Flatulence

Flatulence is often referred to as passing wind, farting, or having gas. It refers to the expulsion or release of gas from the digestive system through the anal passage. Some amount of gas is normally released during the digestive process, but a build-up of excess gas can cause flatulence, burping, bloating, and abdominal cramping can be a symptom of a more serious medical condition.

Symptoms commonly attributed to “too much gas” such as bloating, distension and abdominal discomfort, are the most commonly encountered gastrointestinal complaints, especially in the OPDs. What is said as excessive gas is merely an enhanced sensitivity of the gastrointestinal tract to the normally produced gases during the process of food digestion by the bacteria in the intestine.

Almost half of the Indian population faces this problem of flatulence at one or the other time in their lifetime.

As per news daily from London in Feb 2009, Adolf Hitler’s table manners have been highlighted as an abstract reported by his staff officer

The Nazi leader gorged on the cake in his bunker and suffered from flatulence.

The secret intelligence report discovered during a house clearance outlines Hitler’s terrible table manners, “uncouth behaviour”, cake-scoffing and flatulence problems.

The entries say: “Hitler eats rapidly, mechanically, for him food is merely an indispensable means of subsistence…

“At the table and in his speech he shows many facets of rather uncouth behaviour. He abstractedly bites his fingernails… and his table manners are a little short of shocking.”

One entry reveals that Hitler “ate prodigious amounts of cake” which caused “a slight digestive disorder”.

Hence the main cause of flatulence is inappropriate eating habits. Before we go on to the management of this disorder, it will be pertinent to know certain facts about the problem of gas. This understanding will help us to a great extent in easy management of the problem.

Causes of Flatulence

Normally app 200 ml of gas is present in the intestine at any given time. The main source of production is the digestive process taking place in the intestine and swallowing of air while eating or drinking. On average, a person passes flatus (passing gas per rectum) 14 times (normal range extends from 10-20 times).

The average daily excretion of gas is 750 ml with the range being 475 – 1500 ml. The quantity of the gases expelled is more or less unchanged in an individual. It is the unusual perception of the gases which gives rise to the sense of bloating.

Gas in the digestive tract comes from two sources:

1. Normal breakdown of certain undigested foods by harmless bacteria naturally present in the large intestines.
2. Air swallowing (aerophagia): Everyone swallows small amounts of air when eating and drinking. Eating or drinking rapidly, chewing gum, smoking or wearing loose dentures can also cause some people to take in more air.

Other Causes of Flatulence Are:

• Eating large amounts of non-digestible foods such as fibre.
• Eating foods that are not tolerated, as in lactose intolerance.
• Acute pancreatitis (Accompanied by severe pain abdomen)
• Irritable bowel syndrome
• Malabsorption or inadequate absorption of nutrients from the intestinal tract, often accompanied by diarrhoea.
• Use of oral antibiotics
• Gastrointestinal cancer and its treatment

Alarm Symptoms of Flatulence

• Recent onset change in bowel habits with bloating
• Loss of appetite
• Weight loss
• Blood in stools
• Severe pain abdomen associated with abdominal distension
• Unexplained fever
• Lethargy with cold intolerance
• All these features necessitate immediate attention of the physician

Foods That Most Likely to Cause Gas

Food products that contribute to gas production

Reasons Why Some Foods Cause More Gas

• Complex carbohydrates

  CCI or Complex Carbohydrate Intolerance is a condition in which the body finds it difficult to break down and digest carbohydrates like raffinose, fructose, and sorbitol, leading to bloating and gas. Even in unimpaired people, the consumption of beans, legumes, and other complex carbohydrates may cause excess gas.

• Lactose intolerance

  Milk and dairy products contain a disaccharide sugar that is usually digested by the human body when we consume these products. In cases when the person suffers from lactose intolerance, the digestion of this sugar remains incomplete, causing a number of symptoms, including flatulence.

• Celiac disease

  Celiac disease is an autoimmune disorder that is triggered by the consumption of gluten-rich foods such as wheat and rye. Apart from malabsorption, some of the main symptoms of the disorder are flatulence and bloating.

• Artificial sweeteners

  A number of foods like jams, jellies, candies, and desserts are high in artificial sweeteners. These sweeteners like aspartame, sorbitol, stevia and acesulfame potassium can cause bloating, flatulence, diarrhoea, and other symptoms of digestive disorder.

• Fibre supplements

  Fibre is an important addition to your diet, but fibre supplements can often cause gas and flatulence. If you have been prescribed fibre supplements, you may want to try several different brands before you find one that suits you.

• Carbonated drinks

  Most carbonated beverages and fizzy drinks contain dissolved carbon dioxide. When they are consumed, this gas is released in the stomach and causes belching. Regular consumption can cause gas and flatulence.

Underlying Conditions That Can Worsen Flatulence

Occasional flatulence is a normal occurrence, but some of the following conditions may exacerbate severe and chronic flatulence.

• Constipation

  Chronic constipation can cause flatulence. As the waste is not eliminated, it ferments in the intestine and releases more gas.

• Gastroenteritis

  Gastroenteritis can be bacterial or viral and causes inflammation of the stomach and intestines. Flatulence is one of the first symptoms of this condition.

