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.
Your gut health is certainly more important than you think. Do you know that your gut flora promotes normal gastrointestinal function, provides protection from infection, regulates metabolism and comprises more than 75% of your immune system?
With so much focus on gut health, researchers are focusing on probiotics as these microorganisms are naturally found in the human digestive tract that improves the balance of healthy bacteria. The most common strains are Lactobacillus and Bifidobacterium.
Probiotics has been known to treat or prevent a broad range of human diseases, conditions, and syndromes such as acute diarrhea, anxiety and depression, irritable bowel syndrome, high cholesterol, high blood pressure, lactose intolerance, psoriasis etc (1).
Where do you find probiotics? Probiotics are normally consumed in fermented foods with active live cultures such as yogurt. They are also available in supplement form as capsules, liquid, powder and chewables.
Some of the strong benefits of probiotics include treatment in:
- Acute diarrhea. Many studies done in infants or children have reported the use of probiotics to either treat or prevent acute diarrhea (2). Patients who received Lactobacillus GG had decreased severity, shorter duration of illness, shorter hospital stay and were found to have a decreased likelihood of persistent diarrheal illness (3).
- Prevention and Treatment of Atopic Eczema. A study involving 31 infants with atopic eczema who were removed from exposure to cow milk and were given either Lactobacillus GG or a placebo showed that treatment with Lactobacillus GG resulted in a significant improvement in their conditions that was not observed in the placebo group (4).
- Dental Health. Children in a day care center who were given Lactobacillus GG for 7 months and examined for dental caries. The end result, children in the 3–4-year-old age group had significantly lower rates of dental caries and a reduced oral count of Streptococcus mutans (5).
1: Goldin BR, Gorbach SL. Clinical indications for probiotics: an overview. Clin Infect Dis. 2008 Feb 1;46 Suppl 2:S96-100; discussion S144-51. doi: 10.1086/523333. Review. PubMed PMID: 18181732.
2. Allen SJ, Okoko B, Martinez E, Gregorio G, Dans LF. Probiotics for treating infectious diarrhea. Cochrane Database Syst Rev 2003;2:CD003048.
3. Guandalini S, Pensabene L, Zikri MA, et al. Lactobacillus GG administered in oral rehydration solution to children with acute diarrhea: a multicenter European trial. J Pediatr Gastroenterol Nutr 2000;30:54-60.
4. Majamaa H, Isolauri E. Probiotics: a novel approach in the management of food allergy. J Allergy Clin Immunol 1997;99:179-85.
5. Nase L, Hatakka K, Savilahti E, et al. Effect of long-term consumption of a probiotic bacterium, Lactobacillus rhamnosus GG, in milk on dental caries and caries risk in children. Caries Res 2001;35:412-20.
Dr Nicole Ng (MBBS) is a medical doctor with a passion in women's health and medical research