How can I relieve bloating?

Effective Strategies to Relieve Bloating

The most effective approach to relieve bloating is implementing a low-FODMAP diet, which can lead to up to 80% symptom improvement within one month. 1

Dietary Interventions

• Low-FODMAP Diet:

  • Can provide symptom improvement in >80% of patients at 1 month and complete improvement in 50% at 1 year 2
  • Should be implemented under guidance of a trained gastroenterology dietitian or provider 2
  • Requires a planned reintroduction phase to avoid long-term negative impacts on gut microbiome 2

• Targeted Carbohydrate Elimination:

  • Try restricting specific carbohydrates for 2 weeks (lactose, fructose, fructans, sugar alcohols) 1
  • Recent studies suggest fructans, rather than gluten, may cause symptoms in those with non-celiac gluten sensitivity 2

• Additional Dietary Tips:

  • Avoid carbonated beverages, chewing gum, and drinking through straws 1
  • Discontinue elimination diets if not beneficial after 2 weeks 1

Pharmacological Approaches

• Simethicone:

  • FDA-approved for relief of pressure and bloating commonly referred to as gas 3
  • Can reduce gas bubbles and provide relief from bloating 1

• Central Neuromodulators:

  • Tricyclic antidepressants (e.g., amitriptyline 10-50mg) can help with visceral hypersensitivity 1
  • Antidepressants that activate noradrenergic and serotonergic pathways show the greatest benefit in reducing visceral sensations 2
  • Serotonin-norepinephrine reuptake inhibitors (e.g., duloxetine and venlafaxine) can also be effective 2
  • Pregabalin has shown improvements in bloating in patients with IBS 2

• Constipation Treatments:

  • If constipation is present, secretagogues (lubiprostone, linaclotide, plecanatide) may help bloating as a secondary benefit 2

Non-Pharmacological Approaches

• Anorectal Biofeedback Therapy:

  • Effective when bloating is associated with dyssynergic defecation 2
  • One study reported 54% response rate for bloating scores decreased by 50% 2
  • Uses visual monitoring to demonstrate proper anorectal push and relaxation techniques 2

• Behavioral Therapy:

  • Diaphragmatic breathing exercises can be particularly effective 1
  • Cognitive Behavioral Therapy (CBT) improves quality of life and reduces symptoms 1
  • Other brain-gut behavioral therapies like relaxation training and gut-directed hypnotherapy may help 1

Addressing Underlying Conditions

• Rule out common causes:
  • Carbohydrate enzyme deficiencies
  • Small intestinal bacterial overgrowth (SIBO)
  • Celiac disease or non-celiac gluten sensitivity
  • Pelvic floor disorders
  • Abdominophrenic dyssynergia (APD) 1

What to Avoid

• Probiotics and medical foods:

  • Not recommended for bloating or distention 2
  • May be associated with developing brain fogginess, bloating, and lactic acidosis 2
  • Current guidelines do not endorse their use for bloating symptoms 2

• Peppermint Oil:

  • Recent placebo-controlled trials found no improvement in bloating symptoms 2
  • Despite minimal adverse effects, further studies are needed to document benefits 2

Common Pitfalls

• Continuing ineffective dietary interventions beyond 2 weeks without benefit 1
• Prolonged use of medications not showing improvement within 4 weeks 1
• Missing psychological components that may contribute to symptoms 1
• Overlooking pelvic floor dysfunction as a cause of bloating 2

By following this structured approach to addressing bloating, most patients can experience significant symptom relief and improved quality of life.