Causes of Bloating and Gas (Flatulence)

Bloating

Bloating is a sensation of ‘fullness’ and tightness within the abdomen. It may be accompanied by swelling of the abdomen (distension). Bloating due to the build up of gas within the gastrointestinal tract will often be relieved by belching or flatulence.

Bloating should be differentiated from angina pectoris and myocardial infarction which are two cardiac conditions that may not always result in pain but can be fatal.

Obesity and Pregnancy

Persistent bloating should be investigated as the cause may not be related to gas or the digestive processes. Obesity often results in lax abdominal muscles with a superficial layer of fat tissue that contributes to abdominal distension. Pregnancy causes an increased abdominal diameter as the growing fetus expands within the abdominoperineal cavity. The expanding uterus may compress the organs of digestion thereby contributing to the sensation of bloating. This form of distension is considered a medical norm and is not indicative of any underlying pathology.

Ascites

Swelling is often incorrectly thought to be abdominal distension due to fluid while bloating is ascribed to gas build up. Any abdominal distension is a swelling of the abdomen. Bloating is the sensation of ‘fullness’ and tightness of the abdomen with or without abdominal distension.

Ascites is the medical term for abdominal swelling due to fluid accumulation within the abdominal and pelvic cavities. Swelling may be caused by peritoneal fluid or blood and should be investigated immediately. Ascites can often be diagnosed by physical examination where a succussion splash (sound of moving fluid) indicates fluid accumulation compared to the hollow sound of gas or dull sound of a solid mass. Further investigation is required and an ultrasound, X-ray or MRI scan could provide more definitive evidence of ascites.


Mechanism of Gas and Flatulence

Flatulence is a voluntary or involuntary expulsion of gas through the anus commonly referred to as passing gas or ‘farting’. Gas produced by the breakdown of food within the gastrointestinal tract may cause bloating and discomfort which is relieved upon passing flatus (‘fart’).

Digestion is a physical and chemical process that produces byproducts, including gas that is passed out as flatus. These processes are facilitated by the body’ physical and chemical factors as well as commensal bacteria in the gastrointestinal tract. All the causative factors of belching may also contribute to flatulence and bloating if the trapped gas is not expelled through the mouth.

Flatus is primarily composed of odorless gases. The process of food decomposition and gas produced by intestinal bacteria contribute to the odor of flatus.

Splenic-Flexure Syndrome

Gas trapped within the left side of transverse colon (near the spleen) can cause splenic-flexure syndrome:

  • upper abdominal bloating, often described as an “under ribs” or gastrointestinal chest pain
  • cramping and strong left upper abdominal pain that can be confused with heart related or pancreatic pain

Sulfur Gas

Flatulence with a sulfur-like odor is mainly due to hydrogen-sulfide, a gas responsible for the ‘rotten egg’ odor. Hydrogen-sulfide is produced by the intestinal bacteria. Foreign invading bacteria, yeasts and other parasites (gut fermentation) may contribute significantly to hydrogen-sulfide production within the bowels.

Causes :

  • Foods high in sulfur including eggs, meat, cabbage and beer.
  • Gastroparesis
  • Irritable bowel syndrome
  • Gut fermentation
  • Food intolerance
  • Bowel obstruction

Putrid Gas

Flatus in certain cases may have an offensive putrid odor. This may be described as a ‘dead animal’, ‘rotting garbage’ or ‘fishy’ odor.

Causes :

  • Necrosis of sections of the intestinal lining, like in Ulcerative colitis or Crohn disease
  • Food poisoning
  • Pseudomembranous colitis
  • Any prolonged infection of the gut

Causes of Bloating and Gas

EATING AND BREATHING

1. Aerophagia

Aerophagia is the voluntary or involuntary swallowing of air.

Causes :

  • Eating or drinking
  • Chewing gum
  • Smoking
  • Nasal breathing (blockage of nasal passages)
  • Anxiety (hyperventilation)
  • Poorly fitted dentures

Air is usually trapped within the esophagus and passed out with a belch. If the gas passes lower down the gastrointestinal tract, it will remain trapped until passed out as flatus. Air swallowing is not a common cause of flatulence and bloating but in cases of severe aerophagia, it can contribute to flatulence.

2. Foods That Contribute to Bloating and Gas

Certain foods have a tendency to produce more gas due to the action of intestinal bacteria. These foods are usually carbohydrates and indigestible fiber which may not be digested or absorbed by the body.Carbonated beverages may also contribute to flatulence if gas is not passed out with a belch.

Causes :

  • Carbonated drinks and beverages like beer.
  • High fiber foods like beans, brussel sprouts, celery, cabbage and other fibrous vegetables.
  • Alcohol in excess
  • Sugary foods like sweets
  • Starchy foods: wheat (white bread, pasta), oats, potatoes, corn, and rice
  • Medications: chemotherapy, antibiotics, laxatives, or medicines for diarrhea or pain (naproxen, ibuprofen) can cause gas.

Symptoms may vary but gas and bloating is often noticed a few minutes to hours after consuming the causative foods and beverages.


