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Flatus causes: Flatulence – Better Health Channel

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Flatulence – Better Health Channel

Flatulence, commonly referred to as ‘farting’, is caused by gas in the bowel. Ordinarily, the intestines produce between 500 and 2,000mls of gas, which is passed out of the anus at regular intervals. The gas, or ‘flatus’, consists of a number of gases including methane, nitrogen and carbon dioxide. The varying smell depends on the ratio of gases, which is influenced by the foods we eat.

Flatus is generated by swallowed air, digestion, high-fibre foods and the by-products of intestinal bacteria. Some digestive system disorders, such as irritable bowel syndrome, can produce excess gas.

Symptoms of flatulence

Passing wind is normal, but the amount varies between individuals and depends on a number of factors including diet. Some people pass wind only a handful of times per day, others up to 40 times, while the average seems to be about 15. Symptoms of excessive (or embarrassing) flatulence include:

  • passing wind often
  • smelly flatus
  • loud flatus
  • abdominal distension and discomfort
  • rumblings in the lower abdomen.

Causes of flatulence

Intestinal gas is a normal part of digestion. The gas is produced by different means, including:

  • Swallowed air – the mouth isn’t vacuum-sealed, so small quantities of air are swallowed along with food and liquid. The oxygen and nitrogen from the swallowed air is absorbed into the bloodstream from the small intestine, and any excess is allowed to continue its journey through the bowel for expulsion. ‘Air-swallowing’ often occurs in people who are anxious.
  • Normal digestion – stomach acid is neutralised by pancreatic secretions, and the resulting interaction creates gas (carbon dioxide) as a by-product.
  • Intestinal bacteria – the bowel contains a host of bacteria that help digestion by fermenting some of the food components. The process of fermentation produces gas as a by-product. Some of the gas is absorbed into the bloodstream and breathed out by the lungs. The remainder is pushed along the bowel.
  • High fibre foods – fibre is essential to the health of the digestive system, but it can create excessive gas. The small intestine can’t break down certain compounds, which means extra work for the gas-producing intestinal bacteria, and accompanying flatus. High-fibre diets should be introduced slowly to allow the bowel sufficient time to adjust.
  • Lactose intolerance – the body’s inability to digest the particular sugars found in cows milk will produce excessive amounts of intestinal gas. This is because the bacteria of the gut digest the sugars by fermentation, a gas-creating process.
  • Intolerance of short-chain carbohydrates other than lactose – certain people may be susceptible to gas production from fermentation of other carbohydrates such as fructose, present in many foods including honey, corn syrup and some fruits. These short-chain carbohydrates together are now known as FODMAPS.

Common complaints with flatulence

Some of the more unpleasant or embarrassing problems with flatulence include:

  • Loud flatus – this is caused by the muscles of the bowel forcing air through the tight ring of muscle at the anus. Suggestions include passing the air with less power, and reducing the amount of intestinal gas by making dietary adjustments.
  • Smelly flatus – the gas produced by bacterial fermentation can smell, depending on the food eaten. Suggestions include limiting common culprits such as garlic, onions, spicy foods and beer.
  • Excessive flatus – this is caused by swallowing air, eating high-fibre foods, lactose intolerance or some digestive disorders. Suggestions include reducing the amount of intestinal gas by making dietary adjustments and seeking medical advice.

Foods to limit to reduce flatulence

A healthy diet requires plenty of variety. Foods that tend to produce large amounts of flatus also contain essential nutrients and shouldn’t be eliminated. Limiting their consumption is a better option. Examples of foods that commonly cause flatulence include:

  • dairy products – such as milk, if lactose intolerance is present
  • dried fruit – raisins and prunes
  • fruit – apple, apricot, peach and pear
  • foods high in insoluble fibre – particularly seeds and husks
  • legumes – beans, peas, chickpeas, soybeans and nuts
  • vegetables – carrot, eggplant, onion, Brussels sprouts and cabbage.

Laxatives and flatulence

Many laxatives, including lactulose, sorbitol and some fibre preparations, also cause flatulence and should not be used regularly, except with medical advice.

Reducing intestinal gas

Suggestions to reduce the amount of flatus include:

  • Limit common food culprits.
  • Don’t suddenly increase the amount of fibre in your diet.
  • Reduce milk consumption if lactose intolerance is a problem.
  • Consider taking charcoal products or other over-the-counter preparations.

Seek medical advice for excessive flatulence

Some digestive system disorders, such as irritable bowel syndrome, can produce a sensation of excessive flatus. See your doctor if you experience unusual flatulence, abdominal pain, changes to toilet habits, or any other uncomfortable symptom associated with digestion.

Lactose intolerance can be diagnosed by a biopsy of the small intestine. This procedure is done by a specialist using an endoscope (camera attached to a thin flexible tube). The person is given a sedative. Intolerance to short-chain carbohydrates (FODMAPS) can be diagnosed by a breath hydrogen test. A test carbohydrate is ingested, and a series of breath samples are obtained over two to three hours to detect if abnormal fermentation is taking place.

Where to get help

Things to remember

  • Intestinal gas is a normal part of digestion.
  • Excessive flatulence can be caused by lactose intolerance, certain foods or a sudden switch to a high-fibre diet.
  • Flatulence can be a symptom of some digestive system disorders, including irritable bowel syndrome.

Flatulence causes & treatments – Illnesses & conditions

Excessive flatulence can usually be treated by making changes to your diet and lifestyle.

Several over-the-counter treatments are also available if your flatulence is becoming a problem.

Self care advice

Diet

You should try to avoid eating foods high in unabsorbable carbohydrates. For a list of these foods, see causes of flatulence. Certain processed foods should also be avoided as they can contain ingredients that cause flatulence, including:

  • any foods with artifical sweeteners
  • sugar-free sweets or chewing gum
  • fizzy drinks

However, it’s still important to eat a healthy balanced diet, including at least 5 portions of fruit and vegetables a day. Choose foods containing carbohydrates that are easy to digest. These include:

  • potatoes
  • rice
  • lettuce
  • bananas
  • grapes
  • citrus fruits, such as oranges
  • yoghurt

It’s important to note that people react differently to certain foods, so some foods listed above may still cause flatulence. You may find it useful to keep a food diary to see whether certain foods make your symptoms better or worse.

You may also find it useful to eat 6 small meals a day rather than 3 large ones. Smaller meals are easier to digest and may produce less gas.

There’s some evidence to suggest drinking peppermint tea can help improve the symptoms of flatulence. There’s also some evidence that small amounts of ginger can help with digestion or an upset stomach, which may be causing flatulence. However, pregnant women should consult their doctor before taking ginger.

Swallowing air

When eating, make sure you chew food slowly to reduce the amount of air you swallow. This will also help with digestion. Avoid chewing gum as it can also cause you to swallow more air than usual.

You should also give up smoking, if you smoke. Smoking can cause you to swallow more air than usual, and tobacco smoke can irritate your digestive system. See stop smoking for more information and advice about quitting smoking.

Exercise

Getting plenty of exercise can help improve the functioning of your digestive system and bowel. It has also been shown to help with bloating and the passage of gas.

Medications and other remedies

There are several over-the-counter remedies that can help treat the symptoms of flatulence, some of which are described below.

Charcoal tablets

Charcoal tablets are a type of medication available over the counter from pharmacists. The charcoal absorbs gas in the digestive system, which helps reduce symptoms.

Charcoal tablets may not be suitable for you if you are currently taking other medication. This is because the charcoal might absorb the medication and make it less effective. If you are taking other medication, ask your GP or pharmacist for advice before taking charcoal tablets.

Clothing containing activated charcoal, or charcoal pads placed inside clothing, can help absorb foul-smelling gas released during flatulence. These products can be purchased online.

Simethicone is another over-the-counter medication that can also sometimes help with gas problems.

Dietary supplements

Alpha-galactosidase is a dietary supplement that may help improve the digestion of carbohydrates and reduce symptoms of flatulence. It’s found in a product called Beano, which has been shown to have some effect in reducing flatulence and is available from some pharmacists and health food shops.

Probiotics may also be useful in treating flatulence. Probiotics are a dietary supplement, usually sold in liquid or capsule form, which encourages the growth of “friendly bacteria” in your digestive system.

The “friendly bacteria” should help digestion and reduce the symptoms of flatulence, particularly in people with irritable bowel syndrome (IBS). Probiotic yoghurts may also help, but avoid those with artificial sweeteners or added fibre.

Bowel incontinence – Illnesses & conditions

Treatment for bowel incontinence depends on underlying cause and the pattern of your symptoms.

Trying the least intrusive treatments first, such as dietary changes and exercise programmes, is often recommended.

Medication and surgery are usually only considered if other treatments haven’t worked.

The various treatments for bowel incontinence are outlined below. 

Continence products

You may find it helpful to use continence products until your bowel incontinence is better controlled. Most continence products are available for free on the NHS.

Anal plugs are one way to prevent involuntary soiling. An anal plug is made of foam and designed to be inserted into your bottom. However, they can be uncomfortable and they’re not really a long term solution.

If the plug comes into contact with moisture from the bowel, it expands and prevents leakage or soiling. Anal plugs can be worn for up to 12 hours, after which time they are removed using an attached string.

Disposable body pads are contoured pads that soak up liquid stools and protect your skin. They can be used in cases of mild bowel incontinence.

Single-use silicone inserts, which form a seal around the rectum until your next bowel movement, are also being investigated as a treatment option for moderate to severe bowel incontinence.

Your local NHS continence service can offer help and advice about continence products, and you don’t usually need a referral from your GP to make an appointment. These clinics are staffed by nurses who specialise in continence treatment.

When you’re out

  • Wear trousers or skirts that are easy to undo and have elasticated waistbands rather than buttons.
  • Disability Rights UK offers access to 9,000 disabled toilets around the UK with a Radar NKS key. The key costs £4.50 and is only sold to people who require use of toilet facilities due to a disability or health condition.

Dietary changes

Bowel incontinence associated with diarrhoea or constipation can often be controlled by making changes to your diet.

It may be beneficial to keep a food diary to record the effect of your diet on your symptoms.

Diarrhoea

The National Institute for Health and Care Excellence (NICE) has published dietary advice for managing diarrhoea in cases of irritable bowel syndrome. These guidelines can also be applied to people with diarrhoea associated with bowel incontinence.

The advice from NICE includes the following:

  • limit fibre intake from wholegrain breads, bran, cereals, nuts and seeds (except golden linseeds)
  • avoid skin, pips and pith from fruit and vegetables
  • limit fresh and dried fruit to 3 portions a day and fruit juice to 1 small glass a day (make up the recommended ‘5 a day’ with vegetables)
  • limit how often you have fizzy drinks and drinks containing caffeine
  • avoid foods high in fat, such as chips, fast foods and burgers

Constipation

A high-fibre diet is usually recommended for most people with constipation-associated bowel incontinence. Your GP can tell you if a high-fibre diet is suitable for you.

Fibre can soften stools, making them easier to pass. Foods that are high in fibre include:

  • fruit and vegetables
  • beans
  • wholegrain rice
  • wholewheat pasta
  • wholemeal bread
  • seeds, nuts and oats

Drink plenty of fluids because this can help to soften your stools and make them easier to pass.

Pelvic floor muscle training

Pelvic floor muscle training is a type of exercise programme used to treat cases of bowel incontinence caused by weakness in the pelvic floor muscles.

A therapist, usually a physiotherapist or specialist nurse, will teach you a range of exercises. The goal of pelvic floor muscle training is to strengthen any muscles that may have been stretched and weakened.

