SYMPTOMS

What is bloating?

Bloating is a common digestive symptom, which can be a subjective feeling where patients may perceive abdominal fullness or distension; it can also be an objective manifestation, where abdominal swelling or enlargement is observed during examination^[1,2]. Bloating can be physiological or pathological. Mild cases may only involve slight abdominal fullness, while severe cases can lead to full abdominal distension, affecting breathing and even daily life and work.

Is bloating caused by gas in the stomach?

In most cases, it is due to excessive gas, but factors such as stool, ascites, tumors, and even late-stage pregnancy can also cause bloating.

Normally, the gastrointestinal tract contains a small amount of gas, approximately 200 milliliters. When too much air is swallowed or various conditions lead to excessive gas production in the gastrointestinal tract that cannot be expelled, pressure builds up in the digestive system, causing discomfort. For example, consuming too many carbonated drinks or starchy foods can result in excessive gas and bloating.

When gastrointestinal motility slows down, stool cannot be expelled in time and accumulates in the intestines, also leading to bloating. Other conditions, such as abdominal tumors or diseases (e.g., liver cirrhosis, liver failure, peritoneal tumors, pancreatic tumors) causing ascites to accumulate in the abdominal cavity or large tumors compressing abdominal organs, can also result in bloating^[3].

Why is there gas in the gastrointestinal tract?

Gas in the gastrointestinal tract mainly comes from two sources. One is swallowing air while talking excessively, chewing gum, drinking through a straw, or eating too quickly. The other source is the bacteria in the large intestine, which produce some gas during the breakdown of food^[1].

Does drinking soda affect bloating?

Some people believe that burping after drinking soda relieves discomfort, but in reality, most of the swallowed gas remains in the intestines, worsening bloating.

People suffering from bloating should avoid drinking soda.

TREATMENT

What are some ways to relieve bloating?

Before relieving bloating, it is necessary to identify the cause. If it is caused by a disease, active treatment is required.

The following measures can be taken to alleviate bloating:

• Massage the abdomen clockwise. Warm your palms and massage clockwise, starting from the upper right abdomen, then moving to the upper left, lower left, and lower right in a circular motion for 10 to 20 rounds. This can be done 2 to 3 times a day. Be careful not to apply too much pressure, and avoid massaging immediately after meals.
• Don’t hold in gas. If you feel the need to pass gas (fart), do not hold it in. Excuse yourself and release it to relieve pressure in the gastrointestinal tract.
• Lie flat, bend your knees, and hug your calves. Try to bring your thighs as close to your abdomen as possible. This can effectively help release gas and prevent gas buildup in the stomach. You can do this once every night before bed if you frequently experience bloating.

What foods should be avoided or reduced when bloated?

• Sweet potatoes or taro: Excessive consumption can cause or worsen bloating.
• Broad beans: Modern research confirms that broad beans contain two types of sugars that cannot be broken down in the intestines. When they reach the colon, bacterial fermentation can easily lead to bloating.
• Water chestnuts: Whether eaten raw or cooked, they can cause bloating.
• Chestnuts: Difficult to digest when eaten in large quantities.
• Soybeans: Fried or boiled soybeans should be consumed in moderation.
• Vegetables like cabbage, cauliflower, and onions: These foods easily produce gas in the digestive tract, leading to bloating^[2].

In addition, foods such as leeks, garlic, chili peppers, pumpkin, longan, and red dates should also be minimized or avoided when bloated. Due to individual differences, people prone to bloating should pay attention to which foods trigger their symptoms and avoid them.

A note about glutinous rice: Glutinous rice itself is easily processed by the digestive system and, when consumed in moderation, does not cause bloating.

However, glutinous rice cakes, which often contain added sugar and animal fats, are harder to digest and should be avoided when bloated.

What should people with bloating pay attention to in daily life?

