Bloating is a state in which excessive gas is produced in the stomach or intestines. It may cause discomfort such as bloating, as well as hiccups, or increased exhaust from the rectum. Most people produce between one and three pints of gas per day, and vent about 14 times per day. Flatulence itself, while not life threatening, can definitely cause social embarrassment. This embarrassment is often the reason why people may seek medical help for excessive flatulence or outgassing.
The main components of gas (farts) are five odorless gases.
Nitrogen, Hydrogen, Carbon Dioxide, Methane, and Oxygen. Special odors are caused by trace gases such as skatole, indole, and sulfur compounds. The flammability of farts is caused by hydrogen and methane. The proportion of these gases depends greatly on the bacteria living in the colon and responsible for digesting or fermenting food not absorbed by the gastrointestinal tract. Roughly 30 to 150 grams of undigested food reaches the colon each day in the form of carbohydrates. However, this amount can vary depending on diet and gastrointestinal tract function.
I. Causes
Excess gas in the digestive tract (esophagus, stomach, small intestine, and colon and large intestine) has two sources.
(1) Increased intake of gas, for example, by swallowing air.
(2) Increased gas produced by harmless bacteria in the colon as they break down undigested food.
1. Swallowing of air (gassiness).
May occur from improper swallowing during eating or from habitual unconscious swallowing of air. Activities that can cause a person to swallow air include rapid drinking, chewing gum, smoking, sucking on hard candy, drinking carbonated beverages, loose dentures, and hyperventilation. Most people expel the excess gas they swallow by burping. The remaining gas moves to the small intestine. It then moves along the large intestine until it is released from the rectum. An analysis of the gas can help determine if it originates from gagging (mainly nitrogen, but also oxygen and carbon dioxide) or is produced by the stomach and intestines (mainly carbon monoxide, hydrogen and methane).
2. Break down undigested food if, because of a deficiency or lack of some enzyme.
The body cannot digest or absorb some carbohydrates in the small intestine (such as sugar, starch and fiber in food), and this undigested food passes from the small intestine into the large intestine, where it is broken down by normally harmless bacteria, producing hydrogen and carbon dioxide, as well as methane in about one-third of the population. Eventually these gases are expelled through the rectum. Foods that make one person produce gas do not necessarily make another person produce gas. Some common bacteria in the colon are able to wipe out the hydrogen produced by other bacteria. The balance of the two types of bacteria may explain why some people produce more gas than others. Most foods that contain carbohydrates are capable of producing gas. In contrast, fats and proteins produce only very little gas.
The following common foods and their natural constituents may produce gas.
(1) Legumes.
Legumes contain large amounts of complex sugars, also called myristoxylans. It is found in small amounts in cabbage, spore kale, broccoli, asparagus, and some other vegetables and whole grains.
(2) Starch.
Most starches (potatoes, corn, pasta, and wheat) produce gas when broken down in the large intestine. Rice is the only type of starch that does not produce gas.
(3) Onions.
A sugar called fructose, naturally occurring in onions, artichokes, pears, and wheat. It is also used as a sweetener in some soft drinks and juice drinks.
(4) Sorbitol.
This sugar is found naturally in fruits like apples, pears, peaches, plums, etc. It is also used as an artificial sweetener in sugar-free gum, candy and other diet foods.
(5) Fiber.
Many foods contain soluble and insoluble fiber. Soluble fiber is readily soluble in water and has a soft gel-like texture in the intestine. Present in oat bran, beans, peas and most fruits, soluble fiber is not broken down until the large intestine, where digestion leads to gas production. Insoluble fiber, on the other hand, passes through the intestine largely unchanged and produces little gas. Wheat bran and some vegetables contain this insoluble fiber.
(6) Lactase deficiency.
Another major source of flatulence is lactase deficiency, which leads to a reduced ability to digest lactose. Lactose is a natural sugar found in milk and other dairy products such as cheese and ice cream, and in some processed foods such as bread, cereal and salad dressings. This flatulence is often accompanied by diarrhea and cramping, but may also occur with only gas. Some people usually have lower levels of lactase, the enzyme that digests lactose, after childhood. Also, as people age, lactase levels decline. Therefore, over time, people may produce more and more gas after eating foods containing lactose.
(7) Other problems.
Certain conditions may lead to poorer absorption of food in the intestine, which may result in increased bacterial activity. Impaired absorption syndrome may be the result of a decrease in enzyme production by the pancreas or a problem with the gallbladder or intestinal mucosa. If for some reason transport through the colon is slow, it creates more conditions for bacteria to ferment the remaining food. If a person is constipated or has a weakened bowel function, bloating may result.
Changes in bowel habits may be caused by.
(1) bad dietary fiber.
(2) parasites.
(3) inflammation of the intestinal tract.
(4) Intestinal obstruction (including cancer).
(5) diverticula or diverticulitis.
(6) poor thyroid function.
(7) Narcotics or other drug use.
II. Symptoms
Symptoms of flatulence include increased gas, bloating or pain, and hiccups. Increased farting or the resulting odor can often cause embarrassment.
1. Exhaust: Every person has normal exhaust every day. At any given time, there is a certain amount of gas present in the digestive tract, primarily in the stomach and colon. It is normal for a normal person to fart about 10 times a day, and up to 20-25 times is also normal. More than that is considered excessive.
2. Hiccups: Occasional hiccups during or after a meal are normal. Hiccups can expel gas when the stomach is full of food. If a person burps too often, he may be swallowing too much air and expelling it before it enters his stomach. Some people like to swallow air to make themselves burp, thinking it will relieve the discomfort. This practice can become an annoying habit. Burping can sometimes indicate more serious upper gastrointestinal disorders such as peptic ulcers, gastroesophageal reflux disease, or gastroparesis.
