Beat the Bloat

Bloating is a common complaint, but do you know why it occurs? Here’s the why, how and what to do for those uncomfortable belly blues

Written by Jennifer B. Slaton

“My stomach feels as big as a house!”

“Ooooh I am STUFFED.”

Sound familiar? Or rather, feel familiar?

Abdominal bloating—or a temporary feeling of fullness or swelling in the belly—is a condition that affects many of us at one time or another. Epidemiologists report that up to 30 percent of American adults regularly experience the uncomfortable sensation, which can be accompanied by visible distention of the abdomen. 

“Bloating feels like you have a balloon blown up in your belly,” says Roper St. Francis Healthcare affiliated gastroenterologist Dr. Lori Robbins. Here, Dr. Robbins explains what’s happening internally when we’re bloated, when to seek medical care and how to avoid the puffy unpleasantness. 

Dr. Lori Robbins

Defining the Sensation

One way to define bloat is to clarify what it’s not: excess belly, or visceral, fat. You can squeeze visceral fat between two fingers, whereas bloat feels swollen, explains Dr. Robbins.

Many blame bloat on water retention or excess fluid retained in different parts of the body, including the abdomen. “While water retention can cause the sensation of bloating, it’s not the most common cause that I see,” says Dr. Robbins. That honor goes to something more fitting for a balloon-like belly: gas.

The Roots of the Problem

Excess gas in the digestive system is one of—if not the—top causes of bloating, says Dr. Robbins. There are a host of reasons why gas develops, including, of course, what you eat.

“Dairy is a major culprit,” says Dr. Robbins. Lactose intolerance, or the inability to digest the lactose in milk, is widespread, and becomes more common with age. According to the National Institutes of Health, approximately 30 million American adults have some degree of lactose intolerance by age 20. “Even if a person does fine with dairy products at age 15, it doesn’t mean they will at age 40,” says Dr. Robbins.

Another common dietary trigger for gas is certain high-fiber foods, such as beans and cruciferous vegetables like broccoli. “These foods contain certain carbohydrates, or sugars, that are hard for our bodies to digest,” Dr. Robbins explains. “When our bodies don’t digest the sugars completely, they can become food for bacteria that live in the GI tract. When bacteria break down the sugars (a process called fermentation), gas can occur.” Depending on your body’s tolerance level, eating hefty servings of these healthy foods can wreak havoc on your stomach.

(BUT WAIT! Don’t read that and write off fiber. Because it takes longer to digest than other nutrients, fiber helps keep you full longer. It’s also vital for maintaining healthy gut bacteria and helps keep your digestive tract clean and clear. Instead of avoiding high-fiber foods in hopes of warding off gas, train your body to better handle them by gradually increasing how much you consume. Over the course of a few weeks, aim to reach the recommended 25 to 30 grams per day, suggests Dr. Robbins.)

In addition to excess gas, another common cause of bloating is constipation. “A buildup of stool in the colon produces the feeling of bloat,” says Dr. Robbins, who says adults should aim to have a bowel movement daily, or at least three times a week. To help relieve constipation, she suggests increasing your fiber intake, drinking plenty of water and getting ample exercise. “If those measures fail, visit your doctor, who can help determine and treat the underlying cause,” says Dr. Robbins. 

For women, hormonal fluctuations associated with menstruation, pregnancy and menopause can cause bloating. And more extreme cases of bloat—especially bloating accompanied by other gastrointestinal troubles—may be a sign of a digestive disorder. That can include anything from inflammatory bowel and celiac disease to colon cancer, liver disease, pancreatic cancer and more.  

“One of the most common bloat-inducing disorders I see is small intestinal bacterial overgrowth,” or SIBO, says Dr. Robbins. SIBO is a condition in which high levels of bacteria that belong in the colon end up in the small intestine. This can occur after gastrointestinal surgery or as a result of certain diseases or infections, she explains. “Symptoms of SIBO include severe bloating along with abdominal pain, gassiness, nausea, diarrhea and constipation.”  

SIBO often goes hand-in-hand with another common condition associated with bloating: irritable bowel syndrome (IBS). IBS can affect the large or small intestine and produces symptoms similar to those associated with SIBO. “In fact, some people consider SIBO and IBS to be interchangeable—it may be the SIBO that causes the symptoms of IBS in many patients,” says Dr. Robbins. “There’s a big overlap between these two disorders. Recent research shows that up to 78 percent of people diagnosed with IBS have SIBO as well.”  

In December 2019, North Charleston resident Anna Litchenberg was diagnosed with microscopic colitis, an inflammation of the large intestine. After treatment didn’t improve symptoms, Dr. Lori Robbins tested and subsequently diagnosed her with SIBO. “Dr. Robbins’ expertise about SIBO treatment provided a dramatic recovery,” says Anna. “I am so grateful for her help.” 

When to Get Help

“If you have bloating once in a while or only when you eat certain foods, there’s no need to visit your doctor unless the symptoms are persistent or bothersome,” says Dr. Robbins. However, persistent, intense bloating, or bloating accompanied by other GI issues—especially a significant change in bowel habits, pain in the GI tract, unintended weight loss or blood in stool—should be evaluated immediately as something more serious could be at play. 

For many gastrointestinal conditions, a change in diet can help. For example, people with IBS may benefit from adopting a low FODMAP diet. “FODMAP refers to a group of highly fermentable sugars found in certain foods that are hard to digest for some people,” explains Dr. Robbins. “Basically, it’s a specific diet that’s low in certain fermentable sugars.” Likewise, eliminating gluten from one’s diet can help clear up symptoms for people with celiac disease—a chronic autoimmune disease triggered by gluten ingestion.“Treatment varies from person to person and may involve some trial and error,” says Dr. Robbins. “But in many cases we are able to pinpoint the cause and find a way to relieve the uncomfortable symptom.”

Banish the Bloat

Dr. Robbins shares additional tips for a happier belly

Practice portion control. “When you eat a huge meal, it takes a while for your GI tract to move the food through, which can lead to gas and bloating,” says Dr. Robbins. Aim for smaller meals with healthy snacks in between. 

Slow down when you eat. “If you eat quickly, you’re likely going to swallow a substantial amount of air, which can lead to gassiness,” she says. Take time to chew thoroughly—and enjoy!—each bite. 

Cut artificial sweeteners for good. Gut bacteria have a very difficult time breaking down artificial sweeteners. “Watch out for chewing gum, where artificial sweeteners often hide,” says Dr. Robbins. 

Get a move on. “We know that people who aren’t mobile, for example, those who are confined to bed rest, can end up with severe constipation,” says Dr. Robbins. “Moving around—it doesn’t matter the type of movement you choose—keeps things moving in our gut.” 

Photographs (Anna) by Scott Henderson; (Dr. Robbins) Niki Nero