Over-the-Counter Treatment for Bloating and Intestinal Gas
For simple bloating and gas symptoms, start with simethicone as your first-line OTC medication, though evidence for its effectiveness is limited. 1
First-Line OTC Approach
Simethicone is the primary FDA-approved OTC medication specifically indicated for relief of pressure and bloating commonly referred to as gas 1. However, you should understand that research evidence for simethicone's effectiveness is inconsistent—some studies show no consistent evidence supporting its use for gas-related symptoms 2.
Dietary Modifications Are More Important Than Medication
Before relying on any medication, identify and eliminate dietary triggers through a 2-week elimination trial, which is the most economically sound and effective approach 3:
- Lactose-containing foods (dairy products) - lactose intolerance affects 51% of patients with gas/bloating symptoms 3
- Fructose-containing foods (fruits, honey, high-fructose corn syrup) - fructose intolerance is even more common at 60% 3
- Artificial sweeteners (sorbitol, sugar alcohols) 3
- High-FODMAP foods (beans, onions, garlic, wheat) 4
Enzyme Supplements as OTC Options
If specific food intolerances are identified:
- Lactase enzyme supplements (like Lactaid) for lactose intolerance 5
- Alpha-galactosidase (like Beano) for gas from beans and vegetables 5
These work by breaking down poorly absorbed carbohydrates before they reach the colon where bacterial fermentation produces gas 3, 5.
When OTC Options Fail
If simethicone and dietary changes don't help after 2 weeks, this suggests your symptoms may require prescription management 4:
- Rifaximin (prescription antibiotic) is effective for reducing hydrogen gas production and flatus episodes, but requires a prescription 6
- Secretagogues like linaclotide or lubiprostone (prescription) are superior for bloating associated with constipation 3, 7
- Central neuromodulators (prescription antidepressants) help if visceral hypersensitivity is the underlying cause 3
Important Caveats
Avoid probiotics for treating bloating and distention—they are not recommended by current guidelines 4. While one study showed benefit from a specific probiotic combination with simethicone 8, the 2023 AGA guidelines explicitly advise against probiotic use for these symptoms 4.
Activated charcoal has conflicting evidence—one study showed it was ineffective compared to rifaximin 6, while another suggests it may help in selected patients 5. It is not a reliable first-line option 2.
Red Flags Requiring Medical Evaluation
Seek medical attention rather than self-treating if you have 3:
- Blood in stools
- Unintentional weight loss >10%
- Severe or worsening abdominal pain
- Persistent vomiting
- New onset symptoms after age 50