Abdominal bloating: when to worry?
Bloating is a common experience among many people, but they may not be aware of its significance. Bloating, rather than being a condition in and of itself, is a symptom associated with many conditions that vary from mundane to severe. In this article, a consultant gastroenterologist shares what bloating can indicate and when patients should seek medical assistance.
What is bloating?
Bloating is the buildup of pressure in the abdomen. It can be caused by solids, liquids, but is most often gas. It is often described as feeling like tightness and fullness in the belly, and visually can appear like a distended stomach. Because of this strain on the stomach, bloating can be uncomfortable or even painful. It is commonly accompanied by belching and flatulence as the gas escapes the body through different ‘exits’, and may also be associated with diarrhoea or constipation.
What causes bloating?
Bloating is almost always a gastrointestinal symptom, related to the state of the bowels, stomach, and the dietary habits of the patient.
Bloating can temporarily occur after big or luxurious meals, especially for those with dairy or gluten intolerances; it should subside within a few hours and after the patient has ‘passed’ the food. Eating too quickly, sugary and fatty foods, overeating, and carbonated drinks can all contribute to gas development (indigestion). In the gut, there is a microbiome (bacteria) that is used to break down the nutrients in the food we eat – their respiration releases gas. In cases of microbiome imbalance (SIBO), there is an excess of gas.
Many women experience regular bloating as part of their menstrual cycle, where the flux of hormones affects the digestive system.
When do I need to consult a doctor about bloating?
Occasional and mild bloating is typically not cause for concern, but that which merits medical appraisal is bloating that is:
- Persistent for more than two weeks
- Notably painful
- Frequent but without a discernible pattern (such as menstruation)
- Sudden with no plausible explanation
The diagnostic investigation that follows may include stool and urine tests, blood testing, ultrasounds, and endoscopy.
If the patient is concurrently experiencing blood in the stool, unexplained weight loss, anaemia, ongoing fatigue, and confusion, they should seek medical attention as soon as possible. Additionally, new bowel symptoms in individuals over 50 years of age, or those with a family history of bowel disease, should not be overlooked.
The investigation may reveal that the patient’s bloating is caused by:
- Irritable bowel syndrome (IBS)
- Intestinal bowel diseases (IBD) like Crohn’s disease and ulcerative colitis
- Gastrointestinal or gynaecological cancers
- Gastritis or enteritis
A key principle is that persistent, unexplained, or worsening symptoms merit investigation, even if they appear mild at first. Early assessment allows for reassurance in many cases and timely treatment where necessary.