Question: I’m twenty eight years old and I get really bad bloating quite regularly – it can be very uncomfortable. Could I have Irritable Bowel Syndrome? How can I treat this and does it have implications on my long term health?
Dr Hina J Shahid:
Bloating is a very common symptom and can be caused by a number of reasons. The first step is to identify the cause of your bloating so that the correct treatment can be given.
Causes of bloating
Irritable bowel syndrome (IBS) is one of the commonest cause of bloating, affecting one in five adults in UK. It is a long-term condition where you may have flare ups in between episodes of being symptom-free. IBS occurs due to a complex interaction between the brain and gut. In IBS, the structure of the gut is normal, but the condition occurs due to an abnormality in its function. The gut is a tube of muscles that normally squeeze food along in a coordinated pattern. It is thought that in IBS chemical signals sent from the brain to the gut disturb normal muscle activity and that the gut is more sensitive, leading to symptoms of bloating, pain and bowel disturbance. It is not known what causes it, but in some people, certain foods or irregular eating patterns may be responsible.
IBS tends to affect young adults, and women are more likely to be affected. Patients with IBS have a combination of “ABC” symptoms for at least six months. These are Abdominal pain, Bloating and Change in bowel habit. As well as bloating and stomach swelling you may notice that you have more wind,a change in your stools (diarrhoea, constipation, urgency to rush and go to the toilet or mucus in your stools), abdominal pain, and other non-specific symptoms. Abdominal pain may be cramps and come in spasms like a period pain, and it may be worse after food and improved by passing wind or stool. Non-specific symptoms include feeling full quickly after meals, feeling sick, heartburn, feeling tired, back ache, muscle aches and pains, headache and bladder symptoms may also be present.
There are other causes of bloating that affect the gut. These include constipation, which leads to trapping of wind, food intolerance (notably lactose, a carbohydrate found in dairy products) as well as coeliac disease (sensitivity to gluten in foods which damages the small intestine), bowel infections, and peptic ulcer disease (due to overproduction of acid by the stomach which damages the lining of the stomach and food pipe). Inflammatory bowel disease (IBD) is a group of disorders characterised by inflammation of the gut, and can have symptoms that can mimic IBS but its treatment is very specific and requires specialist care.
Non-gastrointestinal causes of bloating include obesity, pregnancy and gynaecological problems (such as a cyst in the ovary and fibroids). In older people it can be caused by fluid in the abdomen as a result of other other chronic (long term) illnesses affecting the heart, kidneys and liver, as well as certain cancers. Some psychiatric conditions such as anxiety, depression and panic disorder may also make you feel bloated.
There are certain symptoms that need prompt assessment by your GP:
Passing blood from the anus
Waking up at night because of diarrhoea
Unintentional weight loss
Change in bowel habit for those over 40 years old
If you have had bloating for a few months, your GP may organise some tests to rule out certain conditions, especially if you have symptoms that overlap with other conditions. You may have blood tests to look for anaemia and markers of inflammation which are found in other gut disorders, as well as tests for coeliac disease and a stool test. If there are concerns about a gynaecological cause, you may have blood tests to look for certain chemicals and hormones produced by the ovaries, as well as an ultrasound scan. If your symptoms are more complicated, you may have a camera test (endoscopy).
The treatment of bloating depends upon the underlying cause.
1. Symptom diary
Keeping a symptom diary is strongly encouraged, as this will help look for potential triggers such as stress, anxiety and food, and isolate your main symptoms. A symptom diary should be kept for at least 2 weeks and there are many templates on the internet as well as smartphone applications. If you think your symptoms are caused by a food intolerance but you are not sure about the food type, you can discuss this with your GP who may refer you to a dietitian.
2. General lifestyle
Regular exercise, eating regular meals, having at least 8 glasses of fluid of water or non-caffeinated drinks is recommended. Caffeine and fizzy drinks should be restricted.
3. General diet
It is recommended not to have more than 3 portions of fresh fruit a day due to sugar and insoluble fibre content which can worsen symptoms, especially if you have diarrhoea. The type of fibre you eat is important. In general is is advised to have soluble fibre (which dissolves in water) such as oats, and fruit and vegetables such as bananas, grapes, guavas, blueberries, papaya, broccoli, cabbage, carrots, chickpeas, cucumbers, aubergine, okra, spinach, tomatoes, potatoes, peas, and ispaghula husk. Insoluble fibre (does not dissolve in water) should be restricted. This is found in wheat bran, maize and some fruit and vegetables such as apples, pears, mangoes, nectarines, peaches, plums, cauliflower, mushrooms, beetroot, and kidney beans.
4. Nutritional supplements
Probiotics may help your symptoms and are available in a range of preparations from capsules to dairy products. They contain germs (bacteria) which can stimulate the growth of good bacteria normally living inside the gut, and which protect against bad bacteria. Sometimes different probiotics may have to be tried before a benefit is seen, which can take a few weeks.
5. Low FODMAP diet
There is increasing evidence that a diet low in FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols) may help. It is recommended that the diet is used under specialist supervision by a registered dietician to make sure that your overall diet is nutritionally balanced and that advice given is up to date.
6. Medication for symptoms
Peppermint oil can help with bloating and abdominal pain and is available over the counter, as well as antispasmodics which reduce irregular muscle activity. Psychological treatments may be beneficial If you have moderate-to-severe IBS, especially if you have life stressors which may be aggravating your symptoms. As explained above, stress can alter the chemical signals sent between the brain and gut. Some antidepressants also block chemicals acting on the nerves in the gut which cause symptoms of IBS. The role of complementary therapies is not well established and the benefits of acupuncture and herbal remedies is unclear at present.
Long term outlook
IBS is a long term conditions with fluctuating symptoms over many years, and if you have ongoing stressors then these can prolong recovery. However, there is no association between IBS and risk of developing serious disease later in life.
Dr Shahid is a GP and Chairperson of the Muslim Doctors Association. She qualified with a distinction in Medical Sciences at University College London and also holds a Bachelors of Science in Pharmacology from University College London, and a Masters of Science in Public Health from the London School of Hygiene and Tropical Medicine. She has also completed a one-year course in Fiqh and Aqeedah at Ebrahim College, London. She currently works as a GP in Central and West London and has an interest in women and children’s health, mental health and public health. She is an honorary clinical tutor at Imperial Medical School and an honorary faculty member at An Najah National University, Palestine at the Department of Community and Family Medicine. She has also worked in research and humanitarian settings in Lebanon, Greece and Calais. In the UK she delivers outreach clinics and health promotion workshops to ethnic minority groups. She is a keen traveller and linguist and enjoys reading and spending time with her family in her free time. She is currently learning Arabic.
Dr Hina J Shahid MBBS BSc (Hons) MScPH MRCGP DFRSH DRCOG DCH
“The advice offered in this column is intended for informational purposes only. Use of this column is not intended to replace or substitute a formal medical assessment, diagnosis, counselling, therapy or any other treatment. The opinions or views expressed in this column are not intended to treat or diagnose; nor are they meant to replace the treatment and care that you may be receiving from a licensed healthcare professional. This column, its author, the magazine and publisher are not responsible for the outcome or results following any advice in any given situation. If you have specific medical questions, you should consult your own GP. You should never delay seeking medical advice, disregard medical advice or commence any medical action without consulting your GP.”