Stomach distension (the physical expansion of the stomach) and bloating (the feeling of pressure) are technically two different conditions. They can occur separately or together.
Chronic stomach distension and bloating are common, and even more common in patients with irritable bowel syndrome (IBS).
There are numerous underlying causes of distention of the abdomen and bloating, including inflammation, bacterial overgrowth, food sensitivities, and more.
Occasional stomach distension and bloating are completely normal, but if they become chronic, painful, and disrupt your daily life they need to be addressed.
There are simple, natural ways to relieve both stomach distension and bloating.
Have you ever finished a delicious meal, only to experience the uncomfortable feelings of bloating and stomach distension? It can be such a frustrating experience, but you’re not alone. In fact, 16-31% of Americans experience chronic bloating and distention of the abdomen [1 Trusted SourcePubMedGo to source].
While each of us has probably experienced both of these at some point in our lives, bloating and stomach distension shouldn’t be an everyday occurrence. If your symptoms have become chronic, cause you abdominal pain, and/or disrupt your daily life, it’s time to address them.
In this article, we’ll discuss what you need to know about the causes of stomach distension and bloating. We’ll also provide a step-by-step treatment guide for targeting the root causes of your symptoms so you can feel like yourself again.
Step-by-Step Treatment Guide for Stomach Distension
If your stomach distension has become a common occurrence, it’s important to determine the root cause of your symptoms. In our practice, we start with foundational treatments. Using this step-by-step, bottom-to-top approach, we’ve consistently been able to help successfully treat the underlying causes of stomach distension.
Start with step 1 and move on to the next step only if your symptoms persist.
Step 1: Diet and Lifestyle Changes for Stomach Distension
As I describe in Healthy Gut, Healthy You, diet and lifestyle changes are the foundation for healing most gut issues. While diet needs to be personalized, most people will benefit from getting back to basics when it comes to food.
Principles of a healthy diet include:
A diet low in allergens/intolerances
A diet that contains the appropriate amount of bacterial feedings for the individual (prebiotics and FODMAPs)
A diet that regulates blood sugar and contains the appropriate amount of carbohydrates
A diet that focuses on fresh, whole, and unprocessed foods
A good starting point is often the Paleo diet; if you’re feeling great after a couple of weeks, then stick with it. If you still have some lingering symptoms, you may benefit from a low FODMAP plan.
The low FODMAP diet has been shown to improve a variety of gastrointestinal symptoms for people with IBS and other functional gastrointestinal (GI) symptoms:
A 2016 systematic review and meta-analysis found that a low FODMAP diet reduced IBS symptom scores, improved quality of life,and eased abdominal pain,bloating, and overall symptoms in people with functional GI symptoms [2 Trusted SourcePubMedGo to source].
A 2017 systematic review and meta-analysis found IBS patients who maintained a low FODMAP diet had better scores for abdominal pain, discomfort, bloating, and quality of life when compared to IBS patients on a high FODMAP diet [3 Trusted SourcePubMedGo to source].
In addition to the dietary changes, here are some important lifestyle considerations:
Avoid toxins to the best of your ability
Obtain appropriate sun exposure
Spend time in nature
Get enough exercise (but don’t overdo it)
Walk as much as you can; one study found walking for 10-15 minutes after meals was better at reducing bloating than prokinetic drugs in healthy people [4 Trusted SourcePubMedGo to source]
Get enough sleep
Nurture healthy relationships and social connections
Mitigate stress, and/or practice stress management
While cognitive behavioral therapy and gut-directed hypnotherapy have been shown to improve bloating in IBS patients, yoga and meditation can be helpful as well. One 2016 systematic review of randomized controlled trials found yoga to be more effective than conventional treatment for IBS [5 Trusted SourcePubMedGo to source].
In addition, a 2013 randomized controlled trial found IBS patients using a mindfulness-based stress-reduction program had clinically significant reductions in IBS symptoms, which were maintained after six months [6 Trusted SourcePubMedGo to source].