You’ll probably be required to carry out the exercises 3 times a day, for 6 to 8 weeks. After this time, you should notice an improvement in your symptoms.

Exercises to try

Check with your health professional before trying these at home.

First, pretend you’re trying to hold in a bowel movement. You should feel the muscles around your anus tighten.

Next, sit, stand, or lie in a comfortable position with your legs slightly apart.

  • Squeeze your pelvic floor muscles for as long as you can, then relax. Repeat 5 times.
  • Squeeze the muscles as hard as you can, then relax. Repeat 5 times.
  • Squeeze the muscles quickly, then relax. Repeat 5 times.

If you find these exercises too difficult, try fewer repetitions at first and build them up. If they get too easy, try doing more repetitions. You can do the exercises without anyone knowing about them, so they should be easy to fit into your daily routine.

Bowel retraining

Bowel retraining is a type of treatment for people with reduced sensation in their rectum as a result of nerve damage, or for those who have recurring episodes of constipation.

There are 3 goals in bowel retraining:

  • to improve the consistency of your stools
  • to establish a regular time for you to empty your bowels
  • to find ways of stimulating your bowels to empty themselves

Changes to your diet usually improve stool consistency (see above).

Establishing a regular time to empty your bowels means finding the most convenient time when you can go to the toilet without being rushed.

Ways to stimulate bowel movements can differ from person to person. Some people find a hot drink and meal can help. Others may need to stimulate their anus using their finger.

Biofeedback

Biofeedback is a type of bowel retraining exercise that involves placing a small electric probe into your bottom.

The sensor relays detailed information about the movement and pressure of the muscles in your rectum to an attached computer.

You’re then asked to perform a series of exercises designed to improve your bowel function. The sensor checks that you are performing the exercises in the right way.

Medication

Medication can be used to help treat soft or loose stools or constipation associated with bowel incontinence.

Loperamide is a medicine widely used to treat diarrhoea. It works by slowing down the movement of stools through the digestive system, allowing more water to be absorbed from the stools. Loperamide can be prescribed in low doses to be taken regularly over a long period of time.

Laxatives are used to treat constipation. They’re a type of medicine that helps you to pass stools. Bulk-forming laxatives are usually recommended. These help your stools to retain fluid. This means they’re less likely to dry out, which can lead to faecal impaction.

Enemas or rectal irrigation

Rectal irrigation or enemas are used when bowel incontinence is caused by faecal impaction and other treatments have failed to remove the impacted stool from the rectum.

These procedures involve a small tube that is placed into your anus. A special solution is then used to wash out your rectum.

Surgery

Surgery is usually only recommended after all other treatment options have been tried.

The main surgical treatments used on the NHS are sphincteroplasty and sacral nerve stimulation. Other treatments – such as tibial nerve stimulation, endoscopic heat therapy and artificial sphincter surgery – can also be used, but their availability on the NHS is limited.

An operation called a colostomy is more widely available on the NHS, but it’s only used if other treatments are unsuccessful.

These treatments are outlined in more detail below.

Sphincteroplasty

A sphincteroplasty is an operation to repair damaged sphincter muscles. The surgeon removes some of the muscle tissue and the muscle edges are overlapped and sewn back together. This provides extra support to the muscles, which makes them stronger.

Sacral nerve stimulation

Sacral nerve stimulation is a treatment used for people with weakened sphincter muscles.

Electrodes are inserted under the skin in the lower back and connected to a pulse generator. The generator releases pulses of electricity that stimulate the sacral nerves, which causes the sphincter and pelvic floor muscles to work more effectively.

At first, the pulse generator is located outside your body. If the treatment is effective, the pulse generator will be implanted deep under the skin in your back.

The most commonly reported complications of the procedure are infection at the site of surgery and technical problems with the pulse generator, which require additional surgery to correct.

See the NICE guidelines on Sacral nerve stimulation for faecal incontinence.

Tibial nerve stimulation

Tibial nerve stimulation is a fairly new treatment for bowel incontinence.

A fine needle is inserted into the tibial nerve just above the ankle and an electrode is placed on the foot. A mild electric current is passed through the needle to stimulate the tibial nerve. It’s not known exactly how this treatment works, but it’s thought to work in a similar way to sacral nerve stimulation.

NICE concludes that the procedure appears to be safe, although there are still uncertainties about how well it works.

See the NICE guidelines on Treating faecal incontinence by stimulating the tibial nerve.

Injectable bulking agents

Bulking agents, such as collagen or silicone, can be injected into the muscles of the sphincter and rectum to strengthen them.

The use of bulking agents in this way is a fairly new technique, so there’s little information about their long-term effectiveness and safety.

You should discuss the possible advantages and disadvantages of this type of treatment in full with your treatment team before deciding whether to proceed.

See the NICE guidelines on Treating faecal incontinence with injectable bulking agents.

Endoscopic heat therapy

Endoscopic radiofrequency (heat) therapy is a fairly new treatment for bowel incontinence.

Heat energy is applied to the sphincter muscles through a thin probe, to encourage scarring of the tissue. This helps tighten the muscles and helps to control bowel movements.

The National Institute for Health and Care Excellence (NICE) recently produced guidelines on this procedure. NICE concluded that the procedure appears to be safe, although there are still uncertainties about how well it works.

As well as the uncertainties surrounding this procedure, it is also expensive. Therefore, it is usually only used on the NHS during clinical trials.

See the NICE guidelines on Treating faecal incontinence using endoscopic radiofrequency therapy.

Artificial sphincter

An artificial sphincter may be implanted if you have bowel incontinence caused by a problem with your sphincter muscles.

This operation involves placing a circular cuff under the skin around the anus. The cuff is filled with fluid and sits tightly around the anus, keeping it closed.

A tube is placed under the skin from the cuff to a control pump. In men, the pump is placed near the testicles, in women it’s placed near the vagina. A special balloon is placed into the tummy, and this is connected to the control pump by tubing that runs under the skin.

The pump is activated by pressing a button located under the skin. This drains the fluid from the cuff into the balloon, so your anus opens and you can pass stools. When you are finished, the fluid slowly refills the cuff and the anus closes.

The use of an artificial sphincter is a relatively new procedure, so there isn’t much good-quality information about its long-term effectiveness and safety.

Possible problems include infection, injury during surgery and the cuff becoming dislodged. In some cases, further surgery is required to correct problems.

See the NICE guidelines on Treating faecal incontinence with an artificial sphincter inserted through a cut in the abdomen.

Colostomy

A colostomy is usually only recommended if other surgical treatments are unsuccessful.

A colostomy is a surgical procedure in which your colon (lower bowel) is cut and brought through the wall of your stomach to create an artificial opening. Your stools can then be collected in a bag, known as a colostomy bag, which is attached to the opening.

Flatulence: Causes, remedies, and complications

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Flatulence is a buildup of gas in the digestive system that can lead to abdominal discomfort. Most people experience flatulence.

Excessive flatulence can cause discomfort and distress. It often occurs as the result of eating certain foods, but it can be a sign of a more serious condition.

In most cases, a change of diet and lifestyle can help control excessive gas.

When we eat, drink or swallow saliva, we also swallow tiny amounts of air.

This swallowed air accumulates in the gut.

The gas within our digestive system consists mainly of nitrogen and oxygen.

When we digest food, gas, mainly in the form of hydrogen, methane, and carbon dioxide, is released.

As the gas builds up, the body may need to eliminate it, either through the mouth, by belching, or by passing wind through the anal passage.

Flatulence often occurs without the person being aware of it. There is no smell, and the amount is tiny. When there is a smell, there are usually small amounts of sulfur gases. If food has not been properly digested, it starts to decompose, releasing sulfur.

Flatulence can be the result of normal bodily processes, or it may stem from a condition that affects the digestive system.

Exogenous sources are those that come from outside. We swallow air when we eat, drink, or swallow saliva, especially when excess saliva is produced, due to nausea or acid reflux.

Endogenous sources are inside the gut. Gas may arise as a by-product of digestion of certain foods, or when foods are not completely digested.

If any food is not digested completely by the stomach or the small intestine, flatulence can occur when it reaches the large intestine.

Why do some foods cause more gas?

Foods that cause flatulence tend to be those high in certain polysaccharides, particularly oligosaccharides, such as inulin. Inulin belongs to a class of dietary fibers known as fructans.

Examples of foods that can worsen flatulence include:

  • vegetables such as artichokes, broccoli, leeks, cauliflower, cabbage, garlic, onions, beans, Brussels sprouts, and turnips
  • cereals, such as wheat or oats
  • pulses, including beans and lentils
  • dairy produce
  • yeast in baked products, such as bread
  • cashews

Here are some reasons why some foods cause more gas, but there are others.

Share on PinterestBeing aware of foods that cause excess flatulence can help reduce the problem.

Beans: Complex carbohydrates in beans are difficult for humans to digest. They are digested by microorganisms in the gut known as gut flora, which produce methane. When the complex carbohydrates reach the lower intestine, bacteria feed on them and produce gas.

Lactose intolerance: When people consume food that contains lactose, such as milk, and lack the enzymes to break it down, the bacteria feed on the lactose. In some people, this produces large amounts of gas.

Celiac disease: Intolerance to the protein gluten means that some people have excessive flatulence when they consume barley, wheat, and rye.

Artificial sweeteners: Sorbitol and mannitol are found in candies, chewing-gums, and sugar-free sweet foods. Some people develop diarrhea, gas or both when they consume these substances.

Fiber supplements: Adding these too rapidly to the diet can cause flatulence, especially if they contain psyllium.

Carbonated drinks: Fizzy drinks and beer may cause a build-up of gas in the intestinal tract.

Anyone who is concerned about how their diet may be causing flatulence should ask a doctor or a qualified dietitian for advice.

Conditions that can worsen flatulence

Underlying health conditions: Some chronic conditions can cause flatulence, for example, Crohn’s disease, ulcerative colitis, or diverticulitis. Some types of cancer can lead to a blockage in the intestines. Anyone who experiences a sudden or worsening increase in flatulence should see a doctor.

Gallbladder problems: Gallstones and cholecystitis can cause additional gas.

Constipation: Feces can make it harder to expel excess gas, resulting in further accumulation and discomfort.

Gastroenteritis and other intestinal infections: A viral, bacterial, or parasitic infection of the digestive system, or food poisoning, can cause a buildup of gas. Examples include Escherichia coli (E. coli) infection, amebiasis, and giardiasis.

Antibiotics: These can upset the normal intestinal flora, or bacterial flora, in the gut, leading to flatulence.

Laxatives: Regular and excessive use of laxatives can increase the risk of developing flatulence.

Other causes include pregnancy, a hernia, pancreatitis, Hirschsprung disease, premenstrual syndrome, endometriosis, and others.

If there are signs of poisoning or a blockage, or if there is blood in the feces, urgent medical attention is needed.

Flatulence is not usually a serious problem. In most cases, a change in lifestyle and diet is all that is needed.

Diet and digestion

Flatulence can be avoided by not eating foods that are likely to cause it, such as those containing high levels of carbohydrates that cannot be absorbed.

Foods containing carbohydrates that are easier to digest include:

Remember, if you cut out certain foods, you need to make sure that what is left can meet your daily nutritional requirements.

Other tips

Other ways to reduce flatulence include:

Eating smaller meals: Symptoms often improve if the person eats four to six smaller meals each day, rather than three large ones. Peppermint tea may help.

