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Irritable Bowel Syndrome Bloating Treatment

By 19th June 2023Bloating, IBS
bloating treatment

Get Rid of IBS Bloating

For those with IBS, a range of symptoms are commonly experienced. These include abdominal pain, changes in bowel patterns (diarrhoea or constipation as well as bloating. 

While not required for a diagnosis of IBS or bloating, it’s also common for other digestive symptoms to be present such as heartburn or acid reflux.

Out of all of the digestive symptoms experienced in IBS, bloating is often reported to be the most common and the most unpredictable. It is experienced in up to 86% of those with digestive issues [Source: PubMed]

This bloating can occur soon after eating. Alternatively, some find that bloating builds gradually throughout the day, and peaks in the evening time. Even if certain foods may trigger the bloating, the results can be unpredictable with a potential trigger food causing an issue one day and not causing an issue the next day. [Source: PubMed]

What Causes Bloating?

Various factors can contribute to bloating. This can be related to gas production in the gut as well as an increased sensitivity along the gut lining. Both are common factors in digestive disorders. [Source: PubMed]

During the digestive process, food is digested and absorbed. This process involves vitamins and minerals being absorbed in the small intestine. As well as vitamins and minerals, food also contains non-digestible carbohydrates knowns as fibre which is not digestive. However, it does travel to the large bowel. 

Certain types of fibre bulk the stool and support bowel movements, while other types of fibre are fermented but the gut microbiome. [Source: PubMed]

Part of this fermentation process involves gas being produced. When this process is taking place in a balanced manner, there is a balance in the gas production vs the gas disposal. However, it is common when there is bloating for there to be too much gas produced and not enough being disposed of.

From a gut microbiome perspective, this may involve an imbalance in the gut microbiome that allows for more fermentation to take place. [Source: PubMed]

Alongside this, for those with IBS and bloating, it is common for there to be visceral hypersensitivity. This describes an increased sensitivity in the nerves along the digestive tract which increases the perception of high levels of gas. This may make someone feel bloated in the stomach or abdomen, even if there isn’t an excessive level of gas being produced. [Source: PubMed]

Gas-Producing Foods

In susceptible individuals, certain foods may trigger bloating. While these are not necessarily bad foods, for certain patients this may pose an issue and increase gut symptoms. 

The foods that have the most potential to increase bloating contain a higher amount of fermentable fibres. These fibres are in common foods but for patients with symptoms of bloating, and stomach pain this may increase these digestive symptoms.

The reason for this is that they are a food source for the beneficial bacteria in our digestive tract. In a balanced environment, these bacteria digest the fibres in these foods and produce gas. This gas is then often broken down and digested by other bacteria, keeping the levels of gas balanced.

However, if there are changes in the balance of these gut bacteria too much gas may be produced and not enough broken down. This excess gas that is present in the bowel can then lead to bloating as well as potential alterations in bowel patterns (eg constipation or diarrhoea)

These foods that are the most troublesome contain highly fermentable fibres which can lead to excess gas being produced [Source: PubMed]

A diet such as a low FODMAP diet, is one tool to reduce these fermentable fibres. While a low FODMAP diet has been shown to improve a wide range of IBS-type symptoms (which includes bloating) it is not a treatment for these issues as it does not address the specific underlying issue. However, it can be a valuable symptom management tool to improve symptoms of bloating and improve the patient’s quality of life. [Source: PubMed]

Food, Fibre & Bloating For IBS

A common suggestion for those with IBS and bloating is to eat more fibre. This may be helpful for many with gut issues but this may also depend on the underlying issues and the initial dietary patterns. 

However, if the gut is extremely sensitive or there is excessive gas and bloating, introducing more fibre can feel like adding fuel to a fire. Adding more fibres to the gut which is then fermented by the bacteria and leads to an increased level of gas.

In this situation, it can be tempting to see food as the problem and manage the diet to help symptoms of bloating. Rather than seeing dietary restrictions as a treatment, it can be a helpful way to manage symptoms in the short term while the underlying imbalance is addressed [Source: PubMed]

Diet to Reduce Bloating

For patients with bloating adjusting the diet can be a helpful tool to reduce symptoms of bloating, identify triggers and improve quality of life. While the aim should be to have the diet as diverse and unrestrictive as possible, in the short term a reduction in high fodmap foods may be helpful.

FODMAPs are foods that are high in fibres that are highly fermentable by the gut bacteria.

