BLOATING

Bloating is any abnormal general swelling, or increase in diameter of the abdominal area. As a symptom, the patient feels a full and tight abdomen, which may cause abdominal pain, and sometimes accompanied by increased stomach growling or more seriously the total lack of it.

SYMPTOMS

The most common symptom associated with bloating is a sensation that the abdomen is full or distended. Rarely, bloating may be painful or cause shortness of breath.  Pains that are due to bloating will feel sharp and cause the stomach to cramp. These pains may occur anywhere in the body and can change locations quickly. They are so painful that they are sometimes mistaken for heart pains when they develop on the upper left side of the chest. Pains on the right side are often confused with problems in the appendix or the gallbladder.  One symptom of gas that is not normally associated with it is the hiccup. Hiccups are harmless and will diminish on their own; they also help to release gas that is in the digestive tract before it moves down to the intestines and causes bloating. Important but uncommon causes of abdominal bloating include ascites and tumors.

CAUSES

There are many causes of bloating, including: diet, irritable bowel syndrome, lactose intolerance, reflux, and constipation, to name a few.  Specific medical conditions like Crohn's Disease or bowel obstruction can also contribute to the amount of stomach bloating experienced.  Gas and bloating is a sign that food is not being ingested correctly by the body. An inadequate intake of water will cause excessive stomach bloating. Water benefits the body by aiding with digestion because it supports a majority of the body's daily functions. Fatty foods cause a formation of fat cells to develop throughout the body and contribute to bloating as well. A build up of fat cells slows down the body's ability to empty the stomach. Dairy products also contribute to excessive cramps, gas, and bloating. Persons who are intolerant to lactose products experience this effect more than others. Once these foods are digested, the bloating will fade.  Common causes of abdominal bloating are: Overeating Gastric distension Lactose intolerance, fructose intolerance and other food intolerances Food allergy Aerophagia (air swallowing, a nervous habit) Irritable bowel syndrome Partial bowel obstruction Gastric dumping syndrome or rapid gastric emptying Gas-producing foods Constipation Visceral fat Splenic-flexure syndrome Menstruation, dysmenorrhea Polycystic ovary syndrome and ovarian cysts Alvarez' syndrome, hysterical or neurotic abdominal bloating without excess of gas in the digestive tract Massive infestation with intestinal parasites, such as worms (e.g., Ascaris lumbricoides) Diverticulosis Celiac Disease  Important, but uncommon causes of abdominal bloating, include large intra-abdominal tumors, such as those arising from ovarian, liver, uterus and stomach cancer; and megacolon, an abnormal dilation of the colon, due to some diseases, such as Chagas disease, a parasitic infection. Gaseous bloating may be a consequence of cardiopulmonary resuscitation procedures, due to the artificial mouth-to-mouth insufflation of air. In some animals, like cats, dogs and cattle, gastric dilatation-volvulus, or bloat also occurs when gas is trapped inside the stomach and a gastric torsion or volvulus prevents it from escaping.

IRRITABLE BOWEL SYNDROME

Bloating from irritable bowel syndrome(IBS) is of unknown origin but often results from an insult to the gut, and as such can overlap with infective diarrhea, celiac, and inflammatory bowel diseases. IBS is a brain-gut dysfunction that causes visceral hypersensitivity and results in bloating in association with recurrent diarrhea (or constipation) and abdominal pain. While there is no direct treatment for the underlying pathologyof IBS, the symptom of bloating can be well managed through dietary changes that prevent the over-reaction of the gastrocolic reflex. Having soluble fiber foods and supplements, substituting dairy with soy or rice products, being careful with fresh fruits and vegetablesthat are high in insoluble fiber, and eating regular small amounts can all help to lessen the symptoms of IBS (Van Vorous 2000). Foods and beverages to be avoided or minimized include red meat, oily, fatty and friedproducts, dairy (even when there is no lactose intolerance), solid chocolate, coffee (regular and decaffeinated), alcohol, carbonated beverages, especially those also containing sorbitol, and artificial sweeteners(Van Vorous 2000). IBS is most commonly found in patients around the age of 20 and is found more often in women than men. In people with IBS, the intestines squeeze too hard or not hard enough and cause food to move too quickly or too slowly through the intestines.Other terms used to describe this condition include spastic bowel, spastic colon, and irritable colon. Symptoms of the condition will worsen as a person is placed under stress, during travel, and at other times when the daily routine is tampered with. Common symptoms include bloating, constipation, abdominal cramp or pain after bowel movement, or feeling like a movement is required even after one has been completed.

FIBER

Most cases of stomach bloating are due to improper dieting. Fiber is made by plants and is not easily digested by the human gastrointestinal tract. There are two main types of dietary fiber, soluble and insoluble fiber. Soluble fiber is prebioticand readily fermented in the colon into gases, while insoluble fiber is metabolically inert and absorbs water as it moves through the digestive system, aiding in defecation. Most types of fiber (insoluble) are attached to body waterin the intestineand increase the volume of stools. Gas occurs because of the bacteria in the colon and is a by-product of soluble fiber digestion. Inadequate/irregular intake of fiber and water will cause a person to experience bloating or constipation. The most common natural sources of fiber include fruits and vegetables as well as wheat or oat bran. These fibers are most likely to cause flatulence.A diet that is high in fiber will decrease the risk for stomach bloating[citation needed]and help keep the body healthy to fight against disease. Soluble fiber, as part of a diet low in saturated fat and cholesterol, from foods such as oat bran, rolled oats, whole oat flour, oatrim, whole grain and dry milled barley, or psyllium seed husks(with purity of no less than 95%) may reduce the risk of heart disease.