• Avoid hard-to-digest foods, as they stay longer in the digestive tract, producing more gas and causing bloating.
• Change the habit of eating quickly. Eating too fast or while walking can lead to swallowing excess air.
• Using a straw to drink beverages can also introduce air into the stomach, causing bloating.
• Manage negative emotions. Anxiety, stress, sadness, and depression can weaken digestion or stimulate excess stomach acid, leading to increased gas and bloating.
• Exercise regularly. About an hour of moderate daily exercise can help manage emotions and maintain normal digestive function.
• Consume fiber moderately and drink yogurt daily to maintain regular bowel movements.
• Take a short walk half an hour after meals and massage the abdomen daily.

What over-the-counter medications are commonly used for bloating?

Many people consider bloating a minor issue and self-medicate. However, choosing the right medication requires understanding the options.

• Simethicone: Reduces surface tension, eliminating gas bubbles in the digestive tract and relieving bloating. Suitable for those with frequent belching or flatulence.
• Probiotics: Such as bifidobacteria and lactobacillus. They help balance gut flora and alleviate indigestion and bloating.
• Gastrointestinal motility drugs: Like domperidone and mosapride. They speed up gastric emptying and promote the expulsion of food and gas. Note: Pregnant women and children under one year should use with caution, and these drugs should not be taken with atropine or belladonna^[3].

Note: Before self-medicating, it is important to identify the cause of bloating, preferably with a doctor's help.

If symptoms persist despite medication, seek medical attention promptly to avoid complications.

What precautions should be taken when using probiotics for bloating?

• Avoid combining with certain medications: Do not take probiotics with antacids, antibiotics, bismuth, tannic acid, or activated charcoal. If necessary, space them out by at least 30 minutes.
• Refrigerate storage: Probiotics contain live bacteria, and refrigeration helps maintain their viability. Dead bacteria reduce effectiveness.

How to prevent bloating?

Most bloating is diet-related. Suggested lifestyle adjustments:

• Eat slowly and avoid overeating. Smaller, more frequent meals are recommended.
• Avoid carbonated drinks, drinking through straws, and chewing gum, as these increase gas intake.
• Limit foods high in fructose or sorbitol, as well as other gas-inducing foods. Identify and avoid personal triggers.
• After meals, avoid sitting idle. Light activities like walking or doing dishes aid digestion.

If bloating is caused by medication, consult a doctor about adjusting or discontinuing the drug.

Does frequent bloating during pregnancy indicate a health problem?

Bloating during pregnancy cannot be generalized and depends on individual circumstances.

Physiological bloating is common due to hormonal changes and fetal pressure, usually mild.

However, bloating caused by infections or other conditions won’t resolve with rest alone.

Persistent bloating, even if mild, warrants a doctor’s visit. Severe pain with bloating requires immediate medical attention.

How to manage bloating during pregnancy?

If bloating persists after ruling out medical issues with an obstetrician, self-adjustments can help:

• Eat smaller, more frequent meals to reduce abdominal fullness.
• Chew thoroughly, avoid talking while eating, skip straws, and refrain from chewing gum or sucking on sour plums to minimize gas intake.
• Increase fiber intake with vegetables, fruits, and whole grains to promote bowel movements and prevent constipation.
• Avoid gas-producing foods like beans, nuts, potatoes, and carbonated drinks.
• Engage in moderate exercise (e.g., walking, yoga) to stimulate digestion, but avoid intense workouts.
• Manage stress through relaxation techniques like listening to music or walking to prevent anxiety-related bloating.

How to prevent bloating during pregnancy?

• Reduce sweets and refined foods: Sweets are acidic and may increase stomach acid, while refined foods lack fiber, worsening constipation. Incorporate whole grains.
• Avoid self-medicating with laxatives: For severe constipation, consult a doctor for safe options. Laxatives may trigger uterine contractions, risking miscarriage or preterm labor.

DIAGNOSIS

When is it unnecessary to go to the hospital for bloating?