Step 2: Probiotics for Stomach Distension
If you’ve made the above diet and lifestyle-related changes, but still haven’t achieved your desired results, consider adding probiotics. Probiotics are defined as microorganisms that provide health benefits to their host, and they’ve been shown time after time to be very effective for the treatment of bloating. Let’s look at some of the research on the benefits of probiotics when it comes to bloating and distension:
A 2020 systematic review and meta-analysis found multispecies probiotics significantly decreased bloating in adults with functional constipation [7 Trusted SourcePubMedGo to source].
A 2020 randomized controlled trial of IBS patients showed probiotics significantly reduced abdominal pain and abdominal distension in IBS patients [15 Trusted SourcePubMedGo to source].
Step 3: Specialized Digestive Support
If you’re still struggling with distention of the abdomen and bloating after implementing steps 1 and 2, you may consider specialized digestive support in the form of an elemental diet, antimicrobials, antibiotics, digestive enzymes, and/or supplemental acid.
These therapeutics shouldn’t be added all at once. You should consider working with a practitioner to help you determine which digestive aid(s) are most likely to be helpful for you.
Elemental diets: An elemental diet is an anti-inflammatory, antibacterial reparative liquid diet. The contents of the liquid are completely broken down into easily absorbable components. Liquid-elemental and semi-elemental diets have shown impressive results for IBS and SIBO. While elemental diets are very safe, it’s best to use them under the care of a qualified healthcare provider [16 Trusted SourcePubMedGo to source].
Digestive enzymes and supplemental acid:In order to properly digest your food and prevent malabsorption, your stomach must release enough stomach acid, your gallbladder must release bile, and your pancreas must make enough pancreatic enzymes. If any of these are disrupted, digestion is negatively affected and symptoms such as bloating and distension can result. The good news is, all of these can be replaced with simple dietary supplements before meals. One 2011 randomized controlled trial found the inclusion of digestive enzymes helped to significantly improve bloating and flatulence in IBS patients [21 Trusted SourcePubMedGo to source].
Step 4: Consider a Pelvic Floor Therapist
Pelvic floor dysfunction can be a culprit in bloating and distension of the abdomen. If you have ruled out any other medical cause, worked through the first three steps, and still struggle with these symptoms, it may be worth it to consult with a pelvic floor therapist.
A non-randomized clinical trial found manual therapy to break up scar tissue in the abdomen and pelvic floor improved bloating and stomach distension for people with small bowel obstructions. In addition, an observational study where patients were taught exercises to strengthen their pelvic floor muscles relieved bloating [22 Trusted SourcePubMedGo to source, 23 Trusted SourcePubMedGo to source].
Are Stomach Distension and Bloating the Same Thing?
These two terms are often used interchangeably, but they refer to two different conditions. While stomach distension is the physical expansion of the abdomen (think “pregnant belly”), bloating refers to the feeling of abdominal fullness or discomfort [1 Trusted SourcePubMedGo to source].
People can experience them separately, but bloating and stomach distension can occur together. One study found 50-60% of patients with bloating also have distension [1 Trusted SourcePubMedGo to source].
Most people have experienced some digestive symptoms at one point or another, especially after eating a large meal. Stomach distension, abdominal bloating, gas, cramping, and indigestion can be normal every now and then. But if you’ve been taking care to improve your gut health, yet notice an uptick in these symptoms, it’s probably time to look for and target root causes.
What Causes Stomach Distension?
While the occasional large meal can be the culprit when it comes to stomach distension, there are a myriad of possible underlying causes for chronic abdominal distension.
But the most common causes of bloating and chronic stomach distension we see in the clinic are:
Irritable bowel syndrome (IBS): Much of the research on bloating and stomach distension has been completed in the context of IBS. Interestingly, research shows excessive intestinal gas may not contribute much to bloating and abdominal distension in IBS patients, rather it could be a hypersensitivity to gas pressure from abnormal abdominal wall reflexes [24 Trusted SourcePubMedGo to source].
Obesity: If you’ve gained weight in a short period of time, especially in your belly, you may experience bloating since abdominal fat can alter the intestinal nerve impulses of the gut-brain axis [24 Trusted SourcePubMedGo to source].
Pelvic floor dysfunction:Your pelvic floor muscles are important for supporting several organs (anus, rectum, and abdominal organs), they help with bowel and bladder control, and they contribute to sexual function. When the muscle tone is too high or low in your pelvic floor muscles, changes in your anatomy result in constipation, which can cause bloating [1 Trusted SourcePubMedGo to source, 28 Trusted SourcePubMedGo to source].
