What is Gas or Flatulence?

There is air in every ones digestive system. It may be eliminated by burping or passing it through the rectum. When air in the intestine is passed through the rectum, it is called gas or flatulence. If air is passed from the digestive tract through the mouth, it is called belching. Gas is usually made of odourless vapours i.e. carbon dioxide, oxygen, nitrogen, hydrogen and sometimes methane. Unpleasant odour of flatulence is caused because of sulphur formed by bacteria in the large intestine. Gas is a common condition that is not fatal, but can be uncomfortable and embarrassing.

Causes

Gas can be caused because of several reasons. Some of the common causes of gas include: 

• constipation
• taking antibiotics
• eating foods that are difficult to digest, such as fibre or foods with unabsorbable carbohydrates, such as beans, broccoli, cabbage, cauliflower, raisins, pulses, prunes and apples
• intestinal problems, such as irritable bowel syndrome (IBS), malabsorption, (a medical condition in which the intestines are unable to absorb nutrients properly)
• eating foods that you cannot tolerate that cause problems, such as gluten intolerance  (a type of digestive problem caused because of intolerance to a protein called gluten, which is found in wheat, rye and barley) and lactose intolerance (in this condition, the body fails to digest lactose i.e. a type of natural sugar found in milk and dairy products)
• swallowing air while eating.

Symptoms

Common symptoms of gas include:

• abdominal bloating,
• abdominal pain,
• passing too much gas (flatulence) and
• belching.

It is possible to not experience all the symptoms and the severity of symptoms may vary from mild to severe. Severity and nature of symptoms depends on how much gas your body produces, the amount of fatty acids the body absorbs and your sensitivity to gas in the large intestine.

Treatment

Treatment of gas or flatulence aims to reduce discomfort and symptoms. Treatment includes:

• diet changes (avoiding foods that are high in unabsorbable carbohydrates),
• eating and chewing slowly,
• lifestyle changes (such as exercising regularly, quitting smoking) and
• taking medicines. Some medications that are useful for gas are alpha-galactosidase, charcoal tablets and probiotics.

Symptoms of Gas or Flatulence

Gas or flatulence is a common medical condition for which people visit their doctor. Common symptoms of gas are abdominal bloating, abdominal pain, passing a lot of gas (flatulence) and belching. You may not experience all the symptoms and the severity of symptoms may vary from mild to severe. Severity and nature of symptoms depends on how much gas your body produces, the amount of fatty acids the body absorbs and your sensitivity to gas in the large intestine.

• Belching: Gas is a common cause of belching. Most people belch occasionally during or after meals to release gas when the stomach is full of food; this is considered normal. Some people, however, belch more frequently, which may be because of swallowing too much air and releasing it before the air enters the intestine. Chronic belching may be caused because of upper gastrointestinal (GI) disorder, such as peptic ulcer disease, gastroesophageal reflux disease (GERD), or gastroparesis, also called delayed gastric emptying. Some people may belch deliberately or inadvertently develop a habit of belching to relieve discomfort.
• Flatulence: Another common symptom of too much gas is flatulence. Most people do not know that healthy adults pass gas about 14 to 23 times a day, but if you pass too much gas, it can be a problem and source of embarrassment. Too much gas may be caused because of many conditions, such as lactose intolerance, carbohydrate malabsorption, etc.
• Abdominal Bloating: Some people with gas may feel that their abdomen is bloated while others may complain of bloating from gas even when they have normal amount and distribution of gas.

Bloating may be caused because of an intestinal disorder, such as irritable bowel syndrome (IBS). The cause of IBS is unknown, but it may involve abnormal movements and contractions of intestinal muscles and increased pain sensitivity in the intestines. These disorders may give a sensation of bloating because of increased sensitivity to gas. Some other conditions that may cause bloating include many operations of abdomen, internal hernias or formation of bands of internal scar tissue called adhesions. Eating a lot of fatty food can also cause bloating as stomach emptying is delayed making one feel uncomfortable. Bloating may be caused as a complication of fundoplication surgery to correct GERD. In this surgery, a one-way valve is created between the oesophagus and stomach to allow food and gas to enter the stomach, but often prevents normal belching and the ability to vomit. In most cases, however, the symptom improves with time.

• Abdominal Pain and Discomfort: Gas in the stomach can cause pain and discomfort. The pain may be experienced in the abdomen or on the left side of the abdomen and chest. In such cases, it may be confused with a heart disease. If the pain is on the right side of abdomen and severe, it may mimic gallstones or appendicitis.

