Eating problems after critical illness: My tummy feels swollen or bloated

Making changes to your diet can help or stop bloating. Changes that might help are:

• Not eating too much at a time as being too full can make your tummy feel uncomfortable.
• Chewing your food more.  This can make it easier for you to break down food and make it go through your body more easily. Chewing more means you don’t swallow so much air. Also, it makes you eat more slower which can stop you from eating too much in one go.
• Eating 5-6 smaller meals/ snacks per day, so you don’t get too full at any one time.
• try not to miss any meals or eat late at night.
• Eating less fat. Fatty foods can take longer to go through your body and means your stomach is full for longer, and this can cause bloating. Ways to have less fat include:
  • eating less fried or creamy foods
  • taking fat that you can see off meat before you cook it
  • grill or oven bake foods rather than frying them
• Hot drinks can help food to go through your body more easily, but drinks such as too much coffee can make bloating and stomach problems worse. Try to only have 2-3 cups a day of drinks with caffeine in them. Instead try mint or fruit teas or decaffeinated tea and coffees.
• Cutting down on what alcohol you have as this can also make stomach problems worse.
• Certain foods can make you have more wind (gas).  If this wind stays in your stomach (and it doesn’t pass through your body and come out as wind) it can make you feel uncomfortable and bloated. There are some foods which might give you more wind, so try to cut down on foods such as: 
  • beans and pulses
  • vegetables such as brussels sprouts, cauliflower, garlic, onions, cabbage, leeks, mushrooms
  • fruit such as apples, cherries
  • some artificial sweeteners such as xylitol, sorbitol and mannitol which are commonly added to sugar-free products like fruit squashes, mints or chewing gum.

If you cut down these foods, but it doesn’t help your bloating, you can start eating them again.

• Eating more soluble fibre. You could eat more oats or oat bran (such as oat‑based breakfast cereal or porridge) or try adding linseeds or flaxseeds (starting with ½ tablespoon a day and building to 1 tablespoon twice a day as required). Make sure you drink an additional 200ml water with each tablespoon of seeds that you add so that you don’t get constipated.
• Consider trying probiotics. There are many different products available in either drink, powder or tablet form (generally called a probiotic). Choose a product high in bifido bacteria and try it for 1 month. If it doesn’t help, you can stop having it.

There are lots of things that affect how our stomach and gut works, including how we feel and the relaxation or exercise we do.

Lifestyle tips to try are:

• Noticing how stress affects you and your body. In some people, stress slows down how food goes through your body, which can cause bloating, pain and constipation or it can cause an upset stomach and diarrhoea. Stress can make you not feel like eating, or it can make you gulp air. It can be difficult to avoid all stress but having ways to help you manage the stress can be really useful. For example, when you are tense, practise slow breathing or mindfulness exercises. If you are feeling very anxious, stressed or unhappy then it may help to try and calm yourself before eating. Try to keep mealtimes happy and relaxed and put off any difficult conversations until after a meal.
• Wear clothes that are not too tight around your waist, as these can increase the pressure on your stomach and make it harder for wind to pass along normally.

• Avoid swallowing extra air. It can help to:

• cut back on chewing gum
• eat and drink more slowly
• chew your food more
• don’t smoke
• make sure your dentures (false teeth) fit well if you have them, because this may affect how you chew and swallow your food.

• Having a warm bath, and spend time soaking, and relaxing. The heat of the bath can help a sore tummy. Doing this and finding other ways to relax can help you feel less stressed and this helps your stomach.
• Consider counselling to talk about the things that you are finding difficult or stressful. There may be things about your critical illness that you are upset about and need support with.

Exercise and massage might help bloating and wind.  For example:

• If you are able, try to move about regularly. If you are able to walk, get up to stretch your legs and tummy regularly (at least every hour). Stretching out by lying flat may also help you.
• Try to take regular exercise to help food to move through your body. This may be a walk if you are able to, or other movement exercises that you can do.
• Yoga poses may help if you can do them and if it is safe for you to do so. Certain yoga poses can help you release wind from your stomach. Poses such as Child's Pose, Happy Baby Pose, Knees to Chest pose and squats can all help pass wind through your bowels and out.
• Gently, but firmly, massage your lower stomach from right to left to release trapped wind. Ask a doctor before trying this if you have had any surgery on your stomach.

If these tips haven’t helped, you can try medicines to help your bloating. There are different options such as:

-        peppermint oil capsules, which can work by relaxing the gut muscles, allowing gas and poo to move along more easily. If you get heartburn you may want to avoid taking extra peppermint. Talk to your doctor or nurse about this if you are unsure

-        antispasmodics. These help the gut to relax so they can help wind to come out

-        antacids. These can help to reduce heartburn and can also affect your bloating

-        anti-flatulence treatment. These can help to reduce the pressure of trapped wind and help your stomach feel more comfortable.

Ask your GP or pharmacist for more information about what medicines might help you.

If your bloating continues, you are losing weight, or have pain and diarrhoea with it, speak to your GP.  There may be a reason for your bloating such as food allergies, intolerance or Irritable Bowel Syndrome.