Even though these are all generally considered healthy foods, they can aggravate digestive symptoms. By reducing the amount of fermentation taking place in the gut, symptoms may be better managed while the underlying issue is addressed. [Source: PubMed]

The low FODMAP diet was created by Monash University and is in 3 phases.

Phase 1 of the Low FODMAP diet – The Elimination Phase

During this phase, all FODMAPs are removed.

This limits high FODMAP foods such as:

  • Vegetables – garlic, onion, leek, cabbage, asparagus
  • Fruits – apples, pears, peaches, blackberries
  • Grains – wheat and rye
  • Dairy – high lactose dairy products such as milk and soft cheeses

This can often help to reduce symptoms quickly and to allow phase 2 to be more effective.

This diet is often recommended for 2-6 weeks. If no improvement in bloating is noticed within this time, this may not be an appropriate approach to manage this digestive symptom and other options can be considered. [Source: PubMed]

Phase 2 of the Low FODMAP diet – The Reintroduction Phase

If symptoms have improved during phase 1, foods can be gradually reintroduced. It is often unlikely that all high FODMAP foods are problematic and a mistake that is often made is staying on phase 1 for too long. Ensuring the diet is diverse as possible helps can make life easier and more enjoyable.

If specific foods are an issue during the reintroduction phase and lead to digestive symptoms such as bloating these can continue to be avoided. However, this doesn’t mean this food has to be avoided forever.

Phase 3 of the Low FODMAP diet – Personalisation

The third phase of the Low FODMAP diet for bloating involved focusing on continuing to avoid the noted trigger foods.

Ongoing reactions to food may indicate that there is an imbalance in the gut. If this can be addressed and supported in the correct way the aim is to have the diet as varied and unrestricted as possible. There are several ways to support the balance of the digestive symptoms of bloating and IBS. [Source: PubMed]

Resistant Starches and Bloating

Certain carbohydrates may also lead to symptoms of IBS and bloating. These are commonly called resistant starches.

These are found in foods such as:

  • White potatoes
  • White rice
  • Beans and legumes

Although the name is different to fibre, the process is the same with alterations in the absorption of fermentation of these carbohydrates triggering IBS symptoms such as bloating. 

They act as a fuel source for beneficial bacteria, which when the gut is out of balance can then lead to excess gas production and symptoms such as bloating. [Source: PubMed]

Also Read: Addressing The Root cause of Bloating

Best over-the-counter gas and bloating medicine

There are several options to help manage the symptoms of bloating. While there may not be an actual treatment, meaning they may not address the underlying issues, they can help improve symptoms of bloating and improve quality of life.

Digestive Enzymes for Bloating

Depending on specific food triggers, various digestive enzymes may be beneficial. Lactase supplements help you digest the sugar lactose in dairy products.

A broad-spectrum digestive enzyme can be helpful if someone is unsure of a particular food trigger. Alpha-galactosidase is a single digestive enzyme to help break down the carbohydrates in vegetables and beans. [Source: PubMed]

Activated Charcoal for Bloating

Charcoal is a highly absorbent mineral which may act as a sponge and help to reduce the level of gas in the digestive system by absorbing the gas. [Source: PubMed]

Simethicone for Bloating

Simethicone is the active ingredient in products such as Wind-eze or WindSetlers. This can reduce symptoms of bloating.

To reduce the bloat, simethicone works by bringing smaller bubbles of gas together in the gut to form larger bubbles which can pass more easily through the gut and therefore reduce bloating. [Source: NHS]

Probiotics for Bloating

Specific probiotic bacteria have been shown to help with symptoms of bloating. Rather than adding more bacteria to the gut, probiotic supplements support the gut in other ways.

They can help to support the gut immune system, reduce the sensitivity of the gut lining and help the body to produce compounds that have a natural antimicrobial effect to balance the bacteria. [Source: PubMed]

The use of probiotics can be seen as a form of treatment with specific strains of probiotic bacteria being more beneficial to bloating. 

Specific strains of probiotics that have been shown to improve bloating symptoms include:

  • Lactobacillus plantarum 299v [Source: PubMed]
  • Lactobacillus rhamnosus GG [Source: PubMed]
  • Bifidobacterium breve BR03 [Source: PubMed]

Herbal Antibiotics for Bloating

A key indicator of a bacteria imbalance in the gut microbiome is the symptom of bloating. This is often due to the presence of an alteration in the process of fermentation.

Fermentation is considered a beneficial process when the bacteria are in a balanced state, however, if the ratio of levels of these bacteria is disturbed there can be an imbalance in the fermentation process and symptoms such as bloating can follow.