BELCHING AND FLATULENCE

Gas in the gastrointestinal tract has only two sources. It is either swallowed air or is produced by bacteria that normally inhabit the intestines, primarily the colon. Belching or burping is a universal ability that works by removing gas from the stomach through the mouth. The stomach can become bloated when too much air is swallowed during eating and drinking too quickly. As the stomach swells, belching removes the gas and alleviates the pain associated with it. Burping can also be used as a form of relief from abdominal discomfort other than too much gas in the stomach. Flatulence or farting works much like burping, but helps the body pass gas through the anus instead of the mouth. Bacteria present in the intestinal tract cause gas to be expelled from the anus. They produce the gas as food is digested and moved from the small intestine. This gas builds up and causes swelling or bloating in the abdominal area before it is released.

CONSTIPATION

A common gastrointestinal problem is constipation, which causes serious cases of bloating. People with infrequent bowel movements or those that pass hard stools or strain during the movements experience constipation. Since most cases of constipation are temporary, simple lifestyle changes, such as getting more exercise and eating a high-fiber diet, can go a long way toward alleviating constipation. Some cases of constipation will continue to worsen and require unconventional methods to release the feces and reduce the amount of stomach bloating. Blood in the stool, intense pain in the abdomen, rectal pain, and unexplained weight loss should be reported to a doctor. Bloating accompanies constipation every time and they will not develop without an underlying cause.

HEARTBURN AND REFLUX

Painful burning sensations in the chest that is caused by gastroesophageal reflux is known as heartburn. Reflux is the back flow of gastric acidjuices from the stomach into the throat. Heartburn has different triggers, including certain foods, medications, obesity, or even stress. These triggers are different for each individual and should be avoided. Gastroesophageal reflux disease or GERD is a chronic condition that can lead to more serious complications like Esophageal cancer. Treatment options are available to treat the symptoms and the condition, but there is no cure for the disease. Symptoms include burping, abdominal and stomach bloating, along with pain and discomfort. Heavy meals, lying down or bending over after eating should be avoided to help prevent reflux from occurring. The stomach bloating experienced with reflux is intense and will remain until the food is digested all the way. Postmortem bloating occurs in cadavers, due to the formation of gases by bacterial action and putrefactionof the internal tissues of the abdomen and the inside of the intestines.

RELATED CONDITIONS

Conditions that are related to bloating include constipation, lactose intolerance, and acid reflux disease. All of these conditions share the same symptoms and can share the same causative agents. These causes include unhealthy diet, smoking, alcohol consumption, low amount of exercise, and overall health. Each of these conditions can be experienced as a symptom of the others and is also a cause for each of them. In most cases where one of the conditions is present, there is at least one if not two of the others. Treatment for each condition is performed using the same medications and recommended dietary changes like increased fiber intake and reduced fat intake. If the conditions develop into disease such as gastrointestinal reflux disease (GERD) or chronic constipation, additional medications will be required. Bloating and flatulence are sometimes related to constipation, and treating the underlying condition may be helpful.

TREATMENT

There are multiple over the counter medications that can be used to treat bloating. Food enzymescan be found in some products that will help break down the sugars found in grains, vegetables and dairy products. They can be taken before food is consumed or added to the food that causes the gas and bloating. Another type of medicine is activated charcoaltablets that will decrease the odor from gas. The most common treatment is antacids. These medications have no effect on the gas that is presently in the intestines, but it allows for gas build-up to be belched away more easily, reducing the amount of bloating that develops. Another treatment is Simethicone, an oral anti-foaming agent that helps the body to expel the gas more quickly. Also combination of prokinitics like; domperidone metoclopramide diphenhydramine (Diphen for prevention of extrapyramidal reactios-specially acute dystonic reaction) PPI has dramatic effects especially on bloaters and belchers.

PREVENTING WITHOUT MEDICINE

There are several things that can be done to relieve the pressure in the stomach. Taking a walk after eating a meal is a good way to nudge the contents of the bowels along. Exercising releases hormones that work to encourage activity in the bowels. Herbal teas are also recommended to break up gas bubbles that can develop. Drinking extra virgin olive oil helps to stop bloating. Some foods like coffee and chocolate can stimulate the digestive tract and cause a build up of gas to occur, resulting in bloating.[medical citation needed]Meals that are high in fat are often too hard for the system to digest and can stimulate spasmsand bloating. In addition, foods that are extremely hot or cold can draw air inside as they are being eaten. Foods like bubble gum or bubbly beverages also cause a build up of air that results in excessive gas and bloating, as does smoking. There are also certain types of vegetables and fruits that contain types of starches which are poorly digested by people but well digested by bacteria.

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