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Flatulence in Adults

Description - Flatulence is a general term used to describe either the bringing up of wind from the stomach and releasing it from the mouth by belching, or passing wind from the intestine out through the anus. One mechanism is common to both forms of flatulence, aerophagy. Aerophagy is the accidental or deliberate swallowing of air, some of which is brought up, the rest continuing on down to become part of intestinal gas. Some aerophagy is normal, we swallow air as we eat food. "Nervous swallowing" results in air being swallowed and some people in states of anxiety can do this excessively, the stomach becoming filled with air. This leads to upper abdominal discomfort relieved by belching. Unfortunately, some people to promote belching, continue to swallow more air. This can result in more air being swallowed than being belched and distension, and discomfort, become even worse. A few ingested materials do produce more gas to be brought up, fizzy lemonade for example. Some people take bicarbonate of soda "for wind". All they are doing is producing more gas, carbon dioxide, in the reaction between the bicarbonate and stomach acid. Many people feel "windy" after a fatty meal because fat slows down the stomach and swallowed air accumulates. Intestinal gas is more complex and is usually noxious -belching is rarely noxious unless there is some obstruction to stomach outflow resulting in fermentation taking place. Intestinal gas is composed of swallowed air, and the gaseous products of foods that have either not been broken down sufficiently or are of such a nature that they tend to ferment in the intestine. Malabsorption syndrome can result in insufficient breakdown of food.  Foods that are naturally gas producing are ones whose carbohydrate content tends to ferment  e.g. beans, cabbage, broccoli. The intestinal gas is passed through the anus, sometimes building up to produce distension. Sometimes the gas is not easily released and the distension can become painful. In conditions like irritable bowel syndrome (see Irritable Bowel Syndrome), because of the abnormal intestinal muscle activity, intestinal gases may be passed more frequently.

Management - Eating too fast, thus swallowing large amounts of air, is to be avoided. The aerophagy - belching - aerophagy cycle must be broken. It is impossible to swallow when one's teeth are apart and a simple expedient is to place the thumb between the teeth, or a peppermint, or whatever, immediately after belching to stop oneself giving in to the almost reflex urge to swallow more air. This urge passes off within a few seconds. This advice is easier given than taken. Sometimes psychiatric help is needed for severe nervous aerophagisers. Some medicinal products like dimeticone, an anti-foaming agent, can make the bringing up of wind easier. Some people with angina (see Angina) think the pain that they have is "wind" and often belch frequently. To make things even more confusing, this belching can sometimes ease the angina! Intestinal gas can be reduced by reducing aerophagy and paying more attention to diet i.e.avoiding such foodstuffs as beans, if they do cause trouble. Excess flatus may be investigated by the doctor to exclude malabsorption and other problems.

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