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Bloating and abdominal pain: what causes it and how to treat it
Last reviewed: 12.07.2025
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A combination of symptoms such as bloating and abdominal pain, or, using medical terminology, flatulence and abdominal pain, is observed in gastrointestinal diseases, metabolic disorders and enzymopathies; in gastrointestinal infections and food poisoning.
But these symptoms also accompany some physiological processes.
Causes bloating and abdominal pain
According to WHO statistics, bloating is experienced by 10 to 25% of healthy people, especially those who have quickly gained weight or suffer from functional constipation. It is assumed that a significant amount of fatty tissue accumulated in the abdominal cavity in a short time simply reduces the space in which the small and large intestines find it difficult to function normally, and the stomach begins to swell constantly. And how bloating and constipation are related, read more - Common causes of constipation.
The pathogenesis of excessive formation and accumulation of intestinal gases – flatulence (bloating) – is associated with the habit of consuming food too quickly (leading to swallowing air – aerophagia), with its excess volume and/or the presence in the diet of a large amount of poorly digestible animal fats, as well as products that cause flatulence. In addition, flatulence increases due to carbonated drinks (due to their pH level <5, i.e. high acidity), sugar substitutes and sweeteners (sugar alcohols). For more information, see – Causes of Flatulence.
Protein foods can also increase the volume of gaseous by-products – if there is a deficiency of digestive enzymes or low acidity of gastric juice. In people who consume a lot of protein and few carbohydrates, the composition of the commensal intestinal microbiota worsens (in the direction of an increase in the proportion of potentially pathogenic bacteria), the synthesis of short-chain fatty acids in the colon decreases, and the concentration of ammonia and hydrogen sulfide (hydrogen sulfide) in intestinal gas increases.
By the way, the gas formed in the large intestine by bacterial fermentation (in healthy people its volume is approximately 200 ml) is a mixture of nitrogen, hydrogen, carbon dioxide, oxygen and methane, which are odorless, and the characteristic odor and frequent gases with an unpleasant odor are caused by hydrogen sulfide and sulfur compounds (methanethiol and dimethyl sulfide) produced by bacteria - metabolites of protein digestion (the breakdown of the amino acid tryptophan by bacteria of the genus Clostridium).
If healthy people feel only short-term bloating after eating and associated discomfort in the abdominal cavity, then with gastroenterological problems, complaints of bloating, heaviness and pain in the abdomen are common (but this will be discussed below).
Physiological causes include ovulatory syndrome – abdominal pain and bloating in women of childbearing age when a mature egg is released from the ovary, which occurs in the middle of each menstrual cycle. During this period, the synthesis of luteinizing hormone increases sharply, which has an antagonistic effect on gastrointestinal motility.
But if this condition lasts for more than two days, and the woman feels bloating and pain in the ovary, then she should undergo an examination, as this may be a manifestation of an ovarian cyst, polycystic ovary syndrome or endometriosis.
As for PMS, premenstrual bloating is the result of increased progesterone levels immediately after ovulation, which prepares the lining of the uterus for a possible pregnancy.
Why changes in intestinal motility occur, causing bloating during pregnancy, is detailed in the publications:
Experts attribute anatomical causes of these symptoms to abnormalities in the structure or location of gastrointestinal structures, such as congenital elongation of part of the small intestine – the sigmoid colon, called dolichosigma, protrusions of part of the intestine (diverticula), or attachment of parts of the intestine that does not correspond to normal anatomy, as in Ladd's syndrome.
Infections as a cause of flatulence and abdominal pain
Nausea with vomiting, diarrhea, abdominal cramps, bloating and temperature rising to subfebrile and febrile are symptoms of infectious enteritis, gastroenteritis and gastroenterocolitis, which are caused by viruses (Rotavirus, Norovirus, Sapovirus, Avastrovirus, Human herpesvirus 4, Cytomegalovirus) and bacteria (Shigella dysenteriae, Salmonella enteritidis, Escherichia coli, Clostridium perfringens, Campylobacter jejuni, etc.). Details - Types of intestinal infections
Along with enterobacteria, flatulence and abdominal pain can be the result of secondary syphilis, that is, damage to the lower gastrointestinal tract (as well as the mesenteric lymph nodes) by Treponema pallidum (pale treponema).