In these cases, you can try self-adjustment first:

• If you know the specific situations that trigger your bloating, such as when angry or after eating certain foods (e.g., beans, nuts, etc.), and it resolves on its own.
• Some people frequently experience bloating without other accompanying symptoms, and it doesn’t affect daily life. The bloating may lessen or even disappear when they focus on a task.
• Additionally, recent constipation can also cause bloating discomfort, which can be managed with constipation relief methods.

When should you seek medical attention for bloating?

Bloating may be a precursor or symptom of certain diseases. If bloating persists or worsens after lifestyle adjustments, or if other symptoms appear, you should see a doctor.

Seek medical attention in the following situations:

• Bloating accompanied by severe abdominal pain, intense vomiting, or fever.
• Noticeable localized or overall abdominal swelling, or if you can feel a lump in your abdomen.
• Bloating with significant weight loss.
• Bloating lasting over a week without bowel movements, with no improvement from constipation treatments.

Which department should you visit for bloating?

• Chronic bloating: Visit the gastroenterology department.
• Chronic bloating with greasy food aversion or jaundice: Visit the hepatology department (or gastroenterology in some hospitals).
• History of severe heart disease with frequent bloating: Visit the cardiology department.
• Frequent bloating with lower back pain or abnormal vaginal discharge: Visit the gynecology department.
• Sudden, severe bloating with abdominal pain and vomiting: Visit the emergency department at night or general surgery/emergency during working hours.

What might bloating with frequent belching indicate?

Bloating and frequent belching are often caused by insufficient gastric motility due to:

• Functional dyspepsia;
• Chronic atrophic gastritis;
• Gastroptosis, peptic ulcers, or pyloric obstruction.

What might bloating with constipation indicate?

These symptoms often occur in patients with:

• Habitual constipation;
• Irritable bowel syndrome (constipation-predominant);
• Bowel obstruction;
• Left-sided colon cancer.

Constipation or acute/chronic bowel obstruction increases intestinal contents, causing bloating. Causes include functional factors, habitual constipation, and constipation-predominant IBS.

Left-sided colon cancer may narrow the intestinal lumen, leading to obstruction and bloating.

These are common possibilities; specific diagnoses require further evaluation.

What might bloating with diarrhea indicate?

This combination is often seen in malabsorption disorders such as:

• Acute intestinal infections;
• Liver cirrhosis;
• Chronic cholecystitis;
• Chronic pancreatitis;
• Malabsorption syndrome^[3].

Why does bloating with frequent flatulence occur?

This is often due to excessive gas in the colon from intestinal fermentation, such as in irritable bowel syndrome.

Eating gas-producing foods like onions may also cause it.

POTENTIAL DISEASES

What are the possible causes of bloating?

1. Organic diseases:

Organic conditions such as inflammation, cysts, obstruction, or malignant tumors in abdominal organs like the gastrointestinal tract, liver, biliary tract, pancreas, or peritoneum can cause bloating.

2. Functional gastrointestinal disorders:

Conditions like functional dyspepsia or irritable bowel syndrome (IBS) may also lead to bloating.

3. Other diseases:

Severe infections, heart failure, kidney failure, or neurological disorders may present with bloating. It can also result from hypokalemia or thoracolumbar spine lesions^[1].

What are the common causes of bloating in the general population?

People with fast-paced lifestyles and high stress levels are prone to functional gastrointestinal disorders, which may manifest as functional dyspepsia or functional bloating, often accompanied by noticeable abdominal distension.

Additionally, individuals with gastritis or constipation are more likely to experience bloating.

What are functional gastrointestinal disorders?

Functional gastrointestinal disorders are a group of digestive conditions resulting from interactions between physiological, psychological, and social factors. Patients experience genuine discomfort, but routine tests such as blood work, ultrasounds, or CT scans often fail to detect any abnormalities^[5].

Management primarily relies on self-regulation, with severe cases requiring psychological therapy.