Bloating post feed

[ManjiB]

This post is looking for pointers on likely causes of bloating during/post feed.

As Carer for someone whose care needs are fully managed including feeding, I am on occasions finding it hard to know what to do when Cared for (Mum) becomes bloated which results in discomfort and irritability etc.

There doesn’t seem to be an obvious cause and it doesn’t happen all the time which makes it difficult to nail down the cause and how to manage.

There are days when everything is fine, but then seemingly out of the blue, part way into the feed Mum will start to get bloated and this is not always flagged i.e. she won’t start calling out to alert of discomfort but if left unattended, by the end of the feed, she will have wriggled her way down the riser recline in which she sits for her meals and she might slide down so far, she might almost be horizontal!

She is nil-by-mouth and PEG fed which means she can’t refuse food, or at least we have never known her to refuse because she knows the procedure whereby a feed bottle is connect to the feed pump and then connect to the PEG tube leading into her tummy means feeding time. In fact on occasions she will point to the pump as if to say “Let’s eat!”

The point:

1. What might be causing the bloating?
2. Should I skip feeds when she is bloated - it’s not nice seeing her uncomfortable and effectively “force feeding” her by continuing the feed per the care plan feeding times. I have done that a few times and given her only water to make sure she remains hydrated.
3. The dietician has suggested gut bacteria imbalance and so we have in the past given her actimel and currently we are giving her BioGaia Baby drops which are lactic acid bacteria drops with L-reuteri.
4. I don’t want to deprive Mum of her daily calories, but I wonder if she might benefit from a “rest” day as in when people fast (I myself do this).
5. What harm can skipping a meal or two do?

The baby drops seem to help but they don’t stop the bloating hence this post. Despite the use of the drops, I am now dealing with a bloating episode.

Hopefully this makes sense and someone might have a few pointers.

Thanking you in advance.

Namaste|

[EmeraldEyes]

Just a quick one off the top of my head.
Try giving her cooled mint tea after feeds. I usually have mine hot because the heat also help helps with dispersal. The Pukka Three Mint Tea variety is my favourite

Which leads nicely onto to, a hot water bottle on the tummy to ease bloating.

Another one is ages old, Gripe Water, you can get it in most chemists and supermarkets…usually found in the baby products aisle. Its what we used for my son as a baby because he was a bit of a guzzler when it came to feeding time

Got to go now, taking my hubby to the tip…I take him to all the best places in town

Lorraine

[ManjiB]

Thanks Lorraine - Gripe Water was something we looked at when Mum first came back post-stroke but I think the GP poo pooed the idea and the dietician at the time offer anything until much later when she suggested Actimel/Yakkult.

I will try Gripe Water and the hot water bottle too - Does this go on the tummy during the feed to prevent the bloating or after the bloating has started.

Mint tea might be tricky due to the volume - I assume you drink a cup full which would be 200 ml or so? Mum’s total fluid intake is 1500 ml of which 700 is Ensure feed and 700 as pre-post feed flushes to keep the PEG tube clear. That leaves 100 ml which we use to give her asprin and HyFiber. It’s a tight ship what we run

Tips are a potential treasure trove. I was hooked on a programme called “Money for Nothing” on the TV. You may have seen it - the presenter (Sarah Moore at the time, but she moved on and others took over) used to rescue stuff people were discarding and then re-cycle or up-cycle and then sell. The money (if profit) was given back to the people who binned the rubbish and they usually donated to a charity.

I hope your hubby wasn’t rescued and taken away from you - that makes it sound horrible, but I mean it in the nicest way as in he’s a treasure - am I making it worse? I’ll quite while behind

[Mrs5K]

I too was hoing to suggest something with mint in it but don’t know how you’d incorporate it through a PEG. I can’t remember but did you say your mum will take water by mouth sometimes ? If so could you add a little something to it.

Have you kept a diary to try & identify if there’s a pattern. Maybe a particular flavour ensure drink.

Gripe water may help too.

Is she toileting ok?

You ask could she miss a feed. Maybe but not regularly as I imagine she is only having just enough calories a day as it is. Could you split the feedsinto smaller chunks instead? If she is bloating perhaps stop then finish the rest later. That might not be possible with a PEG but a thought.

Actimel or similar may also help.

[EmeraldEyes]

The Gripe water will do the same job as the mint, there is also peppermint water, which also does the same thing. You only need 2 teaspoons of that, 5ml, so that could go in the water for her medications.

The hot water bottle is best after her meals. Alternatively you could use an electric heat pad. Though my daughter doesn’t rate them as you can’t get enough heat out of them to do that particular job. She still swears by the hot water bottle, as do I, for bad period cramps.

