Bloating: The Common Causes We See

Bloating is one of the most common complaints that walks through our door, and in most people it is not a disease. It is gas or stool in the wrong amount at the wrong time, stretching a gut that is good at reporting the stretch. The job is to find which ordinary cause is doing it, and to know when it is not ordinary.

The usual suspects

Swallowed air. Every swallow carries a little air into the stomach. Eating fast, drinking through a straw, chewing gum, carbonated drinks and talking through meals multiply it. Eating slowly, with the fork down between bites, fixes more bloating than most people expect.

A sudden jump in fiber. Fiber is fermented by gut bacteria, and fermentation makes gas. The bacteria adjust, but it takes two or three weeks. Someone who goes from 12 grams a day to 35 in a weekend will feel it. We raise fiber by about 5 grams a week.

Lactose. The enzyme that digests milk sugar declines after childhood in a large share of adults. Undigested lactose reaches the colon, where bacteria ferment it and water follows. The result is bloating, cramping and loose stool an hour or two after dairy. Hard cheeses and yogurt carry much less lactose than milk and ice cream, which is why some dairy bothers people and some does not.

Sugar alcohols. Sorbitol, xylitol, maltitol and the other sugar alcohols in sugar free products are poorly absorbed and ferment the same way. Reading the label on protein bars and gum solves a surprising number of cases.

Constipation. Stool sitting in the colon ferments longer and backs up gas behind it. People often miss this because they still go every day, but going every day and emptying fully are not the same thing.

When it needs a workup

Bloating that comes and goes with food is usually one of the causes above. Bloating that is new, persistent and getting worse is different, especially after 50. We look harder when it comes with unintended weight loss, blood in the stool, anemia, pain that wakes you at night, or a family history of colon cancer or celiac disease. In women, persistent bloating that does not track with meals or the cycle is worth an exam and imaging, because it is one of the more common symptoms of ovarian cancer, a cancer that gives few other warnings.

The basic workup is not exotic. A celiac antibody test, a thyroid check, a look at the stool pattern, and sometimes a breath test for bacterial overgrowth cover most of it. The rest comes from a careful history, which is the part a seven minute visit rarely has room for.

Most bloating is solved at the table, not the pharmacy, but the point is to find out which cause it is rather than guess. If nobody has walked through this with you, it's worth a conversation.

This article is educational and is not medical advice.

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