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The other day I had a patient in his late 30s who complained of persistent bloating for over a month, alternate bouts of constipation and diarrhoea and occasional pain.

He said he would pop gas pills for relief but it would invariably return and that this constant uneasiness in his belly had begun to disrupt his daily functioning and moods. He got worried when he began to lose weight.

We ran all tests and found that he had developed pancreatic insufficiency, which means his pancreas was not producing enough digestive enzymes, crucial for breaking down fats, carbohydrates, and proteins and letting the body absorb nutrients. This results in bloating, greasy stools and weight loss. Now if he had only reported his bloating earlier instead of dismissing it as routine indigestion, we would have spotted the early signs of what was really causing the bloating.

1. Irritable Bowel Syndrome (IBS)

This is a functional gastrointestinal disorder that affects how the gut moves. Bloating in IBS is often due to increased gut sensitivity and abnormal muscle contractions in the intestines. It may fluctuate throughout the day and worsen with stress or certain foods. IBS is usually accompanied by constipation, diarrhoea or alternate between the two.

2. Lactose or Gluten Intolerance

With lactose intolerance, the body lacks the enzyme needed to break down lactose, leading to fermentation in the gut and gas. Similarly, gluten sensitivity can cause bloating, fatigue, diarrhoea, and nutritional deficiencies. These require immediate dietary adjustments.

3. Small Intestinal Bacterial Overgrowth (SIBO)

SIBO occurs when there is an abnormal increase in the number of bacteria in the small intestine. These bacteria ferment food before it's properly digested, leading to bloating, gas and often foul-smelling stools. SIBO can sometimes be triggered by previous gut infections, surgeries, or even prolonged use of certain medications. Treatment includes antibiotics and diet modification.

4. Ovarian Disorders and Hormonal Changes

For women, constant bloating may be linked to hormonal changes, especially around menstruation. However, persistent bloating outside of these windows, particularly if it's associated with pelvic pain or changes in appetite, may be a red flag for ovarian cysts or, in rare cases, ovarian cancer. This type of bloating is often described as a feeling of fullness or pressure in the lower abdomen and should not be dismissed as menstrual-related if it becomes a pattern.

5. Constipation

You might think constipation means just fewer bowel movements but it can also cause the abdomen to feel heavy, tight, or distended. When stool builds up in the colon, it not only increases abdominal girth but also leads to gas buildup and discomfort. Hydration, fibre intake and physical activity often help.

6. Pancreatic or Liver Conditions

While I mentioned a pancreatic condition above, conditions like liver cirrhosis can lead to fluid buildup in the abdominal cavity (ascites), which causes a persistent bloated or swollen belly.

When should you be concerned?

1) If bloating occurs daily or persists for several weeks
2) Is associated with unintentional weight loss
3) Comes with changes in bowel habits (especially blood in stool)
4) Is accompanied by nausea, fatigue, or abdominal pain

Your doctor may suggest blood tests, imaging, or a colonoscopy depending on your symptoms and risk factors.