It’s been three years since I first took up the issue of belly bloating online in my treatise, “A Taxonomy of Tummy Bloating.”
At that time, I described five common causes of belly bloating and their signature characteristics, addressing the telltale signs of a digestive intolerance to certain carbohydrates, acid reflux, undiagnosed celiac disease, constipation and excess belly fat. But for those bloated souls who have yet to recognize their unique brand of bloating in those descriptions, I’d like to offer three additional profiles in bloating to compare against your own. These culprits are often the ones that escape detection by a general practitioner, and therefore can cause prolonged, puffy misery.
Consider this my master course — Belly Bloating: 202.
Small Intestinal Bacterial Overgrowth (SIBO)
SIBO is a condition in which some of the usual bacteria that typically inhabit our colon or mouth manage to gain a foothold in the small intestine and replicate beyond what is normal. (I often describe them as good guys living in the wrong neighborhood.) Because the small bowel is where most nutrient absorption takes place, there are loads of yet-to-be digested food passing through it, and large bacterial colonies take advantage of this fact with gusto by fermenting up a storm. Essentially, when you’ve got overgrowth, there are bacteria in the small bowel beating you to the buffet line.
When to suspect SIBO:
— Somewhat suddenly, you’ve started experiencing large amounts of gas — either belching or flatulence — and a pressured, painful type of abdominal bloating that typically kicks in within 30 to 90 minutes of eating, despite consuming the same foods that you used to tolerate just fine.
— There may also be a change of bowel patterns — either diarrhea within 30 to 60 minutes of eating or significant constipation, often going days without a bowel movement.
— Bowel movements may float.
— In addition to bloating and strange bathroom habits, you may also experience nausea or low energy levels.
— Mornings are generally the best time of day; bloating usually begins right after lunch. Bloating is the worst at night and doesn’t improve until you wake up the next morning.
— You have also been taking an acid-reducing medication classified as a proton-pump inhibitor, or PPI, for a prolonged period of time before the onset of symptoms.
— You also have a history of using supplemental probiotics.
— You have been diagnosed with an unexplained vitamin B12 deficiency.
— Oatmeal or eggs are your best-tolerated breakfasts.
— Sushi is the meal that agrees with you best, so long as you avoid edamame. Salads typically feel OK, too, so long as you leave off the onions and beans.
What to do if you suspect you have SIBO: Stop taking probiotics. Find a gastroenterologist who conducts in-office breath testing, preferably with equipment that measures both hydrogen and methane. If your test is positive, the doctor will select an appropriate antibiotic to treat your condition based on the type of gas predominant on your breath, which is an indication as to the type of organisms overgrowing in your gut. Talk to a dietitian about a temporary low FODMAP diet that may help alleviate symptoms until you can get tested and treated.
Gastroparesis
Gastroparesis is abnormally delayed stomach emptying. It can cause abdominal distension as your full stomach takes hours to empty of its last meal, and abdominal distension typically builds throughout the day as additional meals become bottlenecked on their way out of the stomach.
When to suspect gastroparesis:
— Your upper abdomen is notably distended and possibly uncomfortable, but not necessarily painful.
— Abdominal distention builds as the day progresses.
— You sometimes wake up bloated, distended or nauseous, particularly after a larger, later or heavier dinner.
— You get full even after eating a small amount of food, and can go many hours in between meals without feeling hungry.
— Your bloating is not associated with flatulence.
— You occasionally vomit after eating a high-fat meal — such as steak or fried food — salads, popcorn or just a large volume of anything.
— You’ve also started experiencing heartburn.
— You’ve lost weight without trying.
— You have diabetes, or your symptoms started soon after recovering from a bout of acute gastroenteritis, such as a “stomach flu” or food poisoning.
What to do if you suspect gastroparesis: Talk to a gastroenterologist about your suspicion to see if further diagnostic testing is warranted (usually a gastric emptying study). See if you feel better by giving up raw vegetables, popcorn, nuts, seeds and other types of “roughage;” get your fiber from foods like cooked veggies, prune juice, pureed veggie soups, fruit smoothies, skinless soft fruits and cooked grains or a soft whole-wheat bread. Avoid very rich, high-fat meals.
Dyssynergia
Dyssynergia refers to impaired coordination of muscle contractions, which can affect how food and waste move through your digestive tract. When dyssynergia affects the muscles of the abdominal wall that react to stomach and gut fullness from eating, it is called abdomino-phrenic dyssynergia. Pelvic floor dyssynergia prevents proper function of the pelvic floor muscles, leading to difficulty in defecation. In either case, dyssynergias of the digestive tract can result in visible abdominal distention.
When to suspect dyssynergia:
— You are a thin woman who has been mistaken for being pregnant after eating a meal.
— Abdominal bloating often occurs in the upper portion of the stomach — right beneath your ribs and sternum — rather than in your lower belly.
— Your bloating is uncomfortable, but not typically painful.
— Your bloating can set in even after drinking water.
— In addition to visible abdominal distention, you may also experience severe constipation, going up to a week or more without passing a bowel movement.
— Your constipation does not respond well to typical laxatives, but may respond better to suppositories.
— Many patients with dyssynergia also have a history of disordered eating, or physical, emotional or sexual trauma.
What to do if you suspect you have abdomino-phrenic dyssynergia, pelvic floor dyssynergia or both: You’ll want to develop a relationship with a well-reputed gastroenterologist, gynecologist, physiatrist, urologist or pelvic floor therapist who is experienced with this condition. These health professionals can order various tests to diagnose pelvic floor dyssynergia. For abdomino-phrenic dyssynergia, a physician experienced with the condition should be able identify the condition on the basis of a physical exam. If the bloating comes and goes unpredictably such that it may not be present during a doctor visit, consider taking a photo of yourself when symptoms are severe to bring to your consultation.
Lastly, I’d like to offer a word of caution for those on a mission for a diagnostician. As this series of articles on bloating suggests, there can be many different causes for this chronic, troubling symptom, and it can take multiple rounds of tests to figure out what’s behind it. Unfortunately, many patients hit a diagnostic brick wall with their doctors and give up on Western medicine entirely before they obtain a diagnosis. In my experience, this leaves patients vulnerable to all manner of opportunistic practitioners who claim to have answers and are keen on selling you dozens of expensive supplements as a solution. Bloated, beware! Taking loads of pills — particularly ones of dubious origin and contents — are more likely to make bloating worse than better. (Those coatings take ages to empty the stomach and digest, and many common fillers and ingredients can contribute to gas.)
If at first you don’t succeed with your chosen physician, get copies of all your test results and bring them along on your search for a credentialed, qualified physician who will help you in your quest for inner digestive peace.
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3 (More) Causes of Belly Bloat Explained originally appeared on usnews.com
