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Home , Bloating, Flatulence

Wind and

Introduction eat; the type of in the colon; and the time it takes food to travel through There is nothing more embarrassing the intestine. We produce much more than . It gurgles and squelches than that, but gas can be absorbed during through the intestines during passage through the gut. pauses in conversations, sometimes Intestinal are a mixture of squeaking like a rusty door and and with variable amounts sometimes roaring like an express of and some and an train in a tunnel. admixture of very smelly substances like It can get trapped by spasms causing hydrogen sulphide and skatoles. pain and such severe bloating and distension that women (and men) Where is intestinal gas can look as if they’ve acquired a five-month pregnancy within the generated? space of half an hour. It can rise up Air can be swallowed along with food and in the mouth and be expelled with drink. Carbon dioxide can be generated in a cavernous belch but worst of all, it the by the combination of gastric can escape downwards, either silent acid and digestive secretions containing and deadly at five paces or with a sodium bicarbonate. But these gases are toot or blast that instantly identifies normally absorbed in the . the culprit. But where does all this gas Most intestinal gas is generated in the come from? colon by the of or protein that has escaped What gas do we absorption. Indeed, the colon can be thought of as a large fermenting vat of produce? bacteria, converting sugars and starches During the normal course of a day, people and some protein to short chain fatty acids evacuate as much as two litres of gas (mainly acetic acid, propionic and butyric depending on what and how much they acid), a little alcohol and a lot of gas. Gassy Symptoms • bacterial overgrowth of the stomach due to suppression of acid secretion These include belching, farting, abdominal and stagnation of food. This causes rumbling and bloating. smelly or eggy burps. Gas and wind can be very embarrassing and painful • Farting. People suffer from or farting when they pass too much to people with Irritable wind, when it is too smelly, too noisy Bowel Syndrome. It gurgles and when they can’t control it. and squelches through the It’s not so much the actual expulsion intestines during pauses in of wind that is the problem, it is what conversations, sometimes it represents in our society; a lack of squeaking like a rusty manners or control. So uncontrolled door and sometimes like a expulsion of gas draws attention to itself roaring express train in a because it smells or makes a distinctive sound. tunnel. • Why does intestinal gas smell so • Belching. Belching is the venting of bad? Most intestinal gases have no gas from the stomach and may generate smell, but they do carry small quantities a noise when the ring of muscle at the of ‘rotten egg’ hydrogen sulphide top of the gullet is more tense. and highly potent volatile perfumes, It is quite normal to belch up swallowed such as cadaverine and putrescine, air or the carbon dioxide generated by formed by the bacterial putrefaction of the combination of and proteins. alkaline saliva or bile in the stomach. It relieves a sense of pressure. Indeed, • And what produces the noise? The there was a time when to belch showed expulsion of gas from the anus can a person’s appreciation of a good meal. generate a variety of sounds. The farty noise is produced by the walls of a Excessive belching may indicate: relaxed anal canal behaving like a flutter • swallowing too much air valve, opening and closing as the gas • gastric irritation caused by the reflux escapes. of large amounts of bile into the Trumpeters produce their music by stomach exquisite control of pressure of air and • consumption of fizzy drinks the tension of their lips. Similarly, if a person squeezes their anus to try to to put something looser on. stop gas being expelled, any increase in Physiological studies have demonstrated abdominal pressure that might be several abnormalities. These include: caused, for example, by getting up from • an increase in intestinal gas in some, a chair or laughing, forces the gas out but not all people with bloating with a toot! • an increase in intestinal sensitivity, • Abdominal Rumbles. Abdominal which may be responsible for the gurgles, squirts and rumbles are feelings of pressure produced by the movement of gas and liquid in the guts. High pitched • a relaxation of the abdominal muscles gurgles are more likely to come from accompanied by contraction of the small intestine, cavernous rumbles diaphragm causing the belly to and low pitched grumbles from the protrude stomach or colon. The medical term for such noises is borborygmi. Abdominal • trapping of gas in the small intestine. rumbles are not a sign of any particular Bloating is more likely to occur in disease. Neither do they necessarily people who are anxious. The indicate more gas production, merely emotional tension can make the that the gut is more active and moving intestine more sensitive and encourage the gas and liquid around. relief of pressure by abdominal Abdominal rumbles, or ‘borborygmi’, protrusion. It goes down when people may indicate that you are hungry and are anaesthetised or asleep. your gut is limbering up for a meal. They may also be generated by emotion; a person’s stomach may rumble in quiet What is responsible for moments when they are trying to gassy symptoms? process strong emotions. • Intestinal sensitivity and • Bloating. Bloating is a sensation of reactivity. The intestines of people increased abdominal pressure that may with IBS are often more sensitive to or may not be