1. Abdominal bloating
31 Possible Causes of Abdominal
Bloating and Abdominal Pain
Dr. Yousef Elshrek

2. Definition
Abdominal bloating is a condition in which the
abdomen (belly) feels full and tight. The abdomen
may be visibly swollen (distended).
• Or, Abdominal bloating occurs when the abdomen
fills with air or gas. This may cause the area to
appear visually larger. The abdomen may feel hard or
tight to the touch. The condition can cause
discomfort and pain.
• Abdominal pain is pain that originates between the
chest and the pelvis. Abdominal pain can be cramplike, achy, dull, or sharp. It is often called
stomachache

3. • Common Causes
• Common causes include:
• Air swallowing (a nervous habit)
• Constipation
• Gastroesophageal reflux
• Celiac disease
• Irritable bowel syndrome
• Lactose intolerance and other food intolerances
• Overeating
• Small bowel bacterial overgrowth
• Weight gain
• The diabetes medication acarbose, as well as any medicine containing lactulose
or sorbitol, may cause bloating.

4. • More serious disorders that may cause bloating are:
• Ascites and tumors
• Celiac disease
• Dumping syndrome
• Ovarian cancer
• When the pancreas is not able to make enzymes
needed for digestion (pancreatic insufficiency)

5. • Home Care
• You may take the following steps:
• Avoid chewing gum or carbonated drinks, especially those with high
levels of fructose or sorbitol
• Avoid foods such as Brussels sprouts, turnips, cabbage, beans, and
lentils
• Do not eat too quickly
• Stop smoking
• If you have constipation, it should be treated.
• However, fiber supplements such as psyllium or 100% bran can make
your symptoms worse.
• You may try simethicone and other medicines you buy at the
drugstore to help with gas, but these medications are often not
helpful.

6. 31 Possible Causes of Abdominal
Bloating and Abdominal Pain
1. Lactose Intolerance
Dr. Yousef Elshrek

7. • Lactose Intolerance
I. Lactose Intolerance
• Lactose intolerance occurs when a person's small intestine can't break
down lactose.
• Lactose found in dairy foods.
• The condition can cause many gastrointestinal symptoms.
• What Is Lactose Intolerance?
• Lactose intolerance is the inability to break down a type of natural sugar called
lactose.
• Lactose is commonly found in dairy products, such as milk and yogurt.
• A person becomes lactose intolerant when his or her small intestine stops
making enough of the enzyme lactase to digest and break down the lactose
• When this happens, the undigested lactose moves into the large intestine.

8. • The bacteria that are normally present in the large intestine interact
with the undigested lactose and cause symptoms such as bloating,
gas, and diarrhea.
• The condition may also be called lactase deficiency.
• Lactose intolerance is very common in adults, particularly those with
Asian, African, Native American, or Mediterranean descent.
• The condition is not serious but may be unpleasant.
• Lactose intolerance usually causes gastrointestinal symptoms, such as
gas, bloating, and diarrhea, about 30 minutes to two hours after
ingesting milk or other dairy products containing lactose
• People who are lactose intolerant may need to avoid eating these
products or take medicines containing the lactase enzyme before
doing so.

9. • Types of Lactose Intolerance
• There are three main types of lactose intolerance, each with
different causes:
1. Primary Lactose Intolerance (Normal Result of Aging)
• This is the most common type of lactose intolerance.
• Most people are born with enough lactase.
• Babies need the enzyme in order to digest their mother’s milk.
However, the amount of lactase a person makes may decrease over
time.
• This is because as people age, they eat a more diverse diet and rely
less on milk.
• The decline in lactase is gradual.
• This type of lactose intolerance is more common in people with
Asian, African, Native American, or Mediterranean ancestry.

10. 2. Secondary Lactose Intolerance (Due to Illness or Injury)
• Intestinal diseases such as celiac disease and inflammatory
bowel disease or a surgery or injury to small intestine can
also cause lactose intolerance.
• Lactase levels may be restored if the underlying disorder is
treated.
3. Congenital or Developmental Lactose Intolerance (Being
Born With the Condition)
• In very rare cases, lactose intolerance is inherited.
• A defective gene can be passed from the parents to a child,
resulting in the complete absence of lactase in the child.
• This is referred to as congenital lactose intolerance.

