Windy Symptoms - Flatulence, Belching, Bloating & Breaking Wind

Complaints about having too much wind or gas are very common. In this pamphlet there is a brief explanation of how gassy symptoms are produced, and where bowel gas comes from.

It is hoped that this pamphlet proves helpful to you in the understanding and management of your windy problems. The message is that if you are otherwise healthy, windy symptoms are not due to disease. But if they are severe or troublesome and if you are worried about them you should seek the help of your doctor.

The gut is a muscular tube stretching from the gullet (oesophagus) to the back passage (rectum) and is about 40 feet long when stretched out. It usually contains about 200ml of gas and every day we pass 400-2000ml of this gas out through the back passage as "southerly wind" or flatus.

What is the gas?

Over 90% of flatus is made up of 5 gases - nitrogen, oxygen, carbon dioxide, hydrogen and methane: the remaining 10% is a small amount of other gases.

Where does it come from?

The nitrogen and oxygen come from air which is swallowed; the carbon dioxide is produced by the interaction of stomach acid and the bicarbonate in bile and pancreatic juices. These gases get into the small intestine where most of the oxygen and carbon dioxide are absorbed into the blood stream; the nitrogen is passed down to the large bowel.

The small intestine is the place where the food we eat is digested and absorbed; the residues, such as dietary fibre and some carbohydrates, pass on to the large bowel. The colon acts as a gas works. It contains a huge population of many different kinds of bacteria which are essential to good health and which ferment the residues delivered from the small intestine, producing large volumes of hydrogen, methane, carbon dioxide and other gases in the process. Most of these gases are absorbed into the blood stream and eventually excreted in the breath; the rest is passed as "southerly wind" (flatus).

Going from the top to the bottom of the gut, the principal windy complaints are:

Belching, Burping or "Northerly Wind" (politely called Air Eructation)

Every time we swallow we take some air into the stomach. A belch is an involuntary expulsion of wind (gas) by the stomach when it becomes distended from an excess of swallowed air. Eating rapidly or gulping food and drink, drinking a lot of liquid with meals, chewing gum, smoking, or wearing loose dentures promote air swallowing. Some people swallow saliva to relieve heartburn and swallow air at the same time. Other people swallow air without noticing it, especially when they are tense. Fizzy drinks like beer cause belching because they produce gas (carbon dioxide) in the stomach.

Chronic or repetitive burping (Aerophagy)

In this case air is not swallowed into the stomach but sucked into the gullet and rapidly expelled. Repetitive belching like this can last for minutes at a time and is very embarrassing. It is nearly always due to stress or anxiety. There is no medical "treatment", and the cure lies in realising the cause. Air cannot be sucked in when the jaws are separated, so repetitive belching can be temporarily controlled by firmly clenching something like a pencil between the teeth.

Some people develop aerophagy because of discomfort in the chest. If you develop belching associated with chest discomfort - especially discomfort associated with exertion - or if you have difficulties in swallowing - you should seek medical help promptly.

Bloating

Abdominal bloating is a common complaint often blamed on excess gas in the bowel. It usually occurs in people with irritable bowel syndrome in which the gut is very sensitive to distension, so that normal contents of gas or digestive products cause discomfort; and because the movements are not co-ordinated the gut contents do not pass down the gut in an orderly fashion and this causes discomfort as well. Research has shown that when small amounts of gas are infused into the intestine, people with irritable bowel syndrome develop bloating and pain, whereas other people tolerate the same or even larger amounts of gas without any discomfort. How distention of the gut is perceived as bloating is not known. Bloating may also be caused by rich fatty meals which delay stomach emptying.

Bloating is often associated with abdominal distension so that skirts or belts have to be loosened. This is usually due to relaxation of the abdominal muscles in an unconscious attempt to relieve discomfort. The distension usually disappears on lying flat or on contracting the abdominal muscles.

Bloating is difficult to treat; some understanding of the problem helps. A high fibre diet is responsible for bloating in some people but generally the bloating improves with time. On the other hand, a high fibre diet may relieve bloating in others because fibre absorbs water in the gut and gently distends it helping to prevent the unco-ordinated contractions that are partly responsible for the bloating. An irritable bowel may be caused by stress or anxiety so that stress may be responsible for your bloating.

