DEAR DOCTOR K:
I feel bloated and my belly looks larger than normal. Is this due to excess gas? What can I do to feel better?
That feeling of fullness and tightness in the abdomen is called bloating. Distension is the term for the increased size of your abdomen. Excess gas is probably not to blame for either problem.
It makes sense to think that bloating and distension would be due to excess gas. But scientists have measured gas content in those who have bloating and distension, and people with these symptoms do not have more gas than people without symptoms.
Your bloating is more likely due to irritable bowel syndrome (IBS), a common intestinal disorder with a variety of unpleasant gastrointestinal effects. Three-quarters of IBS patients complain of bloating. In fact, IBS patients often rank bloating as their most bothersome symptom.
Distension probably results from relaxation of the muscles of the wall of your abdomen. Take a look at the skin of your abdomen. Underneath the skin is a flat layer of muscle. When you push out the wall of your abdomen, or suck it in, you are moving that layer of muscle. Abdominal muscles relax during meals to accommodate large volumes of food. In a person with distension, the abdominal wall may relax too much.
There are no surefire treatments for bloating and distension. But because they often go hand in hand with IBS, treating IBS may help relieve them.
ELIMINATE TRIGGERS. Avoiding foods and beverages that worsen symptoms is a good place to start. The following foods may trigger IBS:
- Apples and other raw fruits
- Chewing gum, beverages, or foods sweetened with fructose or sorbitol
- Dairy products
- Fatty foods
- Orange and grapefruit juices
- Wheat products
PROBIOTICS AND PREBIOTICS. Probiotics are living bacteria found in dietary supplements and in cultured and fermented foods like yogurt and miso. Probiotics have long been touted for their ability to ease digestive woes. Prebiotics are non-living substances intended to promote the growth of beneficial bacteria.
PSYCHOTHERAPY. IBS symptoms are sometimes aggravated by anxiety or stress. Cognitive behavioral therapy (CBT) can help to reframe negative thoughts into more positive, productive ways of thinking. This can help improve symptoms.
STRESS REDUCTION. Some people with IBS find relief through stress-reduction techniques. Examples include:
- Relaxation response training
Some physicians believe that there is nothing physically wrong in people with IBS. They believe the symptoms of IBS come from an underlying psychological disorder. Surely, the symptoms of many illnesses can be aggravated by psychological problems. However, in my opinion, recent research indicates that IBS probably is a physical disorder caused by bacteria in the gut.