To rebalance these organisms, herbal antimicrobials can be used, particularly when SIBO is present to support the bacterial balance.

These are herbs such as garlic, oil of oregano and berberine. [Source: PubMed, PubMed]

Peppermint

Alongside the imbalance of bacteria that is often present in those with IBS, there can be changes along the gut lining.

This increased sensitivity in the nerves along the gut wall is something known as visceral hypersensitivity. This can be seen when the nerves are on ‘high alert’ and when even a small amount of gas feels painful or triggers bloating.

Peppermint helps to support the gut lining to reduce this hypersensitivity and also has pain-relieving and anti-inflammatory properties. [Source: PubMed]

When to see a Doctor for Bloating

While symptoms of IBS can be present on a day-to-day basis and change gradually, there are several symptoms/changes in symptoms that would be considered ‘red flags’.

To ensure there aren’t any changes in the digestive system, it is often best to speak with a GP.

Red flag symptoms include:

  • unexplained weight loss
  • rectal bleeding
  • change in bowel habit in patients under 60 years of age
  • family history of bowel/ovarian cancer
  • anaemia
  • abdominal/rectal/pelvic mass
  • raised inflammatory markers. [Source: PubMed]

How to Cure IBS and Bloating Permanently

Whereas a low FODMAP diet and digestive enzymes may be a helpful symptom management tool, to cure IBS and bloating the underlying imbalance, needs to be identified and treated.

These underlying issues can vary between individuals. Common causes of these symptoms of IBS and bloating can include:

  • Changes in the bacterial balance (dysbiosis)
  • Carbohydrate intolerances
  • SIBO (small intestinal bacterial overgrowth)
  • Low-level inflammation resulting from an infection
  • A high level of emotional stress [Source: PubMed]

Depending on the underlying issue in the gut, a more specific protocol can be put into place to address the root causes of symptoms of bloating.

How Do I Get Rid of IBS Bloating Fast?

There are several ways to reduce bloating that may have a quick benefit. These can be considered symptom management tools for bloating. However, a priority when there is a flare-up in symptoms is to quickly reduce gas levels.

  • A low FODMAP diet
  • Digestive enzymes
  • Simethicone
  • Charcoal
  • Fennel tea [Source: PubMed]

What is the best treatment for IBS bloating?

It’s important to remember that IBS is not a single thing with a single cause.

It can be the case that even in people with the same symptoms, the underlying issue can be very different.

This means that the best treatment for IBS with bloating needs to be individualised. [Source: PubMed]

How long does bloating last with IBS?

IBS symptoms can change on a day-to-day basis and vary in intensity.

Many people experience a low-level bloating throughout the first part of the day which gradually builds towards the evening. This does often reduce overnight and feels a great deal more comfortable by the morning time. [Source: PubMed]

If bloating is always present and there are other symptoms such as chronic pain, blood in the stool or fever it is often advised to visit a GP for further consideration or assessments. [Source: PubMed]

Does water help with bloating?

Hydration is a foundational element not only for human health but for digestive health. Dehydration can impact bowel function leading to constipation, which in turn can influence the balance of the gut microbiome leading to bloating. The longer the stool remains in the colon the more the fermentation or gas may increase. [Source: PubMed]

Some patients find that their gut is so sensitive that even water can trigger bloating. This is likely less to do with a fermentation process but with alterations in the muscle reflexes in the gut. [Source: PubMed]

Does lemon water help with bloating?

Lemon water may be a helpful aid to support digestive processes and reduce symptoms such as bloating. While lemon juice doesn’t act as a digestive enzyme support, the acidity of lemon juice has been shown to increase and stimulate the body’s own production of digestive enzymes, in particular gastric acid. [Source: PubMed]

Stimulating the production and release of gastric acid, support the secretion of enzymes further along the digestive tract which help to break down food, thus reducing gas. In part, this is related to the acidity of the stomach contents as it enters the small intestine, triggering the release of pancreatic enzymes from the pancreas. [Source: PubMed]

In addition to this, lemon juice can increase the emptying rate of the stomach, supporting overall digestive health and transit time.

How to Cure Bloating and IBS

There are several factors that can influence gut health, leading to the symptoms of IBS and bloating.

To address these factors, symptom management tools such as the low FODMAP diet or digestive enzyme supplement may be helpful short-term tools. Alongside this, working to address the underlying issue is important.

This underlying issue can vary from patient to patient. Working with a gut health specialist can support this process, and guide the steps to help you reach a symptom-free life.

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