Whether it’s a bout of holiday tummy, heartburn after a heavy meal, or just occasionally feeling bloated, trouble with your digestive system is one of the top five reasons we visit our GP.
Figures show 70 per cent of people suffer regularly from belly woes, with Irritable Bowel Syndrome (IBS), acid reflux and plain old constipation three of the most common causes.
Not many of us are comfortable with talking about our bowel issues, whether it’s food baby related or something more serious which delays us getting help.
It can help to know what is the cause of your bloating – though remember nothing replaces a GP’s advice.
Here are common causes and how to get rid of a bloated stomach.
What are the symptoms of a bloated stomach?
1. Irritable bowel syndrome
Could be the cause if: You’ve been bloated on and off for a long time and have also experienced symptoms including pain, constipation and/or bouts of diarrhoea.
A common bowel condition, IBS is a functional disorder, which means there’s nothing wrong with the structure of the bowel itself, but the way the gut works is abnormal.
Peter Whorwell, professor of medicine and gastroenterology at the University of Manchester, says: “We think the gut is over-sensitive in IBS sufferers so its normal processes cause the symptoms.”
Bloating is one of the most disruptive side effects of IBS. Some women go up a couple of dress sizes and even need different clothes depending on whether or not they are bloated.
For many, it tends to worsen towards the evening, so it can disrupt your social life.
There’s no cure for IBS, but you can manage the symptoms.
“Cutting out cereal fibre eases symptoms by between 30% and 40% in the majority of sufferers,” says Professor Whorwell.
This means avoiding wholemeal bread, oats, muesli, digestive biscuits, cereal bars and all breakfast cereals other than Rice Krispies, but white bread, cakes, cream crackers and most biscuits are fine.
Try doing this for three months to see if it helps. Probiotics may also ease symptoms – Holland and Barrett stock these chewable probiotic tablets .
You can also try Activia yoghurts, as the probiotic strain they contain has been shown to help IBS – Sainsbury’s has packs of 4 Activia yoghurts.
Doctors can prescribe medication for you, such as anti-spasmodics, laxatives and anti-diarrhoeals.
“There’s no problem taking laxatives and anti-diarrhoeals in the long term if you have IBS,” adds Professor Whorwell.
Could be the cause if: You are passing a lot of wind, but don’t notice any other symptoms.
We all experience flatulence from time to time – it’s perfectly normal to do so up to 15 times a day – and sometimes you may not even notice that you are doing it.
While there’s no medical definition of excessive flatulence, if it’s bothering you and makes life awkward or feels uncomfortable, there are steps you can take to reduce it.
Try cutting down on foods that are high in non-absorbable carbs. Common culprits include beans and pulses, broccoli, cabbage, prunes and apples, and foods containing the sugar substitute sorbitol.
These tend to be digested very slowly and can release small amounts of sulphur gas while they pass through the gut.
Nutrition consultant Ian Marber says: “Eat food slowly and remember to chew. Without chewing, food is more likely to pass into the gut partially broken down and there’s a higher chance it will ferment and produce gas.”
Be aware that, occasionally, an underlying health condition – including those that are listed here – could also be causing flatulence.
3. Coeliac disease aka gluten
Could be the cause if: You often feel tired; you’ve lost weight for no apparent reason; you are suffering from abdominal pain.
Coeliac disease is an adverse reaction to gluten, which is found in wheat, barley and rye and all foods containing them – everything from pasta and bread to pies and some gravies and sauces.
It is an autoimmune condition where the body mistakes substances in gluten for a threat and attacks them, leading to damage to the surface of the small bowel, which then affects your ability to absorb nutrients from food.
It used to be mainly diagnosed in children, but it’s now known people can go undiagnosed into middle age.
If you have these symptoms, see your doctor and ask to have a blood test for coeliac disease. National Institute for Health and Clinical Excellence guidelines state that anyone with bloating and other IBS-type symptoms should be tested for it.
If you’re diagnosed, you’ll feel better once you start avoiding all foods containing gluten.
For more information about it visit www.coeliac.org.uk.
4. Hormonal fluctuations
Could be the cause if: You are premenstrual or in the early stages of pregnancy.
During pregnancy, and just before your period, levels of the hormone progesterone are raised.
This can slow down gut motility or movement, which means food passes more slowly through the body, leading to bloating and possibly constipation.
You can beat the bloat. Exercise can help improve gut motility and walking for 30 minutes a day could be enough to make the difference.
Remember to also drink plenty of fluids and eat lots of fruit, vegetables and whole grains to avoid constipation.
5. Ovarian cancer
Could be the cause if: Bloating is persistent and you have other symptoms such as a perpetual feeling of fullness and abdominal pain.
The symptoms of ovarian cancer tend to be quite vague, which is often why it’s diagnosed late when it’s harder to treat, so it’s important to be aware of potential signs. It’s important to go to your doctor rather than self diagnosing.