Sometimes chronic abdominal distention is related to medical conditions such as:
Cirrhosis (a liver disease characterized by ascites or fluid in the abdomen)
If you’ve worked through the step-by-step protocol, but still struggle with symptoms, you may consider some specific testing options such as:
Breath tests to diagnose SIBO
Upper endoscopy for serious symptoms
Abdominal X-rays to determine the level of stool retention in those who are constipated
Gastric emptying studies
Can Stress Cause Distension of the Abdomen?
Have you ever noticed changes to your gastrointestinal function when you’re nervous or stressed? It’s no coincidence since your gut and brain communicate with each other via the gut-brain axis, including the vagus nerve.
When it comes to stomach distension and bloating, stress can both physically change the landscape of your gut and also change your perception.
Stress can create hypersensitivity to gut sensations. Some of our patients develop bloating and distension of the abdomen due to a heightened awareness and attention to their gastrointestinal system, which is common in IBS. In this case, the gut-brain axis may generate feelings of stomach distension and bloating despite normal intestinal contents [24 Trusted SourcePubMedGo to source].
Bloating and Distension Treatments
Beyond our stepwise, holistic treatment approach, there are a number of conventional and alternative treatments that have been found to be beneficial for bloating and distension. Here’s an overview of each treatment, their beneficial effects, and any common side effects.
Beneficial Effect in Studies
Common Side Effects in Studies MA = meta-analysis RCT = randomized controlled trial
Lacy BE, Cangemi D, Vazquez-Roque M. Management of chronic abdominal distension and bloating. Clin Gastroenterol Hepatol. 2021 Feb;19(2):219-231.e1. DOI: 10.1016/j.cgh.2020.03.056. PMID: 32246999. Trusted SourcePubMedGo to source
Marsh A, Eslick EM, Eslick GD. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. Eur J Nutr. 2016 Apr;55(3):897–906. DOI: 10.1007/s00394-015-0922-1. PMID: 25982757. Trusted SourcePubMedGo to source
Varjú P, Farkas N, Hegyi P, Garami A, Szabó I, Illés A, et al. Low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet improves symptoms in adults suffering from irritable bowel syndrome (IBS) compared to standard IBS diet: A meta-analysis of clinical studies. PLoS ONE. 2017 Aug 14;12(8):e0182942. DOI: 10.1371/journal.pone.0182942. PMID: 28806407. PMCID: PMC5555627. Trusted SourcePubMedGo to source
Hosseini-Asl MK, Taherifard E, Mousavi MR. The effect of a short-term physical activity after meals on gastrointestinal symptoms in individuals with functional abdominal bloating: a randomized clinical trial. Gastroenterol Hepatol Bed Bench. 2021;14(1):59–66. PMID: 33868611. PMCID: PMC8035544. Trusted SourcePubMedGo to source
Schumann D, Anheyer D, Lauche R, Dobos G, Langhorst J, Cramer H. Effect of yoga in the therapy of irritable bowel syndrome: a systematic review. Clin Gastroenterol Hepatol. 2016 Dec;14(12):1720–31. DOI: 10.1016/j.cgh.2016.04.026. PMID: 27112106. Trusted SourcePubMedGo to source
Zernicke KA, Campbell TS, Blustein PK, Fung TS, Johnson JA, Bacon SL, et al. Mindfulness-based stress reduction for the treatment of irritable bowel syndrome symptoms: a randomized wait-list controlled trial. Int J Behav Med. 2013 Sep;20(3):385–96. DOI: 10.1007/s12529-012-9241-6. PMID: 22618308. Trusted SourcePubMedGo to source
