Dr. Gonzales: Where You Bloat Tells a Lot About Why

Do you regularly gain a pant size after lunch? Does constipation usually accompany your bloating? Bloat is a very common complaint in Dr. Chad Gonzales’s clinical practice and one that’s fascinated him for years. When patients experience bloating, where it’s felt it is one of his first questions. According to him, where the bloat occurs is valuable information that can help inform a diagnosis.

Next time you feel bloated, pay attention to where you feel it. Here’s what your symptoms may be indicating.

Bloating in the Upper Abdomen

Upper abdominal bloaters feel it very early in relation to eating—usually while eating or within 30 minutes after. They may also have upper abdominal discomfort and experience nausea.

What it might indicate: Upper abdominal bloaters may have stomach ulcers or an infection of the stomach called Helicobacter pylori. An upper abdominal bloater may have abnormal function of the stomach such as slow peristalsis and slow gastric emptying (called gastroparesis), or impaired dispensability (stretching) of the stomach. To determine if one of these conditions is the case, Dr. Gonzales and his staff offer in-house testing at Ogden Clinic GI at McKay.

If the test comes back negative, the patient likely has a condition called functional dyspepsia. Functional dyspepsia is a stomach impaired by abnormal sensation and motility or peristalsis and all testing is normal.

Treatment for Upper Abdominal Bloat

Treatment of upper abdominal bloaters includes treating the underlying condition if one is encountered.

• If H. pylorus is present, antibiotics and antacid treatment are recommended for 10-14 days.
• If gastroparesis (slow peristalsis or stomach emptying) is present, diet modifications and medication will help increase stomach contractions.
• If impaired stomach accommodation is present, there are prescriptions available that improve the relaxation of the stomach.

“For all patients, I recommend smaller and more frequent meals. If the patient frequently drinks coffee, carbonated beverages, and/or alcohol, I will ask them to scale back,” says Dr. Gonzales. “I regularly see patients with tremendous bloating who consume a few carbonated beverages per day.”

Bloating in the Mid-abdomen

These bloaters have a feeling of bloating, flatus, gas, and/or abdominal pain in the mid-abdomen which occurs 30 minutes to several hours after eating.

What it might indicate: Middle abdominal bloaters may be experiencing symptoms of inflammatory bowel disease such as Crohn’s disease. If it’s not Chron’s disease, Dr. Gonzales says that diet malabsorption or a food intolerance could be present.

“When I think of malabsorbers, I think of patients who are intolerant to dairy, fructose (high fructose corn syrup), and/or sucrose (artificial sweetener),” he says. Another culprit could be celiac disease, a wheat gluten intolerance.

Many patients may also suffer from small bowel bacterial overgrowth: a condition caused by the accumulation of excessive bacteria in the small bowel and abnormal bacterial fermentation of carbohydrates in the small bowel.

Treatment for Mid-Abdominal Bloating

If tests indicate that the patient has celiac disease, a lifelong gluten-restricted diet is recommended and their prognosis is excellent. If they are found to have dietary intolerances, Dr. Gonzales will refer them to a dietitian for dietary alterations. These patients also do very well when they come to understand how eating can affect their symptoms. Inflammatory bowel disease or Crohn’s disease can be treated with Crohn’s medications.

Bloating in the Lower Abdomen

Lower abdominal bloat is usually unrelated to eating. Patients with this symptom usually also have constipation or difficulty passing a bowel movement.

What it might indicate: These patients often have irritable bowel syndrome (IBS) or pelvic floor dysfunction: an abnormal contraction/relaxation of the rectum and anal sphincter muscles.

Workup may include a colonoscopy if red flags are present such as rectal bleeding, weight loss, or a family history of colorectal cancer. Another testing for lower abdomen bloat may include x-ray imaging of the rectum and or anorectal manometry (testing of anorectal contractile pressures).

Treatment for Lower Abdominal Bloating

Patients with constipation and predominant irritable bowel syndrome are treated with medication used to improve the consistency and frequency of stool. Dietary changes are recommended, such as upping their fiber and water intake. Patients with pelvic floor dysfunction are sent to a pelvic floor therapist to help with improving rectal anal contractions and relaxation techniques.

“Bloating is one of the most fascinating and interesting conditions that I treat,” says Dr. Gonzales. “The majority of bloaters I see have been suffering for months or even years. Generally, the diagnosis can be found with a simple discussion and careful history of how their diet and symptoms relate to eating.”

If abdominal bloating affects your quality of life, schedule a visit with Dr. Chad Gonzales at Ogden Clinic GI at McKay today.