Lamblia infestation (the protozoa Giardia lamblia or Lamblia intestinalis), as well as helminth infection (parasitic worms) often occur without symptoms, but can also cause serious pathologies. The first signs of intestinal lambliasis: belching and nausea not associated with food, pain in the right hypochondrium and bloating with bowel movement disorder. When pressing on the abdomen - pain in the navel; the nature of the pain is sharp and paroxysmal.
The roundworm Ascaris lumbricoides causes ascariasis, with symptoms including nausea and vomiting, abdominal distension, and constipation alternating with diarrhea.
Enzyme pathologies and endocrine diseases causing bloating and pain
Among fermentopathies, gastroenterologists most often consider insufficient production of the lactase enzyme in the small intestine with the inability to break down the carbohydrate lactose (contained in dairy products) and its incomplete digestion - lactose malabsorption (synonym - lactase deficiency). In this case, milk sugar ends up in the distal part of the large intestine, where it is exposed to the enzymes of enterobacteria with the formation of hydrogen and acids.
Hydrogen can be released with breathing, further metabolized by intestinal bacteria or accumulate, which causes symptoms such as severe abdominal pain and bloating with diarrhea and foul-smelling gases - half an hour to an hour after eating dairy products. Plus, a peristaltic sound created by the movement of intestinal contents - borborygmi or rumbling in the abdomen and diffuse pain can be observed. It should be borne in mind that with age, lactase synthesis decreases, so these symptoms appear more often.
In cases of gluten enteropathy – intolerance to cereal gluten (gluten), also called celiac disease or non-tropical sprue, pathological changes in the intestinal mucosa can cause constipation, constant bloating and abdominal pain.
There are many ways to define maldigestion syndrome (from the Latin male - bad and digestum - to digest): as a syndrome of indigestion, intestinal malabsorption, and chronic pancreatic insufficiency. The pathogenesis of maldigestion is explained by a violation of food digestion in the stomach cavity - due to a lack of gastric pepsins (often - with a deficiency of the hormone gastrin) and pancreatic enzymes. Clinical signs of this syndrome: nausea, dyspepsia, pain in the upper abdomen and bloating, which can be almost constant, and pain is felt on the left and right in the hypochondrium.
In severe hyperglycemia, delayed gastric emptying or partial gastroparesis in patients with both types of diabetes is considered a manifestation of diabetic autonomic neuropathy, leading to gastric motility disorder. This condition may be referred to as diabetic gastropathy or diabetic stomach. Its most common symptoms include early satiety with food intake, abdominal discomfort, bloating and epigastric pain, nausea and vomiting.
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Bloating and abdominal pain in gastrointestinal diseases: causes and pathogenesis
Any pain in the abdomen must have a cause, and the causes of abdominal pain are most often hidden in diseases of one of the sections of the gastrointestinal tract or an organ of the digestive system - the pancreas, liver, gall bladder, which are considered auxiliary. But very often it is the functional disorders of these organs that are not only risk factors for digestive disorders, but also determine their mechanism and clinical picture.
To determine the etiology, the localization of pain and its nature, as well as the presence of other symptoms, are important. According to doctors, patients can cope with the definition of "how it hurts", but problems arise with indicating the exact place where the pain is felt. The fact is that when the stomach is bloated, there is a feeling of its distension and increase in volume, and the pain seems to be spread throughout the entire abdominal cavity.
Bloating and stomach pain (gastralgia) in most cases occur in patients with hyperacid gastritis. The campylobacter Helicobacter pylori, which causes inflammation of the gastric mucosa, produces an enzyme (urease) that neutralizes the acidic component of gastric juice through a cascade of biochemical reactions with the release of carbon dioxide. Therefore, after waking up, there is belching, bloating and abdominal pain. If gastritis has developed into an ulcer, the pain intensifies and becomes acute.