• Food Intolerances, like Lactose Intolerance

  Consuming food you are intolerant to causes flatulence. For example, a person who is lactose intolerant is likely to experience gas when he/she consumes dairy products.

• IBS

  IBS causes excess gas build-up. Both IBS (D) and IBS (C) patients experience flatulence.

• Crohn’s Disease

  Crohn’s Disease is a form of inflammatory bowel disease that can cause severe gastrointestinal symptoms. One of the first presentations of the disease includes Crohn’s Disease.

• Celiac Disease

  Celiac disease is an autoimmune response triggered by gluten consumption. It presents with various symptoms, including excess gas.

• Diabetes

  One of the known complications of diabetes is gastroparesis which causes delayed emptying of food from the GI tract. This delay causes gassiness and flatulence.

• Eating Disorders

  A number of eating disorders, such as anorexia cause can cause several GI symptoms, including bloating, constipation or diarrhoea, indigestion, and flatulence.

• Ulcerative Colitis

  Ulcerative Colitis is a condition that causes acute inflammation and ulceration in the intestinal tract. One of the symptoms is flatulence.

• Dumping Syndrome

  Dumping syndrome is a constellation of a number of digestive issues, including rapid gastric emptying, diarrhoea, and gas.

• Gastroesophageal Reflux Disease (GERD)

  GERD or gastroesophageal reflux disease causes stomach acid regurgitation or backflow through the oesophagus. It causes belching, cough, discomfort, and gas.

• Autoimmune Pancreatitis

  AIP is an autoimmune condition that causes chronic inflammation of the pancreas. It causes excess gas, among other things.

• Peptic Ulcers

  Several factors, including H Pylori, may cause peptic ulcer or gastric ulcer. It causes vomiting, dark stools, gas, and nausea.

Diagnosing Flatulence

Flatulence or excess gas is a symptom of several conditions. To diagnose, your doctor at Max Healthcare may ask you questions to understand your dietary and lifestyle habits and personal and family medical history. This could be followed by a physical exam of the abdomen. If the cause is not clear, the doctor may recommend one or more of the following tests.

• Abdominal X-ray
• Upper GI endoscopy
• CT scan
• Stool tests
• Breath tests

Treatment of Flatulence

It is evident from the above that the problem of excessive gas is basically due to inappropriate sensitivity of the intestine to the normal stretch sensation. There may be certain food products that may be leading to the overproduction of gas than in normal circumstances. So one should avoid such foods mentioned above in the table.

Apart from treating the underlying cause of flatulence, your doctor may treat the symptoms with the help of the following -

• OTC medications

  Over-the-counter medications such as Alpha-galactosidase, simethicone, or lactase supplements can help relieve the symptoms of gas.

• Prescription drugs

  Medicines like antibiotics such as Rifaximin help treat several conditions that cause gas.

• Supplements

  Probiotics and supplements often help relieve gas and flatulence by introducing healthy gut bacteria.

Other than this a few things that can help improve the sense of bloating are

1. Keep abdominal muscles properly toned up by regular physical exercises of the abdominal wall muscles.
2. Chew food properly.
3. Consume digestible fibres in the diet such as oatmeal, bran, multigrain foods and lentils.
   

Most Effective Remedies For Flatulence

1. Use of Baking soda
2. Peppermint extracts
3. Saunf
4. Pudin Hara
5. Use of Isapgula husk for regular bowel movements

Complications from flatulence

Flatulence and excess gas are often accompanied by bloating, abdominal cramping, nausea, and changes in bowel movement. These can cause physical discomfort. Excess flatulence can also cause stress or anxiety in social situations. Complications often arise from underlying causes that go undiagnosed.

How Can Flatulence be Prevented?

• Dietary changes

  Making small but significant dietary changes can help prevent and resolve flatulence. Keeping a food diary helps in detecting food intolerances like gluten or lactose intolerance. Avoiding foods that exacerbate gas is a good idea. Eating smaller, more frequent meals can help prevent gas.

• Increase fluid intake

  Keep yourself hydrated, drink adequate water, and take small sips from a glass instead of gulping.

• Lifestyle changes

  Keeping a healthy lifestyle and exercising regularly keeps conditions like constipation at bay and helps control diabetes. This helps manage gas and flatulence. An active lifestyle is key in preventing gas as well.

• Supplements

  Some home remedies, like probiotics, and herbs like ginger or cumin, help relieve flatulence. You may want to try OTC remedies for minor cases of gas.

• Other changes

  Sometimes, minor changes like using heating pads or changing the sleep posture can help relieve episodes of flatulence.

When should I see a doctor?

Minor episodes of flatulence and gas are resolved within a few days. It is important to seek medical help if flatulence becomes chronic or severe. See a doctor at Max Healthcare if you experience any of the following symptoms –

• Distended abdomen, severe bloating
• Cramps or abdominal pain
• Nausea, constipation, or diarrhoea
• Severe heartburn
• Back, tarry stools or blood in stools
• Weight loss

Conclusion

Gas or flatulence is often a common problem, but it can also be a symptom of a more serious condition. Therefore, it is important to keep a record of the duration and associated symptoms and talk to your gastroenterologist at Max Healthcare. We offer the best patient care services in India, brought to you by experienced medical personnel and state-of-the-art facilities.