Target Ovarian Cancer chief executive Annwen Jones says: “Key symptoms are bloating that is persistent rather than coming and going and increased abdominal size. Look out for persistent and frequent abdominal pain, difficulty eating and urinary symptoms.
“It’s unlikely your symptoms are caused by a serious problem, but it’s important to be checked out.”
Find out more online by visiting www.targetovariancancer.org.uk.
6. Non-coeliac gluten sensitivity
Could be the cause if: The same as coeliac disease, but may also include joint pain, muscle cramps, leg numbness, weight loss and chronic fatigue.
A newly identified condition, NCGS occurs when you have the symptoms of coeliac disease caused by a sensitivity to gluten, but no antibodies show up in blood tests and the gut lining looks normal.
Gastroenterologist Dr Kamran Rostami estimates that for every person with coeliac disease there may be seven with NCGS – that’s up to seven million people.
Not all doctors believe NCGS exists as a separate condition – and there’s no diagnostic test for it yet.
7. Learn your triggers
Knowing what sets off your tummy flare-ups can help reduce their frequency. Buscopan IBS Relief has created a free ‘food diary’ app which can help you identify your food and stress triggers. You can download the app at www.ibs-relief.co.uk/download.htm.
8. Lower stress levels
“Research shows stress can go straight to your stomach, which is why anti-depressants are used for some people with resistant IBS symptoms,” says colorectal surgeon Mr West. “Other drug-free methods are worth trying first, such as hypnotherapy, relaxation techniques and looking at ways to manage your stress day-to-day.”
9. Boost your good bacteria levels
Starting your day with a daily probiotic drink or supplement can raise your gut’s good bacteria level, which can keep your digestive system healthy and could help ease any discomfort. Try Healthspan Super20 Pro (£16.95, from healthspan.co.uk ).
10. Eat early to avoid heartburn
Acid reflux tends to strike at night when you’re lying down, so avoid eating later than 8pm. Try sleeping with an extra pillow to help reduce the backflow of acid and taking a tablet such as Nexium Control (£6.99, from chemists) which blocks acid production.
11. Up your fluid intake
When it comes to fighting constipation, eight glasses of fluid a day can help by flushing waste out of your system and reducing water retention. And the good news is any liquid will do. “We used to think it had to be water, but we now believe any drink, even tea and coffee is fine,” says Mr West.
12. Try the low FODMAP diet
Only recently devised, this has helped many people with IBS, although it’s quite restrictive and can be difficult to follow. It involves avoiding foods – in particular fruit and veg – that contain fermentable sugars known as FODMAPs. These feed the bad bacteria in your gut, releasing the gas that causes uncomfortable bloating, stomach pain and diarrhoea for some. FODMAP foods includes onions, garlic, cauliflower, apples and cabbage. But make sure you get the advice of a registered dietitian first to ensure you don’t miss out on important nutrients.
13. Eat less sugar
Sugar gets the blame for a lot of things, and disrupting gut health is one of them.
“It isn’t known exactly why sugar can lead to an imbalance of beneficial bacteria and non-beneficial bacteria, and bloating, but it’s worth keeping as a treat,” explains Jeannette Hyde.
But don’t replace sugar with unhealthy sugar substitutes.
“Artificial sweeteners, such as those contained in diet drinks, have been shown to cause an unbalance of bacteria in animals, so may be worth avoiding if you want a flat tummy,” warns Jeannette.
Try to reduce the amount of sugar by cutting back on fizzy drinks and sweets. It’s still good to have these from time to time as a treat, however, in excess they can cause digestive issues.
14. Fast for at least 12 hours
“Having a fasting stretch of 12-14 hours between dinner and breakfast can promote weight loss and encourage beneficial bacteria to thrive in the gut which can improve metabolism and balance hunger hormones,” says Jeannette.
“It’s easy to do if you are eating nice and early – say 7pm for dinner and then just having water between then and a 7am breakfast the next day.”
15. Eat a rainbow of fruit and veg
“Often when people have chronic bloating they become nervous of many foods and cut out lots that contain fibre,” says Jeannette.
“For long-term gut health, it’s vital to include lots of different vegetables and some fruit.”
We all have about a kilo and half of bacteria in the digestive tract, mainly in the colon.
“For good health, your colon needs to be thriving with lots of different types of bacteria, and the way to promote it is to feed the bacteria with many types of fibre-rich foods.”
Beat bloating in a week
Nutritional therapist Natalie Lamb has outlined a seven day plan in order to help with bloating. Here are the seven steps:
Start taking a multi-strain probiotic.
Use apple cider vinegar before each meal to support digestive function.
Reduce simple sugars and refined carbohydrates.
Start eating more fibre.
Drink cups of homemade bone stock or including it in soups and stews.
Leave legumes to soak well overnight. It will ease their digestion if they cause you bloating.
