This page exists for visitors who have never yet been to this site or read about IBS, and whom are merely attempting to Google their way to relief. If you already know that your bloating is caused by IBS, skip ahead to the all-to-light section on treatment.
It is worth noting that bloating and distension are two separate phenomona.
Bloating is the feeling that the abdomen is abnormally enlarged. Thus, bloating is a sign of – or, type of – discomfort
On the other hand, distention can be objectively determined. Distension occurs when it is physically true that the abdomen is temporarily larger than normal. Distention (the physicality of bloating) can be determined by being unable to fit into clothes or simply noticing – visually – that your stomach is larger than normal.
Bloating often represents a mild form of distention as the abdomen does not grow (in any visably notable manner) until its volume increases by one quart. Regardless, bloating should never be assumed to be the same as distention.
Very mild cases of distention may be caused by relaxation of the muscles of the abdominal wall.
There are three primary ways by which abdominal distention can occur: an increase in air, fluid, or tissue within the abdomen. All of these three factors are unique.
There are two types of distention; continuous and intermittent.
Continuous distention may be caused by the enlargement of an intra-abdominal (within the abdomen) organ, an intra-abdominal tumor, a collection of fluid around the intra-abdominal organs (ascites), or just plain obesity.
Intermittent distention is usually due to the occasional accumulation of gas and/or fluid within the stomach, small intestine, or colon.
Causes of Bloating and Distension
The most prevalent and likely cause of abdominal bloating/distention is excessive gas produced by intestinal bacteria.
The amount of gas that bacteria produce varies from individual to individual. In other words, some individuals may have bacteria that produce more gas, either because there are more of the bacteria or because their particular bacteria are better at producing gas.
Further, due to IBS, there may be poor digestion and absorption of foods in the small intestine, allowing more undigested food to reach the bacteria in the colon. The more undigested food the bacteria have, the more gas they produce. Examples of diseases of that involve poor digestion and absorption include lactose intolerance (which the majority of people have), pancreatic insufficiency, and celiac disease.
On the other hand, bacterial overgrowth can occur in the small intestine. Under normal conditions, the bacteria that produce gas are limited to the colon. In some conditions, these bacteria spread into the small intestine. When this bacterial spread occurs, food reaches the bacteria before it can be fully digested and absorbed by the small intestine. Therefore, the bacteria in the small intestine have a lot of undigested food from which to form gas. This condition in which the gas-producing bacteria move into the small intestine is called bacterial overgrowth of the small intestine (bowel).
Excessive production of gas by bacteria usually is accompanied by flatulence. Increased flatulence may not always occur, however, since gas potentially can be eliminated in other ways – absorption into the body, utilization by other bacteria, or possibly, by elimination at night without the awareness of the gas-passer.
An obstruction (blockage) can occur virtually anywhere from the stomach to the rectum. When the blockage is temporary or partial, it can cause intermittent abdominal bloating/distention. For example, scarring of the pylorus (pyloric stenosis) can obstruct the opening from the stomach into the intestines, thereby blocking the complete emptying of the stomach. After meals, the stomach is normally filled with food and swallowed air. Then, during the next hour or two, the stomach secretes acid and fluid, which mix with the food and assist in digestion. As a result, the stomach distends further. When the obstruction is incomplete, the food, air, and fluid eventually pass into the intestines and the bloating/distention resolves.
An obstruction in the small bowel, which is most commonly due to adhesions from a previous surgery, is another cause of intermittent abdominal distention. To make matters worse, the distention that is caused by the physical obstruction stimulates both the stomach and intestines to secrete fluid, which adds to the distention.
Severe constipation or fecal impaction (hardened stool in the rectum) can also obstruct the flow of the intestinal contents and result in distention. In this case, however, the bloating/distention usually is constant and progressive and is relieved by bowel movements or removal of the impacted stool.
The treatment of excessive intestinal gas depends on the cause.
For most everyone, the cause – if bloating is frequent and recurring – is life-long adherence to something at least inspired by the F.O.D.M.A.Ps concept. IBS is incredibly prevalent, and the offending sugars can be easily eliminated from the diet (or merely reduced as needed).
If lactose proves to be the sole irritant, enzymes that are similar to intestinal lactase can be added to the milk in order to break down the lactose prior to its ingestion so that it can be absorbed normally. Some people find that yogurt, in which the lactose has been broken down partially by bacteria, produces less gas than milk.
When maldigestion is due to pancreatic insufficiency, then supplemental pancreatic enzymes can be ingested with meals to replace the missing enzymes.
If maldigestion and/or malabsorption is caused by disease of the intestinal lining, the specific disease must be identified, most commonly through a small bowel biopsy. Then, treatment can be targeted for that condition. For example, if celiac disease is found on the biopsy, a gluten-free diet can be started.
An interesting form of treatment for excessive gas is alpha-D-galactosidase, an enzyme that is produced by a mold. This enzyme, commercially available as Beano, is consumed as either a liquid or tablet with meals. This enzyme is able to break down some of the difficult-to-digest polysaccharides in vegetables so that they may be absorbed. This prevents them from reaching the colonic bacteria and causing unnecessary production of gas. Beano has been shown to be effective in decreasing the incidence of intestinal gas.
Two other types of treatment have been promoted for the treatment of gas; simethicone (Phazyme; Flatulex; Mylicon; Gas-X; Mylanta Gas) and activated charcoal. It is unclear if simethicone has an effect on gas in the stomach. However, it has no effect on the formation of gas in the colon. Moreover, in the stomach, simethicone would be expected only to affect swallowed air, which, as previously mentioned, is an uncommon cause of excessive intestinal gas. Nevertheless, some individuals are convinced that simethicone helps them. Activated charcoal has been shown to reduce the formation of gas in the colon, though the way in which it does so is unknown.
If there is a physical obstruction to the emptying of the stomach or passage of food, liquid, and gas through the small intestine, then surgical correction of the obstruction is required. If the obstruction is functional, medications that promote activity of the muscles of the stomach and small intestine are given. Examples of these medicines are erythromycin or metoclopramide (Reglan).
Bacterial overgrowth of the small bowel usually is treated with antibiotics. However, this treatment is frequently only temporarily effective or not effective at all. When antibiotics provide only a temporary benefit, it may be necessary to treat patients intermittently or even continuously with antibiotics. If antibiotics are not effective, probiotics (for example, lactobacillus) can be tried although their use in bacterial overgrowth has not been studied. This condition may be difficult to treat.