Bloating, often referred to as Abdominal Bloatedness is a very common symptom experienced by everyone at some point in their lives.
Abdominal Bloatedness is a feeling of gaseous distension in the tummy. Individuals with this symptom often refer themselves to having a ‘gassy’ tummy or having a lot of gas in the tummy that cannot be expelled out. Individuals will often try to pass out the gas through the mouth (burping) or through the bottom (flatus). Others may resort to abdominal massages or applying some oil to the tummy or taking some antacids to get relief from the bloatedness.
The sensation of Bloatedness arises from a combination of two factors.
The first factor is the Production of excessive gas in the stomach and intestines. This can be due to the swallowing of air or due to increased production of air from the ingested food
The second factor is the Increased Sensitivity of the stomach and intestines to stretching caused by the gas. The exact reason for this is not clear though certain individuals do have an increased propensity for this. This can be partially alleviated through certain medications.
In combination, these two factors will create the sensation of bloatedness in the tummy.
Abdominal bloatedness can occur before or after meals or be unrelated to meals. Abdominal bloatedness can occur suddenly or be brought on by certain innocuous food. Some of these food can be food that the person has been eating for years with no problems
Abdominal bloatedness is usually a benign symptom though it can sometimes be associated with more serious medical conditions
Irritable Bowel Syndrome (IBS)
Irritable Bowel Syndrome, also known as IBS is one of the commonest causes of abdominal bloatedness. The bloatedness related to IBS is usually triggered by particular foods or during periods of stress.
Other symptoms of IBS include either constipation or frequent loose stools, passage of mucus and a sensation of incomplete bowel clearance. The symptoms of IBS mimics colorectal cancer and proper assessment is needed to exclude more serious conditions. Passage of blood in the stools and significant abdominal pain and loss of weight should not occur with IBS.
IBS cannot be completely eradicated though the symptoms can potentially be alleviated through a variety of medications. These medications include probiotics, anti-spasm medications and sometimes laxatives or anti-diarrhoeal medications. The treatment has to be tailored to suit the set of symptoms that the individual is experiencing.
Functional Dyspepsia is a form of IBS that has symptoms that largely affect the stomach. The bloatedness is often experienced in the upper abdomen at the ‘gastric’ area and is usually experienced after meals. Treatment is largely similar to IBS.
Gastritis and Acid Reflux
Gastritis and Acid reflux are conditions that affect the stomach. As such, they can have similar symptoms to Functional Dyspepsia, namely bloatedness at the ‘gastric’ region. In addition, Gastritis can lead on to severe pain and nausea or even vomiting. Acid reflux can have additional symptoms such as a burning pain in the centre of the chest or a sour taste in the mouth or at the back of the throat.
It can be difficult to distinguish between Gastritis/Acid reflux and Functional dyspepsia. A Gastroscopy (stomach scope) may be needed to distinguish between the two.
The treatment of both of the these conditions is a group of anti-gastric acid medications known as Proton Pump Inhibitors. Common drugs in this class include Omeprazole and Esomeprazole. Surgery is usually required for emergencies such as bleeding or perforated ulcers or for reduction of acid reflux.
Gallstones
Gallstones are found in the gallbladder. Gallstones can cause symptoms similar to Gastritis or Functional Dyspepsia in the early stages. The symptoms include a sense of bloatedness in the ‘gastric’ area. What is unique to gallstones is that the bloatedness occurs after a meal, particularly an oily meal. The bloatedness can in turn last for several hours. In addition, there can be a severe squeezing type pain underneath the rib cage on the right side and the pain can also be felt over the right upper back.
Gallstones can be diagnosed with an ultrasound. The difficulty with diagnosing gallstones lies in its similarity with Functional Dyspepsia and Gastritis and hence is often initally treated as such. Patients are often treated for a period of time with anti-gastric meds with no improvement before gallstones are suspected. Any patient who does not respond well to anti-gastric medications should have gallstones excluded by doing an ultrasound scan.
The treatment of problematic gallstones is a surgical removal of the gallbladder and the stones within it. This is done as a keyhole surgery and only requires an overnight stay.
Dietary Intake
Particular foods can cause increased gas production and hence abdominal bloatedness. These include wheat and flour, most types of beans and dairy products.
With increased gas production in the intestines, the patent often experiences abdominal bloatedness for many hours. The only effective treatment method is for avoidance of the aggravating food groups on a temporary basis. Re-introduction of the inciting food groups can be done gradually a few months later and with observation of any recurrence of the bloatedness.
Gastrointestinal Cancers
Abdominal bloatedness can occasionally be associated with more serious underlying conditions, in particular cancers in the abdomen.
Bloatedness over the upper abdomen can be associated with cancers of the stomach, lower esophagus, pancreas or parts of the colon.
Bloatedness over the lower abdomen can be associated with cancers of the colon or the uterus and ovaries in females.
Most cases of abdominal bloatedness is usually due to benign conditions. Factors that increase the likelihood of underlying cancer include an older age, family history of cancer, gradual worsening of bloatedness or the presence of other worrying symptoms
The investigation of any cancer-related bloatedness includes a Gastroscopy and/or Colonoscopy together with a CT scan of the abdomen.
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