Bloating: uncovering the root causes of digestive discomfort

Common bloating symptoms

It’s estimated that up to 30 per cent of the population battle with chronic abdominal bloating. And most of them are unsure why they’re bloated, or what to do about it.

Although most commonly related to minor gastrointestinal disorders, bloating can be a sign of more serious conditions like bowel cancer or ovarian cancer, so all cases of ongoing or chronic bloating should be investigated.

There are 4 defined symptoms of bloating, which can include:

• Sensation/feeling of swelling or bloating in the abdomen, which may increase over the day and may not include an actual increase in size or shape of the abdomen
• Extension/distension of the abdomen (though 24% of cases don’t experience this), where the size of the abdomen increases, altering the fit of clothing
• Increased volume of abdominal tissue or material, due to fluid retention, constipation, or gas
• Increased awareness of muscular activity, and cramping of the abdomen

When bloating occurs regularly or persists long-term, it could be a sign of a more complex underlying issue.

What causes bloating?

Sometimes it’s easy to identify an obvious trigger for bloating, such as lactose intolerance or food sensitivities, and other times bloating can come and go for no apparent reason. To help you understand the potential causes, here are some of the most common bloating triggers.

‍Slow motility of waste: The slow transit time of matter can cause bloating if the bowels aren’t working effectively. “Pooling” of food and waste matter occurs in the digestive system, creating fullness and discomfort. This cause is often associated with constipation, and is exacerbated by dehydration, lack of physical activity, insufficient digestive enzymes and medications such as opioids. Difficulty passing stool may also be a result of abdominal obstruction, a mass in the bowels, or a disorder such as diverticulitis, and should always be investigated.‍

Gas retention: Build-up of gas is a common cause of bloating, and can result in flatulence or belching. This form of bloating expands the volume inside the gastrointestinal organs, which creates pressure on the intestinal walls resulting in bloating. Gas can build up as a volatile response to food and drink, especially where there is microbiome imbalance (dysbiosis), food intolerance, insufficient digestive enzymes to properly break down food, or overeating.

‍Fluid retention: Just like gas and solids, fluid retention increases the space being taken up in the gut, especially in IBS, which bloating is a symptom of. However, fluid malabsorption also contributes to diarrhoea, and pain, and can compound other digestive problems. Fluid retention can be driven by hormones, compromised gut health, a response to food intolerance/sensitivity, or a result of medications.‍

Trapped air: Sometimes the cause of bloating is as simple as trapped air in the GI system, caused by consuming carbonated drinks or drinking through a straw, or even simply eating quickly.

‍Medical conditions: Bloating that is excessive, painful, ongoing, or unrelated to food may be caused by an underlying medical condition. Bloating commonly happens in response to a wide range of health complications, including:

• SIBO
• Irritable bowel syndrome
• Inflammatory bowel disease
• Diverticulitis
• Coeliac disease
• Food intolerance
• Parasites
• Inflammation
• Endometriosis

How to reduce bloating – the conventional approach

Conventional medicine offers limited options for treating abdominal bloating. People commonly reach for over-the-counter treatments targeting wind and gas, such as Immodium and De-Gas. Similarly, people may turn to laxatives to hasten a slow transit time. These medications, however, are only intended for short-term relief, and carry potentially harmful side effects. 

Anti-gas medication: Medications like simethicone, which is used in the popular product De-Gas, use silicone compounds that function by decreasing the surface tension of gas bubbles in the gastrointestinal tract. This results in dispersion and accumulation of gas bubbles and easier removal from the intestines as either flatulence or belching. But unlike the name suggests, they don’t actually reduce the production of gas.

Antacids: Some people may even use antacids in an attempt to reduce bloating associated with heartburn and GERD (gastroesophageal reflux disease). This group of drugs is known as proton pump inhibitors, and they have recently been linked to potentially fatal side effects including cardiovascular disease, chronic kidney disease, osteoporosis and upper gastrointestinal cancers.

Laxatives: As a result of constipation, compacted stool or slow transit time, laxatives are commonly used. Providing short term relief of constipation by speeding up the transit time of material through the gut can impair nutrient absorption from food. Long term use of laxatives can have serious side effects which worsen bowel dysfunction, including dehydration, intestinal paralysis, lazy gut, irritable bowel syndrome, and pancreatitis.

‍Antibiotics: If abdominal bloating is occurring as a result of bacterial overgrowth or a parasitic infection, antibiotics may be recommended. Antibiotics are non-selective, which means that they target both beneficial and non-beneficial bacterial species alike. The resulting microbiome imbalance can be a trigger for bloating, so this option may not provide the desired relief from bloating, and might make bloating worse.

Natural treatment for bloating – the functional medicine approach

The first priority of functional medicine is to identify and understand the underlying root cause of your condition.

Our bloating experts in functional medicine care will ask questions to uncover any patterns that point to a potential trigger for your bloating, using a range of functional testing and diagnostics to find the cause.

We can then help you avoid and remove triggers to prevent bloat from occurring, rather than only suppressing the symptoms.

Dietary change: Our practitioners may ask you to keep a food diary and make a note of any bloating events to help identify potential triggers in your diet. Common triggers include dairy, gluten, grains, legumes, nightshades, processed foods, soft drinks, alcohol, too little fibre, or inadequate hydration. Our practitioners will also consider factors such as dietary nutritional imbalances and deficiencies. A well-rounded diet for bloating with a focus on highly digestible, unprocessed whole foods can help to improve digestion and reduce inflammation and bloat.

Intolerance testing and elimination diets: Food intolerance is one possible cause of regular or chronic bloating issues. It’s a common response in coeliac disease, which is an autoimmune disorder, but also in lower-level sensitivities such as lactose, gluten and FODMAP intolerances. Short-term elimination diets may be recommended to prevent bloating while proactively supporting gut health.

Anti-inflammatory, gut-health compounds: Intestinal flora imbalance is one of the most common causes of bloating, so using prebiotic and probiotic foods and supplements can restore balance and bring about relief. In the initial stages of introduction, prebiotics and probiotics may exacerbate gas and bloat, as can selecting an inappropriate type, therefore should be introduced under the guidance of a trained functional medicine practitioner. Some options include foods such as berries, fermented vegetables and bone broth, through to herbal extracts of curcumin, ginger, cinnamon, peppermint and ginseng.

Importantly, our practitioners understand the discomfort and inconvenience of bloating and will work closely with you to develop a personalised approach to addressing your individual needs.

See how our approach helps our patients achieve better health and richer lives.

Joanne came to Melbourne Functional Medicine feeling overwhelmed by chronic fatigue, digestive discomfort, and sleep disturbances that impacted her training and daily life. Despite her determination, she struggled with low energy, persistent bloating, and anxiety, caught in a cycle where stress drained her wellbeing. She described feeling “wound up yet under-energised,” unable to fully relax or perform at her best.

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