Zhang C, Jiang J, Tian F, Zhao J, Zhang H, Zhai Q, et al. Meta-analysis of randomized controlled trials of the effects of probiotics on functional constipation in adults. Clin Nutr. 2020 Oct;39(10):2960–9. DOI: 10.1016/j.clnu.2020.01.005. PMID: 32005532. Trusted SourcePubMedGo to source
Ford AC, Quigley EMM, Lacy BE, Lembo AJ, Saito YA, Schiller LR, et al. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. Am J Gastroenterol. 2014 Oct;109(10):1547–61; quiz 1546, 1562. DOI: 10.1038/ajg.2014.202. PMID: 25070051. Trusted SourcePubMedGo to source
Yuan F, Ni H, Asche CV, Kim M, Walayat S, Ren J. Efficacy of Bifidobacterium infantis 35624 in patients with irritable bowel syndrome: a meta-analysis. Curr Med Res Opin. 2017 Jul;33(7):1191–7. DOI: 10.1080/03007995.2017.1292230. PMID: 28166427. Trusted SourcePubMedGo to source
Tiequn B, Guanqun C, Shuo Z. Therapeutic effects of Lactobacillus in treating irritable bowel syndrome: a meta-analysis. Intern Med. 2015;54(3):243–9. DOI: 10.2169/internalmedicine.54.2710. PMID: 25748731. Trusted SourcePubMedGo to source
McFarland LV, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol. 2008 May 7;14(17):2650–61. DOI: 10.3748/wjg.14.2650. PMID: 18461650. PMCID: PMC2709042. Trusted SourcePubMedGo to source
Ishaque SM, Khosruzzaman SM, Ahmed DS, Sah MP. A randomized placebo-controlled clinical trial of a multi-strain probiotic formulation (Bio-Kult®) in the management of diarrhea-predominant irritable bowel syndrome. BMC Gastroenterol. 2018 May 25;18(1):71. DOI: 10.1186/s12876-018-0788-9. PMID: 29801486. PMCID: PMC5970461. Trusted SourcePubMedGo to source
Sun Y-Y, Li M, Li Y-Y, Li L-X, Zhai W-Z, Wang P, et al. The effect of Clostridium butyricum on symptoms and fecal microbiota in diarrhea-dominant irritable bowel syndrome: a randomized, double-blind, placebo-controlled trial. Sci Rep. 2018 Feb 14;8(1):2964. DOI: 10.1038/s41598-018-21241-z. PMID: 29445178. PMCID: PMC5813237. Trusted SourcePubMedGo to source
Whelan K. Probiotics and prebiotics in the management of irritable bowel syndrome: a review of recent clinical trials and systematic reviews. Curr Opin Clin Nutr Metab Care. 2011 Nov;14(6):581–7. DOI: 10.1097/MCO.0b013e32834b8082. PMID: 21892075. Trusted SourcePubMedGo to source
Martoni CJ, Srivastava S, Leyer GJ. Lactobacillus acidophilus DDS-1 and Bifidobacterium lactis UABla-12 Improve Abdominal Pain Severity and Symptomology in Irritable Bowel Syndrome: Randomized Controlled Trial. Nutrients. 2020 Jan 30;12(2). DOI: 10.3390/nu12020363. PMID: 32019158. PMCID: PMC7071206. Trusted SourcePubMedGo to source
Pimentel M, Constantino T, Kong Y, Bajwa M, Rezaei A, Park S. A 14-day elemental diet is highly effective in normalizing the lactulose breath test. Dig Dis Sci. 2004 Jan;49(1):73–7. DOI: 10.1023/b:ddas.0000011605.43979.e1. PMID: 14992438. Trusted SourcePubMedGo to source
Menees SB, Maneerattannaporn M, Kim HM, Chey WD. The efficacy and safety of rifaximin for the irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol. 2012 Jan;107(1):28–35; quiz 36. DOI: 10.1038/ajg.2011.355. PMID: 22045120. Trusted SourcePubMedGo to source
Pimentel M, Lembo A, Chey WD, Zakko S, Ringel Y, Yu J, et al. Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med. 2011 Jan 6;364(1):22–32. DOI: 10.1056/NEJMoa1004409. PMID: 21208106. Trusted SourcePubMedGo to source
Lembo A, Zakko SF, Ferreira NL, Ringel Y., Bortey E, Courtney K, et al. T1390 Rifaximin for the Treatment of Diarrhea-Associated Irritable Bowel Syndrome: Short Term Treatment Leading to Long Term Sustained Response. Gastroenterology. 2008 Apr;134(4):A-545. DOI: 10.1016/S0016-5085(08)62544-5.