accompanied by distension. This can mean that even abdominal swelling or distension. modest amounts of gas production may cause symptoms of pressure and It is more common in women, who bloating. often report their stomachs are relatively flat in the morning but by the • Rapid Transit. Food often travels evening they cannot wait to get home through a sensitive small intestine gut more quickly than usual. This often • Coeliac or Pancreatic Disease. reduces the time necessary for complete If bloating or flatulence is associated absorption, increasing delivery to the with diarrhoea, weight loss and colon and fermentation. nutritional deficiency it may suggest due to or • Food. The gassiest people in the world pancreatic disease. This would need to are those who ingest food that contain be investigated by a gastroenterologist. large amounts of poorly absorbed sugars that are rapidly fermented in the colon. These are collectively known as Treating Gassy Symptoms (FermentablOligosaccharides, Options include: Disaccharides, Monosaccharides and • diet Polyols) and include several fruits and • drugs fruit juices, , pulses, brussels • alterations in lifestyle and behaviour. sprouts, beetroot, products, and some dairy products. • Diet • Since most gas is generated by poorly Not everybody with IBS is sensitive absorbed starches and sugars, it would to all of these foods and the symptoms seem sensible to reduce the intake of vary according to the amount eaten, the foods that contain FODMAP. fluctuations in sensitivity and the extent to which the sugar can be digested. This would include cereal fibre, fruits, vegetables and pulses. Unfortunately, • . these are generally considered to is present at birth and breaks be healthy food choices. down lactose sugar to glucose and galactase, which are rapidly absorbed. • Reducing fat intake by cutting down About 30% of people in the UK lose meat and dairy products may help to their lactase enzyme shortly after reduce intestinal sensitivity and spasm. weaning. If they drink milk, lactose • If it’s the offensive odour that is the escapes absorption in the small intestine problem, cutting down the amount of but is fermented in the colon, generating meat in your diet can help. large amounts of gas. • Drugs. Drugs have a limited role in the • Fructose Intolerance. The ability of treatment of bloating and flatulence. people to absorb fructose can vary from Nevertheless, there are several products person to person. that claim to reduce intestinal gas. • Charcoal biscuits. Charcoal biscuits odour of the intestinal gas, which is said have been used for many years; it is to smell more sweetly of peppermint. claimed they work by absorbing the gas onto the charcoal matrix. • Antispasmodics. Some patients with associated pain do report some • Simethicone. Simethicone, (Gas-X, relief with anti-spasmodic medications Phazyme, Mylicon, Flatulex, Mylanta Gas, such as Mebeverine (Colofac) and Flatulex). Is an inert silicon polymer that (Spasmonal). is not absorbed into the body. It is said • Changes in Lifestyle and to work by reducing the Behaviour of small air bubbles, thereby allowing them to come together into larger • Avoid rushing your meal and allow bubbles that are more easily eliminated. sufficient time to digest your food. • Take smaller regular meals. • Beano. BEANO contains a mixture of • Try keeping a food diary, it’s useful in alpha and beta galactosidases, that break identifying and helping avoid ‘trigger down lactose (milk sugar) and also the foods’. complex galactans in pulses to glucose • Take regular exercise. and galactose, thus increasing the absoprion of these sugars and reducing • Allow enough time to relax and gas production. unwind. Relaxation and all methods that help to build confidence are • and Prebiotics. By helpful for all Irritable Bowel changing the composition of colonic Syndrome symptoms including bacteria, probiotics might lead to a those produced by gas. They reduce reduction of flatulence in some people, the sensitivity and reactivity of the but in others they might actually cause colon allowing more gas to be more gas. One commercially available tolerated. (Bimuno) has been shown to • For people who work in an enclosed reduce symptoms of bloating. office, it may be useful to take regular loo breaks or walks to expel the gas. • Peppermint. Although delayed release • Commercially available pants and capsules containing peppermint cushions containing gas absorbents (Colpermin or Mintec) may not reduce may prove useful. These include the amount of gas produced they can Shreddies, www.myshreddies.com/ and relax the colon, allowing more gas to be GasBGon, www.gasbgon.com. retained. They may also disguise the Wind and Bloating

Further Reading Read NW. Bloating, abnormal abdominal Silk DBA, Davis A, Vulevic J, et al (2009). physiology or just a lot of gas. The Sensitive Clinical trial: the effects of a trans- Gut (www.thesensitivegut.com) galactooligosaccharide prebiotic on faecal Nov. 24 2015 microbiota and symptoms in . Al. Pharm. Ther. 29. 508-518. Azpiroz, F and Malagelada, J (2005) Abdominal Bloating. This Factsheet was updated in March 129, 1060-1078 2016 by: Professor Nick Read, M.A., M.D, F.R.C.P Medical Adviser to The IBS Network. Staudacher HM, Lomer, MCE, Anderson, It is published as a service to those with JS et al (2012) Fermentable Irritable Bowel Syndrome, and healthcare Restriction Reduces Luminal Bifidobacteria professionals by The IBS Network, the and Gastrointestinal Symptoms in Patients national charity supporting people living with Irritable Bowel Syndrome. J. Nutr. with Irritable Bowel Syndrome. 142. 1510-1518

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