Accumulation of gas due to constipation, typical of hypoacid gastritis, can cause dull moderate abdominal pain and bloating in the morning.
With inflammation of the duodenum (duodenitis) and ulceration of its mucous membrane, pain is localized in the right hypochondrium, and bloating is accompanied by hyperhidrosis and general weakness. The nature and intensity of pain depends on the degree of damage: pain can be aching, but after eating, sharp pain in the abdomen and bloating most often occur.
The localization of pain, often accompanied by increased gas formation, is similar in patients with cholecystitis and/or gallstones, as well as with a kink in the gallbladder with bile stasis.
Liver diseases, primarily cirrhosis and malignant neoplasms (primary or metastatic), can cause bloating and pain in the right side.
Given the anatomical topography of the stomach and duodenum, as well as the variability of the location of the inflammatory focus in these structures of the gastrointestinal tract, gastritis and duodenitis can induce pain in the left hypochondrium and bloating. Inflammation of the pancreas - pancreatitis - can also manifest itself in this way. With all its types, with fatty degeneration of the pancreas or dystrophy of its parenchyma, the synthesis of enzymes (trypsin, amylase, lipase) is reduced, and the consequences of their deficiency are manifested in serious failures of the digestive process.
Pain in the left side and bloating with constipation are combined with intestinal adhesions or elongation of the sigmoid colon, which impair intestinal patency, or its inflammation.
The pathogenesis of partial small intestinal obstruction, which is accompanied by acute abdominal pain and bloating, is approximately two-thirds due to intestinal adhesions (scar tissue); in other cases, patients are diagnosed with hernia, granulomatous enteritis (Crohn's disease), and malignant tumors.
In patients with renal failure or chronic adrenal insufficiency, mineral metabolism and acid-base homeostasis are disrupted with the development of alkalosis and potassium deficiency in the blood. Hypokalemia negatively affects the functioning of the migrating myoelectric complex (ensuring cyclical increase in electrical potentials and contractility of the smooth muscles of the gastrointestinal tract) and leads to intestinal dyskinesia, and then to dynamic intestinal obstruction (intestinal obstruction) with severe pain and bloating.
Chronic inflammatory processes in the transverse colon, enteritis, duodenitis, pancreatitis and diverticula of the small intestine are most often associated with bloating and pain in the navel or in the navel area.
Belching after waking up, bloating and pain in the stomach and intestines (after eating or regardless of it), heartburn, nausea, moderate delays in gastric emptying or, conversely, its rapid emptying - without a detected gastroenterological disease - is called functional dyspepsia. Such a diagnosis is often made when it is not possible to determine the true cause of this condition and its pathophysiology.
The manifestations of such a disorder as irritable bowel syndrome are just as diverse, which is increasingly associated with its dyskinesia, causing pain in the epigastric region and bloating, spasmodic pain in the lower abdomen, diarrhea or constipation - depending on the intensity of intestinal peristalsis. And peristalsis (cyclic contractions of the smooth muscle fibers of the intestinal walls) is controlled by the body's own (local) autonomic nervous system, called enteric. It includes plexuses of afferent and efferent neurons in the walls of the digestive tract - from the esophagus to the anus. A relatively new field of medicine - neurogastroenterology - deals with problems of gastrointestinal motility (motility) disorders. And today this condition can be defined either as lazy bowel syndrome, or as intestinal atony, or as autonomic dysfunction syndrome (according to the international classification - somatoform dysfunction of the ANS).
Also, bloating and intestinal pain are included in the list of symptoms:
- dysbacteriosis (including after the use of systemic antibiotics),
- intestinal bacterial overgrowth syndrome,
- long-term inflammation of the colon or chronic non-ulcerative colitis,
- malignant tumors of the ovaries or uterus.