Eating slowly: Digestion starts in your mouth, so food should be chewed thoroughly before swallowing.

Avoiding gum and carbonated drinks: Chewing gum makes people swallow more air. This can increase flatulence.

Not smoking: Smoking causes people to swallow more air, and it can also irritate the digestive system.

Choosing low-lactose dairy products: Eliminating foods high in lactose may improve symptoms.

Choosing beans that are fermented before cooking: These have less soluble fiber and a higher nutritional content and may decrease flatulence.

Doing exercise: Activity enhances the functioning of the digestive system, and this can help reduce gas and bloating.

Charcoal pads: Placed inside clothing, these absorb released gas and reduce the impact of foul-smelling gas. These are available to purchase online.

Probiotics: These may reduce symptoms in some people. Probiotic supplements are available to purchase online from different brands.

If lifestyle and dietary changes are not enough to remove flatulence, over-the-counter (OTC) medications may help.

Charcoal tablets are available at pharmacies and online. Charcoal absorbs gas in your gut, and reduces the symptoms of flatulence.

Anyone on existing medications should first check with their physician, because charcoal may also absorb some of the active ingredients. Not all health professionals recommend using charcoal, as the benefit is unclear.

Other OTC remedies include Beano, a product that helps break down complex carbohydrates. It may be useful after eating beans. Beano is available to purchase online.

Persistent pain and discomfort, social embarrassment, and stress are the main complications of flatulence.

However, it may be a good idea to seek advice if:

  • excess amounts of gas accumulate
  • flatulence occurs frequently
  • symptoms start to become more severe
  • gas is often released involuntarily
  • there is a consistently foul smell
  • additional symptoms indicate a possible underlying digestive condition
  • sharp, jabbing pains, or cramps, occur in the abdomen, and the pains change places
  • there is a bloated feeling or knotted sensation in the abdomen

Severe and persistent flatulence can be a sign of an underlying condition, such as irritable bowel syndrome (IBS).

Diagnosis

A doctor can help discover the underlying cause of flatulence and suggest ways to relieve symptoms.

They will ask the patient about their medical history and dietary habits and carry out a physical exam to determine whether there is any distension in the abdomen. They may check for gas by tapping the abdomen and listening for a hollow sound.

They may ask about bowel movements, whether there is any straining when passing a stool, whether there is abdominal pain after meals, and how long the flatulence has lasted.

This can help decide whether the patient might have a condition that needs treatment.

It may help to keep a food diary for a while before visiting the doctor.

Gas and Bloating

Gastroenterol Hepatol (N Y). 2006 Sep; 2(9): 654–662.

Dr. Hasler serves as Associate Professor of Internal Medicine in the Division of Gastroenterology at the University of Michigan Medical Center, Ann Arbor, MI.

Corresponding author. Address Correspondence to: William L. Hasler, MD, 3912 Taubman Center, Box 0362, Ann Arbor, MI 48170; Tel: 734-936-8644; Fax: 734-936-7392; E-mail: [email protected] © 2006, Gastro-Hep Communications, Inc.This article has been cited by other articles in PMC.

Abstract

Gaseous symptoms including eructation, flatulence, and bloating occur as a consequence of excess gas production, altered gas transit, or abnormal perception of normal amounts of gas within the gastrointestinal tract. There are many causes of gas and bloating including aerophagia, luminal obstructive processes, carbohydrate intolerance syndromes, small intestinal bacterial overgrowth, diseases of gut motor activity, and functional bowel disorders including irritable bowel syndrome (IBS). Because of the prominence of gaseous complaints in IBS, recent investigations have focused on new insights into pathogenesis and novel therapies of bloating. The evaluation of the patient with unexplained gas and bloating relies on careful exclusion of organic disease with further characterization of the underlying condition with directed functional testing. Treatment of gaseous symptomatology should be targeted to pathophysiologic defects whenever possible. Available therapies include lifestyle alterations, dietary modifications, enzyme preparations, adsorbents and agents which reduce surface tension, treatments that alter gut flora, and drugs that modulate gut transit.

Keywords: Eructation, belching, gastrointestinal transit, functional bowel disorders, bacterial overgrowth, breath tests

The gastrointestinal tract contains, on average, less than 200 mL of gas, whereas daily gas expulsion averages 600–700 mL.1 On average, healthy men pass flatus 14 times per day, especially after meals. Flatus rates up to 25 per day are normal. The major gases in flatus are nitrogen, oxygen, carbon dioxide, hydrogen, and methane.2 Gases produced by colonic bacterial fermentation of ingested nutrients and endogenous glycoproteins (hydrogen, methane, and carbon dioxide) represent 74% of flatus. Flatus odor correlates with hydrogen sulfide concentrations. Other sulfur-containing gases in flatus include methanetriol and dimethyl sulfide.3 Men produce more aromatic flatus than women.

Insight into normal patterns of intestinal gas transit has been provided by experiments in which physiologic gas mixtures containing nitrogen, oxygen, and carbon dioxide are perfused into the jejunum. In healthy volunteers, gas perfusion produces steady state flow with little distention and few symptoms.4 Gas collected from the rectum in such studies is expelled in pulsatile fashion, indicating that flow is regulated by intrinsic motor patterns in the distal gut.5 Gas transit is accelerated by liquid or solid meals, providing an experimental correlate to the observation that gas passage and gaseous symptoms increase postprandially.6

Clinical Syndromes

Luminal gas is responsible for several phenomena. Eructation, or belching, is the retrograde expulsion of gas from the mouth. The Magenblase syndrome is defined as fullness and bloating relieved by belching. Manometric studies of eructation show decreased lower esophageal sphincter tone followed by upper esophageal sphincter relaxation.7 Flatulence is the volitional or involuntary release of gas from the anus. Manometric studies during flatulence demonstrate propagated colon contractions with increased rectal pressure and early anal relaxation.8 Bloating is the perception of retained gas and is experienced monthly by 15.9% of the population.9 Bloating is more common in women (19.2%) than men (10.5%). Other symptoms experienced by patients with gaseous complaints include abdominal pain, halitosis, anorexia, early satiety, nausea, loud borborygmi, and bowel dysfunction.

Pathogenesis of Gas and Bloating

Gas and bloating are consequences of several disorders (). Symptoms result from excess gas production, altered gas transit, or abnormal perception of normal amounts of gas within the gut.

Table 1.

Differential Diagnosis of Gas and Bloating

Mechanical Obstruction
  • Gastric outlet obstruction

  • Small intestinal obstruction

  • Superior mesenteric artery syndrome

  • Colonic obstruction

  • Volvulus

Carbohydrate Intolerance
  • Lactase deficiency

  • Intolerance of poorly absorbed sugars (eg, fructose, sorbitol)

  • Hereditary disorders (eg, sucrase-isomaltase deficiency)

  • Intolerance of complex carbohydrates and fiber

  • Secondary causes of carbohydrate intolerance (eg, celiac disease)

Small Intestinal Bacterial Overgrowth
  • Small intestinal stasis

  • Hypochlorhydria

  • Immunodeficiency

  • Coloenteric fistula

  • Coprophagia

  • Elderly patients

  • Irritable bowel syndrome

Dysmotility Syndromes
  • Gastroparesis

  • Rapid gastric emptying

  • Gas-bloat syndrome after fundoplication

  • Chronic intestinal pseudo-obstruction

  • Slow transit constipation

  • Acute adynamic ileus

  • Acute colonic pseudo-obstruction

Functional Bowel Disorders
  • Irritable bowel syndrome

  • Functional dyspepsia

  • Functional bloating

Miscellaneous Causes
  • Aerophagia

  • Magenblase syndrome

  • Medications

  • Endocrine disorders (eg, hypothyroidism)

  • Inferior myocardial infarction

Mechanical Obstruction

Several organic conditions produce bloating by mechanically inhibiting gas transit in the gastrointestinal tract. Pyloric obstruction may result from ulcer-induced stricture or neoplasm in adults or from idiopathic stenosis in infants. Small intestinal obstruction most commonly is a consequence of adhesions, but also occurs with inflammation, radiation-induced stricture, or malignancy. Bloating from colonic obstruction occurs less frequently and most often results from carcinoma.

Carbohydrate Maldigestion

Maldigestion and malabsorption of simple and complex carbohydrates and dietary fiber are commonly associated with gas and bloating. Unabsorbed carbohydrates are propelled to the colon and serve as nutrient substrates for enteric bacteria, liberating hydrogen gas and short-chain fatty acids. Carbohydrate intolerance results from loss of enterocyte enzymes in normal intestinal mucosa, inability to transport a poorly absorbed sugar across normal enterocyte membranes, or organic mucosal disorders such as celiac disease.

Intolerance of Simple Sugars The most common carbohydrate maldigestion syndrome, lactose intolerance, results from insufficient levels of enterocyte lactase, which hydrolyzes lactose into glucose and galactose. Lactase deficiency occurs in 21% of nonhispanic whites but is more prevalent in those of African (75%), Hispanic (51%), and Native American (79%) background.10 Individuals with lactose intolerance rarely experience symptoms unless more than 240 mL of milk are ingested per day.11 Impaired assimilation of other simple sugars produces gaseous symptoms as well. Forty percent of fructose is not absorbed in the normal human intestine. Increased gas production occurs after consuming fructose-containing fruits, juices, and soft drinks with a threshold of 37.5 grams of fructose.12 Fructose-intolerant patients pass flatus more frequently and produce more hydrogen for given amounts of fructose versus asymptomatic individuals. Sorbitol, a natural substance in fruits and an artificial sweetener, is malabsorbed by 43% of whites and 55% of nonwhites at doses as low as 5 grams.13 Other potentially malabsorbed carbohydrates include isomalt, xylitol, and (rarely) sucrose. Finally, rare hereditary sugar intolerance syndromes are described. Sucrase-isomaltase deficiency presents with gaseous symptoms after sucrose ingestion, usually in infancy. The disorder is inherited in an autosomal recessive fashion and results from defects in the sucrase-isomaltase gene.

Maldigestion of Complex Carbohydrates and Fiber Ingested complex carbohydrates may also be incompletely assimilated. Twenty percent of carbohydrates in baked beans, 7–10% in wheat, oats, potatoes, and corn, and 1% in white rice are malabsorbed.14 Reduced fecal pH levels and increased lactic and volatile fatty acid concentrations demonstrate that most unabsorbed starch is metabolized in the colon. Undigestible oligosaccharides, such as stachyose, raffinose, and verbascose, are abundant in beans and legumes. Flour from soy beans low in these oligosaccharides produces less gas than from standard soybeans.15 Dietary fiber intake correlates with flatus production in many individuals. In one study, fiber-free diets reduced daily gas expulsion from 700 mL to 200 mL.1 However, fecal gas production from incubation with bran produces only 10% as much hydrogen and carbon dioxide as with lactulose, supporting the observations that fiber supplements elicit feelings of bloating but do not increase flatus frequency, whereas lactulose causes elevations in both.16 In a recent study in healthy humans, ingesting 30 grams of psyllium daily retarded transit of a jejunally-perfused gas mixture, providing a possible mechanism for increased gaseous symptoms after fiber supplementation ().5

Table 2.

