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Are you feeling too swell?

 You know the feeling. Your tummy is stretched, puffy and uncomfortable, your back hurts, you feel irritable and you just want to curl up until it goes away.

Most of us experience a bit of bloating from time to time, especially after a big weekend or during the festive season, but for some it's a much more serious problem.

Over 70 per cent of women consulting nutritionists say that bloating is a feature of their problem with symptoms including a distended stomach to puffy skin and a tender abdomen.

According to experts, the causes fall into two main categories - distention, or protrusion, of the abdomen caused by excess gas or blockage, and swelling of the lower belly caused by fluid retention.

Here, we look at some of the more common causes and the best ways to get rid of bloating once and for all.

Food Intolerance
According to GP Dr Mayur Lakhani, food intolerance is an increasingly important issue for doctors, who don't yet fully understand the condition.

Food intolerance can lead to abdominal distension, he says, if the bowel doesn't empty properly, the food causes gas or wind to be trapped in the gut or if too much gas is produced as a reaction to the food.

This can be uncomfortable and lead to soreness and a feeling of discomfort and bloating of the abdomen.

In some cases, says Dr Lakhani, abdominal bloating can point to a more serious underlying cause like fluid build up inside the gut, constipation or undiagnosed pregnancy which may require medical attention, but this is rare.

The main offenders for food intolerances, says Helen Heap of the Women's Nutritional Advisory Service, are wheat or gluten, dairy products, caffeine, alcohol and citrus fruits.

'In general, we eat too much of certain foods' she says, and if we don't give our bodies a break it can trigger bloating, although the exact reasons aren't yet fully understood. She suggests working out which foods are causing the effects by keeping a food diary, then cutting them out with an elimination diet.

Some people see an effect within the first couple of weeks of eliminating a trigger food, she says, whilst others may take longer. Usually, foods can be reintroduced after six months or so. If you're unsure of what to cut out, she says, you should seek help.

It's important to get enough carbohydrate in your diet and cutting it out completely is not a good idea, she says. However, some people find that eating lighter meals or eating one carbohydrate free meal a day helps to reduce the effects of bloating.

Easy ways to do this, says Heap, are to substitute fruit and yoghurt for morning cereal or cook an extra portion of vegetables to replace rice, pasta or potatoes with an evening meal.

For more information on food intolerance, contact the British Allergy Foundation on 0208 303 8583

Dehydration
Strange as it may seem, not getting enough fluid in your diet can actually lead to fluid retention and bloating.

What's more, fluid retention can be exacerbated by eating salty foods and other 'diuretic' substances like caffeine, alcohol, fizzy drinks and fruit juice which encourage the cells to suck water in, leading to bloating and distension.

The most important thing to combat dehydration and bloating is to drink lots of water. Eight to ten glasses a day (this is roughly equivalent to three mouthfuls every half hour) will keep your fluid levels topped up and allow your body to beat the bloat.

Irritable Bowel Syndrome
Irritable Bowel Syndrome, or IBS, is an intestinal disorder which affects nine million people in the UK. It can lead to a painful, bloated stomach as well as other symptoms like wind, diarrhoea, abdominal pain, constipation, heartburn and nausea.

In IBS, bloating is due to excess wind trapped in the abdomen because of a blockage or over-production of gas, says Dr Lakhani. General treatments for IBS include change in the diet to include more fibre (found in wholegrains, fruit and vegetables) and cutting out any foods which might be triggering symptoms.

Foods which may cause problems are spicy and fatty foods, cheese, citrus fruit, green vegetables, onions and leeks, beans, lentils, chocolate and other high sugar foods, fruit juice, alcohol, milk, red meat, coffee and refined carbohydrates.

Peppermint, in the form of tea, capsules and infusions has been reported to relieve symptoms in some cases. It is also important to chew food properly and avoid rushing or skipping meals.

Although gas distension is thought to be the main factor in IBS bloating, some experts believe fluid retention may be a factor as well. 'If there is a food intolerance', says Helen Heap, 'it is possible that the body, instead of recognising the food as a food, thinks it is a toxin and triggers a reaction in which the cells fill up with fluid as a defence to flush the toxins away.'

She recommends drinking lots of water to help combat symptoms and cutting out offending foods.

For more information on IBS treatments go to www.colpermin.com. Contact the Women's Nutritional Advisory Service on 01273 487366 or go to www.wnas.org.uk

Pre-menstrual syndrome
Many women experience bloating due to fluid retention at some point in their menstrual cycle. For most, this is due to higher levels of the sex hormone progesterone in the week or so before the period, says Dr Lakhani.

In some cases, he says, fluid retention is not confined to the abdomen and breasts but can also affect the face, ankles and hands in a condition known as cyclical oedema.

Caffeine, wheat and salt are all diuretics, which trigger the cells to hang on to fluid, so cutting back on them can help reduce fluid retention. As well as not adding salt to meals, says Helen Heap, cut back on processed foods which are high in salt and eat lots of fruit and vegetables which contain fluid-reducing potassium.

For more information on PMS, contact NAPS on 01732 760012 or go to www.pms.org.uk

Candida
Candida is a yeast which grows naturally in our bodies but in some people certain factors - like stress, hormone imbalances and over use of antibiotics - can lead to overgrowth which can cause a range of symptoms including tiredness, headaches, digestive problems and bloating.

The good news, says Christine Tomlinson of the National Candida Society, is that diet and supplements work to alleviate symptoms in over half the people affected. A diet to combat candida is based on reducing sugar which effectively starves it, halting growth. Dairy products and wheat may be reduced or cut out completely.

In addition, anti-fungal drugs (or herbs) are taken to kill the overgrowth and acidophilus supplements given to re-populate the gut with 'friendly' bacteria. If the condition is longstanding, it might be necessary to take some multivitamin or mineral supplements to build up the body's immune system.

For more information on practitioners, treatments and tests contact the National Candida Society on www.candida-society.org.uk