STOMACH

3. Helicobacter Pylori Infection

Helicobacter pylori is species of bacteria that can infect the stomach cavity. Chronic H.pylori infection (1) may contribute to gastroesophageal reflux disease (GERD), gastritis and peptic ulcers. The pathophysiology of these disease may contribute to flatulence and bloating. H.pylori survives in the stomach acid by producing ammonia which is broken down to form carbon dioxide gas.

Chronic H.pylori infection may be asymptomatic. Typical symptoms are:

  • Uper abdominal bloating
  • Nausea
  • Heartburn
  • Belching
  • Gas (rarely)

4. Dumping Syndrome

Dumping syndrome is the rapid emptying of gastric contents into the intestine.

Causes :

  • Gastric bypass surgery for weight loss
  • Damage of pylorus due to operation or disease (adhesions, cancer)
  • Zollinger-Ellison syndrome (2)
  • Diabetic neuropathy
  • Metoclopramide

Acute symptoms that appear 10-60 minutes after the meal:

  • Nausea
  • Vomiting
  • Abdominal pain and cramps
  • Diarrhea
  • Dizziness
  • Belching
  • Bloating
  • Fatigue
  • Heart palpitations

The following delayed signs and symptoms may develop 1.5-4 hours after eating :

  • Sweating
  • Weakness, fatigue
  • Dizziness
  • Shakiness
  • Feelings of anxiety, nervousness
  • Heart palpitations, rapid heart rate
  • Fainting
  • Mental confusion
  • Diarrhea

With time, many patients start to lose weight because of fear of eating.

5. Slow Gut Motility

Slow gut motility increases the time span that food stays within the gut.

Causes :

  • Gastroparesis
  • Anorexia nervosa
  • Disorders of the nerve supply to the gastrointestinal tract (diabetic neuropathy, atherosclerosis of intestinal artheries)
  • Disorders of the smooth muscle on the gastrointestinal tract
  • Certain drugs may affect normal gut motility (peristalsis): anx
  • Bowel obstruction due to swelling, polyps, tumors

Symptoms :

  • Nausea
  • Vomiting
  • Belching
  • Bloating
  • Flatulence
  • Constipation

PANCREAS

6. Pancreatic Insufficiency

In pancreatic insufficiency, digestive enzymes secreted by the pancreas are reduced or stopped altogether from entering the small intestine.

Causes :

  • Pancreatitis (acute or chronic)
  • Gallstones
  • Hyperlipidemia or hypercalcemia
  • Certain drugs including corticosteroids, NSAID’s, blood pressure lowering agents, antibiotics and immune-suppressants.
  • Surgery
  • Anatomical abnormalities of the pancreas
  • Abdominal trauma
  • Cystic fibrosis
  • Genetic conditions
  • Pancreatic cancer
  • Viral and bacterial infections of the pancreas

Symptoms :

  • Abdominal pain in upper central or left abdomen aggravated after eating and drinking
  • Whitish diarrhea, floating, sticky, and foul smelling stools
  • Bloating
  • Flatulence

LIVER, GALLBLADDER

7. Biliary Stasis

Biliary stasis is the reduction or absence of bile production or secretion into the gut.

Causes :

  • Gallstones
  • Cholecystitis (inflammation of the gallbladder)
  • Cholecystectomy (surgical removal of the gallbladder)
  • Gallbladder cancer
  • Hepatitis
  • Cirrhosis
  • Other liver disease

Symptoms :

  • Pain of the upper right quadrant of the abdomen.
  • Nausea
  • Vomiting (bile may be regurgitated in biliary reflux)
  • Belching
  • Bloating
  • Flatulence
  • Weight loss
  • Anorexia
  • Whitish lose floating sticky stools (if a common hepatic dusct is ocluded with astone)

SMALL INTESTINE

8. Food Poisoning

Food poisoning is a disorder of the gut usually caused by food contaminated with bacteria, viruses or parasites or their byproducts. Food poisoning can also result from chemicals within certain foods. Food poisoning is a common cause of traveler’s diarrhea. (4)

Causes :

  • Microorganisms including viruses, bacteria, parasites
  • Intestinal worms
  • Foods, including certain types of mushrooms, plants or meat. (5)

Symptoms :

  • Nausea
  • Vomiting
  • Watery diarrhea
  • Abdominal pain
  • Stomach cramps
  • Bloating
  • Flatulence
  • Loss of appetite
  • Fatigue
  • Fever

9. Small Intestinal Bacterial Overgrowth (SIBO)

Small intestine bacterial overgrowth is the increased bacterial population within the small intestine. This refers to an overgrowth of the naturally occurring bacterial population within the small intestine.

Causes :

  • Diabetes (Type I or II)
  • Anorexia nervosa
  • Damage to nerve or muscle due to surgery or other trauma
  • Thyroid disorders
  • Pancreatitis
  • Scleroderma
  • Postviral syndromes
  • Intestinal Obstruction
  • Diverticuli
  • Slow gut motility

Symptoms :

  • Belching
  • Bloating
  • Abdominal pain
  • Flatulence
  • Diarrhea
  • Nutritional deficiencies

10. Fructose and Sorbitol Malabsorption

Fructose and sorbitol malabsorption is the body’s inability to digest and absorb these carbohydrates.