Effects of Psyllium on Intestinal Gas Flow

  Control Diet High Fiber Diet
Total gas perfused over 2 hours 1,440 ml 1,440 ml
Lag time to first gas expulsion 1,129 ± 274 sec 2,265 ± 304 sec*
Total gas expelled 1,429 ± 108 ml 1,022 ± 80 ml*
Total gas retained 11 ± 108 ml 418 ± 80 ml*
Number of gas boluses expelled 20. 9 ± 2.5 14.2 ± 1.1*
Mean volumes of each bolus 68.2 ± 5.0 70.7 ± 3.4

Small Intestinal Bacterial Overgrowth

Normal jejunal and ileal bacterial counts are 103-4 and 107-9 colony forming units (CFU) per mL, respectively, whereas densities in the colon approach 1012 CFU/mL. Small intestinal bacterial overgrowth is defined by the presence of greater than 105 CFU/mL in proximal intestinal fluid. The main organisms cultured are Streptococcus, Escherichia coli, Lactobacillus, and Bacteroides species. In addition to producing gas, bloating, diarrhea, abdominal discomfort, and nausea, bacterial overgrowth causes nutrient malabsorption, weight loss, and metabolic bone disease.

The etiologies of bacterial overgrowth are varied. The condition complicates small intestinal obstruction from a variety of causes. Stasis within small intestinal diverticula predisposes to bacterial overgrowth, whereas vagotomy increases intestinal microbial colonization because of hypochlorhydria. Small intestinal bacterial counts are increased by proton pump inhibitors. However, symptoms are not commonly observed.17 Common variable immunodeficiency syndrome may present with bacterial overgrowth from reduced luminal immune surveillance. Forty-three percent of cases of diabetic diarrhea are attributed to bacterial overgrowth, mostly from altered motor function.18 Patients with intestinal pseudo-obstruction develop overgrowth from impaired gut clearance. Cologastric and coloenteric fistulae and coprophagia increase bacterial delivery to the upper gut, overwhelming defenses against infection. Bacterial overgrowth is a recognized cause of gaseous symptoms in the elderly and is likely due to altered motility, acid production, and immune function.

Studies employing lactulose breath testing have reported that large subsets (78%) of irritable bowel syndrome (IBS) patients may have bacterial overgrowth as a possible cause of symptoms.19 Subsequent studies have shown transient resolution of symptoms and hydrogen production after antibiotic treatment. However, other groups using other diagnostic methods report much lower rates of overgrowth (10–31%) in IBS and show no response to antibiotics.20,21 This is an area of active investigation.

Dysmotility Syndromes

Alterations in gut motor function produce gaseous symptoms independent of development of bacterial overgrowth. Bloating and fullness are reported with gastroparesis, intestinal pseudo-obstruction, and chronic constipation from retarded gas transit. Patients with rapid gastric emptying complain of fat intolerance and bloating.22 Fundoplication for gastroesophageal reflux reduces the ability to belch or vomit. Gas-bloat syndrome is common in the early postoperative period after fundoplication, especially with preoperative demonstration of gastroparesis, but resolves in 71% of cases.23 Acute adynamic ileus elicits gas and bloating from involvement of the entire gut as does localized dysfunction with acute colonic pseudo-obstruction.

Functional Bowel Disorders

Gaseous symptoms are prevalent in IBS and functional dyspepsia. In one investigation, bloating was rated the most bothersome symptom by 60% of IBS patients, whereas 29% considered pain to be most intrusive.24 Bloating was experienced on 28% of days in another study, whereas pain was reported on 33% of days.25 Constipation-predominant IBS patients experience greater bloating than those with diarrhea. The pathophysiology of gas and bloating in IBS is poorly understood. Early studies referred to a splenic flexure syndrome with localized air-trapping. More recent computed tomography scans of IBS patients show increased lateral abdominal profiles, which may relate to changes in gut muscle tone. 26 Others have postulated roles for weak abdominal muscles, a low diaphragm, or exaggerated lumbar lordosis. Increased fermentation and gas generation has been proposed as a cause of bloating in IBS, but studies report variable responses to ingestion or exclusion of carbohydrate substrates.

Abnormal gut motor and sensory functions likely participate in generation of bloating in IBS. Ileocolonic transit of radiolabelled bran is accelerated in IBS.27 In argon washout studies, patients with functional abdominal pain retain normal amounts of infused gas although abnormal patterns of transit are observed.28 In jejunal gas perfusion investigations, many IBS patients exhibit abnormal gas retention which correlates with increased distention and symptoms of bloating.29 In a recent study combining gas perfusion with radiolabelled xenon gas transit, patients with bloating exhibited selective retardation of gas flow in the small intestine, suggesting that this region is responsible for gaseous symptoms. 30 However, other studies report no alterations in retention and postulate that bloating results from visceral hypersensitivity—a phenomenon which is believed to contribute to pain in IBS.31 Most recently, rectal gas perfusion studies report increases in perception in IBS and functional bloating, which are associated with changes in external and internal oblique muscle contraction, indicating an interaction of visceral and somatic musculature in production of gaseous symptomatology.32

Miscellaneous Causes of Gas and Bloating

Most upper gut air in healthy individuals results from aerophagia. Aerophagia occurs during negative intrathoracic pressure and is worsened by gum chewing, smoking, or oral irritation. After laryngectomy, air swallowing for esophageal speech may elicit gaseous complaints. Inferior myocardial infarction can lead to excess eructation. Medications (anticholinergics, opiates, calcium blockers, antidepressants) produce gas by effects on gut motility.

Evaluation of Gas and Bloating

The diagnostic approach to the patient with unexplained gas and bloating relies on a careful history and examination complemented by directed structural and functional testing.

History and Physical Examination

Several historical points must be elicited by the clinician. Relief of symptoms with defecation or flatus is consistent with IBS. Superimposed anxiety or psychiatric disease may associate with aerophagia or IBS. Conversely, vomiting, fever, weight loss, nocturnal diarrhea, rectal bleeding, or steatorrhea indicate probable organic disease. One’s ethnicity and family history increase risks of lactase deficiency or celiac disease. Risk factors for bacterial overgrowth should be assessed. A dietary history should quantify consumption of legumes, unrefined starches, and lactose-, fructose-, or sorbitol-containing foods.

The physical examination is usually normal in patients with functional causes of gas and bloating. Abnormal distention with or without altered bowel sounds, occult fecal blood, cutaneous findings (sclerodactyly with scleroderma, dermatitis herpetiformis in celiac disease), peripheral or autonomic neuropathy, cachexia, jaundice, or palpable masses suggest underlying organic disease, which warrants aggressive evaluation.

Serious sequelae of gaseous syndromes are rare. Luminal perforation may result from complete intestinal obstruction or acute colonic pseudo-obstruction. Pneumatosis cystoides intestinalis may occur in chronic intestinal pseudo-obstruction from excess small intestinal hydrogen-producing bacteria.

Laboratory and Structural Testing

Laboratory tests facilitate exclusion of organic disease. In addition to standard hematology and chemistry determinations to screen for inflammatory or mucosal processes, thyroid chemistries or fasting cortisol levels are indicated in some individuals. Serologic testing for celiac disease (tissue transglutaminase or endomysial antibodies) is performed in patients with appropriate ethnic backgrounds or in those with IBS-like symptoms, due to the increased prevalence of celiac sprue in these populations. Other serologies of value in selected cases include antinuclear antibodies and scleroderma antibodies to evaluate for collagen vascular disease and antinuclear neuronal antibodies to screen for paraneoplastic visceral neuropathy. Stool analysis for Giardia may be indicated in some patients with diarrhea.

Imaging tests may be performed to distinguish mechanical obstruction from functional gas retention. Flat and upright abdominal radiographs may show diffuse distention with ileus, haziness in ascites, or air-fluid levels with obstruction. Contrast enema radiography detects distal obstruction, whereas small intestinal contrast studies or CT scanning can characterize partial proximal obstruction. Ultrasound or CT can also further delineate extraluminal processes contributing to gaseous symptoms.

Functional Testing

When structural tests are negative, methods to quantify gut transit, assess carbohydrate absorption, or measure flatus production can provide insight into the cause of symptoms ().

Table 3.

Tests of Gut Function in Patients With Gas and Bloating

Test Category Specific Test Comments
Tests of Gut Motor Function Gastric scintigraphy Diagnoses gastroparesis or rapid gastric emptying
Octanoate breath test Alternative to scintigraphy to diagnose gastroparesis
Small intestinal/colonic scintigraphy Quantifies small intestinal/colonic transit in some academic centers
Radioopaque marker colonic transit tests Common test to diagnose slow transit constipation
Antroduodenal manometry Facilitates diagnosis of pseudoobstruction; helps distinguish neuropathic versus myopathic etiologies
Full thickness intestinal biopsy Definitive test for pseudoobstruction; invasive
Breath Testing Lactose hydrogen breath test For lactase deficiency
Glucose hydrogen breath test Modest accuracy for diagnosis of small intestinal bacterial overgrowth
Lactulose hydrogen breath test Less accurate for diagnosis of small intestinal bacterial overgrowth; used to measure small intestinal transit; may accelerate intestinal transit
Fructose/sorbitol hydrogen breath test Uncertain diagnostic utility in patients with functional causes of bloating
Breath tests with 14C or 13C labeled substrates Require specialized facilities
Flatus Analysis Flatus quantification and gas chromatography Distinguishes aerophagia from increased gas production

Tests of Gut Motor Function Gastric emptying tests or gastrointestinal manometry may be performed for suspected gastrointestinal dysmotility. Scintigraphic measures of emptying of radiolabelled solid meals (99mTc-sulfur colloid in eggs) are employed to exclude gastroparesis or rapid emptying. Other methods of quantifying gastric emptying include isotopic breath tests (eg, 13C-octanoate) and ingested capsule techniques. In some centers, scintigraphy is used to assess rates of small intestinal or colonic transit in suspected pseudo-obstruction and constipation. More often, radio-opaque marker techniques are ordered to diagnose slow transit constipation. In intestinal pseudo-obstruction, small intestinal manometry can distinguish neuropathic and myopathic patterns, which may obviate the need for surgical full thickness intestinal biopsy. In some cases, full thickness biopsy may be required to document degeneration of nerve or muscle layers.

Breath Testing Hydrogen breath testing can be employed to confirm carbohydrate intolerance as a cause of gaseous symptoms. These methods quantify hydrogen produced by luminal bacteria during metabolism of ingested test substrates. Conversely, carbohydrate metabolism by human tissues does not elicit hydrogen production. Expired breath samples are obtained before and for 2 hours after ingesting a solution of the sugar, which is presumed to be maldigested or malabsorbed. Hydrogen rises of more than 20 parts per million within 120 minutes of lactose ingestion distinguish biopsy-proven lactase deficiency from lactase-sufficiency with 90% sensitivity.33 Sucrase-isomaltase deficiency is tested by sucrose hydrogen breath testing. Hydrogen breath testing has been employed to detect fructose or sorbitol malabsorption. However, normal values for these tests are less well defined.34 Hydrogen measurement may be extended to 10 hours to test for maldigestion of complex carbohydrates.

Hydrogen breath testing also is employed to test for small intestinal bacterial overgrowth. Elevated fasting hydrogen or early rises within 30 minutes of substrate ingestion suggest overgrowth. Breath testing after glucose consumption provides sensitivities and specificities of 60–90% for the diagnosis of bacterial overgrowth. 35 Lactulose and rice have been utilized as substrates. However, the sensitivities of these methods are as low as 17–33% for detecting overgrowth.36 False-negative results occur in patients without hydrogen producing bacteria, whereas false-positive tests occur with rapid small intestinal transit. Other centers rely on 14C or 13C-labelled substrates, with measurement of breath 14CO2 or 13CO2, although special facilities are necessary for these analyses. If the diagnosis is uncertain, diagnosis of bacterial overgrowth is made by documentation of bacterial counts greater than 105 CFU/mL on quantitative culture of duodenal or jejunal secretions.35

Finally, hydrogen breath testing utilizing lactulose has been employed to quantify orocecal transit in suspected intestinal pseudo-obstruction. The transit time is measured from the time of ingestion until an increase in breath hydrogen is observed, reflecting colonic bacterial metabolism of the substrate. This method has significant limitations. Lactulose accelerates small intestinal transit.37 Furthermore, erroneous values are obtained with superimposed bacterial overgrowth.