Abdominal pain can spread to adjacent anatomical structures – irradiate. Thus, bloating and lower back pain can be felt in acute pancreatitis and pancreatic adenocarcinoma, in patients with gastric prolapse. Acute cholecystitis, cholelithiasis, inflammation of the appendages in women, ectopic (extrauterine) pregnancy are accompanied by back pain and bloating. And among the symptoms of hiatal hernia, that is, hernia of the esophageal opening of the diaphragm, bloating and chest pain (in the chest area) are noted.
Risk factors
Considering that flatulence and abdominal pain are symptoms, the risk factors for their occurrence include intestinal infections and helminthiasis, the development (or presence) of the above-mentioned gastrointestinal diseases, metabolic disorders and enzymopathies.
And, of course, the risk of digestive disorders and gastrointestinal disorders is increased by poor nutrition, overeating, a low-fiber diet, alcohol, food poisoning, long-term use of antibiotics, and stress.
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Diagnostics bloating and abdominal pain
In gastroenterological practice, diagnostics are based on a comprehensive approach to identifying the causes of abdominal pain and flatulence and determining the specific disease or pathology causing these symptoms, taking into account the medical history and individual characteristics of each patient.
For detailed information on what tests and analyses are prescribed, how instrumental diagnostics are used – X-ray, endoscopic, ultrasound, computed tomography, magnetic resonance; what is the purpose of differential diagnostics, read the materials:
Treatment bloating and abdominal pain
In almost all of the above diseases and pathologies, treatment of abdominal pain can be both etiological and symptomatic.
We remind you that etiological treatment is treatment aimed at the cause. That is, in case of tumors, diverticula, adhesions, gallstones, surgical treatment is necessary (in cases of oncology - in combination with chemotherapy).
What to do with severe bloating? Read - Treatment of flatulence
Gastroenterologists recommend taking tablets for bloating and abdominal pain: for dietary errors - absorbent agents (enterosorbents); for increased gas formation in the intestines - so-called "foaming agents" (Simethicone, Espumisan, etc.); for dyspepsia and deficiency of digestive enzymes - Pancreatin (Festal, Creon, etc. trade names). Dosage, contraindications, possible side effects are detailed in the articles:
Pay special attention to Tablets for abdominal pain, since not all analgesics can be used in gastroenterology, and for gastrointestinal symptoms, antispasmodic drugs are indicated (No-shpa, Bellastezin, Mebeverine).
For infectious enteritis, other medications are prescribed, which are described in the article - Treatment of intestinal infection.
In cases of intestinal microbiota disorders, probiotics (drugs with bifidobacteria) are used to restore it. Read about which ones exactly – List of probiotics
Treatment of bloating at home is carried out in cases not associated with acute conditions (intestinal infection, exacerbation of gastritis, ulcers or pancreatitis). At the same time, the means used to relieve spasms of the gastrointestinal tract in homeopathy are used: Magnesia phosphorica and Magnesia carbonica, Nux vomica, Carbo vegetabilis, Caullophylum, Bryonia alba, Asafoetida (it helps more with stomach pain and flatulence). The dosage is determined by a homeopathic doctor on an individual basis.
Traditional medicine suggests fighting these symptoms with herbal teas and decoctions of medicinal plants. To reduce gas formation, it is recommended to take a decoction of dill, fennel or caraway seeds; chamomile flowers.
In addition, herbal treatment can be carried out using sweet clover, two-leaved orchis, naked hernia, large plantain (seeds), dandelion or chicory roots. Decoctions of creeping wheatgrass, knotweed, and soapwort help with constipation; and centaury and elecampane help with helminthiasis.
Complications and consequences
Experts say that over the past few decades, there has been an increase in the incidence of most gastrointestinal diseases, which have serious consequences and complications that affect the overall health of people, and in terms of the manifestation of symptoms, reduce their quality of life and level of daily activity.
Prevention
To maintain intestinal health, prevention should be aimed at changing the diet and nutritional principles that exclude increased gas formation: eating foods high in fiber and drinking enough water. And in the presence of diseases of the digestive organs and gastrointestinal tract - to follow a diet:
Doctors' advice: don't lie down after eating, move more, be less nervous, do yoga (in particular, learn diaphragmatic breathing), and do intestinal massage.