Triggers :

  • Genetic factors
  • Sweeteners as sorbitol, xylitol, erythritol, found in “sugar free” gum or soda, and many “low-calorie” foods
  • Most fruits, especially pears, apples, prunes, sweet cherries, dried fruits, fruit juices
  • Vegetables, like brocolli, artichokes
  • Honey

Symptoms :

  • Belching
  • Nausea
  • Bloating
  • Flatulence
  • Abdominal cramps
  • Diarrhea

Hereditary fructose intolerance (HFI), that usually become obvious when a baby gets its first solid food, may cause more severe symptoms if dietary changes are not implemented. An excessive intake of fructose and/or sorbitol can cause the following symptoms :

  • Vomiting
  • Jaundice
  • Fatigue
  • Enlarged liver
  • Seizures

11. Lactose Intolerance

Lactose Intolerance is the body’s inability to digest lactose due to a deficiency of the enzyme lactase. Symptoms usually appear a few minutes to hours after consuming milk and dairy products.

Causes :

  • Decrease of lactase activity with age
  • Genetic factors (rarely)
  • Radiotherapy, chemotherapy, food poisoning or other intestinal diseases can cause temporary lactose intolerance

Symptoms:

  • Belching
  • Nausea
  • Bloating
  • Flatulence
  • Abdominal cramps
  • Diarrhea

12. Celiac Disease

Celiac disease is a digestive disorder commonly referred to as gluten intolerance. The inability to absorb the protein gluten within certain starchy foods, grains and legumes like wheat, barley, rye and oats.

Causes :

  • Unknown factors
  • Genetic factors (if not triggered at birth, may be triggered after pregnancy or stress)
  • Surgery
  • Physical injury
  • Infection

Symptoms :

  • Diarrhea
  • Weight loss
  • Abdominal cramps or pain
  • Flatulence and bloating
  • Steatorrhea (foul smelling, light colored and smelly stools that may have fatty or oily residue)

Further complications and other symptoms may include :

  • Malnutrition which may cause stunted growth in children and vitamin/mineral
  • Swelling (edema)
  • Skin rash (dermatitis herpetiformis)
  • Osteoporosis due to calcium deficiency
  • Neuropathy due to vitamin B12 deficiency
  • Weakness and/or fatigue due to iron deficiency anemia

13. Intestinal Obstruction

Intestinal Obstruction is a total blockage or significant partial obstruction of the small or large intestine.

Causes :

  • Intestinal adhesions
  • Hernia
  • Tumors
  • Congenital abnormalities (like Hirschsprung’s disease)
  • Intestinal telescoping (intussusception)
  • Intestinal twisting (volvulus)
  • Hard mass of intestinal contents (meconium) which is more common in newborns and infants
  • Diverticulitis
  • Foreign bodies
  • Scar tissue or inflammation due to Crohn’s disease
  • Ischemia of intestinal tissue

Symptoms :

  • Intermittent abdominal pain and cramps
  • Fever
  • Bloating
  • Difficulty passing gas
  • Vomiting
  • Nausea
  • Anorexia
  • Abdominal distension
  • Peritonitis

14. Short Bowel Syndrome

Short bowel syndrome is a malabsorption disorder due to a functional disorder or surgical removal of a portion of the small intestine.

Causes :

  • Surgical resection
  • Crohn’s disease
  • Mesenteric ischemia
  • Recurrent intestinal obstruction
  • Trauma
  • Radiation enteritis
  • Cancer
  • Volvulus
  • Necrotizing enterocolitis (in premature newborns)
  • Congenital short bowel

Symptoms :

  • Nutritional malabsorption
  • Diarrhea
  • Steatorrhea (oily/fatty residue in stool)
  • Dehydration
  • Intestinal cramping
  • Bloating
  • Abdominal pain
  • Fatigue
  • Weight loss

15. Gut Fermentation

Gut fermentation (dysbiosis) is the increased decomposition and fermentation of food and bowel contents by naturally occurring and/or foreign micro-organisms.

Causes :

  • Chronic use of antibiotics, antiviral and antifungal oral medication
  • Chemotherapy
  • Bacterial, yeast or parasitic overgrowth within the bowels.

Symptoms :

  • Bloating
  • Flatulence with an offensive odor
  • Intestinal cramping
  • Watery diarrhea

COLON

16. Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) is a functional disorder of unknown origin usually affecting bowel movements. Food either passes too fast or too slow through the gut and this affected transient time can cause a host of symptoms.

Causes :

  • Causes of irritable bowel syndrome (IBS) are unknown.
  • Nerves and muscles of the bowels affected by a range of factors.

Aggravating factors :

  • Emotional stress
  • Diet
  • Drugs
  • Stimulants like caffeine and nicotine
  • Alcohol
  • Allergenic foods like dairy, wheat and nuts.