Relax more. Stress is known to reduce the levels of beneficial bacteria in the gut.
For a more detailed outline of the seven day plan, click the link below and look into creating your own food diary.
When should I worry?
Although most digestive issues are down to uncomfortable but not life-threatening conditions such as IBS or heartburn, some symptoms can indicate more serious conditions such as bowel cancer – especially if you’re over 50.
Consultant general and colorectal surgeon Mr Nick West advises: “See your GP immediately if you experience any of the following ‘red flag’ warning symptoms:
- A persistent change in bowel habit (constipation, diarrhoea or both)
- Any lumps or bumps around your bottom or stomach
- Bleeding from your bottom
- Unexplained weight loss
- New and persistent bloating should always be checked in women over 45 to rule out ovarian cancer
Real life cases
We sent four readers with persistent tummy troubles to see Mr Nick West, consultant general and colorectal surgeon at Spire St Anthony’s Hospital in Surrey, for a thorough examination to investigate their problems.
I get so bloated I look pregnant
Hannah Lewis, 36, is a model, who is single and lives with her eight-year-old son in Ascot, Berks.
Abdomen exam: Normal
Hannah says: I’ve suffered from excessive bloating for more than 10 years and can look pregnant after eating certain foods .
I also get terrible stomach cramps, constipation and severe flatulence. My GP hasn’t offered much help.
Some days my tummy is so bad I don’t want to go out. If I have an important event to attend, I either don’t eat at all or just eat crisps which don’t cause me to bloat. I’ve tried over-the-counter medicines, but none have helped much.
Mr West’s assessment: Hannah has classic IBS symptoms. Her mother apparently suffered from it and it can run in families.
I reassured her it isn’t associated with a higher risk of any other more serious conditions.
Treatment for Hannah is all about symptom control, as her bloating gets worse with certain foods including roast dinners and curries.
I’ve advised her to avoid these and keep a food diary to spot other triggers.
Following a low FODMAP diet, avoiding gas producers like onions, broccoli and apples, can improve IBS.
I only have a poo once a week
Michelle Nixon, 37, of Morden, Surrey, works for a medical device firm and is a married mum of two.
Abdomen exam: Normal
Diagnosis: Chronic constipation
Michelle says: I’ve suffered from constipation for as long as I can remember and only open my bowels once every seven days.
I’ve tried several laxatives, which do help me go to the loo more often.
My diet is fairly healthy, although I probably don’t drink enough fluids during the day and my exercise levels could be better. The problem does worry me.
Mr West’s assessment: Michelle has no ‘red flag’ symptoms that could indicate cancer.
Her weight and appetite are normal and she has no family history of bowel conditions.
She simply has idiopathic chronic constipation, due to a sluggish digestive system.
It would be worth having a blood test to check her thyroid levels, as constipation is a classic sign of hypothyroidism when the body doesn’t produce enough of the thyroid hormone.
The prescription laxative Dulcolax can help her. Exercise is also important, as is drinking plenty of fluids.
I just can’t stop myself burping
Angie Chace, 66, is a retired accounts supervisor from Portsmouth, Hants.
Abdomen exam: Normal
Diagnosis: IBS – with further tests recommended
Angie says: For the past three years, everything I eat or drink makes me burp, with pain and discomfort behind my sternum.
Recently I’ve had a very bloated stomach and find both these symptoms get worse with foods such as onions, broccoli and bread. My bowels have never been regular.
Mr West’s assessment: Angie doesn’t smoke, chew gum, drink fizzy drinks or take boiled sweets – all of which can raise gas in an abdomen.
It may be her burping is due to acid reflux. I would recommend checking for gastroesophageal reflux disease (GERD) and hiatus hernia with a gastroscopy.
Her bloating symptoms sound like IBS – but because of their recent onset and her age, an ultrasound scan to rule out ovarian cancer would be wise.
My stomach pains last days
Edson Chace, 74, is a retired credit manager from Portsmouth, Hants.
Abdomen exam: Normal
Diagnosis: Reflux disease or hiatus hernia – requires further tests
Edson says: I suffer from excessive burping about an hour after eating, which started around 10 years ago, but has got worse recently.
I also get bouts of tummy ache which can last several days. I take Omeprazole (which reduces acid levels) every day or I’m in considerable pain.
Mr West’s assessment: Despite his discomfort, Edson’s had no change of bowel habit, which is reassuring.
But he’s in a higher risk age group and, given his previous history of reflux symptoms, I’m recommending he has a gastroscopy (a camera sent down into the stomach via the mouth) to see if he has gastroesophageal reflux disease (GERD).
This occurs when stomach acid flows back into the oesophagus causing heartburn.
Or it could possibly be a hiatus hernia – when part of the stomach squeezes up into the chest through an opening in the diaphragm, causing stomach acid to flow back up.