Flatulence

Everyone has it. Most people think they have too much of it. And passing gas in the wrong place at the wrong time can cause great embarrassment. 

Flatulence is the state of having excessive stomach or intestinal gas. This can result in uncomfortable feelings of bloating, as well as increased belching (burping) or passing of gas from the rectum. 

Most people produce about 1-3 pints a day and pass gas about 14 times a day. Flatulence itself, although not life threatening, can definitely cause social embarrassment. This embarrassment is often the reason why you might seek medical help for excessive gas. 

• History has numerous anecdotal accounts of flatulence, including Hippocrates himself professing, "Passing gas is necessary to well-being." The Roman Emperor Claudius equally decreed that "all Roman citizens shall be allowed to pass gas whenever necessary." Unfortunately for flatulent Romans, however, Emperor Constantine later reversed this decision in a 315 BC edict. 

• In the mid-1800s flatulence took center stage with the French entertainer Joseph Pugol ("Le Petomane"). Pugol was able to pass gas at will and at varying pitch, thereby playing tunes for sold-out shows at the Moulin Rouge. Such was his success that lesser competitors began to appear, including the Spaniard "El Rey" and the female Angele Thiebeau (later revealed as a fake using hidden air bellows). 

• More recently, flatulence was immortalized by Mel Brooks in the movie Blazing Saddles with his bean-eating cowboys. 

• Nonetheless, if you are concerned about excess gas, it is not a laughing matter. It is a medical concern that you will want to talk about with your health care provider. 

• The primary components of gas (known as flatus, pronounced FLAY-tuss) are 5 odorless gases: nitrogen, hydrogen, carbon dioxide, methane, and oxygen. 

• The characteristic odor is attributed to trace gases such as skatole, indole, and sulfur-containing compounds. 

• The flammable character of flatus is caused by hydrogen and methane. The proportions of these gases depend largely  on the bacteria that live in the human colon that digest, or ferment, food that has not been absorbed by the gastrointestinal (GI) tract before reaching the colon. 

• An estimated 30-150 grams of this undigested food reach the colon in the form of carbohydrate every day. But this amount can vary with diet and how well your GI tract is functioning. The unpleasant odor often associated with flatus is generally attributed  to trace sulfur-containing compounds, produced only by particular bacteria not found in everyone. 

• Swallowed air (aerophagia):  This can occur with improper swallowing while eating or even unconscious swallowing of air out of habit. 

1. Activities that cause you to swallow air include rapid drinking, chewing gum, use of tobacco products, sucking on hard candy, drinking carbonated beverages, loose dentures, and hyperventilation in anxious people. 
2. Most people burp or belch to expel this excess swallowed air. The remaining gas moves into your small intestine. Air can be absorbed, but some moves along to the large intestine for release through the rectum. 
3. Analysis of the gas can help determine if it originated from aerophagia (mostly nitrogen, also oxygen and carbon dioxide) or GI production (mainly carbon monoxide, hydrogen, and methane). 

• Breakdown of undigested foods:  Your body does not digest and absorb some carbohydrates (for example, the sugar, starches, and fiber found in many foods) in the small intestine because of a shortage or absence of certain enzymes there. So this undigested food then passes from the small intestine into the large intestine, where normal, harmless bacteria break down the food, producing hydrogen, carbon dioxide, and, in about a third of all people, methane. Eventually these gases exit through the rectum. 
• Foods that produce gas in one person may not cause gas in another. Some common bacteria in the large intestine can destroy the hydrogen that other bacteria produce. The balance of the 2 types of bacteria may explain why some people have more gas than others. 
• Most foods that contain carbohydrates can cause gas. By contrast, fats and proteins cause little gas. These common foods and their natural components may create gas: 

1. Beans:  Beans contain large amounts of the complex sugar  known as raffinose. Smaller amounts are found in cabbage, Brussels sprouts, broccoli, asparagus, and in other vegetables and whole grains. 
2. Starches:  Most starches (potatoes, corn, noodles, and wheat) produce gas as they are broken down in the large intestine. Rice is the only starch that does not cause gas. 
3. Onions:  The sugar known as fructose occurs naturally in onions, artichokes, pears, and wheat. It is also used as a sweetener in some soft drinks and fruit drinks. 
4. Dark beer and red wine 
5. Sorbitol: This sugar is found naturally in fruits including apples, pears, peaches, and prunes. It's also used as an artificial sweetener in sugar-free gum, candy, and other diet products. 
6. Fiber: Many foods contain soluble and insoluble fiber. Soluble fiber dissolves easily in water and takes on a soft, gel-like texture in the intestines. Found in oat bran, beans, peas, and most fruits, soluble fiber is not broken down until it reaches the large intestine, where digestion causes gas. Insoluble fiber, on the other hand, passes essentially unchanged through the intestines and produces little gas. Wheat bran and some vegetables contain this kind of fiber. 

• Lactase deficiency:  Another major source of flatulence is lactase deficiency, which results in a decreased ability to digest lactose, a natural sugar found in milk and other dairy products such as cheese and ice cream and in certain processed food such as bread, cereal, and salad dressing. This flatulence is often associated with diarrhea and cramping but can appear as only gas. Many people, particularly those of African, Native American, or Asian background, normally have low levels of the enzyme lactase needed to digest lactose after childhood. Also, as people age, their enzyme levels decrease. As a result, over time people may experience increasing amounts of gas after eating food containing lactose. 

• Other problems:  Certain conditions can result in other foods being poorly absorbed in the GI tract, allowing for increased bacterial activity. 

• Malabsorption syndromes can be the result of decreased production of enzymes by the pancreas or problems with the gallbladder or lining of the intestines. 
• If transit through the colon is slowed down for any reason, bacteria have increased opportunity to ferment remaining material. Therefore, if you are constipated or have decreased bowel function for any reason, flatulence can follow. 
• Alterations in bowel habits can be a result of the following: 

1. Poor dietary fiber 
2. Parasites  
3. Inflammatory bowel disease 
4. Intestinal obstruction (including cancer) 
5. Diverticulosis or diverticulitis 
6. Poor thyroid function 
7. Narcotic and other drug use 

• Crampy discomfort 
• Change in bowel habits 
• Diarrhea  
• Constipation  
• Blood in the stool 
• Fever  
• Nausea  
• Vomiting  
• Abdominal pain and swelling