Many people with ankylosing spondylitis (AS) are surprised by symptoms of abdominal pain and bloating. In fact, more than 960 MySpondylitisTeam members have reported gastrointestinal (GI) symptoms that affect their digestion, stomach, or intestines. Team members frequently discuss bloating, with some wondering why they’re experiencing this symptom with AS.

“I was only diagnosed a couple of months ago,” one member wrote. “Do you get bloating and stomach pain along with the tendinitis?”

Someone else asked, “I was wondering, does anyone have stomach bloating and constipation?”

“My stomach is very bloated and I look pregnant,” said someone else. “Don’t know what that is about. I seem to be having lots of intestinal issues, gas, and bloat.”

Although medical researchers don’t fully understand the connection between AS and GI symptoms such as bloating, there’s evidence that inflammation associated with AS can affect the gut.

Ankylosing spondylitis is a type of arthritis also known as radiographic axial spondyloarthritis (axSpA). AS is a form of spondylitis (spondyloarthritis), a group of autoimmune conditions that primarily affects the neck, spine, and hips. Changes and deformities in bones from AS are visible on X-rays. Symptoms of AS include joint pain, lower back pain, and joint damage, but other parts of the body can also be affected.

If you have frequent bloating with AS, discuss your symptoms with your health care providers to be sure that you are managing the symptom as well as possible.

Ankylosing Spondylitis and the Gut

Researchers have found that people with autoimmune disorders such as rheumatoid arthritis, psoriasis, and AS have imbalances in their gut microbiome — the naturally occurring bacteria that support intestinal health and the immune system. When the gut microbiome isn’t healthy, damage to the intestine can cause bacteria and toxins to leak into the bloodstream in a condition known as leaky gut. Leaky gut has been linked to autoimmunity, in which the immune system mistakenly attacks healthy cells and tissues in the body.

In people with AS, gut dysbiosis — imbalanced gut bacteria — has been shown to cause abnormally low levels of gut bacteria and a lack of diverse gut bacteria. Rheumatology researchers are still trying to determine whether gut dysbiosis in people with AS may be due to inflammation from AS or if gut dysbiosis may cause AS to develop.

People with AS have a risk of irritable bowel syndrome (IBS) that’s nearly 2.5 times the rate of the general population. IBS can cause painful bloating and changes in bowel movements. It’s treated with a combination of dietary changes, medications that help regulate bowel movements, painkillers, and antidepressants.

Common gastrointestinal symptoms with AS include:

• Bloating
• Diarrhea
• Stomach pain
• Bloody stool

Research has shown that as many as 60 percent of people with AS have signs of microscopic gut inflammation without any GI symptoms.

Ankylosing Spondylitis and Inflammatory Bowel Disease

In some cases, bloating may be a sign of inflammatory bowel disease (IBD), an autoimmune disease that can be linked to AS. IBD includes Crohn’s disease and ulcerative colitis, both of which can cause damage in the intestines.

Between 5 percent and 10 percent of people with AS develop IBD, according to Cleveland Clinic, and approximately 20 percent of people with IBD develop AS. If you have persistent GI tract symptoms, your rheumatologist can refer you to a gastroenterologist who can do blood tests to see if you have IBD. For people with AS and IBD, it’s important that both their rheumatologist and gastroenterologist work together to determine an appropriate treatment plan.

“Wondering if anyone has ankylosing spondylitis that's related to Crohn’s. I’ve had Crohn’s for seven years and was diagnosed with AS last summer,” a MySpondylitisTeam member wrote.

“I too have Crohn’s! It’s interesting how so many different autoimmune diseases are linked together,” said another member.

One member shared their frustration with managing both IBD and AS: “I’m 75, but I have had problems with back, hip, neck, and shoulder pain, as well as GI problems, including ulcerative colitis for years.”

Depending on the severity of either condition and the level of disease activity, AS with IBD is typically managed with:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen
• Biologic drugs such as tumor necrosis factor (TNF) inhibitors
• Disease-modifying antirheumatic drugs (DMARDs)
• Lifestyle changes

Some biologic drugs work for both conditions. Both AS and IBD treatment options are aimed at managing symptoms and reducing disease activity in order to prevent tissue damage in the musculoskeletal system with AS or the gastrointestinal tract with IBD.

Bloating as a Side Effect of Ankylosing Spondylitis Medications

Bloating may be a side effect of some drugs used to treat AS. Ongoing use of NSAIDs for chronic pain in AS can cause stomach upset and irritation, which may feel like bloating. If an NSAID you’re taking causes bloating, your doctor may recommend a change to your NSAID or suggest adding an antacid or another medication to protect your stomach lining.

Bloating can also be a side effect of sulfasalazine (Azulfidine), a DMARD that’s sometimes used to treat AS. It’s good to discuss potential side effects in detail with your doctor before starting a new medication. If a side effect such as bloating becomes intolerable, you can ask them about other treatment options.

Lifestyle Changes To Manage Bloating With Ankylosing Spondylitis

If you experience bloating with AS, there are steps you can take to improve your physical and psychological well-being and boost your quality of life. Here are some ways to help relieve symptoms of bloating and improve your overall health.

Stay Physically Active

Regular exercise is typically an aspect of treating AS to promote good posture, balance, strength, and flexibility. Exercise and physical activity can also help some people reduce GI symptoms such as bloating.

“I’ve seen videos online for chair exercises,” one MySpondylitisTeam member wrote. “I feel worse when I’m not moving.”

Staying active can help reduce inflammation in the gut and improve immune function. Exercise and simple activities such as taking a walk, using stairs, or gardening can help decrease gastrointestinal symptoms. Exercise can also help improve cardiovascular health and weight management, and it may improve the effectiveness of medications.

Your doctor can give you a referral for physical therapy. A physical therapist can help you with movement and exercises that are right for your particular condition.

Drink Plenty of Water

Drinking water and staying hydrated are essential factors for maintaining diverse gut bacteria, good digestion, and intestinal health. Our cells depend on water for proper functioning. Drinking between six and eight glasses of water per day is associated with better health in general.

Maintain a Balanced Diet

Many health professionals recommend an anti-inflammatory diet, particularly for people living with chronic illnesses such as AS or IBD. An anti-inflammatory diet emphasizes nutrition-rich foods such as whole grains, fruits and vegetables, beans, fish high in omega-3 fatty acids, and healthy fats such as those found in olive oil and avocados.

Avoid foods that are associated with inflammation, such as:

• Refined sugars, sweets, and sugary drinks
• Refined carbohydrates such as white rice and white flour breads, pastas, and pastries
• Fried foods
• Red meat and processed meats such as sausage and hot dogs
• Saturated fats such as lard and margarine

If you have IBD, you may need to make adjustments to your diet during flare-ups. Always ask for medical advice if you are experiencing acute gastrointestinal symptoms.

Find Your Team

On MySpondylitisTeam, the social network for people with spondylitis and their loved ones, more than 93,000 members come together to ask questions, give advice, and share their stories with others who understand life with spondylitis.

Do you have ankylosing spondylitis and bloating? How do you manage your gastrointestinal symptoms? Share your experience in the comments below, or start a conversation by posting on your Activities page.