Although ulcerative colitis (UC) is best known for causing symptoms like abdominal cramps, fatigue, and rectal pain, bloating is also common. While it may not be the most disruptive UC symptom you’ve encountered, bloating can be extremely uncomfortable and potentially preventable if you learn to address its potential causes and find treatments that can alleviate it.
“Ulcerative colitis [causes] “It often accompanies other symptoms like urgency and pain.”
Research suggests that even without UC, bloating is a widespread health problem: A survey of nearly 89,000 Americans found that nearly 14 percent reported experiencing bloating in the past week. People with digestive disorders were more likely to experience bloating, and conditions such as UC were also associated with more severe bloating.
Although it can be common, bloating doesn’t have to be inevitable when you have UC, and your doctor may be able to help. Here are four tips for prevention and relief.
1. Talk to your doctor about medications
The first step to relieving UC bloating is making sure your condition is properly managed, says Dr. Dibba. “Medications to reduce inflammation in the gut can be helpful for bloating because when disease activity is controlled effectively, symptoms such as bloating should improve,” she says.
Medications used to treat UC include:
- Anti-inflammatory medications like corticosteroids and aminosalicylates that reduce existing inflammation in the colon (large intestine)
- Immunomodulators like azathioprine (Imuran) to control chronic inflammation caused by the immune system
- Targeted synthetic small-molecule drugs, including upadacitinib (Rinvoq), that work on specific parts of the immune system to reduce inflammation
- Biologic medications such as infliximab (Remicade), which prevent certain proteins in the body from triggering inflammation
- Antispasmodics that help relax the muscles of the digestive system to relieve cramps and bloating
For an over-the-counter option that just treats bloating, consider an anti-gas medication, says Dibba. These contain the active ingredient simethicone (sometimes called simethicone) and include brands like Gas-X, Alka-Seltzer, and Mylanta. They work by allowing small gas bubbles in the intestine to come together to form larger bubbles, which pass more easily to reduce bloating.
But Dibba says they won’t reduce UC-related inflammation, if that’s the cause of the bloating.
“Whether it’s an over-the-counter medication or a prescription medication, these should be used under the direction of a physician, and the treatment plan can be modified over time based on response and disease activity,” she explains.
2. Identify trigger foods
It may take some investigative work to determine which foods may cause bloating, because a food that’s a problem for you may not be a problem for someone else with UC, says Ashkan Farhadi, MD, a gastroenterologist at MemorialCare Orange Coast Medical Center in Fountain Valley, California.
“While there are individual differences in how diet affects each person with UC, certain foods have been shown to trigger symptoms in general,” he says. Common culprits include:
- Sweet treats like cookies, pies, candies, and pastries
- Foods high in insoluble fiber like raw kale, sunflower seeds, and unpeeled apples
- Fiber-rich vegetables like cabbage, cauliflower, Brussels sprouts and asparagus
- Sugar alcohols and artificial sweeteners such as xylitol, aspartame, sorbitol and saccharin
- High-fat foods like butter, fried foods, and cheese dishes
“Keeping a food diary is a good step here because you can track what you ate and relate it to any later symptoms such as bloating,” says Dr. Farhadi. “This is also helpful for discussions with your gastroenterologist, as these food diaries often show patterns of symptoms that could indicate that you may need a change in the management of your condition.”
3. Consider a low FODMAP diet
If bloating isn’t adequately controlled through medication and identifying problem foods, another step may be to temporarily switch to a low-FODMAP diet, says Dibba. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols.
“Basically, these are short-chain carbohydrates that the small intestine doesn’t absorb well,” she explains. “The end result is more gas, which then leads to bloating. But by eating foods considered low FODMAP, you may feel less gassy and have less bloating.”
Low FODMAP foods include:
- Eggs
- Certain cheeses like brie, cheddar and feta
- Almond milk
- Grains like rice, quinoa and oats
- Vegetables like potatoes, eggplant and zucchini
- Fruits like grapes, strawberries and blueberries
Foods high in FODMAPs include dairy, beans, wheat-based foods, and vegetables like onions, garlic, and asparagus. More detailed information on the low FODMAP diet is available from Monash University in Melbourne, where it was developed by researchers for people with digestive disorders, including irritable bowel syndrome (IBS).
People with UC who also have IBS tend to see improvement on the low-FODMAP diet, says Dibba. “For some people, adopting this diet may lead to discovering that they have IBS in addition to UC,” she says. “Fortunately, people with overlapping syndromes tend to respond well to this type of diet, so it should reduce symptoms.”
4. Eat smaller meals more often
Another strategy that could make a major difference is changing the amount and frequency of your diet, says Farhadi.
“Larger meals eaten close together mean food can sit in your gastrointestinal system longer, which can lead to bloating and gas,” he says. “It’s especially difficult if you eat a large meal before bed, because then you also add lying down to the equation, which slows down digestion even more.”
Smaller meals spaced throughout the day can aid digestion and allow for better absorption of nutrients, which in turn can help reduce inflammation, says Farhadi. When inflammation goes down, it can also reduce other symptoms such as abdominal cramps, fatigue and pain, he says.
“There is always an element of trial and error when it comes to ulcerative colitis and how the symptoms are managed,” says Dibba. “However, taking simple steps like chewing your food thoroughly, eating smaller meals, taking medications as directed, and identifying problem foods can all go a long way to preventing bloating and easing any bloating that does occur.”
Takeaways
- Bloating is an uncomfortable symptom of ulcerative colitis that may be linked to inflammation caused by the disease.
- Reducing inflammation overall is helpful in reducing symptoms, including bloating. So the first step is to see your doctor to confirm that your condition is being adequately managed with medication.
- Changing your eating habits by consuming smaller, more frequent meals or temporarily adopting a diet low in foods known to cause bloating can also help alleviate discomfort.
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