Bloating

What are the common causes of bloating?

Gas is by far the most common cause of bloating. This can build up because of:

• eating certain foods and drinks, such as fizzy drinks, cabbage, beans and lentils
• swallowing air when you eat too quickly or chew gum
• constipation
• a food intolerance, such as to lactose or gluten
• coeliac disease
• irritable bowel syndrome (IBS)
• overeating.

Bloating is also common around the time of your period, and during pregnancy and perimenopause (the years leading up to menopause), when hormones cause your body to hold onto more fluid and can speed up or slow down digestion. Less often, ongoing bloating is a sign of a more serious condition, such as:

• small intestinal bacterial overgrowth (SIBO)
• inflammatory bowel disease
• pancreatic insufficiency, when your pancreas doesn't make enough digestive enzymes
• a build-up of fluid in your abdomen, called ascites
• ovarian, colon or pancreatic cancer.

Are there different types of bloating?

There's no formal classification, but it can help to think of bloating in three patterns:

• Occasional bloating: comes and goes, often linked to a particular meal, your diet or swallowing air. This is the most common pattern and usually settles by itself.
• Bloating linked to a digestive condition: recurring bloating that forms part of a condition such as IBS, coeliac disease or food intolerance, often alongside wind, pain or changes in your bowel habits.
• Persistent or worsening bloating: bloating that doesn't settle down, or keeps getting worse. This is less common and worth getting checked by a doctor.

How is the cause of bloating diagnosed?

Your GP will start by asking about your symptoms, how long you've had them, and whether anything makes them better or worse. They'll also ask about your diet and any family history of digestive conditions, then examine your abdomen. Depending on what they find, they may arrange:

• Blood tests or stool (poo) tests, to check for signs of infection, inflammation or other problems.
• A referral to a dietitian, or to a specialist in digestive conditions called a gastroenterologist.
• A gastroscopy or colonoscopy, where a flexible tube with a camera examines your digestive tract and can take small tissue samples (biopsies).
• A hydrogen breath test, which can help identify certain digestive disorders.
• An ultrasound or other scan, to rule out other causes.

How is bloating treated?

Treatment isn't always needed, and the right approach depends on what's causing your bloating.

Diet and lifestyle

Steps that may help include:

• eating smaller, more frequent meals
• eating slowly and chewing with your mouth closed, to avoid swallowing air
• cutting down on fizzy drinks, alcohol and caffeine
• cutting down on gas-producing foods such as cabbage, beans, lentils and onions
• eating more high-fibre foods, such as oats and linseed, if you're constipated
• drinking plenty of water
• exercising regularly
• gently massaging your tummy from right to left to help release trapped wind.

It's best to talk to your GP or a dietitian before cutting out whole food groups, so you don't miss out on nutrients you need.

Medicines

A pharmacist or GP may recommend:

• Laxatives, if constipation is contributing to your bloating.
• Simeticone, a medicine that helps break up trapped wind.
• Fibre supplements, such as psyllium husk.
• Probiotics, which may help rebalance your gut bacteria.

Other options

If bloating is linked to a digestive condition, your doctor may also suggest:

• An elimination diet, such as a low-FODMAP diet, guided by a dietitian.
• Psychological therapies, such as cognitive behavioural therapy (CBT) or gut-directed hypnotherapy, which can help with some causes of bloating.

When should I see a doctor?

See a GP if:

• you're bloated regularly, or it doesn't settle down
• changing your diet hasn't helped
• your bloating lasts more than a week.

Get medical help promptly if you have bloating along with:

• blood in your poo, or black, tar-like stools
• vomiting, diarrhoea or a change in your bowel habits
• ongoing or severe tummy pain
• a high temperature, or feeling hot, cold or shivery
• a swelling or lump in your abdomen
• loss of appetite or feeling full quickly
• you have bloating along with unintentional weight loss.

Call 999 or go to A&E if you have a swollen, painful abdomen that came on very suddenly, you're vomiting blood or your vomit looks like ground coffee, or you have severe difficulty breathing.