Maybe you could try reducing how much HyFiber you give to see if that helps?

I’ve seen that programme you talk about and one of brothers has done quite a bit that with old furniture to refurbish his home over the years, it’s very impressive

And I kept a tight hold of on my hubby at the tip He’s just retired last week so is still on a bit of a high and has all sorts of plans I’m finding hard to keep up with

Lorraine

[ManjiB]

Hi Ann and Lorraine,

Thank you both for your feedback and suggestions.

We do log everything but nothing is leaping out. We had problems with banana and chocolate flavour feeds including the viscosity which was causing the PEG tube to get blocked which is very scary for us and so we stopped using those flavours.

Interestingly Mum’s PEG tube now “by-passes” the stomach and goes right down to the dudenum. This was done last September when we took her to A&E following a blockage and when we had that horrendous time being told by the gastric specialist consultant he would not replace Mum’s tube as it was too risky. I did write up about this and so won’t repeat it here. This means that there may be differences in how the food is digested etc but I am afraid I don’t now too much about that as I/we feel there is not much we can do about this until and unless Mum starts eating by mouth.

In the last two/three weeks we have managed to get Mum to take water by mouth - I use a tablespoon. The water is cooled boiled water as we are worried about the water going into her lungs if she has a mishap. Also, we are doing this off our own backs as the SaLT gave up on Mum and whenever we try to get any help for Mum the GP is not very helpful and they are our point of contact e.g. for referrals etc.

But with a positive result i.e. Mum is happily taking the water, we are slowly building on it by adding a bit of ribena flavour as well as vanilla ice cream. Just tiny amounts on her lips so she can lick and taste them. It’s really lovely to see her react to this and she seems to be enjoying it.

We will continue a bit longer before asking for a SaLT referral - there is a risk we might get ticked off for going off care plan - nil by mouth.

The idea of smaller feeds is what we do when she gets bloated - we just stop and wait until she is settled. This is why I asked about missing feeds because sometimes at the end of the day when this happens she is down on her calorific intake though we ensure she gets the fluids by giving her water to compensate.

Lorraine - thanks for digging out the HyFiber info. Mum has been using HyFiber for over a year now and things were / have been stable and she took to it quite well and it (HyFiber) definitely made her life more comfortable as he stool was more formed.

But interestingly enough last month Abbott’s the feed company ran out of her Ensure Fibre feed (I mentioned this to Ann) and as a result we ended up, on instruction from the dietician increasing the HyFiber and it did cause problems so we cut it back after discussing with the dietician. So you are right to flag it as a possible cause

Mum is normally on the lowest doses of most things as she is tiny. The BioGaia baby drops we are using now are a replacement for the actimel and are normally for babies (Mum is our baby )

Thanks again for your time and input.

The takeaway from this for me is the Gripe Water and the hot water bottle.
With Mum being finely tuned, the smallest change can (and does) cause the biggest problems - the Fibre feed outage and HyFiber being the latest. It does take a while for her to be tuned up again but I think we are getting there.

The fact she is taking water orally and seemingly enjoying it is as huge relief for us - the PEG tube is the highest risk element in her current care plan and to be able to do without it would be a huge benefit.

I have also booked a physio and will ask him if there are any particular exercises Mum might do to help with her bloating. I know there are QiGong and Tai Chi things you can do to help release trapped gases but I have not been successful in trying to do this for Mum.

Sorry for the chapter and verse but I can get carried away at times.

Take care

[EmeraldEyes]

Some other things you can try: one is massaging mum’s tummy, she needs a good tummy rub .
Using the heels of your hands, lightly press down and slide your hands from side just below her ribs to the middle of her abdomen. The from side waistline to middle; then top of hip bone to middle. Alternating hands first left hand then right, left right left right. Only ever work your way down, you don’t want to encourage things to go in the wrong direction.

The other is rocking her lower body side to side. Mum would need to be lying down for this.
With knees together and feet flat on bed, gently roll her to the right 'til her left hip lifts a little then roll to the left 'til her right hip lifts. And just keep rocking her back and forth like that for a minute or two. And you might even rock her to sleep That’s one I remember my brother and sister-in-law used to do for their son who had muscular dystrophy and often had such issues.

Do you think she might be able to suck on a small stick of seaside rock, providing you held it, that’s usually mint

Lorraine

[Sue1958]

Bloating and wind can be caused by constipation, check that first, an allergy to food but seeing she’s being fed this way I’d say pretty unlikely I’m not a medic, but maybe speak to your GP