From the Guidelines
Severe bloating is typically caused by excess gas production, digestive disorders, or fluid retention in the abdomen, and the most effective treatment approach involves a combination of dietary changes, lifestyle modifications, and targeted therapies, as recommended by the most recent guidelines and expert reviews 1.
Causes of Severe Bloating
- Excess gas production
- Digestive disorders, such as irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO)
- Fluid retention in the abdomen
- Food intolerances, particularly lactose or gluten
- Certain medications
Treatment Options
- Dietary changes:
- Avoid gas-producing foods like beans, cabbage, and carbonated drinks
- Eat smaller, more frequent meals
- Keep a food diary to identify triggers
- Lifestyle modifications:
- Regular exercise
- Stress management techniques
- Adequate hydration
- Targeted therapies:
- Antispasmodics, such as dicyclomine 10-20mg three times daily
- Prokinetics
- Central neuromodulators, such as antidepressants, for bloating and distention
- Gut-related medications, such as secretagogues and 5-hydroxytryptamine 4 receptor agonists, for constipation-predominant symptoms
Important Considerations
- Bloating that is severe, persistent, or accompanied by weight loss, blood in stool, or intense pain warrants immediate medical attention as it could indicate more serious conditions like inflammatory bowel disease or malignancy.
- A multidisciplinary approach, involving gastroenterologists, gastroenterology dietitians, brain–gut behavioral therapists, and motility providers, may be necessary for optimal management of severe bloating.
- Education and effective communication skills using a patient-centered care model are essential for improving treatment outcomes and reducing unnecessary diagnostic testing and healthcare costs 1.
From the FDA Drug Label
Symptoms that Cumulatively Support the Diagnosis of Irritable Bowel Syndrome: – Abnormal stool frequency (for research purposes “abnormal” may be defined as greater than 3 bowel movements per day and less than 3 bowel movements per week); Abnormal stool form (lumpy/hard or loose/watery stool); Abnormal stool passage (straining, urgency, or feeling of incomplete evacuation); Passage of mucus; Bloating or feeling of abdominal distension.
The causes of severe bloating are not directly addressed in the provided drug label. However, the label mentions bloating or feeling of abdominal distension as one of the symptoms that cumulatively support the diagnosis of Irritable Bowel Syndrome (IBS). The treatment of severe bloating is not directly addressed in the provided drug label, but rifaximin (XIFAXAN) is used for the treatment of IBS-D, which includes bloating as one of its symptoms 2.
From the Research
Severe Bloating Causes
- Severe bloating can be caused by various factors, including food intolerances, previous infections that perturbed the intestinal microbiota, disordered visceral sensation, delayed intestinal transit, or an abnormal viscero-somatic reflux 3
- Small intestinal bacterial overgrowth (SIBO) is also a common cause of bloating, and it is characterized by an overgrowth of bacteria in the small intestine 4, 5
- SIBO can lead to symptoms such as bloating, diarrhea, abdominal pain, and discomfort, as well as malabsorption and nutritional deficiencies 4
Treatment Options for Severe Bloating
- Treatment for severe bloating depends on the underlying cause, but it often involves a combination of dietary changes, probiotics, antibiotics, prokinetic agents, antispasmodics, neuromodulators, and biofeedback 3
- Rifaximin, a broad-range, gastrointestinal-specific antibiotic, has been shown to be effective in treating SIBO and improving symptoms of bloating and abdominal pain 6
- Alternative therapies, such as probiotics, therapeutic diets, and herbal medicines, may also be useful in managing SIBO and bloating, although more research is needed to confirm their effectiveness 7
- Management of SIBO should focus on identifying and correcting underlying causes, correcting nutritional deficiencies, and administering antibiotics, while being mindful of the potential risks of long-term broad-spectrum antibiotic therapy 4