Is It Normal to Be So Bloated It Hurts?

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Photo: Peter Dazeley/Getty Images

Sometimes my stomach feels like a balloon that I wish I could pop and it really hurts. What’s going on?

Congratulations, you have one of the most common problems women see a gastroenterologist for, says Savita Srivastava, MD, director of Women’s Digestive Wellness at Bon Secours Health in Richmond, Virginia, and an expert with the American Gastroenterological Association.

“Women will come in to talk about their bloating, but women will often express that they have a lot of gas. Both of those symptoms can go hand in hand,” Dr. Srivastava says. “Women are generally more susceptible to bloating and gas than men are for a lot of reasons that include anatomical ones.” Hashtag blessed.

For one thing, we have multiple organs in our pelvic regions that men do not, plus women’s colons are about five centimeters longer than men’s. “It’s very close quarters,” she says. Doctors can see during colonoscopies that our colons, a.k.a. large intestines, make more twists and turns as a result. That can cause constipation, and a side effect of that is bloating.

Also, if you’ve had any kind of abdominal surgery, like a C-section, hysterectomy, or appendectomy, you’re likely to have scar tissue that’s attached to your colon which can cause even more twists and turns and kinks that lead to more retention of stool and gas at those spaces.

Women are also more likely to have irritable bowel syndrome, and bloating is one of the main symptoms: Studies show that 66 to 90 percent of women with IBS will also complain of bloating, she says. Still, there are women who don’t fit the criteria for IBS who have what’s considered “functional bloating.” They have a normal exam and a normal medical history but they’ve had bloating for at least six months and at least once a week for the past three months.

Then there are the dietary factors which can affect any human. “One of the most common scenarios that we run into is people complaining of bloating after eating dairy products,” Dr. Srivastava says. Lots of people in the United States have lactose intolerance, meaning they don’t have the enzyme that breaks down the sugars in milk in the small intestine, so those sugars (a.k.a. lactose) travel to the colon where they’re exposed to trillions of bacteria which ferment the sugar and cause gas and bloating.

People can have similar symptoms from fructose found in fruits and vegetables but also in processed foods, and foods with a high fiber content. Think: beans, legumes, and cruciferous vegetables like cauliflower, broccoli, cabbage, and kale. You’re supposed to eat foods like fruits and veggies, and their undigested fiber feeds the good bacteria in your gut, but it can make you feel literally inflated.

Dr. Srivastava encourages her patients to keep food diaries to see if they can try to pinpoint when the bloating happens and if it’s a dietary thing. Then you can avoid the foods you’re sensitive to — or keep eating them, but just take precautionary measures. She recommends supplements you can take before eating triggering foods like Lactaid to help break down dairy and Beano to do the same for fibrous veggies and legumes. (You can also try buying dry beans and cooking them with a sea vegetable called Kombu if you’re the natural type.)

Though if you can’t tell which foods trigger your bloating, it might be good to keep Gas-X on hand as that can break down the bubbles in your gut. And walking helps, too. “Sometimes the only way to get rid of that bloating is to go for a long walk,” she says. “Your colon requires you to walk or exercise to move things through.”

Too much air could also be causing your problems, in two ways. First, people who drink carbonated beverages like seltzer or soda are putting extra gas into their GI tract and will often complain of bloating, Dr. Srivastava says. But there’s also a condition called air aphasia where people gulp air when they’re talking or eating and don’t realize it. “Those are usually the people who gulp a lot when they eat or have long conversations while they’re eating,” she says. They tend to complain of burping in addition to bloating, so if that doesn’t sound like you, don’t worry about it.

So you can avoid foods that give you problems or take pills to help your body tolerate them, but can bloating be avoided in the longer term? Maybe. Probiotic supplements may help with your symptoms. If you have IBS, studies show that taking one billion colony-forming units (or CFUs) of the strain Bifidobacterium animalis daily for eight weeks can reduce symptoms.

If you don’t have IBS, she says, doctors who practice integrative gastroenterology tend to recommend probiotics that contain at least seven strains to increase bacterial diversity and at least 50 billion CFUs. “There’s some probiotics that might give you a billion CFUs of bacteria, but to really get a good effect from a probiotic, you’re talking about at least 50 billion,” she says. “I think that would work better for the general population.”

Of course, there’s also probiotic-containing fermented foods, like kimchee, miso, kefir, and kombucha. These all are microbially diverse — it’s not like someone is putting one strain into a capsule — but we just don’t know exactly how much bacteria is in them. But just drinking kefir and popping a probiotic every day is not going to solve your problems if you continue to eat a lot of processed food and skimp on fiber. “A lot of patients think they can compensate for bad lifestyle choices by taking a probiotic. Which is really like having a huge forest fire and dumping a little bit of water on it,” Dr. Srivastava says.

If you can’t solve your bloating on your own or it happens so often that it bothers or scares you, it’s time to call a doctor. She says the majority of women with bloating have a benign cause, but it will involve some detective work, so stay patient. “Oftentimes it’s a multidisciplinary approach, meaning it’s going to be part thinking about food as medicine, part thinking about mind-body therapies, about lifestyle factors, and there’s certainly medications as well,” she says.

“The key thing to emphasize for a lot of my patients is if it required just a single pill or an easy diagnosis, somebody would have made it a long time ago. Sometimes it requires a little bit of patience and setting the tone with the fact that it may take a while to really get better … but we can come up with solutions.”

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