Upper Abdominal Bloating

Introduction

You are probably familiar with the unusual discomfort of bloating – perhaps it is an uncomfortable, persistent fullness or even a jarring pain that has led you here. Although known to be a universal experience, it is important to address bloating’s potential causes, as well as its different forms, in order to identify whether it may be a cause for medical attention. 

What is abdominal bloating?

Abdominal bloating is typically characterized by a persistent feeling of fullness in your tummy, usually accompanied by abdominal pain, flatulence, constipation or diarrhoea, and is the most frequently occurring symptom of gastrointestinal dysfunction. Although outward swelling is a common symptom of many diseases and conditions, abdominal bloating is often attributed to a build-up of gas in your gastrointestinal (GI) tract.

Types of abdominal pain

Although more research may be required to fully understand whether there are unique types of abdominal pain, with distinct treatment options, abdominal pain can be categorized into distinct sensations in unique regions of the abdomen.

The pain may be:

• sharp, jabbing
• burning sensation, stomach pain
• cramping 
• pain from bloating (distention)

The location of pain may be divided into the following areas of the abdomen:

• upper
• lower 
• right-sided
• left-sided
• general discomfort with or without diarrhoea

Symptoms of abdominal bloating

Abdominal bloating is often linked to dyspepsia (indigestion) and may be accompanied by the following symptoms:

• a feeling of fullness (similar to that felt after overeating)
• acid reflux
• flatulence
• burping
• constipation
• diarrhoea
• abdominal pain

What are the main causes of abdominal bloating?

Like many health conditions linked to gastrointestinal abnormalities, abdominal bloating is a symptom linked to many diseases. Because of this, it is difficult to pinpoint the precise cause of abdominal bloating. Nevertheless, the following are the main causes that are most likely to explain why you may be experiencing bloating. 

Post-surgery 

• If you have recently undergone invasive surgery, particularly in the abdominal area, then you are likely to experience bloating due to air from the atmosphere being trapped in your abdomen during the operation. This finding is common in surgeries of the GI tract (e.g. bariatric surgery, sleeve gastrectomy).

Gut microbiome imbalances

• A large community of bacteria and other microorganisms in the intestines is called gut microbiome. As this gut microbiome feeds off the food that passes through the GI tract, they produce gas which is eventually farted out.
• The gut microbiome has been shown to play an essential role in gastrointestinal health, mental health, metabolism and immunity.^1,2 The ability of gut microbiome to interact with other body organs (and vice versa) is a good indicator of overall health, whereas symptoms of poor gut health (abdominal bloating and abdominal pain) can be an indicator of a problem not only in the gut but elsewhere in the body (e.g. from stress, smoking, organ dysfunction).
• Both internal and external factors can result in imbalances in the gut microbiome – when the proportions and quantities of the microorganisms and bacteria in the gut change (dysbiosis). Infections such as Clostridioides difficile or conditions such as small intestine bacterial overgrowth (SIBO) are caused by gut dysbiosis and are often characterized by abdominal bloating.

Food intolerances 

• If you experience bloating after eating certain types of food (e.g. gluten from wheat products/celiac disease, lactose in dairy, fructose), then it is possible that you may have a food intolerance. Try experimenting with your diet, cutting out foods that you may deem suspect, and see whether you can notice an improvement. Otherwise, it may be time to see your GP.

Irritable bowel syndrome

• Irritable bowel syndrome (IBS) is one of the most common gastrointestinal conditions and is characterized by chronic or recurring episodes of bloating, cramps, diarrhoea and/or constipation. It may be triggered by certain types of foods like processed or refined foods, dairy, alcohol and coffee. Unfortunately, there is no single cure for IBS, but changes to your lifestyle and diet and the use of over-the-counter medications can help to resolve your symptoms. If you suspect you have IBS, it is advised that you see either your doctor or a registered dietitian to help pinpoint triggers and the best route for your treatment.

Constipation

• Constipation is often a result of poor gut motility. Having your food in your intestines for too long can result in the gut bacteria feeding on the food in your gut for too long, producing excessive gas and resulting in bloating. 
• Constipation can be painful, frustrating and uncomfortable, but it may often be easily resolved by drinking enough fluids, eating enough fibre (or taking a fibre supplement), and with regular movement and exercise. 
• It is important to note that constipation often occurs due to dehydration, which may be due to inadequate water intake (common in warm, dry climates or in those with high activity levels).

