IBS (irritable bowel syndrome) and Bloating
Among all of the different digestive symptoms we can experience bloating can be the most annoying. Often it appears with other IBS-type symptoms such as constipation, diarrhoea and cramping or sometimes just on its own. For many patients with IBS (irritable bowel syndrome), bloating can appear to increase and appear without rhyme or reason. Bloating is a common symptom of (irritable bowel syndrome (IBS).
IBS is often diagnosed once other conditions have been excluded.
These include:
- Celiac disease
- Bowel cancer
- Inflammatory bowel disease [Source: PubMed]
IBS symptoms can include bloating and distention, but also abdominal pain as well as changes to bowel movement. This can be constipation, diarrhoea or alternating between the 2. [Source: PubMed]
IBS symptoms can be commonly experienced, in particular uncomfortable bloating which can also be unpredictable but what causes this gut health symptom of IBS?
Bloating vs Distention
Commonly when discussing bloating, we are actually referring to distention. Whereas bloating refers only to the sensation of feeling pressing in the abdominal region, distention is the visible inflation of the same area.
It’s very common for these to occur simultaneously, with the sensation of feeling bloating being reflected in how large the belly looks. But it’s also possible for someone to feel a high degree of abdominal pressure but have a flat-looking stomach.
However, when discussing bloating, it can refer to a collection of gas in the gut. However, IBS patients often experience bloating and abdominal distension.
In this article, we will be discussing the differences between the 2, and how they can be addressed.
What causes IBS (irritable bowel syndrome) bloating and distention in IBS?
The precise cause of bloating is not exactly well understood by science. However, it appears to be a combination of the following 4 factors:
- The feeling of bloating (this is independent of the visible distention)
- The visible abdominal distention
- The volume of the contents of the abdomen
- Abnormal activity of the muscles in the abdominal wall.
The feeling of bloating can be present without the visible swelling and inflation of the abdomen. The reason for this can be that those with gut issues and IBS (irritable bowel syndrome) can often have a very sensitive gut lining. This is known as visceral hypersensitivity.
This means that the volume of any gas that is produced feels a lot greater than is actually present due to an overly sensitive gut wall.
This has been studied via nerve sensitivity tests which concluded those with IBS-type symptoms (bloating, pain and alterations in bowel movements) had very sensitive nerves in the gut lining [Source: Pubmed].
Causes of IBS (irritable bowel syndrome) Pain
One factor that can contribute to IBS (irritable bowel syndrome) pain is increased sensitivity in the nerves along the gut lining. This increased sensitivity is referred to as visceral hypersensitivity which results in a lower pain threshold in IBS patients. This can then result in the exaggerated sensation of pain and burning.
This can be due to the activation of certain cells in the gut called mast cells. These cells are located in close proximity to nerve cells. It’s possible for these to become activated following a gut infection such as food poisoning or gastroenteritis or as the result of an intestinal allergy. [Source: PubMed]
The Gut Bacteria, Dysbiosis and Bloating
Alterations in the balance of the gut microbiome have been associated with a range of symptoms. These include digestive symptoms such as the issues commonly seen in IBS, for example bloating, diarrhoea and pain.
While imbalances in the gut bacteria can lead to alterations in bowel function and transit time they can also influence the sensitivity of the nerves in the gut and lead to more gas being produced.
The combination of these factors can mean more gas is present, it’s less able to travel through the gut and there is increased pain.
One approach that is considered for IBS is the low FODMAP diet. While this is not a treatment as such, it can lead to a high level of symptomatic improvement in those with IBS. There are several factors that can predict how someone may respond to the FODMAP diet.
When considering the gut microbiome, if a patient has a high representation of bacteria that are better able to ferment FODMAP fibres, this can mean that they will respond better to this dietary approach. This is due to the gas-producing fibres being removed or greatly limited.
While the removal of these FODMAP fibres may not address the underlying issue in the gut, they can often improve symptoms [Source: PubMed]
IBS and Dysbiosis?
A variety of factors can predispose individuals to a disrupted microbiome. These can occur gradually throughout someone’s lifespan and include:
- Antibiotics
- Stress
- Dietary patterns
- Other medications
While antibiotics are important to treat infections, these can greatly reduce the number of many of the bacteria in the gut or alter the balance. [Source: PubMed]
Stress can lower the immune system which can then allow more opportunistic bacteria to make their home in our gut. [Source: PubMed]
A Western-style diet which is high in refined carbohydrates and low in gut-friendly fibre may be starving the beneficial bacteria. This can lead to imbalances and low diversity of bacteria in the gut. [Source: PubMed]
Other medications such as proton pump inhibitors (PPIs) impact levels of stomach acid. Due to the importance of stomach acid to regulate the gut microbiome, reducing levels of this secretion may improve symptoms of heartburn, but can lead to gut bacteria imbalances. [Source: PubMed]
Do I Need More Fibre for IBS (irritable bowel syndrome)?