Flatus Analysis In some research institutions, flatus analysis is performed to gain insight into the cause of excess flatulence.38 Flatus passages are counted and expelled gas is analyzed. Excess release of nitrogen indicates probable aerophagia, whereas increases in carbon dioxide, hydrogen, and methane suggest increased colonic metabolism of ingested food residue.

Principles of Management

Management of gas and bloating depends on the cause of symptoms. Organic etiologies may be best treated surgically or with specific medications. Conversely, functional disorders may respond to dietary measures, enzyme preparations which facilitate digestion, adsorbents and agents that decrease surface tension, treatments that alter gut flora, or drugs that modify gut transit. Evidence favoring any individual therapy is limited, as no controlled investigations have been performed to compare the various treatments of gaseous symptoms.

Dietary and Other Nonmedicinal Therapies

Dietary measures may reduce gaseous symptoms in selected patients. Most lactase-deficient patients have residual enzyme activity and tolerate small amounts of lactose. When consumed in yogurt with active cultures, lactose may be better tolerated because of bacterial β-galactosidase.39 Dairy products containing lactase-producing Lactobacillus acidophilus, Bifidobacterium species, and Lactobacillus bulgofilus reduce bloating in some patients with lactose intolerance.40 Children with sucrase-isomaltase deficiency benefit from elimination of sucrose. In some individuals, dietary sucrose can slowly be reintroduced because of an intrinsic ability of the colon to ferment sugar. Studies of carbohydrate exclusion diets in IBS patients have not shown convincing results. Only a small fraction of IBS patients with documented lactase deficiency respond to lactose restriction. Similarly, less than 40% experience symptom improvement upon exclusion of fructose and sorbitol.41 Low gas diets that exclude many complex carbohydrates reduce flatus frequency by up to 50% in some individuals ().42 In some instances, food can be modified to reduce gas production. Soaking cowpeas and yam beans for 12 hours and cooking for 30 minutes degrades malabsorbed oligosaccharides including raffinose and stachyose.43

Table 4.

Foods That Promote Significant Gas Production

Dairy Products (all)
Vegetables
  • Onions

  • Beans

  • Celery

  • Carrots

  • Brussels sprouts

Fruits
  • Raisins

  • Bananas

  • Apricots

  • Prune juice

Complex Carbohydrates

Lifestyle changes are useful for selected patients. Aerophagia may be reduced by cessation of gum chewing and smoking. Chronic belchers may better understand the role of aerophagia by observing their swallowing mechanics in a mirror. Gas-trapping undergarments are available for those with excess malodorous flatus.3

Enzyme Preparations

Exogenous enzymes facilitate breakdown of undigested food residue (). β-galactosidase (lactase) preparations reduce hydrogen excretion and gaseous symptoms in patients with lactose intolerance. Bacterial α-galactosidase derived from Aspergillus niger (Beano) reduces flatulence in healthy volunteers who consume meatless chili.44 However, most indigestible fiber does not contain galactose and this agent is unlikely to produce benefit in patients not consuming legume-rich diets. Pancreatic enzymes reduce bloating, gas, and fullness after high-calorie, high-fat meals in healthy individuals. However, their utility in patients with excess gas and bloating is unexplored.45 Hydrogen production and gaseous symptoms decrease when children with sucrase-isomaltase deficiency are given sacrosidase from Saccharomyces cerevisiae.46

Table 5.

Medical Therapies for Gas and Bloating

Medication Class Examples Comments
Enzyme Preparations β-galactosidase (lactase) For lactose intolerance; variable effectiveness in lactose intolerant IBS patients
α-galactosidase Effective for legume-rich meals
Pancreatic enzymes Uncertain efficacy for gas and bloating
Sacrosidase May help in sucrase-isomaltase deficiency
Adsorbents and Agents That Reduce Surface Simethicone Possible benefits in functional dyspepsia and gas with diarrhea
Activated charcoal Possible benefits in gas production and malodorous flatus; charcoal-lined undergarments are available
Bismuth subsalicylate Possible benefits in reducing malodorous flatus
Treatments to Modify Gut Flora Antibiotics Useful for bacterial overgrowth; uncertain benefits in IBS
Probiotics (Lactobacillus sp., Bifidobacterium sp.) Possible benefits in IBS
Prebiotics Uncertain benefits
Prokinetic Medications Tegaserod Reduces bloating in IBS
Neostigmine Reduces luminal distention in acute colonic pseudoobstruction; uncertain benefits in bloating
Octreotide Reduces symptoms in pseudoobstruction with bacterial overgrowth alone or combined with erythromycin

Agents to Decrease Surface Tension and Adsorbents

Agents which reduce surface tension of gas bubbles and adsorbents are commonly employed for gaseous symptoms (). Simethicone promotes rupture of thick foam films. Effects of simethicone on hydrogen production are inconsistent. However, benefits have been reported in some patients with functional dyspepsia and with gas-related discomfort from chronic diarrhea.47,48 Activated charcoal reduced flatulence and hydrogen production after consuming carbohydrate-rich meals in two studies. However, another investigation showed no reductions from charcoal after eating baked beans.4951 The benefits of charcoal on flatus odor are unproved. The combination of charcoal, Yucca schidigera, and zinc acetate reduced malodorous flatulence by 86% in one study, but charcoal had no effect in another investigation.52 Bismuth inhibits in vitro fermentation of lactose-enriched feces and impairs hydrogen sulfide release. In flatulent patients, bismuth subsalicylate reduces fermentation of raffinose, suggesting possible benefits in reducing flatus odor.53

Treatments to Modify Gut Flora

Antibiotics provide benefit to selected patients with gaseous syndromes (). Bacterial overgrowth may impressively respond to a single prescription of oral antibiotics, although some individuals require multiple or rotating courses. Antibiotics in several drug classes have shown efficacy in bacterial overgrowth (). Preliminary investigations suggest the recently-approved, nonabsorbable antibiotic rifaximin (Xifaxan, Salix) may be very effective for documented bacterial overgrowth.54 Some investigators who postulate a pathogenic role for abnormal gut flora in IBS have reported short term benefits in less than 50% of patients with neomycin and rifaximin in separate studies,55,56 however others have shown no similar benefits. Further investigation is warranted in this field.

Table 6.

Efficacious Antibiotics for Small Intestinal Bacterial Overgrowth

  • Tetracyclines

  • Penicillin derivatives

  • Cephalosporins

  • Fluoroquinolones

  • Neomycin

  • Metronidazole

  • Sulfonamides

  • Rifaximin

Another means of modifying gut flora is to replace pathogenic colonic organisms with ingested innocuous strains (). Physiologic benefits of such probiotics may include enhancing the epithelial barrier, decreasing luminal pH, blocking bacterial adhesion, and releasing neuroactive mediators such as nitric oxide.57 Placebo-controlled trials of the probiotic preparation VSL#3 in IBS patients showed reductions in flatulence and bloating without improvement in pain or bowel disturbance.58,59 Recent investigations with Bifidobacterium infantis report decreases in pain, discomfort, bloating, distention, and defecatory difficulty in IBS that are associated with reversal of proinflammatory interleukin-10 to interleukin-12 ratios, suggesting a modulatory effect on gut immune function.60 In contrast, no similar benefits are seen with Lactobacillus salivarius. Older studies report benefits from other Lactobacillus strains.

A third potential method to change enteric microbial populations is to administer prebiotic nutrients that promote growth of beneficial bacteria to the exclusion of pathogenic strains. Inulin, oligofructose, and galacto-oligosaccharides selectively nourish Lactobacillus and bifidobacterium strains, in part due to enhanced enzymatic activities in these organisms including β-fructosidase.61 The utility of prebiotics in treating gaseous syndromes is unknown at this time.

Prokinetic Medications

Drugs which stimulate gut propulsion should theoretically benefit patients with gaseous symptoms caused by gastrointestinal dysmotility (). The dopamine antagonists metoclopramide and domperidone decrease fullness and bloating in gastroparesis. The somatostatin analog octreotide reduces breath hydrogen after glucose in scleroderma patients with intestinal pseudo-obstruction and bacterial overgrowth.62 When given over 20–33 weeks, the combination of the motilin agonist erythromycin and octreotide decreases symptoms from chronic intestinal pseudo-obstruction.63 The 5HT4 agonist tegaserod (Zelnorm, Novartis) reduces bloating in controlled trials of constipation-predominant IBS.64 In healthy volunteers, tegaserod stimulates transit of jejunally perfused gas mixtures suggesting that its beneficial effects on bloating may relate to its prokinetic capabilities.65 Similarly, the acetylcholinesterase inhibitor neostigmine stimulates gas flow in patients with functional bloating.66 The clinical utility of this medication to treat gas and bloating has not been confirmed in controlled trials.

Other Therapies

Other therapies are effective for selected cases of gas and bloating. Hypnotherapy and acupuncture have been reported to reduce gaseous symptoms in IBS. Venting gastrostomy is effective in some individuals with gas-bloat syndrome after fundoplication.67 Acute colonic pseudo-obstruction may respond to neostigmine, colonoscopic decompression, or decompressing cecostomy, averting rupture of the organ. Patients with localized intestinal pseudo-obstruction may benefit from resection of the dysfunctional bowel segment, whereas those with more extensive involvement may experience relief after venting jejunostomy.68

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Gas – Digestive Disorders – Merck Manuals Consumer Version

















People with or without awareness of swallowing air


Sometimes in people who smoke or chew gum excessively


Sometimes in people who have esophageal reflux or ill-fitting dentures


Gas from carbonated beverages

Beverage consumption usually obvious based on person’s history






Abdominal pain related to defecation, associated with a change in the frequency or consistency of stool, or both




Typically begins during adolescence and the 20s






Poor emptying of the stomach (gastroparesis), usually due to other disorders such as diabetes, connective tissue disorders, or neurologic disorders

Nausea, abdominal pain, and sometimes vomiting




Sometimes in people known to have a disorder that causes it


Sometimes in people taking drugs with anticholinergic effects

Upper endoscopy‡ and/or nuclear scanning that evaluates stomach emptying


If a drug cause is suspected, stopping the drug to see whether symptoms go away


Long-standing symptoms, particularly in young women


In people who are thin but still very concerned about excess body weight



A long history of hard, infrequent bowel movements



New, persistent bloating in middle-aged or older people


For colon cancer, sometimes blood in stool (blood may be visible or detected during a doctor’s examination)

If ovarian cancer is suspected, ultrasonography of the pelvis



Passing of gas (flatulence)

Foods, including beans, dairy products, vegetables (such as onions, celery, carrots, or Brussels sprouts), fruits (such as raisins, bananas, apricots, and dates or apple, pear, or prune juice), and foods containing fructose (such as cola sodas, honey, or nuts), prunes, or waffle or maple syrup, or complex carbohydrates (such as pretzels, bagels, or wheat germ)

Symptoms that develop mainly when food that can cause gas is consumed



Elimination of the suspected food from diet to see whether symptoms go away


Bloating, cramps, and diarrhea after consuming milk products

A breath test to detect hydrogen, indicating undigested food


Light-colored, soft, bulky, and unusually foul-smelling stools that may appear oily


Weakness, loss of appetite, and diarrhea


Often begins in childhood

Blood tests to measure antibodies produced when people with celiac disease eat foods containing gluten and biopsy of the upper small intestine


Light-colored, soft, bulky, and unusually foul-smelling stools that may appear oily


Nausea, loss of appetite, diarrhea, abdominal cramps, and weight loss

Blood tests and biopsy of the small intestine

Flatulence – Symptoms, Causes, Treatments

Flatulence and belching are natural occurrences that result from eating or drinking too quickly. Eating certain foods or drinking carbonated beverages can also introduce air into the stomach and cause flatulence. Because infants frequently swallow air when feeding, they may have flatulence after they have been fed. The act of burping an infant helps relieve the discomfort caused by swallowed air.

