You’ve been bloated before — and you probably remember the feeling well. But ask 10 different people to describe bloating symptoms, and you’ll be surprised at the range of responses.
Bloating generally refers to a sensation of pressure and sometimes measurable distension in the abdomen — as if someone attached a bicycle pump and filled your belly with air. But “bloated” is a common catch-all term that can imply a long list of underlying problems. Correspondingly, the catalog of related symptoms and factors that people experience with their bloating is vast. Differences in symptoms can help your health care provider sort out a cause, which is the first step toward a treatment plan.
This is where you come in.
Before you talk to your doctor about your bloating, spend a few weeks jotting down notes about the associated symptoms and factors. Details and specifics kept in a symptom journal can be a big help.
A distension convention
Bloating is extremely common. An estimated 30% of U.S. adults experience bothersome bloating some of the time. In some populations — such as those with concurrent bowel disorders including irritable bowel syndrome (IBS) — up to 90% experience regular, bothersome bloating as a major symptom.
Functional bowel disorders — including IBS and dyspepsia — occur in about 14% of women, and in about 9% of men. Bloating and abdominal distention are both more severe and frequent in women as well. The reasons for this gender discrepancy are uncertain, though social pressures on women to be slim may increase how bothersome bloating and distention can be or feel.
To those who don’t experience bloating, it may not seem like that big of a deal. But ask someone who does have it. Research shows that about 75% of those who experience regular bloating have moderate to severe symptoms that drag down their quality of life. And though it’s uncommon, a complaint of bloating can sometimes be a symptom of a serious medical problem such as bowel obstruction, cancer, chronic obstructive pulmonary disease (COPD) or liver disease.
Your bloating journal
To help guide you on observations about your bloating, assess your symptoms as they relate to the following questions:
- What is the predominant symptom? You may think that bloating is bloating, but symptoms come in different forms. One possible predominant symptom is excessive belching. This can be obvious to you, or sometimes a partner points it out. Another is the feeling of internal abdominal pressure — which may occur even without much noticeable abdominal distension. A third predominant symptom is bloating with visible abdominal distension. About half of people who feel bloating will have measurable distension of the belly area.
- What is the timing of bloating onset? Keep track of how long it takes for bloating to occur after you eat. A helpful differentiator is whether bloating occurs within 30 minutes — or whether it takes longer. Some bloating is delayed for up to two hours after eating.
- Do you notice any dietary triggers? A review of your dietary habits is often part of a bloating exam. Take note of your patterns, such as the size of your meals, how many meals you eat in a day, items you snack on and how quickly you eat your meals compared to others around you. Take note also of foods or drinks that may be associated with your bloating, such as carbonated beverages, caffeine, dairy products, grain products such as bread and gas-producing foods such as broccoli, cauliflower, cabbage, onions and garlic. Note any sources of artificial sweeteners, such as coffee or tea sweeteners, diet sodas, or chewing gum. Keeping a food journal can be helpful to discover patterns that you may not have noticed. In addition, a partner can sometimes have better insights into associations with worse symptoms than you do yourself.
- Are there any other gastrointestinal symptoms? Having either constipation or diarrhea that seems to be associated with your bloating is an important clue. In addition, feelings of having incomplete bowel movements — or even having to manually assist your bowel movement — is also important to note. Another must-mention symptom is unintentional weight loss.
While the following don’t need to be regularly marked in your journal, consider noting anything related to these items:
- Could bloating be associated with any medications or supplements you take? A review of medications and supplements is often part of a bloating exam. There are many, many medications and supplements that can cause bloating, but a few common culprits include:
- Opioid pain medications
- Fiber supplements that are perhaps taken in quantities that are too large or too much too quickly
- Iron supplements
- The diabetes drug metformin
- Magnesium supplements
- Certain medications for constipation such as lactulose
- Elixirs used with tube feeding
- Other dietary supplements
Under a doctor’s guidance, temporarily stopping a possible drug or supplement culprit can be an easy way to confirm or rule out that item as a cause of — or contributor to — bloating.
- Does your medical history offer any insights? Your doctor may have records that can help in this regard, but be sure to bring up any medical issues that affect the abdominal area, such as having had gastric bypass surgery for weight loss, having Crohn’s disease, or having had radiation or any surgery to the abdomen. Use of a CPAP machine for sleep apnea is also something to share with your doctor.
Is it pseudobloat?
Bloating should be easy to recognize with a certain degree of certainty. Still, certain conditions are sometimes mistaken for bloating, including:
- Abdominal obesity — At times, we pack on extra pounds almost without realizing it with changes in our routine, diet and activity level. A key differentiator between bloating and abdominal obesity is that most bloating will fluctuate, while carrying extra fat around the middle should not change day to day.
- Fluid build-up — Several medical conditions will cause your abdomen to fill with fluid. This can be detected on a physical exam by your medical provider, and discovering the exact cause of any abdominal fluid build-up is imperative.
- Being pregnant — Many women forget to track their periods and might use contraception inconsistently or not at all. If you’re experiencing a fullness around the middle and are premenopausal, consider whether you’re possibly pregnant. If there’s any chance at all, home testing kits are readily available — or your doctor can check for you.
When it comes to treating bloating, options depend on the suspected cause. Treatment options may include avoidance of a food or beverage, adjusting a medication, addressing constipation issues, or treating an underlying disease or medical condition. Whatever the treatment route, bringing symptom details to your doctor is a great way for you to help speed the journey to bloating improvement and relief.
Amy Oxentenko, M.D.
Dr. Oxentenko is a gastroenterologist at Mayo Clinic, a Professor of Medicine and currently serves as the Chair of Medicine for Mayo Clinic in Arizona. She serves on the Board of Trustees for the American College of Gastroenterology, and has interests in celiac disease, small bowel disorders, leadership development, and diversity, equity and inclusion efforts. In her free time, she enjoys spending time with her family, running, traveling and reading.