Symptoms :

  • Flatulence
  • Bloating
  • Constipation or diarrhea or both alternating
  • Abdominal pain or discomfort
  • Abdominal cramps
  • Sensation of incomplete emptying after defecation

17. Constipation

Constipation is the difficulty in passing stool or infrequent stools associated with straining and hard stools.

Causes :

  • Low fiber intake
  • Low fluid intake
  • Poor bowel habits
  • Irritable bowel syndrome
  • Malabsorption syndromes
  • Lack of activity/exercise
  • Bowel obstruction
  • Drugs

Constipation can occur as a condition itself or as a symptom of other conditions. (3)

Symptoms :

  • Infrequent stools less than 3 times a week.
  • Hard stool
  • Straining upon passing stool
  • Abdominal pain and discomfort
  • Flatulence
  • Bloating

18. Pseudomembranous Colitis

Pseudomembranous colitis (antibiotic-associated colitis) is the inflammation of the colon mainly due to an overgrowth of Clostridium difficile.

Causes :

  • Antibiotics
  • Oral antiviral and antifungal agents
  • Chemotherapy
  • Immuno-suppressants
  • Recent surgery

Symptoms usually appear within 10 days of starting antibiotic therapy, or only after weeks:

  • Nausea
  • Abdominal cramps
  • Bloating
  • Flatulence, barnyard smell of the gas
  • Diarrhea (usually of a watery nature)
  • Blood, mucus or pus in the stool, green stools
  • Low grade fever
  • Dehydration

19. Diverticulosis and Diverticulitis

Diverticuli are small outpouchings of the gastrointestinal tract. Diverticulosis is common in people over the age of 50 years and can affect any part of the gut. If these pouches become infected or inflamed (diverticulitis), it can cause a range of symptoms.

Causes :

  • Spastic colon or any condition causing spasms of the muscles of the intestinal wall
  • Prolonged increase in intestinal pressure
  • Weakening of the intestinal wall
  • Perforations of the intestinal wall
  • Bacterial infection of pouches
  • Inflammation of pouches

Symptoms :

  • Pain in the left low abdominal quadrant
  • Vomiting
  • Bloating
  • Flatulence
  • Abdominal tenderness
  • Abdominal cramps which are often painful
  • Rectal Bleeding
  • Changes in bowel movement

Diagnosis

A case history is essential to diagnose the causative factor. The following information needs to be taken into account.

Concomitant symptoms will provide a better indication for a differential diagnosis. Changes in bowel movement. Pain after eating or drinking.

Medical and family history will assist with identifying any predisposing factors. Lactose intolerance. H.pylori infection. Aggravated by certain foods.

This information should be carefully noted and provided to the consulting physician to assist with a diagnosis.

Tests :

  • An endoscopy and/or colonoscopy are the most definitive diagnostic tools.
  • Stool samples will often indicate the presence of microbial byproducts and residue of foods.
  • Stool cultures will assist with identifying causative micro-organisms.
  • X-rays and ultrasound scans will assist with identifying anatomical features / abnormalities.
  • Barium contrast X-rays are useful in identifying anatomical abnormalities within the gut.
  • Hematological studies will indicate nutritional deficiencies, infection and therapeutic drug use.
  • Paracentesis is the withdrawal of fluid from the abdominal cavity and this is a useful investigative technique to identify the cause of ascites.

Treatment

Treatment should be directed at the causative factor(s).

  • Discontinue the foods or lifestyle factors that contribute to the condition.
  • Activated charcoal may be used in cases of chemical and or food poisoning.
  • Studies have indicated that activated charcoal may assist directly with flatulence and reduction of malodor. (6)
  • Fiber may assist with irritable bowel syndrome and constipation but may exacerbate flatulence.
  • Probiotic supplements containing intestinal bacterial spores may assist with restoring intestinal bacterial populations.
  • Antibiotics and other antimicrobial agents are required for infections within the gut.
  • Antidiarhheals (loperamide) and laxatives are useful for restoring bowel movements.
  • Antispasmodics (scopolamine butylbromide) are useful for intestinal cramping.
  • Surgical intervention may be necessary in cases of intestinal obstruction.
  • Bloating accompanied by dizziness, sweating and fainting should be treated as an emergency and immediate medical attention should be sought.

Related Articles:

References:

  1. Helicobacter Pylori (emedicine.com)
  2. Zollinger-Ellison Syndrome (merck.com)
  3. Constipation (healthhype.com)
  4. Traveler’s Diarrhea (cdc.gov)
  5. Food poisoning (merck.com)
  6. Treatment of Bloating and Gas (ncbi.nlm.nih.gov)
  • blue

    hi,

    i have been suffering from pain under my stomach around intestine area more than a year now.. when i push with my hand it hurts very bad… i have seen my doctor and we did cat scan, colonoscopy but nothing found… they told me to not to worry but at 33 years old, i cant live with this pain…
    i dont know what else i can do…

    second problem just started 3 days ago.. left side of lover abdomen started hurt and its been 3 days doesnt stop.. especially it hurts when i touch or push on it.. if i sit long time and try to stand up pain get worse… my doctor told me it might be kidney stone but he said he is guessing.. last 2 days i also get a lot of gas around my intestine… and sometimes its give me pain..

