Ah, bloating, everyone’s favorite gastrointestinal-slash-hormonal issue. Because is there anything better than finishing a delicious meal and realizing you need to unbutton the pair of jeans that fit just fine an hour ago? Bloating, as many of us know, happens when your stomach feels full, tight, or painful. It can sometimes even get swollen or distended (hence the uncomfortable jeans). It’s definitely no fun, but bloating should typically go down and feel better after a while. So what happens when it doesn’t, or when it’s causing you extreme pain? When does bloating warrant a trip to the doctor’s office?
It’s an especially important question for those of us who experience bloating regularly, whether because of our digestive systems or our hormones. And by hormones, yes, we mean periods. Bloating is common when you’re menstruating, but that doesn’t make it any easier to deal with — especially if you have reproductive issues like endometriosis, which can exacerbate bloating and make it even more uncomfortable. While most bloating will go away on its own, it’s worth discussing what to do when it doesn’t or when it’s a frequent occurrence, and when you should make an appointment with your doctor to see if something more serious is going on.
Common causes of bloating
Bloating can be caused by a multitude of issues, which is why it can be so hard to pinpoint the problem when you’re trying to manage it on your own. According to gastroenterologist Dr. Roshini Raj, founder of Yay Day, your bloating could be caused by:
- Overeating: One of the most common symptoms of temporary bloating is simply eating too much, especially if that big meal includes a lot of fatty, rich foods (think: Thanksgiving dinner) or if you’re eating it too quickly.
- Dysbiosis: Dysbiosis happens “when there’s a major reduction in the diversity of your microbiome and/or an overgrowth of un-friendly bacteria,” Raj tells SheKnows. (Your microbiome refers to all the bacteria and microorganisms that live inside your body, helping you do things like digest food and fight off infections, per the Harvard T.H. Chan School for Public Health.) While the symptoms can vary greatly, the most common digestive symptoms include nausea, constipation, diarrhea, gas, and bloating.
- Leaky Gut: Leaky gut, aka intestinal permeability, occurs when your stomach lining barrier is compromised, meaning that “the tight junctions of your small intestine open up too widely or stay open too long, or the delicate walls of your small intestine develop tiny holes and cracks,” Raj explains. This allows large food particles, bacteria, and other intestinal matter to leak into your bloodstream, triggering your immune system to respond to the “invaders” and causing inflammation. Leaky gut symptoms can be similar to dysbiosis, Raj says: bloating, nausea, gas, and cramps.
- Acute inflammation: “Just as an alarm system would signal for backup, so does your body,” Raj says. As your immune cells activate, they also send out cytokines, aka “chemical messengers,” that help control your body’s inflammatory response and “tell more immune cells to come to kill off invaders,” she continues.
“The tricky thing about acute inflammation in the gut is you can’t see it, but your body has a lot of the same recovery mechanisms, like getting swollen and painful with cramps and bloating.” - Long COVID: “I have seen several patients in my practice who, several months after recovering from COVID, still have persistent bowel issues like bloating, abdominal pain, and diarrhea,” Raj tells SheKnows — to the point one of her first questions for patients coming in with digestive symptoms is whether they had COVID. “It’s a frustrating situation, and we don’t yet know all the answers in terms of treatment, but I have seen good success using strategies to restore a balanced microbiome to help these patients feel better.”
- Suddenly adding fiber to your diet: Fiber is a good thing for your digestive system (more on that in a minute), but if you’re looking to consume more of it, it’s important to add it to your diet gradually. “Suddenly adding a lot of fiber can cause uncomfortable gas, bloating, and diarrhea,” Raj says. That said, it’s “essential for gut health, lowering cholesterol, keeping your weight down, controlling your blood sugar, and reducing the risk of gastrointestinal cancer” — you just don’t want to overwhelm your gut with it all at once.
- Lactose intolerance: If you’re lactose intolerant, that means your body no longer produces lactase, an enzyme needed to digest the sugar lactose that’s present in milk and milk products. It’s a common condition, Raj says, with about 30 million Americans having some degree of lactose intolerance by age 20. A lactose intolerant person might experience bloating, gas, and diarrhea if they consume milk or milk products.
- Irritable bowel syndrome (IBS): “People with IBS have more difficulty than usual digesting these foods because they can’t break them down well in the small intestine,” Raj explains. Because of that, the food absorbs a lot of water when it gets to the colon, providing “a real feast of partially digested food to your bacteria.” The resulting symptoms can include bloating, cramping, gas, diarrhea, constipation, and possibly dysbiosis.
- Celiac disease: People with celiac disease have an immune reaction when they consume gluten. That reaction includes many digestive symptoms, Raj says, with bloating being one of the most common. (If you think you have celiac disease, your doctor can test for it via blood testing.)
- H. pylori bacterial infection: “This common stomach infection can lay dormant in your body for years and then cause symptoms out of the blue,” Raj says. “Bloating, abdominal pain, or diarrhea are possible symptoms and you can be tested for this with either a breath test or a stool test.”
- Gynecological issues: As we mentioned, not all bloating is caused by digestive issues. Your period might come with some bloating, and it can also be a symptom of endometriosis, ovarian cyst(s), or even ovarian cancer.
When to see a doctor for bloating
“If the bloating is bothering you to the point that you notice it often and/or it interferes with your daily activities, you should talk to your doctor about it,” Raj says. If you’re experiencing bloating along with blood in your stool or weight loss, “this is a reason to see a doctor urgently,” she adds.
Maybe your bloating isn’t frequent or painful enough to warrant a trip to the doctor just yet — or you want to try and do some trouble-shooting on your own first. If that’s the case, Raj recommends keeping a food diary. “Write down what you eat every day and also any symptoms such as pain, bloating, or diarrhea that occur,” she explains. “If you do this consistently for a week or two, the information gathered can help you and/or your doctor draw some correlations and identify food triggers.”
Treating bloating at home
There are a few things you can do to reduce bloating at home, including limiting your overeating and eating more slowly. Raj also recommends slowly introducing more fiber to your diet, aiming for at least 25 grams a day as a woman and 30 grams a day as a man — the standards set by the National Academy of Nutrition and Dietetics. “As I see every day in my office, not enough fiber is a contributing cause to a lot of digestive problems,” Raj explains, noting that the recommendations are actually “the bare minimum” and that we should really be eating about 10 more grams day than the 25- and 30-gram guidelines. The best way to get more fiber “is by eating a diet with minimal sugar, very few processed foods, and lots of plant-based foods,” Raj says. “In other words, a plant-forward, Mediterranean-style diet.”
You can also use a fiber supplement, like Raj’s YayDay, provides digestive enzymes to help you break down fiber. Prebiotics and probiotics are also great for rebalancing your microbiome and improving gut health, Raj says, which can also reduce bloating. You can consume them through supplements or in foods: yogurt, kefir, kombucha, and sauerkraut are great sources of probiotics, while oats, apples, leeks, and asparagus are good for…