3. Bloating: Many people believe that bloating is caused by excess gas. However, usually people who complain of gas and bloating have a normal amount of gas. They may actually have an unusual perception of gas in the digestive tract. Fatty foods in the diet can delay gastric emptying and cause bloating and discomfort, but do not necessarily produce excessive gas. Certain conditions such as irritable bowel syndrome, Crohn’s disease, or colon cancer may cause bloating. People with scar tissue (adhesions) from abdominal surgery or those with internal hernias may experience bloating due to increased sensitivity to gas.
4. Abdominal pain and discomfort: Some people experience pain when there is gas in the intestine. When the pain occurs on the left side of the colon, it may be confused with heart disease. If the pain occurs on the right side of the colon, it may resemble the sensation of gallstones or appendicitis.
III. When to seek medical attention
Medical attention should be considered when the following symptoms occur that go beyond simple excessive flatulence.
1. severe cramping abdominal discomfort.
2. change in bowel habits.
3. diarrhea.
4. constipation.
5. blood in the stool.
6, fever.
7. nausea.
8. vomiting.
9. abdominal pain and swelling, especially in the right lower abdomen.
IV. Diagnosis
The doctor can review the patient’s diet and symptoms. You can keep a diary of diet for a specific period of time and record the daily exhaustion.
Keeping a detailed record of diet and amount of gas can help us relate symptoms to specific foods and determine the severity of the problem. The primary test, if needed, should include measuring the amount of hydrogen in the patient’s exhaled gas after eating the suspect food. Since bacteria are primarily responsible for producing hydrogen, measuring excess exhaled hydrogen through a breath test may indicate food intolerance because bacteria produce excess gas when fermenting undigested foods. A breath test should show an increased amount of hydrogen gas within 2 hours after the patient has eaten a problematic food. Another possible test is the analysis of the contents of the exhaust.
This test helps to distinguish whether the exhaust is caused by swallowed air or produced by the gastrointestinal tract. If these tests do not confirm the diagnosis, more extensive testing can help rule out more serious conditions such as diabetes, cancer, absorption disorders, cirrhosis, poor thyroid function, and infections.
If a patient has symptoms such as abdominal pain or swelling in the abdomen, the doctor can use x-rays to determine if there is an intestinal obstruction or perforation.
X-rays can also be performed after the patient drinks x-ray dye to show the gastrointestinal tract, and if a problem is found subsequently an internal view can be examined by colonoscopy. If lactase deficiency is suspected of causing gas production, the doctor may advise the patient to avoid dairy products for a period of time. Blood or breath tests can also be used to diagnose lactose intolerance.
V. Treatment
The most common ways to reduce the discomfort caused by gas are to change the diet, take medication and reduce the amount of air swallowed.
1. Self-care of flatulence at home is often related to diet, and some specific habits can also cause a person to swallow air.
First try to remove the problem food from your diet. For many people, this is a process of trial and error. This may require careful observation to discover which foods cause increased gas. Keep a diary of your diet and watch for excess gas to be expelled. Any foods that cause gas production can be removed from the diet as a group until symptoms are felt to be relieved. Sorbitol and fructose are the most common culprits and should be the first to try to eliminate them.
If this approach does not work, a more rigorous approach is to start with a limited number of safe foods and add a new food every 48 hours to determine which foods are causing the excess gas. If a problem food is found, we can avoid that food or prepare in advance for the consequences it will bring.
If lactose intolerance is suspected of causing flatulence, all dairy products should be removed from the diet for 10-14 days to assess their effect on flatulence (by keeping a diary). Lactase, which helps digest lactose, is available over-the-counter in a number of liquid or tablet formulations (e.g., Lactase, Lactase Maltodextrin Capsules, DairyEase, etc.). Adding a few drops of liquid lactase to milk or chewing on a lactase tablet before eating can help digest foods containing lactose. In addition, low-lactose milk and dairy products are available in supermarkets.
If odor is a nuisance, you can use activated charcoal filtered underwear. If burping is a problem, consider avoiding behaviors that cause artificial swallowing of air, such as chewing gum, or eating hard candy. Chew carefully and swallow slowly. Make sure dentures fit properly. Overall, avoid overeating, as this can lead to bloating and obesity. Limiting high-fat foods can reduce bloating and discomfort. The stomach will empty faster, allowing gas to enter the small intestine.
2.Treatment The goal of treating gas and bloating is to reduce gas and odor.
If bacterial overgrowth or parasitic infection is found in the gastrointestinal tract, medical intervention includes antibiotic treatment. Regulation of bowel function is crucial. Constipation should be treated by increasing dietary fiber or certain laxatives. If a person swallows air in association with anxiety, the doctor may suggest that the person seek counseling to change this habit.
3. Medication If a patient is unwilling to avoid air-producing foods, many over-the-counter medications can help reduce symptoms.
(1) Beano is an enzyme supplement that is useful for digesting legumes. Beano has no effect on gas production caused by lactose or fiber. beano can be purchased over-the-counter. Adding 3-10 drops before eating beans or vegetables will break down the sugar produced during digestion.
(2) Antacids such as MylantaII, MaaloxII, and Di-Gel, all contain dimethicone oil, a foaming agent medium that connects gas bubbles in the stomach so that gas can be easily expelled through burping. However, these drugs have no effect on intestinal gas. They can be used before meals. The dosage is different.
(3) Activated charcoal tablets can reduce colonic flatulence. If used before or after a meal, it can reduce the amount of gas. The common dosage is 2-4 tablets before or one hour after a meal.
(4) Certain prescription medications can help reduce symptoms, especially if you have irritable bowel syndrome. Some medications, such as Gastroflucan (methotrexate), have also been shown to reduce gas by increasing intestinal activity.