    any help? please.. thnk you

  • Pingback: Sulphur or Rotten Eggs Burps (Belching), Foul Smelling Gas | Healthhype.com()

  • Dr. Chris

    Hi Blue

    Your doctor should consider doing a number of investigations to identify if it is a kidney stone or not. This can be done with an IV pyelogram, ultrasound and even just a normal x-ray might reveal the presence of the stone. There is no guessing and I am surprised that your doctor did not advise this. The reality is that non-specific pain can be just about anything – no diagnosis should be made without complete medical history, clinical evaluations and other tests. What I mean by this is that a pain without any other signs and symptoms could be due to so many causes that it would be dangerous to “guess”. There is a possiblity of splenic flexure syndrome where intestnal gas is trapped at the bend of the colon and would explain some of what you have described. However, further investigation is necessary. At this point you will need to see a specialist like a gastroenterologist. Usually a doctor would not pass off such extreme pain unless there is some evident cause, possibly related to your lifestyle, which you are not revealing or it may be due to irritable bowel syndrome (IBS) which can cause a multitude of symptoms yet there is no effective treatment for it. You need a second opinion ASAP.

  • danny s

    I had a robotic prostatectomy May 2009 due to cancer. Now, I feel bloated all the time. I have gained 30 pounds in the last year. My right side hurts all the time. I take one bite of food or one sip of water and my stomach feels like it’s going to burst. yet I’ve gained weight, I eat all the time. what’s up?

  • Dr. Chris

    Hi Danny S

    The symptoms you are experiencing are common immediately after or up to a week or more after the surgery. If you have noticed these symptoms have started up recently, it may not be related to the prostatectomy and could be due to another unrelated gastrointestinal condition. A lot depends on your bowel movements as well and whether these symptoms were present ever since the prostatectomy or suddenly started up. The question arises as to whether this weight gain may be associated with fluid accumulation in the abdomen or is due to a greater body fat percentage. I would advise that you see your physician and report these symptoms.

  • Pingback: Pancreatic Enzyme Deficiency - Causes and Symptoms | Healthhype.com()

  • Jewellette

    I am suffering from a sharp pain in my left abdominal area, front to back pain. It is also in my left shsoulder and down my arm. Difficult to lift my arm as it feels weak and hurts. Doc did urine test; found no blood but found white blood cells. I also have a lot of gas – both ways. I am always constipated (have seen numerous doctors for this with no explaination). I had my gall bladder removed a few months ago, but the gas and constipation has been the norm for me for years. Please – if you can give me advise for relief of all this discomfort, it will be so greatly appreciated!

  • Dr. Chris

    Hi Jewellete

    There is a range of conditions that may causes these symptoms but what is a concern here is the weakness of the arm. You don’t mention your age, past medical history and so on, so it is difficult to offer an specific advice. Gas trapped in the colon (splenic flexure) may account for many of the symptoms you are experiencing it terms of the pain, however, the exact cause for this increased gas needs to be investigated.

    Your history of constipation is another issue as well. Apart from IBS, a possible cause of partial bowel obstruction need to be excluded. You should see a gastroenterologist and have a colonoscopy as well. Speak to your doctor about this.

  • john c

    I have suffered from ibs for several years and it has recently taken a turn for the worst. I have had upper/lower gi, gall bladder removed, ct scan, camera pill, ultra sound, all results have been normal except for a slight case of diverticulitis. I was reading your article about sticky poop (which I have) and wondered what this condition means? My Dr. wants to do ordinary tests which all come back normal, but I am EXTREMELY bloated and dizzy at times and cannot find a solution or any relief. Any information you could give me would be appreciated.

  • Dr. Chris

    Hi John C

    Sticky stool can occur for a number of reasons and is most likely related to mucus content within your stool. Of course the consistency and composition of the feces may also be related to the water content, foods you ate and bacterial byproducts, all of which could give it a more sticky form.

    Given your history of IBS, it most likely related to mucus. I would advise that you speak to your doctor again as this may be the start of inflammatory bowel disease. Dizziness is never a good sign. If you are not seeing a gastroenterologist at this point, it is important to consult with one now. Seek a second opinion if your symptoms persist and there is no conclusive diagnosis to explain your symptoms.

  • Jackie

    Female 54 yrs old Problem started several years ago with significant weight loss. Symptoms… stomach always feels full ,food gets stuck somewhere, severe headache pulses at temples, then nausea and vomiting. Vomit is always yellow. The headache lasts for days. Also abdominal swelling. Splashing of liquid in my left abdominal area. I have a small hernia that Dr’s do not think would cause this problem. So…based on barium x-rays and a ct scan (findings normal) I was diagnosed with possible Gastroparesis with Pseudo-obstruction. The medicines prescribed do not help! Prokinetics, laxatives only make matters worse. What other tests should they do to confirm this diagnosis. Thanks for your input. Desperate…

  • Dr. Chris

    Hi Jackie

    There are various causes of delayed gastric emptying that have to be considered. All your symptoms accompanied by the bright yellow vomit (likely bile) is indicative of an obstruction distal to the pylorus though. An endoscopy should have been considered at this point. The problem is more likely related to a intestinal motility disorder (dysmotility) if any mass can be conclusively ruled out.

