Bloating and distension have been reported in up to 96% of patients with irritable bowel syndrome (IBS) and in 20% to 30% of the general population, In fact, more than 50% of persons with bloating and distension report a significant impact on quality of life. In general, the term bloating refers to the subjective sensation of increased abdominal pressure without an increase in abdominal size, whereas distension describes the same subjective sensation but with a corresponding objective increase in abdominal girth.
Patients who are constipated commonly report bloating and more than 80% describing severe symptoms. The pathogenesis of bloating in patients with constipation is likely multifactorial. First, the direct mechanical effects of fecal impaction and colonic loading can mimic bloating. Second, colonic stasis may cause increased fermentation of the colonic contents by intestinal bacteria and, therefore, increased gas production. Other than that rectal hypersensitivity is also a common scenario found in IBS and patients with constipation. Interestingly, alterations in visceral sensitivity may explain why symptoms of bloating and distension may be worse in women during the perimenstrual phase as visceral sensitivity varies throughout the menstrual cycle and is generally most acute in the perimenstrual phase (1)
The most significant advance in the treatment of bloating has been the identification of a group of poorly absorbed short-chain carbohydrates (FODMAPs) and individually, these carbohydrates have been considered to be potential triggers of IBS symptoms for decades. In well controlled dietary trials, modification in diet to a low-FODMAP diet can decrease symptoms in at least 75% of IBS patients (2).
If there is severe constipation, laxatives can be used as initial treatment to ensure that constipation is aggressively managed. On top of that, consider using probiotics. A systematic review concluded that bloating is significantly reduced by the probiotic Bifidobacterium infantis 35624 (3).
There is emerging evidence that kiwifruit is effective in the treatment of constipation and bloating. Although the mechanisms remain unknown, kiwifruit appears to promote both laxation and gastric motility.
In conclusion, bloating and distension are highly prevalent symptoms with a marked effect on health status and quality of life. Emerging evidence indicates that targeting colonic motility, gut flora, visceral sensitivity, and dietary intake is helpful in controlling such symptoms.
1. Altman G, Cain KC, Motzer S, Jarrett M, Burr R, Heitkemper M. Increased symptoms in female IBS patients with dysmenorrhea and PMS. Gastroenterol Nurs. 2006;29(1):4-11.
2. Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014;146(1):67-75.e5
3. Brenner DM, Moeller MJ, Chey WD, Schoenfeld PS. The utility of probiotics in the treatment of irritable bowel syndrome: a systematic review. Am J Gastroenterol. 2009;104(4):1033-1049; quiz 1050.
Dr Nicole Ng (MBBS) is a medical doctor with a passion in women's health and medical research