Why Am I Always Bloated?

Does your stomach ever feel like a balloon about to burst? The tight, uncomfortable pressure in your abdomen may mean you are bloated. A bloating episode can strike after a seemingly harmless meal, leaving you self-conscious in your clothes and putting a dampener on your day. But what causes this inflated sensation? The reasons behind bloating can be varied. 

Studies estimate that nearly 18% of the general population experiences bloating at least once a week. This translates to a large number of people worldwide dealing with this uncomfortable experience. Bloating prevalence appears to vary somewhat geographically. Studies show a lower prevalence in Asian populations (around 11%) compared to Latin America (around 20%).

Bloating, medically known as abdominal distension or meteorism, is a condition characterised by the abnormal swelling or enlargement of the abdomen due to the accumulation of gas, fluid, or solids in the gastrointestinal tract. It can result from various factors such as excessive gas production, impaired digestion, gastrointestinal disorders like irritable bowel syndrome (IBS), constipation, or overeating. 

Dr Sundeep Shah, MBBS, MD, and DM in Gastroenterology, says that bloating may lead to discomfort, pain, and a feeling of fullness in the abdomen, frequently accompanied by a visible enlargement or distension in the abdominal area.

Studies estimate that nearly 18% of the general population experiences bloating at least once a week.

A variety of factors can cause bloating. Here's a breakdown of some common ones —

Aerophagia or air swallowing can occur unconsciously when you’re eating, drinking quickly, chewing gum, or smoking. This air gets trapped in your digestive system and contributes to bloating.

Our gut bacteria also break down certain foods, including vegetables and lactose-rich dairy products. This process produces gas as a byproduct, leading to bloating. Unlike much of the gas, which gets absorbed into the bloodstream in the small intestine, some swallowed air gets trapped in your stomach and intestines.

Dr Sundeep says, “Food can move slowly through your digestive system when your stomach muscles weaken or nerve signals are disrupted. This trapped food and gas can cause bloating. Also, difficulty passing stool can lead to a backup in your intestines, causing a feeling of fullness and bloating.”

Even Irritable Bowel Syndrome (IBS) can cause bloating along with cramping, diarrhoea, and constipation. Even though what exactly causes IBS is unknown, it's thought to involve gut bacteria and nerve signalling issues.

Studies show lower bloating prevalence in Asian populations (around 11%) compared to Latin America (around 20%).

If your body struggles to digest lactose—the sugar found in milk and dairy products—it can cause bloating, gas, and other digestive issues. Individuals with gluten intolerance or celiac disease encounter bloating, among other reactions, upon ingesting gluten, a protein found in barley, wheat, and rye.

Hormonal changes during menstruation can cause fluid retention and bloating in some women. Also, as the uterus expands throughout pregnancy, it can put pressure on the intestines, resulting in bloating and various changes in digestion.

Bloating, gas, and abdominal discomfort can feel similar, but they have distinct characteristics. Bloating is a feeling of tightness and fullness like a balloon inflating your belly. Gas is more about pressure and the urge to release it with a burp or fart.

Dr Sundeep explains, “Abdominal discomfort is a broader term for pain or achiness in your abdomen, potentially caused by gas, bloating, or other digestive issues. While bloating can sometimes make your abdomen look bigger, gas usually doesn't.” The key takeaway is that bloating feels full and tight, gas is about pressure and release, and abdominal discomfort is general pain that can have various causes.

Dr Sundeep explains, “High cortisol levels, a result of stress, can disrupt gut function by affecting intestinal motility and gut bacteria balance, leading to increased gas production and bloating.” Stress triggers the 'fight or flight' response, resulting in blood being redirected away from the digestive system, slowing down the process and potentially causing bloating.

Unhealthy eating habits and chronic stress can further impair digestion, causing poor nutrient absorption and abdominal discomfort. Additionally, prolonged stress can reduce sensitivity to digestive issues, masking symptoms like bloating.