Mahboubi M. Therapeutic Potential of Zataria multiflora Boiss in Treatment of Irritable Bowel Syndrome (IBS). J Diet Suppl. 2019;16(1):119–28. DOI: 10.1080/19390211.2017.1409852. PMID: 29333891. Trusted SourcePubMedGo to source
Ciacci C, Franceschi F, Purchiaroni F, Capone P, Buccelletti F, Iacomini P, et al. Effect of beta-glucan, inositol and digestive enzymes in GI symptoms of patients with IBS. Eur Rev Med Pharmacol Sci. 2011 Jun;15(6):637–43. PMID: 21796867. Trusted SourcePubMedGo to source
Rice AD, Patterson K, Reed ED, Wurn BF, Robles K, Klingenberg B, et al. Decreasing recurrent bowel obstructions, improving quality of life with physiotherapy: Controlled study. World J Gastroenterol. 2018 May 21;24(19):2108–19. DOI: 10.3748/wjg.v24.i19.2108. PMID: 29785079. PMCID: PMC5960816. Trusted SourcePubMedGo to source
Iovino P, Neri MC, D’Alba L, Santonicola A, Chiarioni G. Pelvic floor biofeedback is an effective treatment for severe bloating in disorders of gut-brain interaction with outlet dysfunction. Neurogastroenterol Motil. 2021 Sep 16;e14264. DOI: 10.1111/nmo.14264. PMID: 34532928. Trusted SourcePubMedGo to source
Mari A, Abu Backer F, Mahamid M, Amara H, Carter D, Boltin D, et al. Bloating and abdominal distension: clinical approach and management. Adv Ther. 2019 May;36(5):1075–84. DOI: 10.1007/s12325-019-00924-7. PMID: 30879252. PMCID: PMC6824367. Trusted SourcePubMedGo to source
Burta O, Iacobescu C, Mateescu RB, Nicolaie T, Tiuca N, Pop CS. Efficacy and safety of APT036 versus simethicone in the treatment of functional bloating: a multicentre, randomised, double-blind, parallel group, clinical study. Transl Gastroenterol Hepatol. 2018 Sep 25;3:72. DOI: 10.21037/tgh.2018.09.11. PMID: 30511026. PMCID: PMC6256934. Trusted SourcePubMedGo to source
Schumann D, Klose P, Lauche R, Dobos G, Langhorst J, Cramer H. Low fermentable, oligo-, di-, mono-saccharides and polyol diet in the treatment of irritable bowel syndrome: A systematic review and meta-analysis. Nutrition. 2018 Jan;45:24–31. DOI: 10.1016/j.nut.2017.07.004. PMID: 29129233. Trusted SourcePubMedGo to source
Altobelli E, Del Negro V, Angeletti PM, Latella G. Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis. Nutrients. 2017 Aug 26;9(9). DOI: 10.3390/nu9090940. PMID: 28846594. PMCID: PMC5622700. Trusted SourcePubMedGo to source
Shi Q, Tan L, Liu C, Wang H, Zhang J, Wang H, et al. Comparative efficacy of pharmacological and nonpharmacological treatments for chronic idiopathic constipation in China: a Bayesian network meta-analysis. BMC Complement Altern Med. 2019 Nov 14;19(1):311. DOI: 10.1186/s12906-019-2741-z. PMID: 31727037. PMCID: PMC6857160. Trusted SourcePubMedGo to source
Barba E, Burri E, Accarino A, Cisternas D, Quiroga S, Monclus E, et al. Abdominothoracic mechanisms of functional abdominal distension and correction by biofeedback. Gastroenterology. 2015 Apr;148(4):732–9. DOI: 10.1053/j.gastro.2014.12.006. PMID: 25500424. Trusted SourcePubMedGo to source
Ford AC, Lacy BE, Harris LA, Quigley EMM, Moayyedi P. Effect of Antidepressants and Psychological Therapies in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-Analysis. Am J Gastroenterol. 2019 Jan;114(1):21–39. DOI: 10.1038/s41395-018-0222-5. PMID: 30177784. Trusted SourcePubMedGo to source
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