medications: Bile acid sequestrants (like colestipol), which are used to lower cholesterol, can cause bloating and constipation (35).

Medical procedures and conditions associated with bloating:

  • After weight-loss surgery: Digestive symptoms (like bloating) after gastric bypass surgery may prompt consideration of bacterial overgrowth (10).
  • After colonoscopy: Up to 20% of patients experience ongoing abdominal symptoms with bloating after a colonoscopy (36).
  • After laparoscopic surgeries: Bloating is common following laparoscopic surgical procedures, as a result of residual gas within the abdominal cavity. Early mobilization after surgery may help reduce the associated discomfort (68).

Psychological Factors

Your mental state can also affect your digestive system, with stress and anxiety potentially worsening bloating symptoms.

Mental health can affect your digestive system. Daily stress can change how your gut works and lead to symptoms like bloating (2).

IBS and related bloating are common among people with post-traumatic stress disorder (PTSD). Research shows that the severity of digestive symptoms relates to the severity of PTSD and depression (37).

Note
The connection between your brain and gut (called the gut-brain axis) is powerful. Stress, anxiety, and depression can trigger or worsen bloating symptoms, while digestive discomfort can also increase stress and anxiety, creating a challenging cycle.

Signs and Symptoms

Understanding the different ways bloating can manifest helps identify when you might need to seek treatment or make lifestyle changes.

Primary Symptoms

The main symptom of bloating is a feeling of fullness, pressure, or swelling in the abdomen. Many people also notice visible swelling of their stomach, especially after eating (5).

Bloating is frequently accompanied by:

  • Excessive gas or flatulence (38)
  • Abdominal pain or discomfort (39)
  • Visible abdominal swelling (distension) (40)
  • Sensations of pressure or fullness (18)

Associated Symptoms

Bloating rarely occurs alone and is commonly accompanied by other digestive symptoms that can help identify the underlying cause.

  • Changes in bowel habits, such as constipation or diarrhea
  • Burping or belching (41)
  • Early satiety (feeling full quickly when eating) (42)
  • Nausea in some cases (43)
  • Rumbling or gurgling noises in the belly (23)

Symptom patterns can fluctuate throughout the day and after meals for many people. Research has found that bloating symptoms often worsen during the day and especially after eating (5).

Diagnosis and Testing

Getting an accurate diagnosis is important for finding the right treatment approach for your bloating symptoms, and this may involve several different types of tests and evaluations.

Clinical Evaluation

When you see a doctor about bloating, they’ll typically start with a thorough medical history and physical examination. Doctors often use established criteria, such as the Rome criteria, for diagnosing functional gastrointestinal disorders like IBS (44).

Manning and Rome criteria have shown good accuracy in diagnosing IBS, with Manning’s criteria correctly identifying 78% of people with IBS while correctly ruling out 72% of those without it (44).

Diagnostic Tests

While no specific test can diagnose conditions like IBS with complete accuracy, several tests can help rule out other causes of your symptoms.

  • Blood tests: These have limited accuracy in distinguishing IBS from other digestive diseases but may help rule out other conditions (44).
  • Breath tests: The fructose breath test helps identify fructose malabsorption as a cause of symptoms (45).
  • Lactulose challenge testing: This helps identify subgroups of IBS patients based on how they respond to a specific sugar that’s poorly absorbed (46).
  • Ultrasound: Real-time ultrasound imaging can evaluate stomach emptying in patients with upper digestive symptoms (47).

More invasive testing may sometimes be necessary:

  • Colonoscopy: To rule out inflammatory or cancerous conditions
  • Upper endoscopy: May be indicated for upper digestive symptoms
Warning
While many cases of bloating relate to functional disorders or food intolerances, persistent or severe bloating, when accompanied by weight loss, blood in the stool, or severe pain, should prompt medical evaluation to rule out serious conditions.

Treatment Options

There are many different approaches to treating bloating, from medications to lifestyle changes, with options that can be tailored to your specific symptoms and needs.

Medications

Several types of medications can help treat bloating, depending on the underlying cause. Based on clinical trials, these medications have been shown to demonstrate beneficial effects for most people. However, individual results may vary.

Prokinetics and Antispasmodics:

  • Prokinetic drugs (like levosulpiride) significantly improve symptoms of functional dyspepsia with bloating (48).
  • Studies show that domperidone can improve symptoms in patients with diabetic gastroparesis who experience nausea, abdominal distention, bloating, and early satiety (42).
  • Otilonium bromide effectively improves the frequency of abdominal pain and reduces the severity of distention in IBS patients (49).

