We rounded up our most frequently asked questions on the topic of bloating and sat down with Dr Sarah Jarvis to explain more. From the scientific process that happens in your gut when you bloat to Sarah’s tips to helping ease it, we’ve got you covered.
What is bloating and how can you deal with it?
Bloating is a feeling of tightness or swelling in your tummy, which often gets worse after eating or as the day goes on. It can be down to a host of different reasons, most of which lie in your gut.
Sometimes it's because you've got an underlying problem of inflammation within your gut, such as inflammatory bowel disease, (Crohn's disease or ulcerative colitis). It could also be due to diverticular disease or celiac disease, but in many cases, it could be down to irritable bowel syndrome, commonly known as IBS
IBS is what's called a functional problem with your gut. That means that there's no problem if you look under the microscope at any one bit of the gut, but the different parts of the gut don't work well together. It’s very common, with about 1 in 5 adults in the UK getting symptoms at some point. It affects women much more often than men and symptoms usually start when you’re a young adult. Nine out of ten people with IBS complain of bloating.
There are also several other things that could cause bloating. If you’ve developed bloating after starting a new medication, it’s always worth checking the patient leaflet or speaking to your pharmacist. If you put lots of air or gas into your stomach at the top end - swallowing it when you chew, when you talk, or when you smoke, or drinking fizzy drinks – you could end up with bloating.
A lot of times bloating is down to a problem called dysbiosis. It’s a very long medical term but basically it means that the microbiota, those trillions of bacteria and fungi and viruses and things that live inside your gut and without which you couldn't digest food, are producing too much gas. That can be because the balance of the gut microbiota is wrong, it can also be because of what they're feeding on. So, for instance, you could be intolerant of certain foods, say, lactose, or you could be eating a lot of food that naturally cause gas when they’re digested, such as beans, pulses, some fruit and vegetables.
Much less often, ovarian cancer can lead to bloating. In this case the bloating doesn’t tend to come and go, and can be linked with other symptoms.
What's the connection between bloating and gut health?
For the majority of people who don't have a serious underlying condition, dysbiosis is one of the most common culprits. There are trillions of bacteria, as well as fungi and viruses, that live in your gut. You couldn't digest food without them, so, they are really important for good health. However, if the balance gets shifted and you have too many bad bacteria inside your gut, those bacteria can produce a lot of wind, particularly as they digest food.
They're producing gas as a byproduct of digesting that food, and that can lead to bloating. That's why getting your gut in balance, so-called healthy microbiota, can be so important. Eating the right ‘prebiotic’ foods, including a variety of fruits and vegetables, which will feed all your gut bacteria (the good ones more than the bad) can help. Probiotic foods provide a ready-made supply of those healthy bacteria and probiotic supplements do the same thing in high concentrations.
What's the scientific process going on in your gut when you bloat?
It's normal for your tummy circumference gradually to increase as the day goes on. The process of digestion goes on throughout your GI tract, your gastrointestinal tract, and that reaches from your mouth, right down to your back passage -in other words, from where things go in to where things come out. Now, there's lots going on there. Food is being taken in and it's digested right the way through your tract, starting in your mouth, where enzymes start the process of digestion and chewing helps break it down so your body can digest and absorb it.
But most of the bacteria which do the final breaking down are found in your large bowel, which goes down from your right hip bone to the top under your right ribcage, swivels across in little loop across the left-hand side and then goes down to your left hip bone. Living in there are the bacteria which are really key for breaking down food.
If you have dysbiosis, these unhealthy gut bacteria can produce methane-like gas as they digest food. The almost inevitable result is bloating, often along with excess wind.
How much bloating is normal?
Everybody feels a little bit bloated from time to time. Maybe you've just had a heavy meal because it's Christmas and you're celebrating. Of course, if you've eaten a lot, you may feel bloated, particularly in the short term this sort of mild bloating, particularly if it comes and goes and doesn't interfere with your lifestyle, is okay.
There are things that you can do about it by adjusting your eating, exercising more and changing the foods you eat. You can feed your good bacteria with probiotic or prebiotic foods. But bloating becomes abnormal if it's interfering with your day-to-day life. It's also abnormal if it doesn't come and go, rather than feeling more bloated as the day goes on and back to normal when you wake up.
For women in particular, persistent can occasionally be a warning sign that must never be ignored. That’s because persistent bloating is one of the warning signs of ovarian cancer. You should pay special attention to bloating that doesn't come and go, especially if it’s present on more days than it's not or if you also have other symptoms like feeling full early, feeling sick, having persistent tummy or pelvic pain, or changes to your bladder or to your waterworks.
