How to Cure Bloated Stomach

Bowel Gas And A Bloated Stomach: What Do You Need To Know?

Abdominal bloating is a condition in which the tummy feels full, tight and distended (swollen). It is also called meteorism and tympanites. Belching, flatulence, and bowel movements relieve the symptom of abdominal bloating in most of the cases. The majority of medical conditions or other factors that can cause bloating in the abdomen are not serious, and they would include conditions like aerophagia, in which abdominal bloating is caused by the subconscious swallowing of air. [1]

The bowel of a healthy person contains about 200 ml of gas. About 600 ml of gas is evacuated (expelled) as flatus (or farts) every single day, and yes, the average person passes gas five to 15 times a day, even if they don't notice, because they may for instance be asleep. The five main gases found in the bowel are nitrogen, oxygen, carbon dioxide, hydrogen and methane.

 Of these, nitrogen and oxygen are derived from swallowed air and the remaining gases are formed due to a fermentation process by bacteria (which play an important role in the digestive system) in the large bowel. [2] Fun fact: most flatulence is actually odorless. The "stinky farts" you pass can be blamed on bacteria that produce sulfur.

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The excess gas you may have in the upper gastrointestinal tract is, on the other hand, released by belching or burping. Burping is less frequent than flatulence, and belching often over a prolonged period of time could be the sign of an underlying condition, or of swallowing too much air.

Bloating is the perception of retained excess gas within the lumen of the gut. Women report bloating more often than men. Although some conditions lead to increased gas production, many individuals with bloating exhibit normal gut gas volumes.

What Causes A Bloated Stomach?

Abdominal bloating usually results from a disorder of the function of the gastrointestinal tract. Abdominal bloating could be due to any of the following causes [1]:

• Subconscious swallowing of air – This is called aerophagia. Swallowing excess amounts of air usually occurs during rapid eating and drinking, chewing gum, smoking and wearing loose dentures. This is more pronounced in nervous individuals. Most of the upper intestinal air is accumulated because of aerophagia.
• Irritable bowel syndrome – IBS is characterized by abdominal pain or discomfort associated with altered bowel habits, specifically alternating episodes of diarrhea and constipation. In this condition, the amount and distribution of gas in the gut will be normal. But due to increased sensitivity, there is increased awareness of gas and bloating. Sometimes certain fiber supplements used to treat irritable bowel syndrome and constipation can cause bloating.
• Constipation – Chronic constipation can cause a bloated stomach.
• Small intestinal bacterial overgrowth – This is a condition in which abnormally large amounts of certain kinds of bacteria are present in the small intestine. This interferes with digestion and the absorption of nutrients and causes symptoms like bloating, abdominal discomfort or cramps, and diarrhea.
• Excess gas in the bowel – Excess gas could build up in the bowerl due to a malabsorption of nutrients. This is seen in medical conditions like lactose intolerance and other food sensitivities. Malabsorption, in addition to abdominal bloating, also causes other symptoms like abdominal pain, weight loss and diarrhea. Sometimes overeating or eating excess of fatty food can cause similar symptoms. Fatty food delays emptying of the stomach and allows the gas to accumulate, causing bloating.
• Abnormal motility of the bowel – Conditions that affect the motility (movement) of the bowel can result in prominent gas and bloating. Gastroparesis is one of the common conditions that affect the motility of the gut, causing symptoms including bloating. Certain medications like opiates, calcium channel blockers, anticholinergics and antidepressants can affect the motility of gut, again causing abdominal bloating.
• Intestinal obstruction – If there is intestinal obstruction, it causes abdominal distention, vomiting and constipation. It is an extremely serious condition and immediate medical attention is necessary.
• Gas-bloat syndrome - It is a consequence of the fundoplication surgery for gastroesophageal reflux disease. Following this surgery, there will be an inability to belch or vomit. In the initial months after fundoplication, up to 20% of patients experience bloating.

Abdominal bloating sensations need not be always due to gas in the bowel. Sometimes the tummy may feel full, tight and distended in other conditions as well which include:

• Ascites – In this condition, there is an accumulation of excess fluid which may be due to liver disease, kidney disease, cancer, or infection.
• Tumor – A tumor in the abdomen can cause distention and a tense feeling. 

Ascites and tumors are usually reported as abdominal swelling and not as abdominal bloating. If the abdomen is more seen as distended it is more likely to be abdominal swelling rather than abdominal bloating. On the contrary, abdominal bloating is more felt than seen.  About 25% of those who complain of abdominal bloating do not complain of abdominal distension. Up to 1400 ml of gas, which is about 7 times the normal gas level (200 ml), is required to cause an increase in the abdominal girth by 2 cm. [3]

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Treatment Of A Bloated Stomach

Treatment depends on the underlying cause of abdominal bloating. The following is the usually recomended treatment of each of the common causes of a bloated stomach.

1. Aerophagia (Subconscious swallowing of air) - Behavioral modification is necessary to treat this condition [4].
   • Avoid chewing gum
   • Wear correctly fitting dentures
   • Eat slowly
   • Chew well
   • Avoid hard candy
   • Avoid carbonated drinks
2. Irritable bowel syndrome - Low dose antidepressants and antispasmodics are used to treat or manage irritable bowel syndrome. Recent meta-meta-analyses have indicated the benefit of antibiotics, probiotics, and anti-tumor necrosis factor agents in patients with IBS [5].
3. Constipation – Osmotic laxatives and plenty of fluids will be helpful. Certain fiber supplements like psyllium should be avoided as they can worsen bloating. [6]
4. Small intestinal bacterial overgrowth – Bacterial infections are treated with a course of antibiotics. For example, an analysis of small bowel biopsies in elderly patients with small intestinal bacterial overgrowth revealed blunting of the intestinal villi, thinning of the mucosa and crypts, and increased intraepithelial lymphocytes. All of these symptoms reversed with antibiotic treatment. [7]
5. Malabsorption syndrome – Nutrients that are not absorbed well are eliminated from the diet. For example, lactose is to be avoided in lactose intolerance and gluten in case of celiac disease. Alternatively, digestive enzymes (like lactase enzyme for lactose intolerance) can be taken for relief. [8]
6. Abnormal motility of gut – Diabetes mellitus is a risk factor for the development of gastroparesis, which is a chronic disorder that affects a significant part of the population. Gastroparesis is treated with prokinetics like metaclopramide.  If abnormal motility is due to medications, one should investigate alternative options. [9]
7. Intestinal obstruction – Surgery is done urgently to treat this condition. [10]

In addition to the treatment mentioned above, which is directed towards the specific underlying cause of abdominal bloating, there are a few other treatment options which treat the symptom of bloating. These steps, which you can take at home to reduce bloating, include:

• Gas-forming food items should be avoided, and they would include whole wheat, milk and milk products, sugar-free candies, beans, cabbage, and broccoli. Alternatively, Beano or Fiberease can be taken to prevent gas formation. Five drops or one tablet of Beano per serving helps prevent gas formation. Fatty foods should also be avoided.
• Simethicone and activated charcoal help in reducing bowel gas [11].
• Drinking Fennel tea may relieve the symptom of bloated stomach.