Feeling Bloated? A Gastroenterologist Explains What's Happening in the Gut

Abdominal bloating is one of the most common and uncomfortable digestive complaints: that swollen, tight feeling in your gut that can make you loosen your waistband or skip dinner altogether.

"For some people, bloating is mild and occasional, but for others, it can become chronic and significantly affect quality of life," says Dr. Feenalie Patel, a gastroenterologist at Houston Methodist. "It's not an easy symptom to describe — or diagnose."

When abdominal bloating lingers or keeps returning, it may signal a more serious condition. Understanding what's really going on inside your body when you feel bloated can help you find relief — and know when to get help.

What's happening when we feel bloated?

Abdominal bloating is a subjective sensation of fullness, tightness or pressure in the abdomen that's often related to trapped gas. A few key biological mechanisms contribute to this sensation.

• Excess intestinal gas: This can be due to increased gas production from food fermentation or delayed transit of gas through the digestive tract.
• Visceral hypersensitivity: If the nerves in your gut are overly sensitive, you may perceive normal amounts of gas or fullness as painful or excessive bloating.
• Abdomino-phrenic dyssynergia: This involves an impaired coordination between your diaphragm (the muscle of breathing) and your abdominal muscles, which can cause the abdomen to visibly distend.
• Changes in the microbiome: Shifts in the balance of gut bacteria can lead to increased gas production.
• Hormonal changes: Higher estrogen levels before and during menstruation cause women's bodies to retain more water and salt, which can cause bloating.

"Many people who report bloating may not actually have more gas in their intestines than others," Dr. Patel says. "Instead, their bodies are reacting differently to normal amounts of gas, leading to sensations of pressure or distention."

(Related: What to Do If Digestive Problems Are Giving Your Gut Grief)

Which health conditions can cause bloating in men and women?

Bloating is rarely an isolated issue and is frequently a key symptom of underlying gastrointestinal conditions. The most common association is with functional gastrointestinal disorders, such as irritable bowel syndrome (IBS), where more than 90% of patients report bloating.

Other common gastrointestinal conditions that can cause chronic bloating include:

• Small intestinal bacterial overgrowth (SIBO): An excess of bacteria in the small intestine, leading to increased gas production during the digestion process.
• Constipation: When stool remains in the colon longer, bacteria have more time to ferment the contents, resulting in more gas and bloating.
• Food intolerances: Common intolerances include lactose intolerance (difficulty digesting the sugar in milk) or fructose malabsorption.
• Dyspepsia: Often referred to as indigestion.
• Celiac disease: An autoimmune disorder where consuming gluten damages the small intestine.

"If bloating is frequent and paired with other digestive symptoms, it may signal an underlying disorder that needs attention," says Dr. Patel.

(Related: Should You Take a Food Sensitivity Test?)

When might bloating be a sign of something serious?

For most people, bloating is a benign symptom related to diet or lifestyle. However, it is crucial to recognize the "alarm" symptoms that may signal a more serious underlying condition, such as cancer.

Your doctor will want to know if you're experiencing:

• Unintentional weight loss
• Gastrointestinal bleeding (blood in your stool)
• Persistent vomiting
• Chronic diarrhea or constipation
• Severe or persistent abdominal pain

"You should consider seeing a gastroenterologist for further evaluation if bloating is impacting your daily life," Dr. Patel says. "If it's new, persistent or accompanied by other symptoms, it's worth checking out."

(Related: What Gut Microbiome Tests Do (& Don't) Tell You)

Can stress cause bloating?

If you've ever noticed your stomach acting up before a big presentation or during a stressful week, you're not imagining it. The gut-brain axis, a two-way communication system between your digestive system and nervous system, plays a big role in bloating.

"It's well-established that stress can increase visceral hypersensitivity and alter gut motility," Dr. Patel said. "When we're anxious or stressed, our digestive tracts can become more reactive, and we may feel bloated even without changes in diet."

Managing stress through regular exercise, mindfulness or cognitive-behavioral therapy can help calm the brain and the gut.

How can someone prevent bloating?

The first line of defense against frequent bloating is to make smart, simple lifestyle and dietary adjustments.

• Identify your trigger foods: Keep a symptom diary to figure out which foods are contributing to your bloating. The most common culprits are lactose, gluten and a group of hard-to-digest carbohydrates called the FODMAP foods.
• Avoid swallowing excess air: Skip the chewing gum and hard candies, and cut back on carbonated beverages (soda and beer).
• Don't rush your meals: Eating too quickly can cause you to swallow more air. Slow down and chew your food thoroughly. Eating fewer fatty foods can also help, as fat slows down digestion.
• Stay active: Regular physical activity, such as a short walk after eating, can help with the digestive process and facilitate passing gas.

"Reducing stress is key," says Dr. Patel. "Mindfulness, yoga and relaxation techniques can calm the gut-brain connection."

(Related: What Foods Should You Avoid if You Have IBS?)

Are there effective over-the-counter remedies for bloating?

While there's no single cure-all, several OTC options can help relieve symptoms:

• Simethicone: This works by combining small gas bubbles into larger ones, making them easier to pass.
• Probiotics: These beneficial microorganisms may help balance the gut microbiome.
• Peppermint oil: Some find relief with peppermint oil capsules, which can help relax the intestinal muscles.

"Fiber supplements can help regulate bowel movements, but use them with caution," Dr. Patel says. "For some patients, fiber worsens bloating, especially if it's added too quickly. Start low and increase slowly, with plenty of fluids."

How can a gastroenterologist help with bloating?

If you are struggling to manage persistent bloating, a gastroenterologist can be your most valuable ally.

A specialist will start by evaluating your symptoms to rule out any serious conditions. Testing might include breath tests for bacterial overgrowth or food intolerances, endoscopy for structural issues or imaging to rule out other causes.

"Many of the lifestyle changes to relieve bloating can be challenging to do on your own, and a gastroenterologist can help provide guidance with your diet or supplements," Dr. Patel says. "Getting expert support can make a big difference."

(Related: 7 Signs It's Time to See a Gastroenterologist)

Occasional bloating is common, but it shouldn't control your life. If you've tried dietary changes and stress management but still feel persistently uncomfortable, it's time to get help.

"Bloating is a very real and treatable symptom," Dr. Patel says. "With the right evaluation and care, most people can find relief and get back to feeling like themselves again."