Flatulence is also caused by the passage of undigested food from the small intestine to the large intestine. Bacteria in the large intestine process the food and produce harmless gases, such as carbon dioxide, hydrogen, and methane, which are released as gas through the rectum. Certain foods, such as carbohydrates, fiber and sugars, are more likely than other foods to cause gas.

Food causes of flatulence

Flatulence may be caused by eating certain foods including:

  • Fiber, especially soluble forms of fiber, which passes undigested until it reaches the large intestine

  • Starchy foods, such as breads and rice

  • Sugars, including fructose (found in some foods and sweeteners), lactose (found in dairy products), raffinose (found in brussels sprouts, broccoli, cabbage, and beans), and sorbitol (found in fruits and artificial sweeteners)

Gastrointestinal causes of flatulence

Almost any condition affecting the digestive tract can cause flatulence. These include conditions in which the normal movement or flow in the digestive tract is obstructed, interrupted or delayed. Examples include gastroparesis (delayed stomach emptying), intestinal obstruction, hiatal hernia, and gastrointestinal reflux disease (also known as GERD). In other types of disorders, the enzymes or processes that are needed to digest food completely are either deficient or absent. Examples include food intolerance and gallbladder disease.

Flatulence can be caused by many conditions affecting the digestive tract including:

Serious or life-threatening causes of flatulence

Flatulence is a normal body process that is rarely serious in nature. However, in rare cases, flatulence may be a symptom of a serious or life-threatening condition that should be evaluated immediately in an emergency setting. These include:

Questions for diagnosing the cause of flatulence

To diagnose your condition, your doctor or licensed health care practitioner will ask you several questions related to your flatulence including:

  • How long have you experienced flatulence?

  • Does your flatulence worsen when you consume certain foods or drinks?

  • Are you experiencing any other symptoms along with your flatulence?

  • Is your flatulence becoming worse or more frequent?

What are the potential complications of flatulence?

Flatulence is generally a harmless symptom that does not produce long-term complications. However, some of the gastrointestinal conditions associated with flatulence may have serious complications as a result of the underlying disease rather than the symptom of flatulence itself. For example, intestinal obstruction due to cancer is a condition that can have long-term and potentially serious or life-threatening complications.

90,000 Flatulence. Reasons, diagnosis, treatment | Directory of the Kuntsevo treatment and rehabilitation center

What is flatulence

Flatulence is the accumulation of gases in the intestines due to their ingress from the cecum.
Flatulence occurs after overeating or constantly as a result of diseases of the digestive system. In this case, you need to consult a doctor to identify the causes of the unpleasant condition.

Causes of

In addition to overeating and intolerance to any foods, increased gas formation develops due to the progression of diseases of the gastrointestinal tract, for example, cholecystitis, dysbiosis, gastritis, duodenitis, pancreatitis, colitis, intestinal obstruction, etc.d.
In adult patients, the reason often lies in the lunch on the run at a fast pace. In addition, a lack of enzymes and disturbed intestinal microflora can provoke the production of gases. In some cases, after operations in the peritoneal region, the motor activity of the intestines slows down, due to which the products are slowly processed.

Symptoms

Flatulence itself is not dangerous to humans, but sometimes, together with other symptoms, the accumulation of gases signals a pathological state of the gastrointestinal tract.Among these signs, it should be noted:

  • bloating with a feeling of bursting,
  • belly rumbling,
  • enlargement of the abdomen,
  • burp,
  • uncontrolled emission of gases, odorless and odorless,
  • upset stool (alternating diarrhea and constipation),
  • heartburn,
  • pain and pain in the abdomen.

If this clinical picture occurs often and the reason for its development is not an unhealthy diet, then you need to consult a doctor.

Which doctor treats flatulence

With any problems of impaired functioning of the digestive tract, they turn to a gastroenterologist. To consult a doctor, you must first make an appointment with a gastroenterologist, for this, choose any method convenient for you:

  • call by the clinic’s phone +7 (495) 103-99-55,
  • request a call back,
  • leave a request for an appointment, through a convenient form on the website:

Flatulence is a phenomenon that requires serious attention from both the patient and the attending physician.

IMPORTANT! The fact is that increased gas production can appear both due to a certain nature of the food (rough, requiring prolonged digestion), and due to the occurrence of pathology of the gastrointestinal tract.

In any case, it is necessary to abandon self-medication, which will certainly lead to complications. Make an appointment with the gastroenterologist of the Kuntsevo Medical and Rehabilitation Center to determine the causes of flatulence and determine the treatment tactics to eliminate the symptom.

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Treatment methods

To normalize the motor function of the intestine, the gastroenterologist develops a complex treatment. As part of therapy, prescribes the use of pharmacological agents to normalize the microflora of the colon and breakdown gases:

  • enzymes of different groups to restore missing elements in the body,
  • bloating sorbents,
  • prokinetics, which accelerate the movement of food through the intestines and promote the elimination of gas,
  • defoamers, destroying gas bubbles,
  • probiotics and prebiotics that facilitate the digestion of food in the intestines.

If, according to the results of the analyzes, gastrointestinal diseases are detected, then the gastroenterologist selects a therapy aimed at eradicating their causes.

Rehabilitation and Lifestyle Restoration

Since many foods provoke gas formation, you need to abandon legumes, potatoes, cabbage, lamb, kvass, beer and soda. Smoking and bad habits also negatively affect intestinal motility, so it is important to get rid of addiction.
The gastroenterologist advises to give up chewing gum, because.because they produce the production of gastric juice, as well as thoroughly chew food, while not drinking it with water.

Why it is necessary to treat flatulence with us

Experienced gastroenterologists are receiving appointments at the Kuntsevo treatment and rehabilitation center, located a stone’s throw from the Molodezhnaya metro station. They regularly improve their skills and learn new methods of treatment, helping to cure the disease in a short time. Doctors not only carry out symptomatic treatment, but also identify the true cause of increased gas production so that flatulence does not occur again.

Flatulence: Causes and Treatment – ProMedicine Ufa

Flatulence – increased accumulation of gases in the gastrointestinal tract. Flatulence can be felt in practically healthy individuals when overeating, eating foods, the digestion of which causes increased gas production.

Reasons

The causes of intestinal flatulence are extremely varied. Flatulence can occur in a child in the first days after birth as a result of imperfection of the enzyme system or a violation of its function.Lack of enzymes leads to the ingress of a large amount of undigested food residues into the lower parts of the digestive tract and activation of the processes of decay and fermentation with the release of gases.

Disorders of the enzyme system can occur with an unbalanced diet, as well as with various diseases of the upper digestive tract. Another reason for increased gas production in the intestine is a violation of the microflora of the colon. Also, flatulence can occur due to previous operations on the abdominal cavity.

In people over 65-70 years old, flatulence most often occurs against the background of the process of atrophy of the muscular layer of the intestine. Also, the causes of flatulence in old age can be: lengthening of the intestine, deterioration in the functioning of the glands that produce digestive enzymes.

Women sometimes experience flatulence during gestation, usually due to pressure from the uterus on the intestines and hormonal changes in the body.

Under normal conditions, most of the gases are absorbed by the bacteria in the gut.When the balance is imbalanced, flatulence occurs.

Sometimes flatulence is provoked by nervous situations that “awaken” stress hormones.

Symptoms

Flatulence manifests itself as bloating or cramping pains, and may be accompanied by nausea, belching, loss of appetite, constipation or diarrhea, sleep problems, headache, and general weakness.

Bloating with flatulence is one of the most striking manifestations of an increase in the amount of gas in the intestines.It is impossible not to notice it, since the bloating is accompanied by pain and a feeling of pronounced discomfort. The abdomen increases in size due to the overflow of the intestines with gases. In this case, their discharge does not occur, since the colon is spasmodic.

Diagnostics and treatment

Flatulence is treated by a gastroenterologist.

In the presence of flatulence, the gastroenterologist prescribes various research methods to establish the cause of the discomfort.

If it is established that flatulence is the result of an irrational approach to nutrition, then the existing errors should be eliminated.It is important to eat regularly. Doctors recommend including fermented milk products in the diet. If they are taken regularly, the metabolic activity of the microflora will normalize, and the motor function of the intestine will be restored.

The principle of treating flatulence is to eliminate the cause of increased gas production. For this, a diet is prescribed, as well as drugs for the treatment of diseases that caused flatulence.

In the treatment of flatulence, absorbing agents are used, for example, activated carbon (effective only in large doses), white clay, polyphepan, dimethicone, polysorb.They reduce the absorption of gases, toxins and other compounds, and also promote their elimination.

It is also advisable to take pancreatic enzymes, since flatulence almost always occurs against the background of digestive disorders.

Flatulence: norm and pathology | # 02/08

The human gastrointestinal tract, in addition to solid and liquid components, contains a gaseous component in fairly significant volumes.The intestinal gases are distributed in a more or less dense mass of chyme and are enclosed in bubbles of various sizes with mucus membranes. The increased content of gases in the intestine and associated clinical disorders are included in the term “flatulence”. An increase in the volume of intestinal gases can lead to symptoms that give the patient very noticeable discomfort in the form of a feeling of fullness in the abdomen, rumbling and pain. There may also be an increase in the abdomen, increased gas flow. Severe flatulence can disrupt a person’s usual lifestyle, significantly affect his mental state, lead to anxiety, anxiety and even depression.In children of the first year of life, flatulence can lead to disruption of sleep, nutrition of the child, and affect psychomotor and physical development.

Normally, the intestines of an adult contain about 200 ml of various gases. The composition of these gases is very variable: they include nitrogen (11–92%), oxygen (up to 11%), carbon dioxide (up to 50%), hydrogen (up to 10%), methane (up to 60%), hydrogen sulfide (up to thirty%). ammonia and some others.

Relatively most of the gases enter the intestines during swallowing, incl.including nitrogen, oxygen and carbon dioxide. Increased gas in the intestines may be associated with increased swallowing of air (aerophagia) during meals, facilitated by hasty eating, talking while eating, drinking through straws, and chewing gum. A large amount of carbon dioxide enters the gastrointestinal tract with carbonated drinks. Some carbon dioxide can be produced in the stomach as a result of the reaction of food carbonates with the hydrochloric acid of the stomach contents.In children of the first months of life, swallowing of increased volumes of air during feeding is often observed and is associated with insufficient maturity of the nervous system and an incompletely formed swallowing reflex (especially in premature and immature children by the time of birth), which can cause regurgitation and even profuse vomiting only what food eaten. Perinatal disorders of the central nervous system also contribute to dyskinesia of the digestive system, one of the manifestations of which may be aerophagia.In this regard, in order for excess air to escape from the stomach without taking its contents with it, it is recommended to keep infants in an upright position for some time after feeding. Aerophagia, due to nutritional characteristics, is relatively physiological and quite easily corrected. At the same time, aerophagia, as a symptom of a serious disease of the nervous system and / or digestive organs, may require both a serious examination and long-term treatment.