Menstruation

• Bloating is one of the most common symptoms of menstruation. Menstrual bloating typically affects the lower abdomen and can be extremely uncomfortable. It is often accompanied by lower back pain, headaches, changes to your appetite and skin break-outs, which are linked to hormonal changes. 

Ovarian cancer 

• To all the ladies out there, if your bloating is persistent and unresolved, accompanied by distension of the abdomen, not because of any of the above-mentioned causes, then it is highly recommended to talk to your GP. Persistent lower abdominal bloating is a common symptom of ovarian cancer and should not be dismissed or ignored.

Locations of abdominal pain and bloating

Locations where you experience abdominal pain and bloating, may help you to indicate its cause. 

Left side of the abdomen

If you are experiencing pain, with or without bloating, on the left side of your abdomen, this is likely due to gas, but may also be a sign of other more serious conditions. If the pain is specific to your lower left abdomen and becomes more severe during or after eating, you may be suffering from diverticulitis. In this case, it is highly recommended that you see your GP to arrange treatment options specific to you.

Right side of the abdomen

If the pain is occurring on the right side of your abdomen, then this may be a cause for concern. Appendicitis is the inflammation of your appendix and is characterized by pain that radiates from the middle to the lower right of your abdomen. If this sounds familiar to you, then it is important that you seek a health professional immediately, as appendicitis can be fatal.

Middle of the abdomen 

If you experience a burning pain in the middle of your abdomen, accompanied by acid reflux, heartburn and/or upper abdominal bloating, then you may have stomach ulcers. Other causes of pain in the middle of your abdomen include constipation, acid reflux, bowel blockages, constipation and appendicitis.

When to seek medical advice about abdominal bloating?

It is highly recommended that you seek medical advice for your bloating if:

• It affects you on a regular basis
• Itsonset is sudden and persistent 
• If the pain is severe
• If the bloating does not resolve itself within days or weeks

Diagnosing causes of abdominal bloating

Elimination diet

An elimination diet is a dietary plan that removes a suspected food or food group that is believed to be the cause of adverse symptoms. It is recommended that this diet is implemented by a registered dietitian, who can monitor your progress professionally and identify potential food suspects with greater accuracy. 

Blood count

Your doctor may suggest performing a blood test to support diagnosis for inflammatory bowel diseases, stomach ulcers, food intolerances or allergies, or stomach cancer. This will involve a blood sample being taken, usually from the arm, using a needle. You may experience bruising and mild discomfort for a few days post-injection. A blood count may be useful, for instance, if your doctor finds that you have an elevated white blood cell (lymphocyte) count, which is a sign of infection and inflammation.

Urine test

Alternatively, your doctor may choose to perform a urinalysis. This usually involves being handed a specimen collection tube to collect the urine sample, before being handed back to a clinician to be sent to a laboratory for analysis. There, they will look for the presence of blood, bacteria, or the levels of protein and sugar in your urine. These markers can help to identify whether your bloating or abdominal pain may be attributed to a urinary tract infection (UTI), diabetes, kidney disease or certain cancers.

Stool analysis

Your doctor may also choose to perform a stool analysis. This analysis involves collecting a small piece of your stool to be sent to a laboratory and analyzing for the presence of certain bacteria, blood and antibodies, which may indicate imbalances in your gut microbiome or a gastrointestinal infection.

Prevention and treatments

Successful treatment for abdominal bloating depends on the root cause of the bloating. However, bloating can often be resolved by making changes to your lifestyle and diet. You may want to try:

• Increasing your fibre intake (with a combination of both insoluble and soluble fibres)

e.g. oat porridge, chia seeds, fruits, vegetables

• Drinking more water (NHS recommends 6-8 glasses of water in a day)
• Regular exercise and full-body movement
• Avoiding highly processed foods
• Reduce your salt intake, which can decrease water retention and prevent you from feeling bloated.

Summary

Overall, it is difficult to pinpoint the exact cause of abdominal bloating without careful analysis of diet, lifestyle or proper physiological assessment by a medical professional. Nevertheless, most abdominal bloating cases can be resolved with dietary and lifestyle changes.