13. Abdominal Bloating

  1. Anton Emmanuel MD Senior Lecturer in Neurogastroenterology & Consultant Gastroenterologist2 and
  2. Eamonn M.M. Quigley MD, FRCP, FACP, FACG, FRCPI Professor of Medicine and Human Physiology3
  1. Peter J. Whorwell

Published Online: 9 APR 2013

DOI: 10.1002/9781118444689.ch13

Irritable Bowel Syndrome: Diagnosis and Clinical Management

Irritable Bowel Syndrome: Diagnosis and Clinical Management

How to Cite

Whorwell, P. J. (2013) Abdominal Bloating, in Irritable Bowel Syndrome: Diagnosis and Clinical Management (eds A. Emmanuel and E. M.M. Quigley), Blackwell Publishing Ltd, Oxford. doi: 10.1002/9781118444689.ch13

Editor Information

  1. 2

    GI Physiology Unit, University College Hospital, London, UK

  2. 3

    Department of Medicine, University College Cork, Consultant Gastroenterologist, Cork University Hospital, Principal Investigator, Alimentary Pharmabiotic Centre University College Cork, Cork, Ireland

Author Information

  1. Education and Research Centre, Wythenshawe Hospital and University Hospital of South Manchester, Manchester, UK

Publication History

  1. Published Online: 9 APR 2013
  2. Published Print: 28 MAY 2013

ISBN Information

Print ISBN: 9781118538623

Online ISBN: 9781118444689



  • bloating;
  • distension;
  • irritable bowel syndrome;
  • pathophysiology


Most patients with irritable bowel syndrome complain of abdominal bloating but this can mean one of two things. Firstly, it could indicate a sensation of increased abdominal pressure or, secondly, this feeling could be accompanied by an actual increase in girth which should more appropriately be referred to as distension. Research in our laboratory has suggested that in approximately 50% of patients reporting bloating, the symptom is accompanied by actual distension. Furthermore, the pathophysiology of bloating and distension appears to be subtly different, with bloating being more associated with abnormal gas handling, hypersensitivity of the gastrointestinal tract, a loose bowel habit, fermentation and possibly abnormal gut flora. In contrast, distension seems to be associated with weak abdominal musculature, an abnormal accommodation reflex, slow gastrointestinal transit, constipation, fermentation and changes in bacterial flora.

Consequently, treatment needs to take account of these various and differing mechanisms. For example, accelerating transit or relieving constipation should theoretically help to improve distension whereas targeting visceral sensation may be more effective in the management of bloating. However, although it is important to consider the underlying pathophysiology, effective management of these problems still quite frequently involves a process of trial and error.