Antibiotics:

  • Rifaximin effectively relieves bloating and flatulence (50).
  • Antibiotic therapy effectively treats SIBO and related bloating in patients after gastric bypass surgery (10).

GI Secretagogues and Laxatives:

  • Linaclotide improves abdominal pain and bloating in patients with IBS-C (51).
  • Plecanatide effectively improves abdominal bloating and bowel symptoms in patients with IBS-C (52).

Anti-gas Medications:

  • Alpha-galactosidase (an enzyme) significantly decreases the severity of flatulence and gas-related symptoms after eating beans and other gas-producing foods (53).

Natural Remedies

If you prefer a more natural approach to managing bloating, several evidence-based options are available.

Probiotics:

  • Bacillus coagulans MTCC 5856 effectively improves symptoms of gas and bloating in healthy adults (11).
  • Lactobacillus acidophilus NCFM reduces bloating symptoms in patients with functional bowel disorders (54).

Herbal Remedies:

  • Ginger supplements can reduce gastrointestinal symptoms with bloating in patients with multiple sclerosis (55).
  • Peppermint oil in a special delayed-release capsule effectively treats multiple IBS symptoms and provides significant relief of gastrointestinal discomfort (56). Recent systematic reviews confirm its effectiveness for IBS symptoms (57).

Other Natural Approaches:

  • Abdominal massage can effectively reduce symptoms of perceived abdominal bloating in patients with malignant ascites (fluid in the abdomen due to cancer) (58).
  • Daily yoga practice significantly reduces bloating, low-back pain, and menstrual cramps during the menstrual cycle (59).

Dietary Modifications

Making changes to what you eat is one of the most effective approaches for managing bloating symptoms.

Low FODMAP Diet:

  • A low FODMAP diet is effective in reducing abdominal symptoms in adults with IBS (60).
  • Different FODMAPs affect symptoms differently; fructans and galacto-oligosaccharides (GOS) are associated with worsening abdominal pain and bloating (61).

Other Dietary Approaches:

  • A starch- and sucrose-reduced diet improves gastrointestinal symptoms in IBS patients, with 66.3% responding positively after just two weeks (62).
  • Small amounts of lactose (0.5-7.0 g) in the diet generally don’t induce gastrointestinal symptoms in people with lactose maldigestion (63).
Summary
A diet low in fermentable carbohydrates (FODMAPs) is the best-supported dietary approach for reducing bloating, especially in IBS. This diet reduces foods high in certain sugars and fibers that can be poorly absorbed and fermented by gut bacteria. Key foods to limit: certain fruits, wheat, onions, garlic, and some dairy products. Working with a dietitian can help make this approach more sustainable.

Lifestyle Modifications

Simple changes to your daily habits can have a meaningful impact on reducing bloating symptoms.

Physical Activity:

  • Even mild exercise enhances intestinal gas clearance and reduces symptoms in patients with abdominal bloating (64).

Weight Management:

  • For people who are overweight, losing weight can help reduce bloating. Studies show that excess weight, particularly around the abdomen, can increase pressure on the digestive system and worsen bloating symptoms. Weight loss through healthy diet and exercise may improve the physical feeling of bloating and visible abdominal distension.

Stress Management:

  • Studies show that cognitive-behavioral therapy can help improve gastrointestinal symptoms in patients with IBS (65).

Eating Habits:

  • Irregular dietary habits are associated with more severe gastrointestinal symptoms in IBS patients (62).
  • Body position affects gas movement in the intestines. Upright posture helps release gas more easily than lying down (66).

When to Seek Medical Attention

While bloating is usually not serious, certain circumstances warrant consulting a healthcare professional for proper evaluation and treatment.

  • Persistent or severe bloating that doesn’t respond to lifestyle changes
  • Bloating with weight loss, blood in stool, or severe pain
  • New onset of bloating in adults over 50, which could signal more serious conditions

Conclusion

Abdominal bloating is a common yet complex condition that can significantly affect quality of life. While often not dangerous, it may signal underlying digestive disorders that need medical attention. Bloating involves multiple bodily processes: abnormal coordination between the diaphragm and abdominal muscles, intestinal gas production, and heightened sensitivity to normal amounts of gas.

Effective management typically requires a personalized approach based on specific triggers and symptoms. Dietary modifications, particularly a low FODMAP diet, have strong evidence supporting their effectiveness. Probiotics, certain medications, and lifestyle changes can also provide significant relief for many people.

If you experience chronic or severe bloating, consulting with healthcare providers is essential to rule out serious conditions and develop an effective management plan. With proper diagnosis and treatment, most people can achieve significant improvement in their symptoms and quality of life.

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