QUESTION: I am a 65-year-old woman with an embarrassing problem.
I suffer from severe flatulence and have almost no control. I read somewhere that charcoal tablets can help, but do not know if it is so or where or how to obtain them. Is this true?
Are you able to give me some advice about what the problem could be and whether it can be remedied? I have a great fear of sleeping out because of it.
ANSWER: This is a common complaint I receive regularly from patients. Most people never find the cause of their flatulence because they are too shy to seek help.
Activated charcoal has been used for a long time in the detoxification process.
In the acute management of drug overdoses, as well as baby colic formulas, charcoal is used with variable and often immeasurable efficacy. Other natural remedies for bloating and indigestion include Aloe crystals. I’m sure there are thousands of readers who use aloe for many gastrointestinal (GIT) symptoms.
What is flatulence?
Flatulence is described as the presence of excessive stomach or intestinal gas. It often leads to a feeling of bloatedness or burping which causes severe embarrassment socially. Excessive gas is then passed in large amounts from the rectum.
This process is difficult because of the sound effects, which are often uncontrollable and manifest while laughing or exercising in people with even a minimal decrease in anal sphincter tone and the pungent odour is occasionally evident.
What comprises flatus?
The odourless gases found in flatus are hydrogen, carbon dioxide, nitrogen, methane and oxygen.
What causes the smell?
Skatole, indole and sulphur-containing compounds are the trace gases leading to the smelly odour.
Is it true flatus is flammable?
Hydrogen and methane make this gas flammable. The mix of these is dependent on the bacteria in the colon and the digestion and fermentation of undigested food.
What causes flatulence?
Excessive gas is a result of increased ingestion of air (aerophagia) or excessive gas production formed during the digestive process. Causes of increased gas intake are abnormal swallowing or even habitual swallowing difficulties often linked to poor co-ordination between talking, breathing and swallowing.
Chewing gum and drinking fizzy drinks can aggravate flatulence. Certain foods are known to cause more bloating.
It is important to note that enzyme deficiency leads to the prolonged presence of undigested food in the gut, particularly starches and carbohydrates. Lactose intolerance has become a popular example of an enzyme deficiency resulting in the inability to digest the natural sugar lactose. Patients often suffer from cramping, diarrhoea and bloating.
When should one seek help?
When it affects your daily lifestyle. Take note of other GIT symptoms associated with known clinical syndromes. Look for stool changes like mucus, blood and pus, persistent cramping or colic, nausea and vomiting. These are red flags that further investigation might be indicated.
Mechanical factors that play a role
A history of chronic constipation, anal fissures or tears and even complicated haemorrhoids can contribute to decreased sphincter tone and poor control or gas incontinence. Soiling of the underwear can accompany the condition.
Treatment options
At the core of successful treatment lies an excellent assessment and history of symptom onset, course and progression. Associated symptoms and the holistic yet simple analysis of contributive factors such as anxiety and hyperventilation syndromes should not be overlooked.
First seek help from a trained professional such as a gastroenterologist who, with the assistance of a dietician, can help improve the condition. General surgeons are often the first port of call due to untreated symptoms and the eventual presenting complaint being severe abdominal pain and stool changes. In difficult cases, where dietary adaptations show slow or no improvement, complex malabsorption syndromes and specific enzyme deficiency, can be investigated.
What foods are best avoided
Most foods that contain carbohydrates can cause gas. By contrast, fats and proteins cause little gas.
Common foods and their natural components that may create gas:
* 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 wholegrains.
* 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.
* 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.
* Dark beer and red wine
* Sorbitol: The 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.
* Fibre: Many foods contain soluble and insoluble fibre. Soluble fibre 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 fibre is not broken down until it reaches the large intestine, where digestion causes gas. Insoluble fibre found in wheat bran and some vegetables passes essentially unchanged through the intestines and produces little gas. – Info: www.emedicinehealth.com)
Cape Argus
* Dr Darren Green, a trusted figure in the field of media medicine, is a University of Stellenbosch graduate who adds innovative spark to health and wellness issues.
He features on 567CapeTalk, and is a regular guest on SABC3 and the Expresso show. Dr Green works as an emergency medical practitioner at a leading Cape Town hospital and completed four years of training as a registrar in the specialisation of neurology.
If you’ve got medical problems, contact the doctor at [email protected], 021 930 0655 or Twitter @drdarrengreen. Catch him in Cape Town on 567 CapeTalk, most Fridays at 1.30pm.
The advice in this column does not replace a consultation and clinical evaluation with a doctor.