  • cathy

    I am a 29 yr old female who was otherwise healthy (aside from ups and downs in weight) up until a few months ago. I always had perfect regular bowel movements and a healthy diet. Several months ago I started having constipation with no change in diet, which after about a week was accompanied by nausea, bitter taste in mouth even when not eating, poor appetite. I used to regularly exercise and started getting reflux when running or jumping so have had to stop running which pains me. About 2 weeks after that happened I woke up in the middle of the night with horrible pain middle of my abdomen right under my rib cage – couldn’t breathe, lay or anything and nothing would relieve the pain. Went to the ER and they did some tests, told me it was gastritis and to follow-up with a GI doc.
    I went to see the GI doc, he told me my ultrasound showed a contracted gallbladder but no stones or wall thickening. (I hadn’t eaten anything for about 6-7 hours when i got the US). I do have occasional nausea and acidy stomach so he did an endoscopy and said I have gastroparesis because they found food still in my stomach 10-11 hrs after eating. I also had recurring sinus infections (or so I thought they were) over the months while this happened – saw an ENT and he told me I have LPR. Both docs told me to take Prilosec 20 mg twice a day. Have been doing this for 3 months now and symptoms have gotten worse. I now have bouts of constipation where I am unable to have a BM for 4-5 days, doc told me to take MOM and when that didn’t work Senokot. All this does for me is gives me horrible diarrhea and I can see undigested foods in my stool – romaine lettuce, spinach, carrots, all things that I never saw before up until now. Many of these days I have had horrible foul smelling gas, which will last for sometimes days and doesn’t seem to change with diet. I have tried cutting out fiber, cutting out milk, eating bland foods and no raw fruits and veggies. Then I just get constipated again and need to use laxatives to go. My stomach has bouts of burning ever few weeks or so – no matter what antacids I take it burns. It is worse on an empty stomach because sometimes I will just not eat thinking that will help the problem but it doesn’t. Eating something will relieve the burning for maybe 15-20 minutes then it starts up again. I have had other strange symptoms like new onset middle back muscle spasms (not really pain), strange pulsating pain near my ovaries (told I had an ovarian cyst via US). I have been losing weight because I am unable to eat much. No vomiting has ever happened in all this which I am grateful for but I miss eating healthy and working out and feeling like a normal person. I have been given no remedy and no explanation for why all this suddenly happened and I’m very frustrated. I hate to be that person that goes from doctor to doctor but my GI doc is not able to explain or help relieve any of this. I might also add I have been on thyroid med in the past for several years but was taken off of it around 22 when I lost a lot of weight. Since then my thyroid tests keep coming back normal but I am overweight again, 5’4″ 183lbs (though I lost about 25 lbs in past year). Also have bouts of skin problems – chronic rashes mostly elbows and on butt/hip area, had chronic hives for a year and was given hydroxyzine daily but that has gone away now. Any advice would be greatly appreciated, I’m sorry this is so long but I have been keeping track of my symptoms so that I can get this under control.

  • cathy

    Oh also wanted to add when I went to the ER they said my blood cell count was high (14.9) and my liver enzymes a little elevated, ionized calcium low. Liver enzymes were retested and came back normal at GI docs office. US said liver, pancreas were normal.

    Thanks

  • Please help

    My most pressing issue is the different types of noises (gurgling, popping and others) that begin without warning usually below the belly button and on both sides. In addition, I have low-grade, diffuse bloating that never goes away and is compounded with tenderness/pressure in the abdominal region below the navel. Related to all this is a constant gassiness that fluctuates in magnitude but never goes away completely. Any suggestions will be greatly appreciated.

  • lucy

    I’m 16 years old and for as long as I can remember I’ve always had some type of stomach “problems”
    For the past year and a half I’ve had constant heart burn everyday and acid reflux. I’ve gone to the doctor once and have been tested for h-pylori but it came back negative.
    I also have bloating and constant all day burping. From the time I wake up until I go to sleep I burp all day. The doctor didn’t give me a clear diagnosis,but she said that I could be swallowing air involuntarily, but I don’t feel like that is the problem because I also have other symptoms.
    I also suffer from abdominal pain, which is most noticable in the early mornings, it is usually in my lower abdomen and sometime the pain is so severe that it begins to radiate onto my back, sometimes when this occurs I feel a sudden urge to go to the bathroom. I wake up and immediatly feel the urge to burp and after breakfast sometime I feel naseous but it usually helps to burp and the feeling will subside.
    Lately I’ve been feeling full really fast when eating a meal, even if its only a couple bites.
    Please help..thank you