These are some symptoms of gas or flatulence, though all the symptoms can be caused because of many other conditions of the abdomen. Your doctor can examine you and diagnose the cause of your symptoms and treat it appropriately.

Prognosis of Gas or Flatulence

Gas or flatulence is a condition in which excessive air is passed through the rectum (air passed through the rectum is called gas or flatus). Gas can be caused by many causes, such as eating foods that are difficult to digest, such as fibre, constipation, irritable bowel syndrome (IBS), coeliac disease, lactose intolerance, gastroenteritis, and malabsorption. Prognosis of gas is affected by the cause of flatus.

Prognosis of gas or flatulence

Flatulence because of foods: Flatulence is most often caused because of foods you eat and sometimes, by habits that cause a person to swallow air. Prognosis is good if there is no other problem that is causing gas. In these people, diet and lifestyle changes and self-care can significantly improve the symptoms. Avoiding eating foods that cause gas is important. One should avoid eating foods that are high in unabsorbable carbohydrates. Since different people react differently to certain foods, even when you eat foods that usually do not cause gas, you may continue to experience flatulence.

Flatulence in constipation: Many people experience gas because of constipation. They may pass gas often, which may be foul smelling. Flatulence may get relieved with the control of constipation by taking measures, such as drinking plenty of non-alcoholic fluids, eating plenty of fruits and vegetables and if needed, taking medications for constipation and gas.

Flatulence in irritable bowel disease and other intestinal problems: Prognosis of flatulence because of irritable bowel disease may not be so good as flatulence caused because of diet. Such people may have recurrent episodes of flatulence (when there is flare-up of symptoms of primary disease). Even in these people, however, it may be effectively controlled by diet changes and over-the-counter medications, such as alpha-galactosidase and probiotics.

Flatulence in food intolerance: Gas because of eating foods that you cannot tolerate, such as lactose intolerance or celiac disease improves as soon as the person avoids eating food that is problematic. Coeliac disease is a type of digestive problem caused because of intolerance to a protein called gluten, which is found in wheat, rye and barley.  Lactose intolerance is a condition in which the body fails to digest lactose i.e. a type of natural sugar found in milk and dairy products.

Diagnosis of Gas or Flatulence

Gas or flatulence is a common condition for which a person visits the primary care doctor. It is diagnosed based on signs and symptoms, such as abdominal bloating, abdominal pain, passing too much gas (flatulence) and belching.

Medical history and physical examination: Your doctor will take a detailed medical history and do physical examination with special attention to your abdomen. Some of the questions that your doctor may ask include:

• What types of food do you eat usually?
• Have you made any changes in your diet recently?
• How long have you had the problem of gas?
• Do you have any other problem, such as abdominal pain, diarrhoea, early satiety (premature fullness after meals), bloating or weight loss?
• What foods have you eaten in the past few days?
• Have you recently increased fibre in your diet?
• Whether you chew and swallow slowly or fast?
• Is your gas problem mild or severe?
• Do you think that eating any specific food, such as eating milk products, increases your symptoms?
• What improves your gas and other symptoms?
• Are you taking any medication?

Your doctor may ask you to keep a food diary. This can be helpful in reviewing your dietary habits and symptoms.

Diagnostic tests: Treatment for gas is usually started based on clinical diagnosis, but if the diagnosis is not clear or some other medical condition is suspected as the cause of your symptoms, tests may be done.

• Lactase deficiency: If deficiency of lactose enzyme is suspected as the cause of gas, the doctor may take blood or breath test to diagnose lactose intolerance and suggest avoiding milk products.
• Hydrogen breathe test: The doctor may take a test to measure the amount of hydrogen in your breath after you eat suspected foods. As bacteria mostly produce hydrogen, an increase in hydrogen level in the exhaled air as measured by the breath test will suggest food intolerance. Breath test is done a few hours after eating the food that is suspected to be the cause of the problem as an increase in hydrogen level becomes evident in as little as 2 hours.

Some other tests that may be performed include:

• abdominal CT scan
• abdominal ultrasound
• barium enema x-ray
• barium swallow x-ray
• blood studies such as CBC or blood differential
• sigmoidoscopy and
• upper endoscopy (EGD).

Treatment of Gas or Flatulence

Treatment of gas or flatulence aims to reduce discomfort and symptoms. Treatment involves self-care and diet changes, taking medicines and reducing the amount of air swallowed. Your doctor will prescribe medicines if flatulence and other symptoms are severe.