Most of the gases from the stomach pass into the intestines along with food.

The second important source of intestinal gases is the metabolic activity of intestinal microorganisms, which is most actively represented in the colon. The saccharolytic microflora, prevailing in the intestine under normal conditions, largely utilizes carbohydrates not digested and not absorbed in the small intestine for its energy needs. First of all, we are talking about dietary fiber and some oligo- and disaccharides. As a result of fermentation processes, the microbe receives ATP, and its environment (i.e.i.e. intestinal contents) a number of metabolites, including gaseous ones.

So, as a result of homofermentative lactic acid fermentation, characteristic of lactobacilli and colon streptococci, lactic acid (up to 90%), carbon dioxide, hydrogen, and water are predominantly formed. Heterofermentative lactic acid fermentation, in which, in addition to lactic acid, other metabolites (including acetic acid) are formed, is inherent in bifidobacteria. Alcoholic fermentation, leading to the formation of carbon dioxide and ethanol, is a side metabolic pathway in some representatives of lactobacilli and clostridia.Separate strains Escherichia coli and Clostridium receive energy as a result of formic acid, propionic acid, butyric acid, acetone butyl or homoacetate fermentation. In this case, volatile fatty acids, carbon dioxide, hydrogen and water are formed in all types of fermentation. Organic acids are utilized by microorganisms, carbon dioxide is largely converted by other microorganisms into acetate, hydrogen is mainly absorbed and excreted through the lungs. Increased excretion of hydrogen with exhaled air is observed with an increase in the microbial population or with an increase in its saccharolytic activity, for example, with lactase deficiency.

Methane can form in small amounts in the intestines. Its presence in intestinal gases indicates the presence of Methanobrevibacter smithii in the intestinal microbiocenosis . The microbial metabolism of sulfur-containing compounds, primarily proteins (in particular, mucus proteins), determines the presence of hydrogen sulfide, but its large concentrations are associated with excessive activity of the proteolytic flora, often as a result of disruption of the processes of digestion and absorption in the small intestine and the entry of undigested proteins into the large intestine. …Also, as a result of microbial metabolism of proteins, ammonia is formed, which easily diffuses through the intestinal wall into the blood of the portal system and is mainly retained by the liver. Normal intestinal microflora helps to reduce the diffusion of ammonia into the blood, lowering the pH in the lumen of the colon, as a result of which ammonia is ionized with the formation of ammonium ions, which bind in salt and are excreted in the feces.

Finally, a certain amount of gases enters the intestinal lumen from the blood, but their volumes are relatively small.

The gas contained in the intestine is mainly evacuated through the anus, although some of it is absorbed into the bloodstream and excreted through the lungs or utilized by the body. A healthy adult per ani emits 0.2–2.5 liters of gases for 5–15 passages per day [1, 2].

The main reason for the increased content of gases in the intestine is the increased metabolic activity of the intestinal microflora. Among the physiological reasons for this phenomenon should be noted the use of fiber-rich plant foods, as well as raisins, beans, peas, black bread, kvass, beer.Also, gas production increases in many pathological conditions leading to a violation of the composition of the intestinal microbiocenosis.

The increased content of gases in the intestines leads to stretching of the intestines, thereby stimulating peristalsis, causing pain symptoms. At the same time, there is no clear correlation between the content of gases in the intestine and the clinical manifestations of flatulence, which is associated with a significant individual variability in interoception. In patients with a low threshold of reaction of intestinal interoreceptors, a pronounced clinical picture can be observed with insignificant gas production, and in persons with a high threshold of response, complaints are not observed even with significant formation of gases in the colon [3, 4].

A change in the composition of the intestinal microbiocenosis and, as a consequence, the development of flatulence can be facilitated by a violation of the processes of digestion, absorption, as well as a change in intestinal motility. In fact, in almost any disease of the digestive system, intestinal dysbiosis and flatulence as a manifestation of the latter can be observed.

A common cause of flatulence is lactase deficiency, lactose intolerance to milk sugar as a result of a deficiency of the small intestine enzyme lactase.Normally, lactase breaks down milk sugar into glucose and galactose, which are absorbed into the blood in the small intestine, however, with lactase deficiency, milk sugar is not broken down and reaches the large intestine unchanged, where it is utilized by microorganisms with an increase in gas production. In this regard, one of the tests for detecting lactase deficiency is to determine the increased concentration of hydrogen in the exhaled air. In addition, undigested lactose in the colon stimulates the secretion of water, which leads to the development of loose, frothy stools with a sour odor.All these symptoms occur only against the background of the use of dairy products containing lactose, primarily whole milk. Fermented milk products contain less milk sugar and can be eaten with a slight decrease in lactase activity. Cottage cheese and cheese do not contain lactose, and their intake does not cause symptoms. Lactase deficiency can be primary, associated with the genetic characteristics of the individual and inherited, and secondary, that is, arising against the background of diseases of the small intestine, as well as constitutional.The latter is due to the fact that in some people (clinically healthy!), The activity of lactase in the small intestine decreases with age and they cease to tolerate dairy products. This process can begin in the second half of the first year of life and is not considered pathological. There are entire regions and continents in the world (for example, Africa), the adult population of which does not tolerate milk sugar.

Another common cause of flatulence is irritable bowel syndrome (IBS), which is a combination of abdominal pain with changes in stool and / or flatulence.IBS belongs to the group of functional disorders of the digestive system, in which the nervous and / or humoral regulation of the gastrointestinal tract motility is impaired, and the organic pathology of the intestine is not detected. One of the causes of IBS may be a disorder of the intestinal nervous system, manifested in a decrease in the sensitivity threshold of intestinal interoreceptors. Clinical signs in favor of IBS are variability and variety of complaints, no progression, normal weight, increased complaints with stress, no symptoms at night, and association with other functional disorders.Most often, pain occurs before and after a bowel movement.

The main clinical manifestations of IBS include abdominal pain or discomfort that has been observed for at least 3 months of the last year, which decrease after a bowel movement, combined with a change in stool frequency (more than 3 times a day or less than 3 times a week) and / or shape stool (either hard, dry lumps – like “sheep feces”, or unformed – mushy). In addition to the main ones, additional symptoms are also distinguished: difficulty in the act of defecation or a feeling of incomplete emptying of the rectum, profuse mucus, rumbling or bloating.

By the nature of the stool, there are three main clinical variants of IBS: IBS with pain and flatulence; IBS with constipation; IBS with diarrhea. Flatulence can be observed with any type of IBS, but it is most pronounced with the first.

The cause of flatulence in IBS is a violation of intestinal motility, which leads to a change in the composition of the intestinal contents and, as a consequence, the composition of the intestinal microflora. Under certain conditions, the gas-forming activity of the latter increases, which is clinically manifested in the form of flatulence [3, 4].On the other hand, it has been shown that the reason for the development of a feeling of “bloating” in the abdomen in IBS can be not only and not so much an increased gas filling of the intestine, but a slowdown in intestinal motility. One of the reasons for such a slowdown may be a violation of the reflex regulation of motility at the level of the intestinal nervous system, in particular, a violation of the reflex to stretch the intestine [5, 6].

To effectively eliminate flatulence, you must understand the cause that causes it.Very often flatulence is associated with the peculiarities of the diet and the patient’s regimen, which in most cases it is quite possible to eliminate. In this regard, regular, nutritious meals in a relaxed environment should be recommended. It is advisable to include in the diet of probiotic fermented milk products “Activia”. Their regular use contributes to the restoration of the composition and metabolic activity of the intestinal microflora, as well as the normalization of intestinal motor function [9]. In controlled clinical studies, it was shown that regular consumption of these products for 14 days was accompanied by a decrease in the severity of bloating, flatulence, and the appearance of regular (at least 6 times a week) independent stool [10].The amount of gas-forming products must be selected individually. If diseases of the gastrointestinal tract are detected, these diseases should be treated first. The diet for flatulence is determined by the main pathological process. With lactase deficiency, it is imperative to follow a lactose-free or low-lactose diet with the exclusion or reduction of milk sugar in the diet. For children of the first year, in this case, low-lactose milk formulas or special lactase preparations should be used.In IBS with flatulence, the amount of plant products should be temporarily reduced, it is necessary to consult a neuropathologist and a psychologist, and antispasmodics can be used as a symptomatic remedy for pain relief (in older children and adults, for example, Duspatalin).

In order to correct the composition of the intestinal microflora, the appointment of probiotics is shown – preparations containing live microorganisms that have a positive effect on the microbial balance of the intestine.These preparations may contain Lactobacillus acidophilus, Lactobacillus GG, Lactobacillus fermentum, Streptococcus (Enterococcus) faecium SF68, S. termophilus, Bifidobacterium bifidum , for which the probiotic effect has been proven in double placebo-controlled studies. It is desirable that the strains of microorganisms that make up the preparations have antibiotic resistance and be protected from acidic gastric contents. On the other hand, the correction of intestinal microbiocenosis can be effectively carried out with prebiotic drugs, the most common component of which is lactulose (Duphalac).Low doses of lactulose contribute to the restoration of intestinal microflora with intestinal dysbiosis of various origins, by stimulating the growth of “own” microflora. Doses of the drug Duphalac are selected individually and vary depending on age, can be divided into two doses (table). In real practice, the combined use of pre- and probiotics is often used.

For many years, preparations containing simethicone, a mixture of a polymer of dimethsiloxane with silicon dioxide, have been widely used as an additional means to eliminate the symptom of flatulence and alleviate the patient’s condition.Simethicone is insoluble in water, quickly spreads through the media section and displaces foaming agents from the surface layer of the film. At the same time, it destroys the shells of gas bubbles in the intestinal contents and promotes the removal of gases from the intestines. Simethicone quickly and effectively eliminates the signs of increased gas filling in the intestines, has no side effects and age restrictions. The efficacy and safety of simethicone has been proven in a number of studies, and preparations based on it are recommended for use in many conditions accompanied by flatulence, in particular, in functional disorders [7, 8].Since in almost all cases of flatulence there are disturbances in the digestive processes, it is advisable to administer simethicone with pancreatic enzymes in combination, which significantly increases the effectiveness of eliminating flatulence. Enzymatic drugs can be prescribed independently (for example, Creon) or as part of drugs combined with simethicone (Pancreoflat).

The positive effect of pancreatic enzymes is due to the improvement of digestion processes, which is reflected in the functional state of the intestinal microflora and a decrease in the intake of undigested, in particular, gas-forming components into the colon.The use of microspherical preparations (Creon) turns out to be more effective than conventional tablet preparations, firstly, due to the high degree of activity of the initial substrate (pancreatin), and secondly, a special dosage form of the drug (microspheres 1–1.2 mm in size) providing uniform mixing with gastric contents, thirdly, the pH-sensitive shell of microspheres, which protects the enzyme from destruction in the stomach and ensures its maximum release in the duodenum [10-13].

Creon should be taken with meals. The dose is selected individually, the daily dose depends on the severity of exocrine pancreatic insufficiency. In pediatric practice, to facilitate the intake of the drug, the capsule can be carefully opened and microspheres can be taken without chewing, with a small amount of water. If the microspheres are mixed with food, they should be taken immediately after mixing; otherwise, damage to the enteric coating may occur.

