Medically Reviewed by Jenny Blair, MD
Bloating can be a common symptom of inflammatory bowel disease, and dealing with a swollen belly can be more than just uncomfortable—it can be downright painful.
“People with ulcerative colitis (UC) and Crohn’s disease have chronic inflammatory processes that can manifest in abdominal pain,” says Shannon Chang, MD (Twitter: @shannonchangmd), gastroenterologist and assistant professor of medicine at New York University (NYU) Langone’s IBD Center. As a result, these patients tend to have “some problems with motility—or the way their guts moves—and that can predispose them to feeling like they’re bloated or have pain that feels like bloating.”
Other Reasons for Abdominal Distention
Another possible reason for abdominal distention can be due to having “some underlying hypersensitivity” caused by chronic inflammation, says Dr. Chang. Plus, those with Crohn’s disease can develop scar tissue in the intestinal tract, which can lead to narrowing, called strictures, of the GI passage. “This prevents food from passing through as easily as it should, and these patients can be predisposed to bloating and fullness.”
Adhesions due to intestinal surgery may also lead to difficulty passing gas, says Roshini Rajapaksa, MD (Twitter: @drroshiniraj), a board-certified gastroenterologist, a clinical associate professor of medicine at NYU School of Medicine, and an attending physician at NYU Langone Medical Center who sometimes goes by the name Dr. Raj. “And people with UC and Crohn’s are more likely to have lactose intolerance, which can cause bloating,” she adds.
Prevention Is Key
No two patients are the same, says Berkeley Limketkai, MD, PhD (Twitter: @berkeleydoc), an associate clinical professor of medicine at David Geffen School of Medicine at UCLA and a gastroenterologist at Ronald Reagan UCLA Medical Center. “For instance, some individuals tolerate dairy products better than others—it varies across individuals,” he explains.
However, certain dietary measures may help keep abdominal pain at bay. Dr. Limketkai says that limiting your intake of common gas-producing foods and identifying (and reducing) symptom-provoking foods may help. Some foods to avoid might include:
• Legumes like chickpeas, lentils, black beans and kidney beans
• Whole grains and starches, like wheat bran, corn and potatoes
• Lactose-containing dairy products like milk, cheese and ice cream
• Certain fruits and vegetables like apples, peaches, asparagus, peas, cabbage and broccoli
Receiving proper medical treatment and being proactive in your healthcare can also help keep symptoms at bay. “Asking your physician questions, such as, ‘Do I have active inflammation?’ and ‘Did anything come up recently in my bloodwork or colonoscopy?’ will help you get the full picture and increase your chances of having less pain,” says Chang.
According to Dr. Raj, other non-medical ways to prevent gas formation and reduce bloat include:
• Eat smaller meals and chew slowly
• Sip drinks without a straw
• Nix gum and carbonated beverages
All these actions can result in swallowing excess air, which can worsen bloating.
Ways to Alleviate Stomach Pain from Bloating
While various remedies can ease abdominal tenderness in different people, finding the right treatment for you may come down to trial and error. Here, Doctors Chang, Limketkai, and Raj share the strategies they discuss with their IBD patients:
1. Heat it.
Applying a heating pad or hot water bottle to your sore abdomen can offer temporary relief, says Raj.
2. Keep moving.
Staying active during your daily routine (like taking short walk breaks from your desk job) can stimulate the GI tract and improve bowel function, says Chang. While daily movement is a good idea, if you are planning on starting a regular workout regimen be sure to discuss it with your gastroenterologist.
3. Take an OTC med.
Both doctors recommend taking simethicone, a non-prescription gas-remedy drug that treats the painful symptoms associated with bloating and fullness.
4. Lay off certain types of fiber.
If constipation is not an issue, Raj advises avoiding complex carbohydrates like beans, oatmeal, and whole grain breads. The Crohn’s & Colitis Foundation also suggests staying away from insoluble fiber—like nuts, prunes, and leafy greens—since these items can add more bulk to your already-enlarged belly.
5. Consider a low FODMAP plan.
“The low FODMAP diet [a plan that restricts fermentable carbs]
can be an appropriate trial for excessive gas and bloating,” says Dr. Limketkai. He further explains that FODMAP reduction can be helpful in managing symptoms—but not inflammation—in patients with IBD. “The drawback with the low FODMAP diet over the long term is weight loss and potential malnutrition (including micronutrient deficiencies), but for the short term, it would be okay,” he adds. Before starting any new diet, be sure to loop in your gastroenterologist.
6. Find ways to de-stress.
Chang and Raj suggest practicing non-traditional methods like meditation and acupuncture to reduce worry and anxiety, as decreasing stress may help with symptoms or pain. Research published in Inflammatory Bowel Diseases, the official journal of the Crohn’s & Colitis Foundation, found that IBD patients who took part in guided meditation sessions and a day-long intensive session reported greater reductions in anxiety and depression after eight weeks, along with improved physical and psychological well-being, than did patients who did not participate. Even more promising, these patients reported that their improved quality of life continued six months after the trial.
7. Go for a breath test.
“If you have a history of bowel surgery and have persistent bloating—with or without diarrhea—you should consider getting breath-tested for small intestinal bacterial overgrowth, or SIBO,” states Chang. This condition involves large amounts of bacteria that are typically found in the large intestine to be present in the small intestine. As a result, these bacteria feed on the digested carbs and cause gas, bloating, pain, constipation, or diarrhea.
When to Get it Checked Out
Yet if bloating persists—or worsens—after 48 hours, contact your physician, since it could be a sign of an obstruction, warns Raj. “You want to make sure there’s nothing else going on and also find out if any changes [in medications] need to be made,” adds Chang.