Patients might perceive various gastrointestinal symptoms differently due to their subjective experiences. The feeling of bloating can be conveyed through different terms, such as feeling gassy, undergoing a sense of ballooning, tightness, or heaviness, explains Dr Sundeep. In medical terms, these symptoms are categorised under dyspepsia, which originates from the Greek word meaning ‘difficult digestion’ and is commonly associated with food intake.

Bloating is a temporary sensation. Dr Sundeep says that it might make you feel heavier, but it doesn't translate to actual weight gain. Weight gain, on the other hand, happens when you consume more calories than what your body burns over time. This excess energy gets stored as fat, leading to a long-term increase on the scale. 

Sometimes, bloating can be caused by water retention. This trapped water might show a slight weight increase on the scale, but it's not true weight gain. It's temporary and will dissipate once the cause of bloating is addressed.

Hormonal fluctuations may cause bloating, especially during menstruation and pregnancy. Our digestive system is influenced by hormones like oestrogen and progesterone, which fluctuate throughout the menstrual cycle. Higher oestrogen levels can slow down digestion, leading to bloating and constipation. Progesterone can also contribute by relaxing intestinal muscles. Additionally, hormonal shifts can cause the body to retain more fluid, which can accumulate in the abdomen and create a bloated feeling. This is particularly common during PMS, when bloating often occurs a week or two before the period.

Pregnancy brings its own set of bloating triggers. As the uterus grows, it puts pressure on the intestines, slowing digestion again. The hormonal changes throughout pregnancy also play a role. While bloating due to hormones is common, do see a doctor if it's severe, persistent, or accompanied by other concerning symptoms of a bloated stomach, as it could indicate an underlying medical issue.

Dr Sundeep emphasises that bloating usually isn't a cause for alarm. Common culprits like excess gas, fluid retention due to hormones or medication, and constipation can all lead to that uncomfortable feeling of abdominal fullness. However, in some cases, persistent bloating can be a sign of a more serious condition.

If your bloating is severe or lasts for weeks, see a doctor to rule out any underlying issues.

Dr Sundeep says, “The red flags include unexplained weight loss, blood in your stool, significant changes in bowel habits, fever, vomiting, and severe abdominal pain.”

Dr Sundeep shares some remedies to manage bloating — 

Eating a fibre-rich diet, about 25-30 grams daily, can facilitate consistent bowel movements and decrease bloating. Make sure that your diet comprises plenty of fruits, vegetables, whole grains, and legumes. But remember that excessive fibre consumption can cause bloating and loose stools.

Consuming 8-10 glasses of water every day is recommended to avoid dehydration and constipation while reducing bloating.

Foods like beans, broccoli, cabbage, onions, and fizzy drinks can lead to increased gas and bloating. Limiting these foods may help reduce bloating.

Eating large meals can strain your digestive system and lead to bloating. To help prevent this, try eating smaller, more frequent meals throughout the day.

Aerophagia is a medical term for when a person excessively and repeatedly swallows air. Smoking, using a straw for drinking, chewing gum or eating food in a hurry may result in you swallowing excess air, which could lead to bloating. Try to avoid the abovementioned habits to reduce bloating.

Consuming salt excessively can cause water retention in your body, which may result in bloating. Aim to decrease your consumption of processed foods and those high in sodium.

Being physically active regularly can help your digestion and reduce bloating. Try to do at least 30 minutes of moderate exercise most days of the week.

Stress can impact your digestive process and cause bloating. To help reduce bloating, practise stress-reducing techniques such as deep breathing, meditation, yoga, or spending time outdoors.

Probiotics are helpful bacteria that can support a healthy gut microbiome and alleviate bloating. Consider adding probiotic-rich foods like yoghurt, kefir, sauerkraut, or kimchi to your diet

Monitoring what you eat and its impact on your bloating enables you to recognise trigger foods and make the necessary changes to your diet.

Don't hesitate to talk to your doctor if you're experiencing bloating. Early diagnosis and treatment can benefit your health immensely.