Management of functional bloating
This topic describes the management of functional bloating. For general advice about managing functional gastrointestinal disorders, including patient support and psychiatric or psychological assessment, see Approach to managing functional gastrointestinal disorders.
Many patients strongly associate bloating with ingestion of certain foods (eg artificial sweeteners, fructans, FODMAPs) or irregular eating patterns. Dietary assessment is important, and dietary manipulation is often useful—see Initial dietary therapy for irritable bowel syndrome. If there is no clear benefit from initial dietary therapy, consider referral to an accredited practising dietitian for a 4- to 6-week trial of a low-FODMAP diet.
Management of constipation is particularly important for patients who are bloated. Macrogol 3350 (a nonfermentable osmotic laxative) is a suitable first-line laxative; typical regimens include:
macrogol 3350 orally1; for example: macrogol 3350 macrogol 3350 macrogol 3350
Movicol (with electrolytes) 13.12 g per sachet, use 1 or 2 sachets (mix each sachet with 125 mL of water), up to 3 sachets daily
OR
OsmoLax (without electrolytes) 17 g per measuring scoop, use 1 level scoop (mix each scoop with 240 mL of water), up to 2 scoops daily.
Bulk-forming laxatives, fermentable osmotic laxatives (eg lactulose) and stimulant laxatives may be poorly tolerated in patients who are bloated. For more information about laxatives, see Choice of laxative therapy for adults. Prucalopride (a prokinetic drug) may be useful for severe cases (see Stepwise approach to laxative therapy for adults for dosage).
Patients often benefit from behavioural or psychological therapies (eg cognitive behavioural therapy, gut-directed hypnotherapy)—see Psychiatric and psychological assessment of patients with functional gastrointestinal disorders.
Limited evidence suggests that manipulation of gut microbiota may be beneficial for bloating—see Modification of the gut microbiota.
A number of over-the-counter preparations are available (eg activated charcoal, peppermint oil, simethicone), but these are not consistently better than placebo. The herbal preparation Iberogast (also known as STW5) may be of benefit for some patients.