Abdominal bloating and distension are common, often debilitating symptoms affecting up to 90% of IBS patients and about one-third of the general population. Bloating refers to a subjective sensation of gassiness or pressure, while distension is an objective increase in abdominal girth. These symptoms, especially prevalent in women and patients with IBS-C, can significantly impair quality of life. Their causes are multifactorial—ranging from small intestinal bacterial overgrowth, carbohydrate intolerance, and celiac disease to disorders of gut-brain interaction, altered motility, pelvic floor dysfunction, and abdominophrenic dyssynergia. Diagnosis relies on detailed history, physical exam, and targeted testing such as breath tests, imaging, and motility studies.

Treatment must be individualized and multifaceted. Dietary interventions, particularly low-FODMAP diets, are often first-line approaches. Depending on the cause, probiotics, rifaximin, secretagogues, prokinetics, or antispasmodics may help. Neuromodulators, biofeedback, and hypnotherapy are effective in patients with visceral hypersensitivity or abnormal reflexes. Complementary therapies like peppermint oil can also provide relief. Ultimately, managing bloating and distension requires identifying key contributing factors and engaging patients in shared decision-making to tailor safe, effective, and sustainable treatments.

Reference: 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. Epub 2020 Apr 1. PMID: 32246999.