How to treat bloating – the 12 ways to beat bloating

Easy Ways to Live Well: Steph McGovern discusses bloating

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Bloating impacts more than 60 percent of women and 40 percent of men, and it normally comes alongside digestive discomfort, flatulence and tummy pain. While bloating can be harmless and temporary, lots of people experience an extreme version on a regular basis. Express.co.uk chatted to Dr Deborah Lee from Dr Fox Online Pharmacy to find out how to treat bloating.

Bloating is very uncomfortable and has been shown to have a negative impact on quality of life.

While more women experience bloating than men, it can happen to anyone at any time and has a whole range of potential causes, from IBS and food intolerance to endometriosis and PCOS.

Bloating can impact your physical activity, mental health and self-esteem, deciding when you can socialise, what you can wear and what activities you feel comfortable doing.

In fact, it has been proven that women who complain of bloating are more likely to have a past history of depression and anxiety.

Many of us will have mild or intermittent bloating with few or no other symptoms that may be explained simply by a recent night out, Dr Lee explained.

However, the doctor warned: “If your symptoms are severe, persistent, or are associated with anything more worrying, such as loss of appetite, weight loss, or blood in your stools, you are strongly recommended to see your GP.

“The doctor will ask questions about your symptoms, medical, surgical, family and drug history.

“They will then examine you. The next step is blood tests, to check your blood count and your antibodies for coeliac disease. Other tests may include B12 and vitamin D levels.

“You may then be referred for an upper GI endoscopy. Other tests depend on your symptoms but may include breath testing, small bowel imaging (CT or MRI scan), a gastric emptying scan, stool cultures and a colonoscopy.”

IBS, poor gut motility, problems with the gut, and period pain are common causes of bloating, but it could also be down to:

• Aerophagia – excessive swallowing of air when eating or talking
• Anorexia and bulimia – restricting the intake of food leads to atrophy (shrinkage) of the muscles of the digestive tract
• Gastroparesis – partial paralysis of the stomach
• Gastric outlet obstruction – any medical condition that results in a mechanical blockage to the stomach emptying
• Functional Dyspepsia – indigestion that occurs for no obvious reason
• Dietary factors – Lactose intolerance, fructose intolerance, artificial sweeteners such as sorbitol, high carbohydrate intake, gluten sensitivity
• Coeliac disease – this causes inflammation of the digestive tract
• Chronic constipation – if the stool sits for too long in the large bowel, the bacteria start to ferment.
• Irritable bowel syndrome – IBS affects the gut microflora, resulting in too much gas.
• Small intestinal bacterial overgrowth (SIBO) – This is a serious condition in which abnormal bacteria grow in the small intestines.
• Abnormal small intestinal motility – Many different neurological conditions can affect gut motility.
• Diverticulitis – This can affect the passage of gut contents through the affected area.
• Ovarian cancer – Although rare, bloating can be a sign of ovarian cancer.

How to treat bloating

To treat bloating, specialists usually start by educating the patient about the possible reasons for bloating.

Dr Lee said: “After investigation, this is then classed as functional bloating.

“Management of bloating as a symptom sometimes depends on the cause.

“If you think bloating may be related to your hormones, discuss this with your doctor.

“You may benefit from a change in your contraception, perhaps to a different pill or a different contraceptive method.

“You might need help and advice about how to treat premenstrual syndrome (PMS).”

The following 12 things are all potential treatment options for bloating.

Diet

Gastroenterologists sometimes recommend gradually eliminating substances from the diet to see if this improves your symptoms, for example, dairy products, then those containing fructose, then those high in fibre.

Research suggests that in IBS, bloating may be improved if fermentable oligosaccharides, disaccharides, monosaccharides and polyols are removed from the diet – this can be done by following the FODMAP diet.

Exercise

Bloating has been shown to improve with regular physical exercise.

It is known to be worse when lying down and better in the upright position. Exercise should therefore be encouraged.

Tricyclic antidepressants (TCAs)

Although these are antidepressant treatments, they are often effective at relieving bowel symptoms such as bloating.

This is most likely because they increase levels of neurotransmitters such as serotonin, dopamine and noradrenaline.

TCAs are most likely to be beneficial, but serotonin reuptake inhibitors (SSRIs) are often used instead these days.

Activated charcoal

Charcoal is porous and can help absorb excess gas in the colon. It can be taken by mouth, along with simethicone, although research studies have had mixed results.

Probiotics

Probiotics are live bacteria which can be given by mouth and seem to result in health benefits.

Many studies have now been published to show these improve IBS symptoms, including bloating.

The most researched options are those containing lactobacillus and Bifidobacterium.

Rifaximin

Rifaximin is an antibiotic which works locally in the gut and is not absorbed into the bloodstream.

Studies have shown that a 14-day course of treatment can significantly improve bloating in IBS sufferers.

Osmotic laxatives

Osmotic laxatives are laxatives such a polyethene glycol which work by drawing water into the bowel from the bloodstream.

They have been shown to relieve bloating in those with constipation.

Prokinetic agents

Drugs such as domperidone, and metoclopramide are frequently used to stimulate gut activity, although results are mixed.

Chloride channel activators

The drugs lubiprostone and linaclotide have been found to be effective at relieving bloating in IBS patients with constipation.

These work by increasing the amount of fluid in the intestines, helping the stools to pass along more easily.

Abdominal biofeedback

Abdominal biofeedback is a specialist bowel retraining programme usually led by a physiotherapist.

Some studies have shown biofeedback can reduce bloating by up to 70 percent.

Kiwi fruit

Studies suggest kiwi fruit can be an effective treatment for GI tract symptoms possibly owing to the fact kiwi fruit promotes gastric emptying and contains specific bioactive substances that aid GI motility.

Smooth muscle antispasmodic

These are not recommended for bloating as they relax smooth muscle, reduce gut transit time, and can make bloating worse.

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