Some people find that activated charcoal or defoaming agents containing simethicone are helpful. Avoiding gassy foods may help (see overleaf). If the bloating is severe your doctor may prescribe drugs that help to co-ordinate the contractions of the gut or prevent spasms.

Bloating due to a build up of gas occurs in intestinal diseases such as Crohn’s disease or bowel tumour. These conditions give rise to other symptoms such as weight loss, severe abdominal pains or diarrhoea and require prompt medical investigation.

Rumblings/grumblings or noisy guts (politely called borborygmi)

Bowel noises or borborygmi are produced when the liquid and gas contents of the intestine are shuffled backwards and forwards by vigorous contractions of the gut. They may be produced by hunger, or by anxiety, or a fright: they are very common in irritable bowel syndrome.

Loud borborygmi or rumblings also occur because of vigorous contraction caused by diseases of the intestine like Crohn’s disease or to overcome obstruction. These conditions are associated with other symptoms such as severe abdominal pain and should be reported to your doctor.

Flatus or "Southerly Wind"

The complaint of excessive flatus is made when a person believes he/she passes wind more often than their friends or more often than in the past. Often this is because an embarrassing incident like a loud or smelly break of wind in public has led to the belief that something is wrong.

A normal individual passes wind by the rectum on average 15 times per day (ranging between 3 and 40 times), depending on diet. A high fibre diet produces more wind than a low fibre diet or a low carbohydrate diet.

So if you think you have excessive flatus count every time you break wind - even the little silent ones - for a day or so. (If you break wind less than 40 times a day you are normal.)

But whatever your count you may wish to reduce it. Most flatus is generated by the normal bacterial fermentation of food residues in the colon. On the principle "no bugs - no gas" you might think that antibiotics would work. But they don't. Although the bacteria are killed off by the antibiotics they quickly re-establish themselves. Besides, antibiotics produce more flatus in most people.

A high fibre diet has mixed blessings. It produces a soft satisfying stool, protects against colon cancer and may protect against stroke and heart disease, may help people to lose weight, and improves symptoms in irritable bowel syndrome. The downside is that a high fibre diet produces a lot of flatus. However, it is possible to reduce flatus production even on a high fibre diet by avoiding the big gas producers. Beans are notorious gas producers - "beans are good for the heart: the more you eat the more you break wind". They contain carbohydrates called oligosaccharides which cannot be digested in the small intestine but are food to bacteria in the colon. Cabbage, brussel sprouts, cauliflower, turnips, onions, garlic, leeks and some seeds such as fennel, sunflower and poppy all produce a lot of gas in the colon. Reducing the amount of these foods in the diet will reduce flatus. Sometimes activated charcoal seems to reduce the amount (and smell) of flatus.

Some otherwise healthy people lack the enzyme necessary to digest lactose, the sugar in cow’s milk. As a result the lactose is fermented by the colon bacteria with the production of large amounts of carbon dioxide and hydrogen. The condition is called lactose intolerance and besides gas production may cause abdominal cramps. It occurs most commonly in people born around the Mediterranean basin but occurs sporadically everywhere. The ‘cure’ is to reduce milk intake to a level at which symptoms are controlled. Your doctor may carry out special tests to confirm the diagnosis.

Sorbitol, a sweetener used in diabetic diets and present in jams, sweets and sugarless chewing gum, is also not digested in the small intestine and can give rise to flatus for the same reason as lactose.

Certain medical conditions such as Crohn’s disease, Coeliac disease and other malabsorbative states cause excess flatus because of impaired digestion. These conditions are associated with symptoms such as severe abdominal pains, weight loss, anaemia and persistent diarrhoea with pale smelly stools that tend to float in the toilet pan. These symptoms require medical investigation.

Loud Wind

Loud wind is produced by powerful contractions of the bowel wall forcing gas out through a narrow anus - the muscle at the bottom of the rectum that keeps the intestinal contents in their place. There is not much you can do about this except grin and bear it, but measures to reduce flatus production may help.

Smelly Wind

- is not your fault. It is caused by smelly substances like indoles, skatoles and hydrogen sulphide that are produced by bacterial fermentation in the colon. Garlic and onions, many spices and some herbs of the fennel family, particularly asafoetida which are used in Indian cooking, produce smelly gases. Beer, white wine and fruit juices give rise to smelly hydrogen sulphide in some people. Worse still, some of these smelly gases are absorbed into the blood stream and excreted in the breath as well, so that you may smell at both ends: be warned.