Flatulence

Flatulence is often referred to as passing or breaking wind, and happens when your body needs to get rid of the excess air that builds up from drinking and swallowing food and saliva.

Flatulence can be embarrassing, but it is a common problem and affects everyone at some point.  On average, the majority of people pass gas 15 times a day but anything up to 40 times in one day is considered normal.

The gut (the long muscular tube that stretches all the way from your oesophagus - or gullet - to your rectum) contains a lot of gases, mainly:

• nitrogen and oxygen -  via air taken into the body through the mouth during eating and talking.
• carbon dioxide - produced when the acid present in the stomach comes into contact with bile and juices from the pancreas.
• hydrogen and methane - produced when the bacteria in the colon starts to ferment the residues delivered from the small intestine.

Over 90% of gas is made up of nitrogen, oxygen, carbon dioxide, hydrogen and methane and the remaining 10% is a small amount of other gases.

Much of this gas is released within our bodies, gets into our bloodstream and lungs and is lost through our mouths when we breathe.  The rest has to escape either through your mouth (belching) or through the anus as flatulence.

Excess flatulence may be accompanied by other symptoms caused by bowel gas:

• Belching (burping) - gas is released through your mouth in a sudden reflex movement. This happens when your stomach becomes filled with excess swallowed air, usually from eating, drinking or smoking.
• Bloating - your stomach feels very full and may make you feel as if you need to belch. It is often caused by eating rich foods that take a long time to digest properly.
• Borborygmi (rumbling stomach) - this occurs when your stomach contracts quickly, causing the contents of the intestine to be pushed backwards and forwards. It can happen when you are hungry but can also be triggered by anxiety and nervousness.

The food we eat is digested and absorbed in the small intestine. Wind is produced by the digestive system as enzymes and bacteria break down carbohydrates and proteins in your food. Anything that is left over, such as dietary fibre and some carbohydrates, pass on to the large bowel.

If you have had a change in your usual diet then this can cause your body to produce more wind than usual. This is because the bacteria that live in our bowels get used to coping with whatever we eat on a regular basis, and have a bit more difficulty handling anything we're not used to.

If you regularly overeat then your stomach will have to work faster than normal, breaking down all the extra food, which can lead to more wind.

Foods such as beans, cauliflower and cabbage, contain insoluble fibre and take a long time to break down in the bowel, which can also trigger excess wind.

Certain foods such as kidney beans and artichokes cause an overproduction of bacteria in the stomach, which can in turn lead to excessive flatulence. Food containing a lot of fibre such as baked beans and brown rice and drinks, such as beer and coffee can also contribute to flatulence.

Other foods that can cause flatulence in some people are lettuce, apples, cabbage, cauliflower, turnip, lentils, parsnip, swede, onions, brussel sprouts, beans, garlic, leeks, and products made with malt extracts.

Foods which are rich in sulphur, like cauliflower, eggs and meat are more likely to make the gas smelly. Bacterial fermentation in the colon can also cause smelly wind.

Medical conditions that can cause flatulence are:

• irritable bowel syndrome (IBS),
• gastroenteritis,
• diverticulosis or diverticulitis,
• coeliac disease,
• if your thyroid is not working properly,
• if your body is not absorbing food properly, or
• if part of your intestine is blocked.

Flatulence can also be an unwanted side effect of laxatives taken for constipation, antibiotics, certain medications, or from misuse of opiate based medicines like pethidine and morphine.

Above all, the most common cause for flatulence is swallowing air.  This is because each time we swallow; we take air into the stomach. Eating too fast, gulping food and drink, drinking with meals, chewing gum, smoking, or wearing loose dentures can all contribute to swallowing excess air. The air normally leaves the body as a belch (burp) but sometimes it can travel further into the intestines and can only be released through your anus.

Wind is the result of excess gas in the colon and is not normally a cause for concern. However, if your wind is accompanied by other symptoms, you may need to talk to your GP, as the combination of symptoms may be due to an undiagnosed condition.

Although the large majority of cases of excessive flatulence are harmless, it can be a symptom of digestive disorders such as gastroenteritis or irritable bowel syndrome (IBS).

If you have other symptoms such as abdominal pain, blood in your stools, pale stools that are difficult to flush away, constipation and/or unexpected loss of weight, arrange a visit to your GP for an individual diagnosis.

If you are generally healthy, then flatulence should not be a cause for concern.

Treatment may be necessary if the flatulence become very severe or is accompanied by other symptoms such as abdominal pain, vomiting or diarrhoea, in which case you should first get advice from your GP.

There are some gut relaxant drugs available, which can help to ease bloating and the symptoms associated with flatulence. Asmebeverine and Alverine are available in over-the-counter treatments or on prescription through your GP.

Diet can be an important factor in helping to reduce flatulence. Rich foods or foods that are high in fibre can be difficult to digest and can result in excess gas being produced inside your gut.

Foods that are well known to produce excess gas are beans, cabbage cauliflower, brussel sprouts, broccoli, peas and lentils. We all need to eat five portions of fruit and vegetables a day, so try to remove one food at a time from your diet to find out which one is the problem.

Some people may notice that they have sensitivity to certain foods and produce more gas after eating them, for example, gluten, lactose (milk sugar); if this is the case, you should limit the amount you eat.

However, it is important to have some fibre in your diet as it can keep your intestine healthy by helping waste products to travel through the bowel and preventing constipation. Some research suggests that fibre may also help to reduce the risk of bowel cancer.

To reduce the causes of flatulence, you should:

• try not to eat your food too quickly and chew it properly - when you gulp down your meals, you swallow more air,
• avoid overeating - when you're overfull your stomach tries to make room by getting rid of some gas,
• avoid smoking and chewing gum- both of these make you produce more saliva, which means you swallow more air,
• avoid foods with a high quantity of unabsorbable carbohydrate (carbohydrate which cannot be broken down and absorbed by your intestine), for example beans and broccoli,
• avoid slimming foods that contain sorbitol,
• cut down on fizzy drinks, beer and/or coffee,
• get some exercise - it'll keep your bowels moving normally.
• avoid tight clothing - to allow wind to pass through unrestricted, and
• try anti-wind medication or charcoal tablets from your local pharmacy,
• a natural remedy is to drink two teaspoonfuls of peppermint water mixed in a small cup of hot (not boiling) water, or
• herbal teas such as fennel or dill, may also help.

Wind is not a cause for concern unless there has been a change in the frequency of your bowel movements, excessive mucus or bleeding from the anus. Or if you are experiencing other symptoms such as pain, constipation, weight loss or unexplained weight gain.

If the pain becomes severe or persistent and is accompanied by diarrhoea, visit your GP to check that there is no underlying cause.