Question

Like many people with ME I have what my doctor calls irritable bowel symptoms. These include having colicky stomach pain and constipation. But the worst part is the bloating – where my tummy often feels full and uncomfortable. A nutritionist suggested an elimination diet but that didn’t help.

Is there anything else worth trying?

Answer

Bloating, or a feeling of fullness in the abdomen that can sometimes lead to visible distension, is normally the result of having too much gas in the stomach and intestines. It’s a very common symptom that’s experienced by about one in five people in the general population.

As you indicate, it’s a common component of irritable bowel syndrome (IBS). However, there are other causes of bloating with similar symptoms to IBS that are sometimes over-looked. These include:

• Gastroparesis – where there is a delay in food moving from the stomach to the intestines

• Lactose intolerance – where you cannot properly digest lactose, a type of sugar found in milk and dairy products

• Coeliac disease – where sensitivity to gluten causes an immune-system response that can cause tissue damage

• Inflammatory bowel disease such as ulcerative colitis

• Bile acid malabsorption – which can co-exist with IBS

• Small intestinal bacterial overgrowth – which can co-exist with IBS

Bloating is also quite common at period time and during pregnancy and it’s important to note that bloating and abdominal symptoms occur in about a quarter of cases of ovarian cancer.

So persistent bloating (i.e for more than a few weeks if it’s a new symptom) is a symptom that shouldn’t be dismissed. To establish the cause, a doctor should take a careful medical history, carry out a physical examination and arrange some tests to rule out other possible causes before concluding that it’s just part of IBS.

Whilst there are no simple drug treatment solutions to bloating, there are plenty of self-help measures that are worth trying:

• Chew with your mouth closed to avoid swallowing air
• Have small and more frequent meals and avoid large meals, especially at night
• Drink plenty of water but avoid fizzy drinks and cut down on caffeine
• Avoid gas-producing foods such as cabbages, beans and lentils
• If bloating is associated with constipation, a steady increase in dietary fibre may help.

Drugs and other treatment that may be worth trying include:

• Buscopan to help with colicky pain – this does not require a prescription
• Peppermint oil capsules (Apercap, Colomint, Colpermin) help to relax the bowel wall. Peppermint oil products do not require a prescription but speak to your pharmacist because there are conditions where it is not recommended or needs to be used with care
• A probiotic supplement – in the form of capsules or yoghurt – will help restore the natural balance of bacteria in the intestines and may also help with constipation

More information

Peppermint oil:
https://www.nhs.uk/medicines/peppermint-oil/