Diet changes: Flatulence is most often caused because of foods that one eats and sometimes, by habits that cause a person to swallow air. Avoiding problematic foods in the diet are important to prevent excessive gas. Some of the problematic foods include those that are high in unabsorbable carbohydrates. Some foods high in unabsorbable carbohydrates include:

• beans
• broccoli
• cabbage
• cauliflower
• artichokes
• raisins
• pulses
• lentils
• prunes
• apples and
• brussels sprouts.

Eating a healthy balanced diet, which includes at least five portions of fruits and vegetables a day is important. Your doctor or dietician can help you choose foods to avoid. Some foods that contain carbohydrates and are easy to digest include:

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

As different people react differently to certain foods, even when you eat foods that usually do not cause gas, you may continue to experience flatulence. Keeping a food diary can help you to find out the foods that make your symptoms better or worse. Besides changes in what you eat, eating six small meals a day rather than three large ones can also be helpful. Eating small meals makes it easy to digest and help produce less gas.

Swallowing air

When eating, chew your food properly and make sure that you eat slowly. This helps reducing the amount of air that you may swallow, thereby improving digestion. Avoid chewing gum as it makes one swallow more air than usual.

Exercise

Doing exercises regularly improves the functioning of digestive system and bowel movements. It also improves symptoms, such as bloating and clearing of gas. Exercising for 20 to 30 minutes on most days of the week is adequate.

Quit smoking

Quit smoking if you are a smoker as it can cause you to swallow more air than usual. In addition to the likelihood of swallowing more air, tobacco smoke has substances that can irritate the digestive system.

Medication and other remedies

If diet and lifestyle changes do not improve gas and bloating, you may need medicines. Several over-the-counter remedies are available to help treat symptoms of flatulence. Some medications that are useful for gas include:

• Alpha-galactosidase: It is a dietary supplement, which has been shown to improve digestion of carbohydrates and reduce the symptoms of flatulence.
• Charcoal tablets: Charcoal absorbs gas in the digestive system and reduces the symptoms of flatulence.
• Probiotics:  Probiotics can encourage the growth of 'friendly bacteria' in your digestive system. As 'friendly bacteria' aid digestion, probiotics can reduce the symptoms of gas and flatulence.

Tips to Prevent Gas or Flatulence

Flatulence is a common problem, which is not life–threatening, but can be a major cause of discomfort and embarrassment for the person experiencing it. Here are some tips to prevent gas or flatulence. 

• Eat slowly: When you eat, a little bit of air goes down every time you swallow. Eating slowly and chewing the food properly can reduce the amount of air that you swallow and improve digestion. Avoid chewing gum as it makes one swallow more air than usual.
• Avoid airy drinks and foods: Air also gets into one’s stomach and intestine when one eats food and has drinks, such as beer, soda or sponge cake that contain air.
• Don’t smoke: Quit smoking if you are a smoker as it can cause you to swallow more air than usual while smoking. In addition to this, tobacco smoke has substances that can irritate the digestive system.
• Avoid sulphur: Bad smell of flatus is caused because of gases that contain sulphur. If you ingest less sulphur, the smell of the flatus would not be as bad. Avoid foods that contain sulphur, such as eggs, meat, and cauliflower.
• Cook your beans: Bacteria in colon feed on the carbohydrates in beans and produce a gas by-product. The gas making potential of the beans can be reduced by boiling the beans briefly, letting it stay in the water and cooking them after changing the water.
• Consider Beano: According to research, high doses of the over-the-counter product Beano reduced flatulence and digestion of carbohydrates. Beano (is alpha-galactosidase) is a dietary supplement.
• Exercise regularly:  exercising regularly is helpful in improving the function of the digestive system and bowel movement. It also improved symptoms, such as bloating and clearing of gas. Exercising for 20 to 30 minutes on most days of the week is adequate.To prevent flatulence, proper digestion of food is prerequisite.

 Limit high-fructose corn syrup: Foods that contain this sweetener may cause gas and bloating (especially when large amount of fructose is ingested) as it does not get absorbed by the small intestine.

• Take probiotics: If there is too few or too much of a particular bacteria in the intestine, one may experience flatulence. Consult your doctor for probiotics. Probiotics are available both as solids and liquids. They encourage the growth of 'friendly bacteria' in the digestive system. As 'friendly bacteria' aid digestion, probiotics can reduce the symptoms of gas and flatulence, especially if flatulence is caused by irritable bowel syndrome.

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