Thus, increased gas production can be associated with a wide variety of reasons and, therefore, the approach to correcting this condition should be strictly individual.In general, the main directions of this correction are diet therapy, treatment of the underlying disease (if any), correction of microbiocenosis and symptomatic therapy with the inclusion of drugs containing simethicone.

For literature questions, please contact the editorial board.


A.A.Kovalenko , Candidate of Medical Sciences
T.V. Gasilina , Candidate of Medical Sciences
S.V.Belmer , Doctor of Medical Sciences, Professor
Russian State Medical University , Moscow

90,000 Bloating and flatulence: causes and how to get rid of

For bloating and flatulence, even TV ads offer different pills and remedies.After all, the problem of the accumulation of gases in the digestive system: stomach and intestines, gives a lot of unpleasant sensations: pain, sting, rumbling.

The main reasons for increased gassing

The cause of such discomfort in the human gastrointestinal tract is gases and the process of their formation. Where do they come from in the stomach?

There are several reasons for this. Normally, the human stomach contains a certain amount of various gaseous substances. Another part of the gases is emitted by microorganisms living in the intestine, if the number of beneficial bacteria is sufficient, then gas formation is normal.

Let’s try to analyze the most common causes of gas formation in excess of the norm.

If you are in a hurry while eating, swallow poorly chewed food, and even talk a lot – be sure that an excess amount of air will enter the stomach along with the food. Simple, old, good advice will help here:

  • do not talk when you eat;
  • Eat liquid food, drink solid food.

Eating foods that produce gases during digestion.

These are, as a rule, all legumes, cruciferous vegetables: cabbage, turnips, horseradish. Fatty, fried, spicy. Some types of bread. And sparkling water, especially sweet. Avoiding such an impact is also not difficult:

  • Soak legumes in cold water before cooking;
  • cabbage vegetables, even chopped for salads, briefly pour boiling water over;
  • do not overeat fatty, fried, spicy foods;
  • Multiple meals in moderation will also play a positive role.

The most dangerous cause of gas formation and flatulence when they are caused by acute and chronic diseases: gastritis, pancreatitis, ulcers and a number of other diseases of the human gastrointestinal tract. Here you need to undergo examination and treatment by a gastroenterologist. And do not postpone going to the doctor indefinitely.

To tolerate or tame?

Any accumulated gas will find at least two natural outlets. And he can do this with a decent noise, making others aware of your digestive problems.To quickly and effectively prevent an unwanted reaction, you need to take special medications.

The most affordable of them is activated carbon, you need to take 1 tablet per 10 kg of weight, if your weight is 70 kg, then you will need 7 pieces. Smecta powder has the same effect.

Preparations from the group of “defoamers”, such as Espumisan, Gastal, Bobotik, have proven themselves well. They contribute to the disintegration of the shells of gas bubbles and their absorption. Espumisan is available in the form of tablets and emulsions, is taken orally with food or immediately after a meal, has proven itself well in adults and children.

You can also buy enzyme preparations in the pharmacy: Mezim, Festal. They should be taken either with meals or immediately after, washed down with water. They will ease the condition and traditional medicine: place two large tablespoons of dill seeds in a container, pour 300 ml of boiling water, close the lid. After a three-hour infusion, take 100 ml three times a day between meals.

Remember, eating well is a recipe for well-being. 90 040 90 000 Causes of flatulence: facts and myths

Flatulence is one of the most common symptoms of indigestion.On the air of the Russia 1 channel, the leading programs “On the Most Important” Mikhail Politseimako and Sergei Agapkin, together with a gastroenterologist Sergei Vyalov, analyzed several popular facts about flatulence and decided which of them are really trustworthy and which are not.

Normally, a person releases gases about 14 times a day. “If flatulence, for example, every hour, then this is, of course, overkill. If flatulence swells the stomach so much that it increases in size, this is also a wake-up call.Even if flatulence is accompanied not only by a feeling of puffiness, but also bursting out from the inside out, as if the stomach wants to explode, this is also an alarming symptom, “explained the gastroenterologist, hepatologist Sergei Sergeevich Vyalov.

Causes of flatulence

Incorrect power supply. Most of the gaseous substances are found in the intestines. Lack of vegetables, fruits and fiber-rich plant foods in the diet leads to stool disorder. Try to eat at least 500 g of fruit per day!

Excessive intake of air in the gastrointestinal tract when eating.Stress and anxiety accelerate bowel movements! Chew food thoroughly, drink slowly, try not to speak while eating! If you have a tendency to gas production, drink water at least half an hour before meals!

Inflammatory bowel disease. Ulcerative colitis or Crohn’s disease is a serious bowel disease. If, when eating more fiber, gas formation increases, then we can talk about the presence of mild inflammation or irritation in the intestines.

Helicobacter pylori. The waste products of this bacterium cause inflammation and damage to the stomach lining. The mucous barrier and the production of hydrochloric acid are disrupted, which leads to disruption of the functioning of acid-producing cells. Bacteria in the small intestine begin to multiply actively, gas formation occurs, which leads to constant bloating. Get tested for Helicobacter pylori!

Facts and Myths

Raw vegetables and bran will cause flatulence.Raw vegetables tend to be slightly more gas and bloating than cooked vegetables.

Taking antibiotics or other medications. Some antibiotics also kill germs in the intestines, leading to bloating and gas. However, for example, the drug amoxicillin in combination with clavulanic acid causes asthmatic diarrhea, but does not affect the microflora.

Flatulence and dysbiosis are synonymous. Dysbacteriosis in the overwhelming majority of cases is accompanied by flatulence.An imbalance in the composition of the intestinal microflora can cause ulcerative colitis.

90,000 12 Possible Causes of Abdominal Pain

Abdominal pain is a common complaint and can be caused or complicated by many factors. We present to your attention the 12 most common reasons for this.

  1. Gastroenteritis (stomach flu)

In this case, abdominal pain is usually accompanied by nausea, vomiting and frequent loose stools.It is most commonly caused by bacteria or viruses, and symptoms usually resolve within a few days.

  1. Gassing

Gases occur when bacteria in the small intestine metabolize certain foods. The increased pressure of gases in the intestines can cause severe pain. Gas can also cause flatulence and belching.

  1. Irritable Bowel Syndrome (IBS)

For unknown reasons, individuals with IBS are unable to digest certain types of foods.Abdominal pain is a major symptom for many IBS patients and often resolves after a bowel movement. Other common symptoms include gas, nausea, cramps, and bloating.

  1. Acid Reflux

Acid reflux is a condition in which the acidic contents of the stomach pass into the esophagus. This process is almost always accompanied by burning and pain. Acid reflux also causes symptoms such as bloating or cramping.

  1. Gastritis

When the protective lining of the stomach becomes inflamed or destroyed, pain occurs. Nausea, vomiting, gas, and bloating are other common symptoms of gastritis.

  1. Constipation

When problems with bowel movements occur, pressure on the large intestine increases, which can be accompanied by pain.

  1. Gastroesophageal reflux disease (GERD)

GERD is a chronic relapsing disease caused by spontaneous, recurring discharge of gastric and / or duodenal contents into the esophagus, leading to damage to the lower esophagus.GERD can cause stomach pain as well as heartburn and nausea.

  1. Ulcers

Ulcers (peptic or stomach) usually cause severe and prolonged abdominal pain. The most common causes of ulcers are H. pylori bacteria and excessive and / or long-term use of non-steroidal anti-inflammatory drugs (NSAIDs).

  1. Crohn’s disease

Crohn’s disease is accompanied by inflammation of the digestive tract, which leads to pain, gas, diarrhea, nausea, vomiting and bloating.Given its chronic nature, this condition can lead to malnutrition, causing weight loss and wasting.

  1. Celiac disease

Allergy to gluten, a protein found in cereals that causes inflammation in the small intestine. This, in turn, is accompanied by painful sensations.

  1. Menstrual cramps or endometriosis

Menstruation may be accompanied by abdominal pain.Bloating, gas, cramps, and constipation can also occur during menstruation, causing discomfort. Patients with endometriosis may experience severe or chronic pain due to inflammation.

  1. Urinary tract and bladder infections

Urinary tract infections are most commonly caused by bacteria. Symptoms include pain, pressure in the lower abdomen, and bloating. Most infections cause painful urination.

Unusual and more serious causes

In some cases, abdominal pain is a symptom of a serious illness that, without prompt medical attention, can be fatal.

Some of the less common causes of abdominal pain are:

  • appendicitis;
  • kidney stones;
  • hepatitis;
  • stones in the gallbladder;
  • food poisoning;
  • parasitic infections;
  • infections of the abdominal cavity;
  • ischemia of the abdominal organs;
  • atypical angina or congestive heart failure;
  • cancer, in particular cancer of the stomach, pancreas or intestines;
  • cyst.

Based on materials from www.medicalnewstoday.com

90,000 Bloating, rumbling, flatulence, diarrhea? – Gastroenterology – Departments

Bloating, rumbling, flatulence, diarrhea?

SIBO (Small Intestine Bacterial Overgrowth Syndrome) IS POSSIBLE!

The syndrome of bacterial overgrowth in the small intestine (SIBO) is characterized by an overgrowth of bacteria in the small intestine and / or a change in their species composition.

What symptoms can be caused by SIBO?

  • bloating
  • rumbling
  • feeling of fullness of the abdomen
  • Excessive exhaust of gases
  • prolonged diarrhea
  • abdominal pain
  • Poor tolerance of some foodstuffs

In severe cases, there may be impaired digestion of fats, deficiency of iron, vitamins A, D and E, folic acid, vitamin B12.

In what situations is it important to identify SIBO?

The reasons for the development of SIBO are varied.These include a decrease in the secretion of hydrochloric acid by the stomach in atrophic gastritis or prolonged use of drugs that reduce the acidity of gastric juice, liver disease, pancreas (chronic pancreatitis) and small intestine (celiac disease, inflammatory bowel disease), conditions after surgery on the digestive system , long courses of antibiotic therapy, intestinal infections. SIBO can often be detected in patients with irritable bowel syndrome.The possible role of SIBO in obesity and type 2 diabetes is discussed.

How can SIBO be diagnosed?

In world clinical practice, the main method for diagnosing SIBO is the hydrogen breath test (determination of the concentration of hydrogen in the exhaled air on an empty stomach and after taking lactulose). In the presence of SIBO, the level of hydrogen in the exhaled air is high due to the formation of microbial metabolites in the small intestine. The same method can be used to control the results of treatment with various drugs that suppress the growth of excess flora in the small intestine.

The advantages of the method include its non-invasiveness, relative ease of implementation and low cost.

The result is ready immediately after the end of the study.

How do I prepare for the test?

  1. Avoid all alcoholic beverages (including beer) at least 24 hours in advance.
  2. 24 hours before the test, exclude: apples, pears, plums, cabbage, onions, garlic, legumes, pickled vegetables, smoked meats, milk, juices, chocolate, chewing gum.
  3. Do not eat at least 14 hours before the test, you can drink water.
  4. No smoking 12 hours before the start of the study.
  5. On the day of the study, do not use denture adhesives.
  6. Do not sleep or exercise 2 hours before the study.
  7. Brush your teeth in the morning
  8. Research time is about 2 hours.

Treatment for bacterial overgrowth syndrome?

It should be borne in mind that SIBO is not an independent pathology, but only a secondary syndrome that accompanies many pathological conditions.