Bloating also isn't normal if it's accompanied by a sudden change to your bowels. That could be a sudden increase in diarrhoea; getting blood in your poos or black tarry poos; vomiting a lot when you weren't before; or being off your food or losing weight without meaning to. As you get older, it gets more important to get your bloated looked into if you haven’t had it regularly before.
I would say that any woman over 30, certainly over 40, who develops bloating for the first time should always get it checked out by a doctor.
Why do I bloat when I eat?
An awful lot of people complain of bloating when they eat. And that can be for a host of reasons. Not surprisingly, eating really big meals can make you feel bloated, but so can eating too fast. It takes about 20 minutes for messages from your stomach saying that you're full to reach your brain.
If you eat too fast and don't chew your food, or are distracted when you're eating, it may go down and you may not notice those messages from your brain telling you to stop. Sometimes it's down to what kind of foods you eat. Some foods are high in insoluble fibre, which your gut doesn't absorb. That's good for your gut, but if you have too much of it and your gut is sensitive you may find that that causes bloating. We're thinking there about wholemeal and whole grain foods, some fruit and vegetables, beans, pulses, lentils and so on.
Dysbiosis, having an unhealthy balance of the bacteria that naturally live in your gut can also make you really prone to bloating, particularly when you eat. Many people find that after they eat or as the day goes on, their bloating gets worse. And addressing that by thinking about your diet and feeding your healthy bacteria in your gut can really make a difference.
Why do some vegetables cause bloating?
We all need fibre in our diets. It's good for your gut health, and it's good for your general health. On the whole, most of us eat far too little of it. Most vegetables are high in fibre, but the problem is that too much fibre, particularly if you change your diet suddenly, can increase bloating because it's food that your gut can't digest, so it builds up.
That does help to keep you regular, but it can also lead to bloating, particularly in the short term. In addition, many vegetables are high in something called FODMAPs – fermentable (that's the really important word), oligo, di and monosaccharides and polyols, which can cause bloating for several different reasons.
Firstly, FODMAPs are small molecules and they can draw fluid into the gut, which can lead to diarrhoea as well as bloating. Secondly, the bacteria in your gut basically ferment them as they digest them – and this produces gas and other chemicals. What are the solutions to bloating caused by vegetables?
Keeping a food diary and identifying foods which particularly give rise to your symptoms can be really helpful. There are quite a lot of fruit and vegetables which are lower in FODMAPs than others. We don't want you to cut out vast swathes of food from your diet all at once, particularly without advice from a dietitian, because that could really leave you at risk of being short of vitamins and minerals.
But if you do use of food diary and identify some of those foods, then you can often cut them down or build them up more gradually or think about fibre-filled foods and take it gradually with those.
If you're a vegetarian it can be harder to get enough protein, vitamins and minerals unless you’re eating a wide variety of healthy vegetarian foods. If you’re cutting out lentils, beans and pulses to reduce bloating you may find keeping your protein intake up is a particular challenge on a vegetarian diet But you may find that foods like tempeh, tofu, nuts, seeds, and so on can provide you with some of those essential vitamins, minerals and protein, without making you prone to bloating.
What helps bloating?
What will help with your bloating will largely depend on what the cause is.
- If you're swallowing a lot of air or gas you can cut down on fizzy drinks. You can chew more slowly andchew with your mouth closed - really important for chewing gum, for instance. And I'm afraid just another reason for giving up smoking.
- Eating smaller, more frequent meals may well help you with bloating, particularly if you tend to bloat up towards the end of the day as many people do.
- It may feel hard to exercise when you've got bloating, but actually exercising regularly really can help with bloating.
- Of course, bloating is often down to things you're eating as well, so you may find that keeping a food diary so you can cut down on some of the traditional bloating foods and very high fibre foods such as beans, lentils, pulses. You may find some of them may cause you bloating while others do not. They're really good for your health, so it's important not to cut them out completely. But you may find that focusing on some rather than others by using a food diary will really make a difference. Always see a dietitian before making major changes to your diet or cutting out whole food groups.
- And finally, of course, most importantly of all, perhaps for many people, is putting your gut bacteria in a position where they can digest your food without producing gas. Now, if you've got the wrong balance of gut bacteria, that's called dysbiosis. And those bacteria produce a lot of gas as they digest food. Surprise, surprise - that causes you to bloat. So feed your healthy gut bacteria, whether it's with probiotic foods which are basically doses of healthy bacteria, probiotic supplements, which again provide healthy gut bacteria, or prebiotic foods, which are foods which your healthy bacteria love to feed on.
