“Abdominal bloating every day doctor. I can’t find relief, I’ve done three diets and I don’t know what to eat. I’m afraid of having something wrong “
This surely sounds familiar to you if you suffer from this problem and that’s why I’m going to tell you today about bloating
What is abdominal bloating
Abdominal bloating is the feeling of bloating, fullness, or heaviness in the abdomen. It may or may not be accompanied by an increase in the diameter of the abdomen. Some patients tell me: I feel like a balloon or like I’m pregnant. For all people, the sensation or location may be different, but what is common is that it greatly affects the quality of life. Sometimes bloating comes alone but sometimes it accompanied by problems such as constipation or chronic diarrhea, bowel syndrome irritable or functional dyspepsia.
What causes abdominal bloating
There are many causes of abdominal bloating such as:
❇️ Small bowel Bacterial overgrowth (SIBO):
It is the increase in the number of bacteria in the small intestine. When this happens the carbohydrates that pass through this organ are fermented by these bacteria producing more gas and bloating of the bowel wall.
❇️Malabsorption of Carbohydrates:
It may happen that carbohydrates are not absorbed properly in the small bowel or that although this is done well they are not properly tolerated. The most common is malabsorption or lactose and fructose intolerance
❇️ Abnormal movement of the digestive tract:
There may be bloating when there is slower or abnormal movement of the digestive tract walls such as in these diseases: Gastroparesis, Diabetes, Scleroderma, chronic constipation or use of opiates or antidiarrheals
❇️Malfunction of the pelvic floor:
When there is weakness or discord in these muscles, there may be an inability to pass gas or stool and increase the feeling of bloating
❇️Digestive hypersensitivity: Nerve endings in the small intestine can cause perceived stimuli or normal activities with greater intensity. It may be related to anxiety, depression, hypervigilance or stress
❇️ Altered Microbiota:
Although the number of bacteria in the intestinal flora is normal, there may be a greater number of gas-producing bacteria or having a change in the flora that we had from just born
Don’t panic but it can be due to cancer of the ovary or any part of the digestive tract, liver, kidney, pancreas, or abnormal fluid in the abdomen (Ascites)
❇️ Abdominophrenic dyssynergia:
In normal conditions our body accommodates the gas by relaxing the diaphragm (It takes it up) and contracting the muscles of the abdominal wall. In some people this pattern is reversed and in this case the diaphragm contracts or goes down and the musculature of the abdomen relaxes which causes the obvious distension to occur
How to diagnose the cause of abdominal bloating
1. Breath tests:
These tests measure safely and non invasive if a carbohydrate is not digested properly. Substances used to measure nclude fructose, lactose, or lactulose that when they are not absorbed by the small intestine they are degraded by bacteria from the colon or small intestine increasing the amount of hydrogen gas which passes into the circulation and then breathing, being able to measure with the breath.
1.1 Breath tests for malabsorption and lactose intolerance:
Lactose is the main carbohydrate in milk and is made up of two molecules: Glucose and Galactose. To be digested, there is on the surface of the cells of the small intestine a enzyme that breaks the bond between these allowing them to pass into the blood separately. Poor digestion of lactose produces symptoms such as bloating, abdominal cramps, flatulence or diarrhea. At first it seems unnecessary to do a breath test for intolerance to the lactose because most people with bloating the first thing they do is avoid dairy. But many times the problem continues or hardly improves and we have removed our life a very important food in the diet that is a source of protein, calcium and vitamin D.
Make the test helps us to define if it is of any use to eliminate milk or dairy products or if we can optimize their consumption
1.2 Breath test for malabsorption and fructose intolerance:
Fructose is a natural sugar found in fruits, sweeteners, and in many foods. The ability of the small intestine to absorb fructose is thus limited that when we consume too much or do not digest it properly it will cause us distension.
1.3 Breath test for bacterial overgrowth:
This is done by administering lactulose and when it is positive it is necessary to evaluate if there are predisposing causes in the small intestine such as diverticula, tumors, narrowing or inflammatory diseases in the small intestine. Sometimes it is necessary to carry out a small bowel examination with endoscopic capsule or enteroresonance
2. Upper digestive endoscopy:
It is done to rule out obstruction to the passage of food through the stomach or to take biopsies in the intestine and thus know if there is inflammation that suggests celiac disease or other inflammatory problems of the small intestine
It is used in people in whom it is necessary to rule out cancer of this organ or in the evaluation of chronic constipation. In this exam we can evaluate the functioning of the pelvic floor
4. Ultrasound of the abdomen:
It is used to rule out if there is fluid in the abdomen (Ascites), tumors or problems in the ovaries or liver
5. Other tests:
According to the prevailing symptoms, I can also request a gastric emptying scan to rule out gastroparesis or laboratory tests such as fecal calprotectin or tests for celiac disease, among others
What is the treatment of bloating?
As you can see, the causes of abdominal bloating are multiple and therefore there is no single intervention for all people. Treatment should be directed at finding and
correct the cause or causes of the problem. While you consult with your Gastroenterologist you can do things like:
✅ Avoid or reduce the consumption of sweets (Candies, caramels, dulce de leche, snack, chocolates among others). It also limits the consumption of sodas, soft drinks or artificial juices
✅ Don’t restrict yourself unnecessarily. If you have already removed several things from your diet and you see improvement food is most likely not the cause of the problem. If you stop eating everything can make you sicker. I have patients who have removed many things from their diet and this makes them lose weight weight which in turn scares them and makes them sicker
✅If you have constipation or chronic diarrhea, you must find the solution to these problems
✅ Exercising and improving mood are key to feeling better even if they are not the causes of problem. Don’t despair if you can’t find the solution f you have bloating, I help you find the solution to this problem.
Program your Appointment for Consultation / Endoscopy / Colonoscopy here: http://wa.me/573207571313
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Mauricio González Hernández
Your Gastroenterologist in Medellín