Functional Bloating

What is bloating?

Bloating is explained as a trapped gas in your stomach that makes you feel like you're carrying an inflated balloon around in your stomach, causing abdominal pressure and heaviness. It's a common problem that affects 10% to 25% of the world's population.

This problem is often disregarded because many people assume that bloating is caused by their food. Functional gastrointestinal disorders, such as functional dyspepsia, irritable bowel syndrome, and functional constipation, can give rise to bloating. When the reason for bloating cannot be determined, this is known as functional bloating.

Are bloating and distension the same?

Bloating and distension are two common presentations by patients with functional GI disorders. While the terms ‘bloating’ and ‘distension’ are often used interchangeably, they are different.

Abdominal bloating is the feeling described by the patient as ‘carrying a balloon in the tummy’ with increased abdominal pressure. Abdominal distension, on the other hand, is a widening of the abdomen that may be measured by a doctor which can be measured by the doctor. In short, bloating is a symptom and distension is a sign.

Bloating and distension can happen together or separately in the same person.
The distinction between these two is seen in the diagram below.

What is functional bloating?

When the inflated balloon in your tummy is not linked to changes in bowel movements, this is often considered as functional bloating. Functional bloating does not usually appear right after you wake up, but rather at random periods during the day. It could be sporadic and triggered by the eating of particular foods.

According to the Rome IV criteria, functional abdominal bloating is diagnosed as a sense of bloating or abdominal expansion that happens at least once in a week.

What are the causes of functional bloating?

Although the exact mechanisms that generate functional bloating are unknown, there are a few possibilities:
Diet: Eating short chain carbohydrates, such as added sweeteners, cordial syrup, carbonated drinks, boxed juices, canned coffee/tea and breakfast cereals may trigger the symptom. Unabsorbed short chain carbohydrates are usually processed by bacteria in the intestine, which emits gas that could create bloating.
Alterations in gut bacteria: Even little changes can have an impact on the intestine's functionality.
Gas in the intestines is excessive.
Oversensitivity in the intestinal wall: An abnormally high response of the intestinal wall to stimuli when eating.
Psychological concerns such as stress, anxiety and frustration.
Abdominal muscle relaxation that isn't done at the proper time and in the right place
Eating too fast: It takes approximately 15-20 minutes for your stomach to send a signal to your brain indicating that you are full. As a result, you won't be able to detect when you're full if you eat too rapidly, and you'll overeat until you're bloated.
Eating too much: When you eat too much at once, your stomach stretches and expands to make room for the food, causing you to feel bloated.
Obesity: Bloating may occur because of limited space for the abdomen to stretch or expand comfortably.
Constipation: It can be due to a lack of fibre, not drinking enough water, stress, or other health issues.
Hormones: Especially before a menstruation or during menopause.

What are bloating-related signs and symptoms?

Burping
Flatulence
Nausea
Dizziness
Stress
Weight loss*
Bleeding in stool*
Symptoms of anaemia such as fatigue, pale, weakness*
Changes in bowel habits*
Unusual stomach ache*
Chest discomfort*

*Red-flag symptoms that necessitate immediate medical attention.

How can a doctor tell whether you have functional bloating?

Because detecting functional bloating is tricky, your doctor will collect a detailed history of your condition by asking you the symptoms, duration, medications, diet and previous medical record. Doctors may continue carrying out a physical exam. To rule out probable conditions, a few tests will be scheduled, including routine blood, stool tests, ultrasound, a colonoscopy and allergy tests to look for all kinds of illnesses. If all of your tests come back negative, your doctor may think that it is a functional gastrointestinal disorder.

A set of Rome IV-based criteria must be met before the diagnosis may be confirmed:

Bloating that occurs at least once each week on average.
Inadequate information for a diagnosis of irritable bowel syndrome, functional constipation, functional diarrhea, or postprandial distress syndrome.
Criteria must have been met consistently for the past three months, with symptoms beginning at least six months prior to diagnosis.

How to reduce the symptom of functional bloating?

Therapy approaches for bloating caused by functional digestive system abnormalities may be split into three categories: dietary treatment, psychological treatment, and pharmacological treatment.

Diet

Healthy eating habits: Prioritizing a nutritious diet can help to alleviate bloating symptoms. It is advised that you eat a nutritious and balanced diet based on the Malaysia Food Pyramid 2020, as illustrated in the diagram.

Removing troublesome foods from your diet can also help. In other words, avoiding foods that aggravate your disease can significantly reduce symptoms. The low FODMAP diet, which we recommend as a dietary therapy, is gaining favour. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, as portrayed in the diagram. These foods are poorly absorbed in the intestines, causing luminal distension and bloating.

Psychological

Functional bloating is not a psychological disorder, but negative thinking has been found to interfere with gut-brain communication. The gut receives a signal from the brain that the body is in danger when you are nervous. As a result, bloating and other symptoms of functional gastrointestinal illnesses may worsen.

Regular exercise and rest can help to reduce stress and improve functional bloating symptoms.
The importance of good sleep quality should not be overlooked.
Additionally, you can seek assistance from healthcare professionals who can offer therapies including cognitive behavioral therapy, hypnotherapy techniques, and relaxation breathing techniques.

Medications

There is a selection of medications designed specifically to aid relieve bloating. These include:

Laxatives: Laxatives treat constipation and the bloating that comes with it by speeding up the digestive process in the intestines.
Antispasmodics: Antispasmodics relax the intestinal muscles, which relieves symptoms of iirritable bowel syndrome (a common functional gastrointestinal condition), such as bloating.
Antacids: It makes it easier for gas to be belched away, lowering the amount of bloating that occurs.
Probiotics, prebiotics, and antibiotics: Our intestines' microorganisms may have a role in the symptoms of intestinal issues. These supplements or treatments have the potential to impact, enhance, and regulate gut microbial populations.