  • Dr. Chris

    Hi Cathy

    This is quite a complex situation. Your initial symptoms were a clear indication of some bowel obstruction or impaired gut motility. The fact that you have been diagnosed with gastroparesis is not sufficient. The exact cause has to be ascertained. It is quite surprising that none of the practitioners you have consulted with have seen fit to investigate further. This is highly unlikely and I hope that you have not been jumping from doctor to doctor. Until the cause is identified, any treatment will only provide moderate, if any, relief. Hypothyroidism can affect gut motility but would no cause gastroparesis per se. Considering that you have been reported euthyroid, your conditionS need to be looked at holistically, as part of a syndrome that has as yet been unidentified. An endocrinologist should be where you should start at. I assume that you have excluded any chronic infections like EBV, CMV or HIV. If it was just a straightforward case of gastroparesis where the cause is known then treatment could be directed at the cause. An autoimmune screen may be a consideration which could account for many of the symptoms you are experiencing. You need to stay with a single practitioner until he/she has concluded all tests and investigations. This may be long and cumbersome but it is the only way to get to the bottom of this problem. Management or treatment without specialist medical attention is going to be very unlikely.

  • Dr. Chris

    Hi Please Help

    It is difficult to say without conducting necessary investigations like a stool test, endoscopy and/or colonoscopy. It could be related to hypermotility or even on the other end of the spectrum, a minor obstruction within the gut. Refer to these articles for more information :
    Stomach noises
    Abdominal bloating

  • Dr. Chris

    Hi Lucy

    Your doctor is correct about the burping. One of the most common causes of excessive belching is air swallowing. H.pylori is a common cause of gastritis and peptic ulcers. It is not always an issue in GERD (gastroesophageal reflux disease) or simply acid reflux which causes your symptom of heartburn. There are various causes for your symptoms and it can only be isolated if you undergo further investigations like an endoscopy and/or colonoscopy.Unfortunately these ailments in your age group does not often prompt immediate and further investigation by many practitioners. You should speak to your doctor about other investigations and ask to see a gastroenterologist. It could be related to inflammatory bowel disease, IBS, small intestine bacterial overgowth, food intolerances or malabsorption syndromes. A stool sample may be considered as a starting point before other investigations are scheduled. You can only treat this condition once you know the exact cause. It may be two separate conditions, for example GERD in the upper gut and IBS of the lower gut, which may be unrelated. Speak to your doctor.

  • Rich

    I’m 26 years old and as of late have been dealing with a wide array of GI symptoms. It started a couple of months ago with a couple of instances of diarrhea and almost daily burping fits. Shortly thereafter I began to experience difficulty sleeping. I would wake up after only a few hours sleep and have to attempt to go back to sleep. Eventually, abdominal rumbling and urge to use the bathroom would develop and remain for as long as I remained lying down in bed. Once I got up and began to walk around, things subsided. I first went to my primary physician who felt it might be IBS. I began a program of Prilosec to treat the IBS and trazadone to help sleep. My condition only improved by a little bit, so I was referred to a gastroenterologist. I was tested for H. Pylori (negative) and told to stop the Prilosec since it was doing little. Soon after, I began to have attacks of bloating and gas. I initially had two strong attacks which resulted in having a bowel movement that was mostly air. I was instructed to try a probiotic on a regular basis as well as Maalox for attacks. The bloating attacks continued, but to a lesser degree, though now with regular abdominal pain and aches. The next step was to check for lactose intolerance or Celiac’s. The blood work is still being done for Celiac’s, while I have spent the last week sans dairy. So far, nothing has gone away, in fact the bloating seems to be occurring on a more regular basis, but everything seems to be less intense. If it was lactose, shouldn’t the symptoms have ceased completely after a near week off dairy? Is there any way the sleeping problem is connected to a GI issue? If not, why all the rumbling in the morning while in bed? Can this all be IBS or GERD despite no regular disruption to bowel habits (only two disruptions in past three months)? I know I should wait on results and my physicians for exact diagnosis, but any thoughts/suggestions would be appreciated.

  • http://healthtype.com emily

    I am writing for my husband. He is 67 not an active person-would get an award for being a couch potato Have have excessive belching and dry heives. 5’9″ weight is 162 and have had lots of surgery, recently (3 yrs ago) cancer of the kidney, did not have to remove kidney but did cut a small amount of it. In his youth (40yrs old) have spline removed, 17 inches of colon removed due to gangreen, apex. removed and am badly scared from the above surgerys.
    This belching had started 3 weeks ago along with dry heives. Have an appointment next week but want to see what you can come up with
    TY

  • jen

    hi my bro has been excessively burping for the last 8 months and its getting worse. Everytime he eat he has to wait a good 1-2 minutes before taking another bite of food so he can burp. I want to know what is causing the problem. Bcuz this happens whether he has liquids or solids.

  • Dr. Chris

    Hi Rich

    Yes, this could definitely be linked to IBS but should only be diagnosed as such if all tests and investigations, including and endoscopy ad colonoscopy (which you do not mention) and stool test, shows no abnormalities. GERD is also another possibility. If it was lactose intolerance then the symptoms should have improved substantially, if not resolved, at this point in time provided that you followed an appropriate diet religiously.

