Abdominal Gas (Flatulence)

“Doc, your column on constipation was interesting. What about bloating and flatulence? Don’t you think it is a major problem for many individuals!”

Dave, you are absolutely right. Call it what you want – flatulence, burp, belch, gaseous distention, wind, flatus, fart – excess intestinal gas can be a nuisance.

There is a social taboo associated with this topic. Unlike Eddie Murphy’s family dinner explosions in The Nutty Professor, most of us find a socially convenient place to “cut the cheese”.

From birth to death, the production of gastrointestinal gas continues unhindered. We are all familiar with our child’s difficulty with gas and colic. What about that burp? I bet that gave more sense of relief to the parent than the child.

There are 3 phenomenon of gas production: 1) Flatus is mainly due to production of gas by colonic (large intestine) bacteria, 2) Belching or burping is due to swallowed air, and 3) Bloating – the mechanism of which is not very clear.

A normal diet emits about one liter of gas in the intestine. Some gas is absorbed by the body. The rest, about 50 to 500 ml, is passed as flatus in small quantities several times a day. At night, minimal gas is produced, but we continue to release wind in our sleep. So, first thing in the morning, our abdomen is as flat as can be.

It is normal to pass flatus. Usually, it consists of odorless gas – carbon dioxide and hydrogen – produced by bacterial action on carbohydrates and the proteins in the food we eat.

Hydrogen, carbon dioxide, methane and swallowed nitrogen comprise 90 percent of colon gas. The remaining one percent consists of trace gases that compensate for their small quantities by their strong odors. Smelly gases include hydrogen sulfide, ammonia, indole and volatile fatty acids.

Belching and burping occurs from the air ingested with breathing and swallowing. Anxiety, thumb sucking, gum chewing, drinking carbonated drinks, rapid eating and wearing poor dentures increase the amount of gas swallowed. Stomach gas has the same composition as the atmosphere.

Bloating occurs in 30 percent of adults. Individuals complaining of bloating and distention are convinced that they have excess gas. But this is not true.

In the morning the abdomen is nice and flat. As the day progresses, the abdominal girth increases by 3 to 4 cm. Plain x-rays and CT scan of the abdomen fail to show that this is due to gas. Passing flatus may temporarily relieve the symptom but the
phenomenon is not due to gas. By next morning the distention is gone.

“What influences the production of excess gas?” Dave asks.

Beans, broccoli, and cabbage have a high content of nondigestible polysaccharides. Other foods are cauliflower, corn, brussels sprouts, eggplant, nuts, onions, and prunes.

Most of the intestinal gas consists of swallowed air. Only about 10-30 percent of gas is produced in the intestine.

Furne and Levitt did a study looking at factors influencing frequency of flatus emission by healthy subjects. They concluded that some subjects consistently passed gas more often than did others. The individual differences depend on the ability of the bacteria to produce gas from the fermentable food residue.

Therefore, the management of “too much gas” should be directed toward reducing swallowed air and avoiding gas producing food. This is not always easy. But worth trying.

Finally, Dave, here is what Sir John Suckling (1609-1642) said about love and flatulence:
Love is the fart
Of every heart:
It pains a man when ‘tis kept close,
And others doth offend, when ‘tis let loose.

This series of articles explore the health problems of Dave and his family. They are composite characters of a typical family with health problems.

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