11. • The baby will be intolerant of his or her mother’s milk.
• He or she will have diarrhea as soon as human milk or a formula
containing lactose is introduced.
• If it is not recognized and treated early on, the condition can be
life threatening.
• The diarrhea can cause dehydration and electrolyte loss.
• The condition can be treated easily by giving the baby a lactosefree infant formula instead of milk.
• Developmental Lactose Intolerance
• Occasionally, a type of lactose intolerance called developmental
lactose intolerance occurs when a baby is born prematurely.
• This is because lactase production in the fetus begins later in the
pregnancy, after at least 34 weeks

12. • What Are the Symptoms of Lactose Intolerance?
• The symptoms of lactose intolerance typically occur between
30 minutes and two hours after eating or drinking a milk or
dairy product, and may include
1. abdominal cramps
2. bloating
3. gas
4. diarrhea
5. nausea
• The symptoms can range from mild to severe.
• The severity depends on how much lactose was consumed
and how much lactase the person has actually made.

13. • How Is Lactose Intolerance Diagnosed?
• If you are experiencing cramps, bloating, and diarrhea after drinking milk or eating
and drinking milk products, your doctor may want to test you for lactose intolerance.
• Confirmatory tests measure lactase activity in the body. These tests include:
1. Lactose Intolerance Test
• This blood test measures body’s reaction to a liquid that contains high lactose levels.
2. Hydrogen Breath Test
• This test measures the amount of hydrogen in your breath after consuming a
drink high in lactose.
• If a body is unable to digest the lactose, the bacteria in your intestine will break it
down instead.
• The process by which bacteria break down sugars like lactose is called
fermentation.
• Fermentation releases hydrogen and other gases.
• These gases are absorbed and eventually exhaled.
• If the lactose is not fully digested , the hydrogen breath test will show a higher
than normal amount of hydrogen in your breath.

14. • Stool Acidity Test
• This test is more often done in infants and children.
• It measures the amount of lactic acid in a stool sample.
• Lactic acid accumulates when bacteria in the intestine ferment the
undigested lactose.
• How Is Lactose Intolerance Treated?
• There is currently no way to make a body produce more lactose.
• Treatment for lactose intolerance involves decreasing or completely
removing milk products from the diet.
• Many people who are lactose intolerant can still have up to a half cup
of milk without experiencing any symptoms.
• Lactose-free milk products can also be found at most supermarkets.

15. • Also, not all dairy products contain a lot of lactose.
• You may still be able to eat some hard cheeses (such as cheddar,
Swiss, and Parmesan) or cultured milk products (such as yogurt).
• Low-fat or non-fat milk products typically have less lactose as well.
• An over-the-counter lactase enzyme is available in capsule, pill,
drops, or chewable form to take before consuming dairy products.
• The drops can also be added to a carton of milk.
• People who are lactose intolerant and not consuming milk or dairy
products may become deficient in calcium, vitamin D, riboflavin, and
protein.
• Taking calcium supplements or eating foods that are either naturally
high in calcium or are calcium-fortified is recommended.

16. • The Long Term: Adjusting to a Lactose-Free Diet and Lifestyle
• Symptoms will go away if milk and milk products are removed from the diet.
• Learn to read food labels carefully to detect ingredients that may contain
lactose.
• Aside from milk and cream, look out for ingredients derived from milk, such as:
1. whey or whey protein concentrate
2. casein or caseinates
3. curds
4. cheese
5. butter
6. yogurt
7. margarine
8. dry milk solids or powder
9. nougat

17. • Many foods that you would not expect to contain milk may actually contain milk and
lactose.
• Examples include:
1. salad dressings
2. frozen waffles
3. non-kosher lunch meats
4. sauces
5. dry breakfast cereals
6. baking mixes
7. many instant soups
8. Milk and milk products are often added to processed foods. Even some nondairy creamers and medications may contain milk products and lactose.
• Lactose intolerance cannot be prevented.
• However, the symptoms of lactose intolerance can be prevented by eating less dairy.
• Most people who are lactose intolerant can still drink up to a half cup of milk without
having symptoms.
• Drinking low-fat or fat-free milk may also result in fewer symptoms.
• Try dairy milk alternatives such as almond, soy, or rice milk.
• Milk products with the lactose removed are also available.

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31 Possible Causes of Abdominal
Bloating and Abdominal Pain
2. Gastroesophageal reflux disease