All of those can put your gut back into balance.
How can I ease trapped wind?
Trapped wind can be really uncomfortable but there are several things that you can do to ease it.
- Movement. It may feel difficult to exercise when you've got trapped wind, but moving around can help move that gas around your digestive system.
- Warmth. So, for instance, a hot water bottle placed over your tummy can often ease trapped wind. In terms of preventing it, eating smaller meals more frequently can make a difference.
- Speak to your pharmacist about remedies you can buy to help with trapped wind.
- Peppermint tea may make a difference because it opens up the sphincters -one-way valves between different parts of your gut that lets that gas travel through your system.
- And then there's the ‘I love you’ massage method. You want to follow the direction of food and wind as it travels through your colon (large bowel) towards your back passage. I. Start with massaging gently from the top of your tummy under your left ribcage down to the bottom to move that gas along. L. Massage in an upside-down L shape from the top right, across the top of your tummy to top left, and then down the left side towards your pelvis. U. Finally, try the upside down U, starting on the bottom right, following the direction of your large bowel up to the top, across the top and down from top left to bottom left. If you do each of those movements ten times, it can help to move gas along. It may also help to propel digested food along your large bowel down the left-hand side to your back passage, where you get rid of it.
Why do I bloat after exercise?
It's very common to feel bloated after exercise, and there are several reasons which all make sense when you drill down. The first is that when you're exercising, you tend to breathe harder, and that means you may be swallowing more air. Guess what? That air gets into your stomach, making you feel bloated.
When you're exercising your body needs oxygen to supply the muscles because they’re using more energy. That means it diverts oxygen and blood away from your stomach. That slows down digestion. Part of is process comes because you’re releasing adrenaline - the so-called fight or flight response, way back in our evolution. If you’re faced with an enemy, you’ll need all your muscle strength to stand up and fight or run away at top speed. Digesting food isn’t a top priority when faced with a sabre-toothed tiger!
You may also find that if you eat a heavy meal before you exercise, particularly one that's high in say fats, carbs, or protein, you get more bloated. If you are going to exercise, have a meal high in slow-release, unrefined carbs a few hours beforehand. If you’re eating less than an hour before exercise, opt for a smaller, easily digested snack.
Why do I bloat when I wear tight clothes?
If you're wearing a really tight pair of control pants, tight trousers, tight leggings or tight belt, you may feel more bloated. Tight clothes can restrict the movement of gas within your digestive system, and that can lead to that gas building up because you're not getting rid of it, and therefore you feel more bloated.
Why do I bloat when I'm on my period?
Unfortunately, pretty much every woman knows about bloating just before her period. Your female hormones, particularly oestrogen and progesterone, are responsible for your natural cycle. They tell your body to produce an egg every month and determine when you have a period. But those hormones are constantly fluctuating, and changes round about the time coming up to your period often lead to fluid retention.
You may find that you breasts, as well as your tummy, feel bloated and tender before your period. I'm sure everybody's heard of premenstrual syndrome or PMS. It is no laughing matter. In very extreme forms, there's something called premenstrual dysphoric disorder, where your hormones can have a huge impact on your mood and your ability to cope, as well as your day-to-day functioning.
Bloating is a major symptom of premenstrual syndrome. Some women find that taking the oral contraceptive pill will make their bloating before their period better. Sadly, some people will find that it makes their bloating worse, so you may need to do a little bit of playing around with your contraception, always in conjunction with your healthcare professional.
But you may find that changing a contraceptive pill, especially if you're bloating before your period got worse when you started on the pill, could make a difference.
When do normal symptoms change to something like IBS?
Irritable bowel syndrome is a very common condition. It's what's called a functional bowel condition. That very definitely does not mean it's not real it can cause huge disruption to your life. In a functional disorder, there's no one bit of your gut, if we look at it under a microscope, that looks abnormal. But the different parts of your gut don't work smoothly together, and smooth passage of food and gas through your digestive tract is essential to be symptom free.
When we think about the symptoms of IBS, many of us will have had them now and again. They include pain, which is often colicky and may be made better when you pass wind or when you open your mouth. Bloating which comes and goes, is often worse after you eat, and is frequently better in the mornings, is another common symptom. So too is change in your bowel habit – diarrhoea, constipation or a mix of the two. If you're getting those symptoms regularly and they're interfering with your lifestyle, then that could be IBS.
Nice, The National Institute for Health and Care Excellence, says that we should be, as doctors, considering IBS if you've had those symptoms for at least six months. Although frankly, if you're really troubled then don't wait that long, please do see your GP.
