Bloating can be a distressing symptom. Here, Dr Heap presents his approach to helping patients with this difficult problem.
- People who complain of bloating may be more sensitive to apparently normal amounts of gas. A recent study suggests that gas retention causes abdominal symptoms and distension through poor transit and gas pooling in the colon. Muscle relaxation of the anterior abdominal wall is another possible mechanism.
- People with an increase in gut gas may develop gut hyperalgesia, even if the increased gas is still within the normal range. Theoretical ways to reduce discomfort include decreasing gut gas (by reducing air swallowing or gas production and increasing gas transit) or by reducing sensitivity.
- Psychological factors and stress influence pain thresholds. We all see patients whose gut symptoms (including bloating) settle down towards the end of a relaxed holiday. The problem is helping these patients when they return to work.