    There are a number of other possibilities as well like small intestinal bacterial overgrowth, pancreatic exocrine insufficiency and possibly even the early stages of inflammatory bowel. You will have to wait for the test results and if the an endoscopy, colonoscopy and stool test has not been done as yet, then it should be considered if the current round of tests are inconclusive.

    If you are currently on an elimination diet and considering different foods and factors that may causing this, try to also remove all stimulants (caffeine and nicotine if you are a smoker). It would be irresponsible of me to try to “diagnose” you prior to receiving the test results. Follow through with your doctors and go through each test until certain conditions can be excluded and the final diagnosis can be made.

    Your sleeping problem may be related to your gastrointestinal condition. If you are undergoing any stress, then it is also likely that the stress is causing or aggravating both conditions.

  • Dr. Chris

    Hi Emily

    Firstly this platform is here to guide you to the appropriate medical professional who can assist you further with your complaint. We cannot make a diagnosis. Given your husband’s history, I would not like to “guess” what could be wrong since he has had so many conditions and no tests have been done as yet. The information you have provided here is also subjective and there may also be points that you are missing or not aware of. It would be difficult to say much at this point. Rather just go through with the appointment and allow the doctor to come up with the diagnosis.

  • Dr. Chris

    Hi Jen

    This may be related to an obstruction in the upper part of the gastrointestinal tract. Its not the burp that allows him to eat another but but rather waiting for a few minutes allows the previous bite to pass through. If this is the case, it is very serious and needs to be investigated by a doctor immediately. The other possibility here is that if it is a gas problem, then he may be swallowing a lot of air when eating. This could be due to various reasons but mainly with nasal congestion. This too needs to be treated for the symptoms to settle.

  • tonsoffun1001

    Hi,

    I have been experiencing bloating and a lot of gas movement over the past few weeks. I also find it VERY difficult to pass the gas, even when I strain or put my self in positions that would typically expedite the passing of gas.

    I have some constipation and find it uncomfortable to “push” when trying to expel feces, if I “push” too hard I feel as though something is going to burst in my lower left abdomen near the waistline.

    My lower left quadrant of my abdomen has a lot of gas-like sounds coming from it and makes noise almost constantly.

    My lower left quadrant seems slightly bloated and is where my main problem lies.

    Notes: I have a varicocele on my left testicle and it causes some pain sometimes extending down my left thigh, I have had a sonogram and CT looking for a hernia (or other issues) but my doctor told me nothing gave him reason to believe that. I feel the description of a hernia correlates to my discomfort. I also consider the idea of an enlarged prostate being involved. Also, sometime my left side feels itchy in the area of concern, but it may just be me subconsciously “tending” to the discomfort I think. I’m 22yrs, fairly active, and eat mostly natural foods. I am scheduled to see the GI in 12 days to hopefully resolve my issues.

    Please provide me with any ideas or suggestions I can attempt/discuss with my GI. I feel my abdominal area is often out of proper operation.

    Thank you!

  • tonsoffun1001

    Hi,

    I’m experiencing trouble passing gas. I feel like I have a lot of gas inside and it’s constantly working around. However, when it acts as if it wants to expel, it get very close and 90% retracts back up and begins the cycle again. I feel bloated and I eat very healthy foods. I don’t know how to relieve this discomfort. It keeps me up for hours sometimes.

    I have a vericocele on my left testicle and I don’t know if that could be causing any problems.

    I am also constipated a lot of the time and my poop comes out in small chunks. I feel as though it might be a blockage or something.

    Any suggestions on what I can take to help clear me out? I’m open to natural remedies, pharmaceuticals, or even an operation if necessary. Some days are extremely uncomfortable. Thanks!

  • Dr. Chris

    Hi Tonsoffun1001

    Most of your symptoms can be attributed to the constipation. Only if your constipation resolves and you are having regular bowel movements but these symptoms persist, then there may be some cause of concern. It is possible that this is a diverticulum which is an outpouching of the colon wall. You should report your symptoms to the gastroenterologist and conduct the relevant tests that he/she deems necessary. The gastroenterologist will come to the final diagnosis.

  • Marshall Iverson

    hi Dr.

    I read most of the comments on here. I have hep C. I did the interferon treatment over 6 years ago and there was no sign of the virus. It’s back now and I am on a strict regiment. Since I started eating for Liver Health ( no salt, no sugar, no dairy, no animal fats, only organic and homemade juices and teas, etc) I have developed very smelly farts. Today my stomach is in pain from the gas. Is it safe for me to take anti gas meds? Should I do a colon cleanse? I eat lots of beans, greens, fruit, sometimes a little chicken or fish ( organic of course) .

  • Dr. Chris

    Hi Marshall

    Given your history it is best that you speak to your doctor before starting any medication for the gas. “Cleansing” and “detox” and so are not really helpful and often just a marketing ploy to sell health products. Remember that your body is constantly cleansing itself. If you are constipated, then it is a good idea to speak to your doctor about meds to ease this. Also speak to your doctor about a reputable probiotic containing Saccharomyces boulardii and possibly Lactobacillus casei. This will help with restoring your good bowel bacteria which could be part of the reason for your abnormally smelly flatulence as well but constipation if present has to be treated.