Usually benign. Persistent bloating in a woman over 50 is the exception that must not be missed.
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Bloating is one of the commonest reasons people see a GP, and one of the most dismissed. It is worth separating two things that get muddled:
They often occur together, but not always, and the difference guides what is going on.
The single most important thing on this page concerns women. Persistent bloating — present on most days rather than coming and going — is the commonest symptom of ovarian cancer, and it is regularly labelled IBS or "just hormones". Bloating on most days for three weeks or more, particularly over 50, needs a CA125 blood test and usually an ultrasound. Not reassurance.
Most bloating is not that. Most is IBS, constipation, food-related, or swallowed air — all manageable. But the pattern that matters is persistence, and it is easy to miss precisely because each individual symptom sounds trivial.
One thing we will say plainly: "candida overgrowth" and "leaky gut" are not diagnoses we can act on. The expensive protocols sold around them have no evidence base, and they delay finding what is actually wrong.
Individually vague, which is exactly the problem. What matters is persistence — most days, for three weeks or more:
Abdomino-phrenic dyssynergia. In some people with visible distension, the problem is not gas at all — the diaphragm pushes down while the abdominal wall relaxes outwards, so the same volume of gut contents produces a visibly swollen abdomen. It is a genuine, measurable phenomenon, and it explains the frustrating situation of obvious distension with normal scans. It responds to diaphragmatic breathing and specialist physiotherapy rather than to any dietary change, which is why elimination diets get people nowhere.
Bloating is assessed from the history plus a small set of tests, which works well remotely.
IgG "food intolerance" panels, hair analysis and "candida" or "leaky gut" testing have no diagnostic validity. They produce long lists of foods to avoid, cost a great deal, and reliably delay a real diagnosis.
A genuinely and progressively enlarging abdomen, a palpable mass, or bloating with weight loss — all of which need examination and imaging rather than dietary advice.
Coeliac serology, calprotectin, bloods — and CA125 in any woman with persistent bloating. Everything else follows from that being clear.
Frequently the whole answer, and frequently skipped because people do not consider themselves constipated. A trial of proper treatment — including the footstool position — resolves a great deal of bloating on its own.
The low FODMAP diet has good evidence, but it is a three-phase process — restrict, systematically reintroduce, then personalise — and it is not a long-term diet. Staying in the restriction phase narrows nutrition and gut bacteria. We refer to a dietitian rather than handing over an app.
Diaphragmatic breathing and specialist abdominal wall physiotherapy — the treatment for abdomino-phrenic dyssynergia, and worth knowing about when scans are normal and diets have not helped.
Go to A&E for:
Arrange an urgent appointment for:
Book a routine consultation for:
Two to four weeks of food, symptoms, bowel habit and — for women — cycle day. It identifies patterns you cannot see from memory, particularly delayed reactions to food eaten the previous day, and the cyclical pattern many women have. It is also considerably more persuasive at an appointment than "I'm always bloated".
Even if you go most days. Incomplete emptying causes bloating, and the footstool position — knees above hips, leaning forward — makes a real difference at no cost.
Persistent bloating in a woman is not something to explain away. The symptoms of ovarian cancer sound minor individually, and that is precisely why the diagnosis is often late. Bloating on most days for three weeks or more deserves a blood test and a scan — not a dietary experiment, and not a label.
Bloating is one of the areas where the most money is spent on the least evidence, and it is worth being direct about that.
What we will not arrange, and would advise against buying: IgG food intolerance tests, which are sold widely and which allergy societies across the UK and Europe explicitly state have no diagnostic value — they detect exposure, not intolerance, and lead to unnecessary and sometimes harmful dietary restriction. Also gut microbiome analysis marketed to the public, hair mineral analysis, and most probiotic protocols.
What is worth doing costs very little. Coeliac serology is a genuinely useful blood test and is under-requested — but it must be done while still eating gluten, which is why going gluten-free before testing is a common and frustrating mistake.
The low FODMAP diet has real evidence in IBS, but it is complex and should be done with a dietitian rather than from the internet — NHS dietetics is free on referral.
Where a consultation is genuinely worth paying for is arranging coeliac testing, blood counts and inflammatory markers quickly, and — in women — taking persistent bloating seriously rather than assuming IBS.
That last point matters most: persistent bloating occurring more than twelve times a month, particularly in women over 50, warrants a CA125 and ultrasound, because it is how ovarian cancer commonly presents and is commonly missed.
NICE CG61, Irritable bowel syndrome in adults, is the principal reference for functional bloating. It recommends first-line dietary and lifestyle advice, and specifies the blood tests used to exclude other causes — full blood count, inflammatory markers and coeliac serology.
NICE CG20 / NG20, Coeliac disease: recognition, assessment and management, recommends serological testing in people with persistent unexplained abdominal or gastrointestinal symptoms, and is explicit that gluten must be eaten in more than one meal a day for at least six weeks before testing.
NICE CG122, Ovarian cancer, recommends CA125 testing in women with persistent bloating, early satiety, pelvic pain or urinary urgency occurring more than twelve times a month — and in women over 50 with new IBS-type symptoms.
BSACI and EAACI both state that IgG food antibody testing has no role in diagnosing food intolerance, which is the basis for the position above.
British Dietetic Association guidance recommends the low FODMAP diet be delivered by a trained dietitian.
When it is persistent rather than intermittent. Bloating that comes and goes, worse by evening and settled by morning, is usually functional. Bloating present on most days for three weeks or more — particularly with early fullness, appetite loss or urinary urgency, and particularly in a woman over 50 — needs a CA125 blood test and usually a scan. These symptoms sound minor individually, which is exactly why ovarian cancer is diagnosed late.
That daily pattern is characteristic of functional bloating and IBS, and it is reassuring rather than worrying. It reflects gas accumulating through the day in a gut that is unusually sensitive to stretch. Constant swelling that does not settle overnight is a different matter and warrants assessment.
Get tested for coeliac disease first. The blood test only works if you have been eating gluten regularly for at least six weeks — cutting it out beforehand makes the diagnosis impossible to confirm, and that is one of the main reasons coeliac disease is missed for years. After that, a trial is reasonable.
No — "candida overgrowth" as a cause of bloating and fatigue is not a recognised diagnosis, and the tests and protocols sold around it have no evidence behind them. The same applies to "leaky gut" programmes. They are expensive, restrictive, and they delay finding what is actually causing the symptoms.
Possibly abdomino-phrenic dyssynergia — where the diaphragm pushes down and the abdominal wall relaxes outwards, producing visible distension from a normal volume of gut contents. It is real, measurable, and largely unknown outside specialist gastroenterology. It responds to diaphragmatic breathing and abdominal wall physiotherapy, not to dietary change — which is why elimination diets get nowhere.
Sometimes. Take one product for four weeks and stop if there is no benefit, rather than working through them indefinitely. The evidence is mixed and strain-specific, and it is easy to spend a great deal on this.
Cyclical bloating before a period, and through perimenopause, is genuine and common. But "it's hormonal" should not be the answer to bloating that is present every day — that is a different pattern, and it is one of the phrases that most often precedes a delayed diagnosis.
August 23, 2026
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