Islam GouasmiaAlways Feeling Bloated? Causes and When to Get a Scan
It's midday, and suddenly your jeans feel tighter, and your tummy feels full and uncomfortable; in other words, you are feeling bloated. While having a bloated stomach now and then is normal and pretty common, in fact, 10-25% of healthy people report occasional bloating, with 10% stating that they experience bloating regularly. Persisting bloating on the other hand can point to a deeper issue! Digestive issues and hormonal fluctuations are the most common. But before that, what is bloating? What is actually causing it? And when should you get medical help and maybe even a scan?
What Is a Bloated Stomach?
Bloating refers to the subjective sensation of fullness or pressure in the abdomen; it can be mildly uncomfortable to intensely painful. This is not always the same as abdominal distension, which is a visible measurable expansion of the stomach. In fact, only 50% of people who experience bloating also report a distended abdomen; the two usually co-exist, but you can feel bloated without your abdomen being noticeably swollen.
Why is my stomach bloated?
Bloating is not a diagnosis but a symptom. So, it's essential to address the root cause, we can summarise the most common causes into:
Ø Gas build-up
Ø Digestive content and constipation
Ø Hormones
Gas
While gas is a natural byproduct of digestion, A bloated stomach is most commonly due to an excess buildup of gas in the gastrointestinal tract, this buildup is caused by either excess entry or excess production. If you eat with your mouth open you swallow a lot of air, most will come out with burping but some escape and will build up in your stomach, the same thing happens when you drink a lot of carbonated beverages.
The production is mainly caused by the bacterial fermentation of undigested carbs in the colon, producing hydrogen, methane and CO2; if there is too much fermentation, this means the carbs are not being digested as they should be before reaching the intestines; this may be caused by simply eating too much too fast, intolerance to some food or a digestive illness. The possible causes are:
1. Eating too fast and swallowing air
2. Poor carb absorption
Also known as carbohydrate malabsorption, occurs when the small intestine is unable to digest and absorb certain carbohydrates as it should because of a dysfunction of the digestive enzymes or the transport mechanism, leading to the carbs passing into the colon undigested.
· Bloating..
· Diarrhoea.
· Steatorrhoea (fatty stools).
3. Small Intestinal bacterial overgrowth (SIBO)
It's a condition defined by an abnormal increase in the amount/type of bacteria forming the small intestinal microbiome, where normally it's low compared to the large intestine
Common Symptoms of SIBO
· Loss of appetite
· Abdominal pain
· Nausea
· Bloating
· Diarrhoea
· Malnutrition
4. Functional digestive disorders (FGIDs)
Also known as disorders of gut-brain interaction, are a group of conditions characterised by symptoms related to the gastrointestinal (GI) tract without a clear structural or biochemical cause, according to recent studies 40% of the population worldwide lives with FGIDs. Irritable bowel syndrome (IBS), gastroesophageal reflux disease, functional dyspepsia and functional constipation are some of the most common ones.
Common symptoms include:
· Abdominal pain
· Bloating
· Burping
· Constipation
· Diarrhoea
· Flatulence
· Nausea and vomiting
· Swallowing difficulties
5. Visceral hypersensitivity
A condition where the normal functioning of your internal organs may cause you discomfort, meaning your threshold for pain in your internal organs is lower. This condition is linked to many of the FGIDs, such as IBS.
Digestive contents and constipation
Regardless of whether it is a fluid, solid, or gas. A buildup of any of those will lead to you feeling tighter. This can be caused by constipation due to a bad diet (that's why it's important to eat enough fibre), motility disorders or in severe cases bowel obstructions caused by scars, tumours etc.
What scans may be needed?
It depends on the symptoms you're presenting, but for most cases, an abdominal ultrasound scan is the best test to explore and diagnose the cause of bloating, it's a non-invasive medical imaging test that uses sound waves to create images of the organs inside the abdomen. Unlike with X-rays or CT scans, this test does not expose you to ionising radiation. You will be lying down for the procedure. A clear, water-based conducting gel is applied to the skin over the abdomen. This helps with the transmission of the sound waves. A handheld probe called a transducer is then moved over the abdomen. In most cases, this test doesn't take more than 30 minutes.
Another imaging test may be required, such as an MRI or CT scan, if a tumour is suspected or if the ultrasound is not enough to make a conclusive diagnosis. A CT scan uses X-rays while MRI uses radiomagnetic waves. Each of them is used for different cases check our article where we go into detail on what are they and what are the differences between them here.
CT is on the first line for its speed and effectiveness at diagnosing emergencies such as bowel obstructions, diverticulitis, appendicitis as well as other conditions like inflammatory bowel syndrome (IBS), kidney stones, and tumours in abdominal organs.
MRI scan is excellent for assessing blood flow, lymph nodes, and masses in the liver, kidneys, pancreas and spleen as well as other abdominal organs. MRI also is really good at distinguishing tumours from normal tissues, helping with staging and treatment planning for the tumours.
So in conclusion, Ultrasound scan is usually the first line imaging for bloating. If it is not conclusive or extra imaging is needed; CT or MRI scans can provide doctors with more details and information.
Fgid study : https://www.sciencedirect.com/science/article/pii/S001650852030487X