How can a female reduce bloating?

How to Reduce Bloating in Females

Start with dietary modifications under dietitian supervision, specifically a low-FODMAP diet, which has demonstrated quality of life improvements in randomized controlled trials for bloating, followed by psychological therapies if dietary measures fail. 1

First-Line Approach: Dietary Interventions

Begin with a low-FODMAP diet supervised by a gastroenterology dietitian, as this represents the most evidence-based dietary approach for bloating reduction. 1 The low-FODMAP diet has shown bloating and quality of life improvements in randomized controlled trials, though it was studied primarily in functional dyspepsia and IBS rather than isolated bloating. 1

Specific Dietary Modifications:

• Identify and restrict fermentable carbohydrates including oligosaccharides, disaccharides, monosaccharides, and polyols under dietitian guidance. 1
• Test for carbohydrate malabsorption through dietary restriction and/or breath testing, as 65% of bloating patients may have carbohydrate malabsorption, with dietary restriction improving symptoms in >80% at 1 month. 1
• Consider fructan avoidance specifically, as recent evidence suggests fructans rather than gluten cause symptoms in nonceliac gluten sensitivity patients. 1
• Reduce lactose intake if consuming >0.5 pint (280 ml) milk daily, particularly in non-European descent women who may have hypolactasia. 1

Critical Dietary Caveat:

The low-FODMAP diet may negatively impact gut microbiome (decreasing Bifidobacterium species) and risk malnutrition, so implementation must include plans for food reintroduction. 1 This is why dietitian supervision is essential rather than self-directed restriction. 1

Second-Line: Address Underlying Pelvic Floor Dysfunction

In women with bloating plus constipation or difficult evacuation, pursue anorectal physiology testing to rule out pelvic floor disorders, as both the American College of Gastroenterology and British Society of Gastroenterology specifically advocate this testing for women with IBS-C not responding to standard therapies. 1

• Biofeedback therapy is effective for bloating when pelvic floor disorder is identified, addressing the visceral hypersensitivity and retained stool load causing colon distention. 1
• If constipation is present, treat the constipation directly with medications like polyethylene glycol, as constipation treatment reduces bloating. 1

Third-Line: Pharmacological and Psychological Interventions

Central Neuromodulators:

Antidepressants reduce bloating by decreasing visceral hypersensitivity, raising sensation threshold, and improving psychological comorbidities. 1 This addresses the brain-gut interaction that underlies many cases of functional bloating.

Psychological Therapies:

Cognitive behavioral therapy, hypnotherapy, and other brain-gut behavioral therapies should be used when dietary and pharmacological measures are insufficient. 1 These have shown long-term benefit, unlike many pharmacological treatments where placebo response diminishes over time. 1

Diaphragmatic Breathing:

For abdominophrenic dyssynergia, use diaphragmatic breathing techniques combined with central neuromodulators. 1

What NOT to Do:

• Do not use probiotics for abdominal bloating and distention, as they are not recommended by current guidelines. 1
• Avoid simethicone despite its FDA approval for gas relief 2, as it lacks evidence for functional bloating and is not mentioned in expert gastroenterology guidelines.
• Do not order gastric emptying studies unless nausea and vomiting are present, as bloating alone does not warrant this testing. 1
• Avoid restrictive diets without dietitian supervision, as patients may adopt inappropriately restrictive diets leading to malnutrition. 1

When to Evaluate for Serious Pathology:

Order serologic testing for celiac disease in women with bloating, particularly if alarm features present (weight loss, iron-deficiency anemia). 1

Consider ovarian cancer screening in women ≥50 years presenting with new-onset bloating and abdominal fullness, as these are common presenting symptoms. 1

Obtain abdominal imaging and upper endoscopy only if alarm features, recent worsening symptoms, or abnormal physical examination are present. 1

Practical Algorithm:

1. Refer to gastroenterology dietitian for low-FODMAP diet trial with planned reintroduction phase 1
2. If bloating persists with constipation, pursue anorectal physiology testing and consider biofeedback 1
3. If still refractory, initiate central neuromodulators (antidepressants) 1
4. Add psychological therapy (CBT, hypnotherapy) for comprehensive brain-gut approach 1
5. Throughout, maintain effective patient-provider communication about the biopsychosocial model, as this improves outcomes and prevents patients from seeking unscrupulous social media remedies 1