Bloating: What’s Normal, What’s Not

Written by registered dietitian Maeve Hanan

Bloating is the term used when the abdomen (tummy) feels more distended than usual.

What causes it?

While it can often be very uncomfortable, it is usually normal - for example after a big meal or during periods of stress or travel. Also at certain points in the menstrual cycle. Certain things we do every day can also trigger bloating, such as chewing gum, using straws, and smoking, though swallowing excess air. 

However, bloating can also be abnormal and a symptom of a gut condition such as; Irritable Bowel Disease, food intolerances (such as lactose intolerance), coeliac disease, small intestinal bacterial overgrowth (SIBO), and gut infections (such as giardiasis). It can also be a symptom of ovarian cancer, but this is less common than the other causes.

When should you see a doctor?

If you’re experiencing bloating more than usual and it’s causing you distress either physically or mentally, a trip to your doctor is always wise. The NHS advise that the following red-flag symptoms warrant a discussion with your GP:

• you've been feeling bloated for 3 weeks or more

• you feel bloated regularly (more than 12 times a month)

• you've tried changing your diet but keep feeling bloated

• you have a swelling or lump in your tummy

• you have bloating along with being sick, diarrhoea, constipation, weight loss or blood in your poo

• you find it difficult to move or do daily activities because you’re bloated

Tips to beat bloating

At meal times:

• Avoid skipping meals or overeating in one sitting.

• Try to eat smaller, more regular meals across the day.

• Make sure to relax and slow down at mealtimes, chewing each mouthful roughly 20 times. This is a really important step, so take your time to build these habits before trying other tips on this list.

Nutrition:

• Common bloating triggers include; caffeine, alcohol, gassy veg (beans, pulses, brussels sprouts, cauliflower), spicy and fatty food, sugar-free gum/mints/sweets, and fizzy drinks. It can also help to limit fruit to 3 portions per day and fruit juice to one 150ml serving per day. 

• Keep a food diary to highlight any foods which may trigger symptoms. You may also wish to consider seeking support from a gut-specialist dietitian to help you to identify your individual triggers, this may include assessing your tolerance level to FODMAPs and fibre. Note: a low FODMAP diet should only be trialled with support from a FODMAP-trained dietitian. A gut-specialist dietitian can also support the treatment of certain underlying causes of bloating such as constipation.

• Milled linseeds/flaxseed may help with symptoms of wind and bloating. If you wish to try this, it is best to build this up gradually, for example starting with 1 tsp of linseeds/flaxseeds per day for a few days, then increasing to 2 tsp and possibly 3 tsp or 1 tbsp if needed (1). It is also important to stay well hydrated, as these seeds draw extra water into the stools. 

• Try eating more oats by switching to an oat-based breakfast like porridge or granola, snacking on oatcakes or adding oats to smoothies or on top of casseroles. This may help with symptoms of bloating, wind and constipation. 

• There is some evidence that taking peppermint oil capsules can help with reducing stomach pain and bloating, by relaxing the muscles in the bowel wall (2). See here for more information on peppermint oil from the NHS.

• Some people find probiotics can help with reducing bloating, but this doesn’t work for everybody and it can take some experimenting (3). You can get individual advice from a Dietitian on which probiotics to try or you can try one brand for four weeks to see if you notice an improvement (at a time you aren’t making other changes), and if they don’t work you can then try another brand for four weeks or stop taking probiotics (4).

Lifestyle changes

• Avoid high-waisted pants with tight-fitting waistbands. 

• Exercise can help by moving gas through the gut and reducing bloating. 

• Prioritise stress management as there is a strong connection between the brain and the gut, so stress can often manifest in gut symptoms including bloating.

It is best to take these steps one at a time so that you can see what is or isn’t making a difference. Please seek support from your doctor if bloating is ongoing or severe, and from a gut-specialist dietitian if you are struggling to identify or manage your dietary triggers.