A common recommendation for IBS (irritable bowel syndrome) and digestive symptoms such as bloating can be to increase fibre. While this may be a sensible approach for long-term gut health, if the gut is imbalanced or sensitive, increasing fibre may worsen bloating. This can be due to the 2 factors already discussed, visceral hypersensitivity and dysbiosis.
Even though the ultimate aim of any gut-focused approach is to address the underlying imbalances within the gut so that foods and fibre don’t need to be avoided, it’s also true that many people will have a personal tolerance to fibre. This tolerance may be reduced if IBS is present. [Source: PubMed]
In the short term to manage symptoms, a low FODMAP diet can be used to assess fibre tolerance. This can be particularly for those who experiencing the diarrhoea subtype of IBS (irritable bowel syndrome).
While the first phase of the low FODMAP diet is to be followed for a period of 2-6 weeks, if this is the right approach, it’s common for symptoms to improve over the initial 2 weeks. If there has been no improvement over the 6 weeks the diet can be discontinued. [Source: Monash]
Following the elimination phase, gradual reintroductions are made to assess tolerance to fibre and create a personalise fibre level. However, as mentioned the aim is to improve the underlying factors in the gut and for the diet to ultimately be fully discontinued.
IBS (irritable bowel syndrome) Foods to Avoid
Before removing foods, it’s important to set certain foundations to support the gut and digestive function.
The foundation aspects include:
- Eating in a calm environment
- Chewing food slowly and thoroughly
Certain foods can also be limited while symptoms are monitored. These foods include:
- Limiting fatty foods
- Limiting spicy foods
- Limiting sorbitol (an artificial sweetener found in sugar-free products)
- Limiting fruit intake to 3 points
- Limiting the intake of tea, coffee, alcohol and carbonated drinks
From this point, depending on the response, a more restrictive approach such as the low FODMAP diet can be considered to further assess for sensitivities and manage symptoms.
Read more about the low FODMAP diet here – read more.
IBS (irritable bowel syndrome) Bloating Relief
Along with dietary approaches, bloating can be supported in a number of ways. This can include strategies to reduce gas production in the short term as a form of symptom management but also to work to address the underlying issue in the gut.
Digestive enzymes can be used to support the breakdown of carbohydrates and thus reduce gas production. Depending on if a specific food trigger is known, this may direct the selection of the product used. For example, if lactose is a known issue then lactase enzymes would be an appropriate selection. However, if bloating is an ongoing and unpredictable symptom then a product with therapeutic doses of several enzymes may be more appropriate. [Source: PubMed]
Activated charcoal is used due to is ability to absorb gas. This has been shown in clinical trial that concluded that bloating and abdominal cramping were both significantly reduced in those prescribed the charcoal tablet. [Source: PubMed]
Probiotics can be used for a variety of purposes with the precise strain of bacteria studied being an important reference to understand its action within the gut. For example, the probiotic bacteria L. Plantarum 299v has been found to offer significant benefits to those with IBS. The improvement in symptoms was most notably reported in abdominal pain and bloating. [Source: PubMed]
Simethicone is used for its ability to improve gas levels with studies reporting its benefit in IBS. In particular, the symptoms of bloating and abdominal discomfort. [Source: PubMed]
How do you get rid of bloating from IBS?
Bloating from IBS can be unpredictable. Some patients find that this IBS symptom increased soon after eating while others find this IBS symptom increasing slowly throughout the day.
The initial foundations of digestive health can involve the following ways to support digestive function. These can help the digestive process in the gut to reduce gas building up.
- Eating in a relaxed and calm environment
- Chewing food very well
- Leaving 3-4 hours between meals [Source: PubMed]
There are certain foods that may increase gas. Commonly these are referred to as FODMAP. These foods contain fibres that are easily fermented in the gut, especially if there are imbalances in the gut bacteria (such as in SIBO), and more gas can be produced.
The Low FODMAP diet is a short-term approach to identify specific triggers.
Alongside this, working to address the underlying imbalance in the gut with targeted supplements is a central part of the treatment of bloating in IBS. [Source: PubMed]
Does IBS make your stomach swell?
IBS symptoms include abdominal bloating and swelling. This can be very uncomfortable and lead to a long list of foods being avoided.
Once tests have been carried out by doctors to rule out other causes of gut health symptoms (cancer, coeliac or inflammatory bowel disease), a diagnosis of IBS is provided along with basic information on foods to avoid. This list may include eliminating or reducing:
- Lactose
- Spices
- Fats
- Caffeine [Source: PubMed]
This swelling can be due to high amounts of gas being produced or increased sensitivity in the gut lining. While this is a common symptom of IBS, addressing the underlying imbalance in the gut is an important way to restore gut health.
Further tips that Doctors can provide information for include following a low FODMAP diet to identify trigger foods. While this may help with managing symptoms it does not address the underlying imbalance in the gut. [Source: PubMed]
How to Cure IBS (irritable bowel syndrome) Permanently
Rather than approaching IBS as a disease, seeing this condition are a set of symptoms, each with underlying issues can be a helpful way to understand how it can be resolved.
Each symptom of IBS has an underlying biological mechanism. By identifying and addressing these underlying issues symptoms can improve and, in many cases, resolve entirely.
