Bloating

The normal digestive process breaks down food, primarily starch and cellulose-containing foods, into a soluble, easy-to-digest form, releasing gas as a by-product. However, certain conditions may result in excessive gas formation, leading to troublesome symptoms. For example:

• Consuming larger quantities of certain foods that are not easily digested in the small intestine, such as beans, cabbage, cauliflower, broccoli, and cereals.
• Eating stale or undercooked food, which can lead to over-fermentation in the intestine and the release of foul-smelling gases.
• In individuals with lactose intolerance, the consumption of milk and dairy products can cause indigestion and excess gas formation.
• Swallowing a significant amount of air while eating, which enters the stomach and mixes with food, potentially leading to burping.
• Consuming aerated beverages, which can introduce excessive gas into the stomach, resulting in belching.
• Certain protein and multivitamin supplements, as well as artificial sweeteners, may also contribute to excessive gas.
• Small intestinal bacterial overgrowth, a condition characterized by an increase in intestinal microbes, can lead to increased food breakdown, causing gas, bloating, malabsorption, and nutrient deficiencies.
• Chronic constipation or intestinal obstruction can result in excessive gas formation, as food remains in the bowels longer, causing degeneration and the release of a rotten smell.

Following factors can increase the chances of excessive gas in the gastrointestinal tract:

• Increasing age: With age, the body’s digestive system weakens, leading to an increased likelihood of flatulence, even with simpler meals.
• Heavy meals: Consuming large meals at once instead of smaller portions throughout the day.
• Pregnancy: Pregnancy can result in excessive gas formation as the growing uterus presses on the intestines.
• Sedentary lifestyle: A sedentary lifestyle can increase the risk of digestive issues and lead to higher gas formation.

Usually, intestinal gas causes no medical problems and is a normal occurrence. However, if excessive gas develops daily along with other gastrointestinal symptoms, such as heartburn or hyperacidity, medical evaluation is necessary to check for concurrent medical conditions.

Gas is a common presenting symptom in the following medical conditions:

• Lactose intolerance: This condition refers to the body’s inability to digest lactose, a sugar found in milk and milk products. Consumption of these products can lead to indigestion, bloating, diarrhea, and flatulence.
• GERD (gastroesophageal reflux disease): A chronic condition where acid from the stomach regurgitates into the digestive tract, irritating the esophageal lining. Chronic belching may be a symptom of GERD.
• IBS (irritable bowel syndrome): Symptoms such as bloating, diarrhea, and excessive gas are common in this condition affecting the large intestine.
• Celiac Disease: In this condition, the body abnormally reacts to gluten, a protein found in grains like wheat and barley. Symptoms include bloating, diarrhea, and excess gas formation.
• Crohn’s Disease: A type of inflammatory bowel disease presenting with symptoms like abdominal cramps, diarrhea, and increased gas passage.

Passing gas daily, as many as 14-21 times, is considered normal. It is not a cause for concern and requires no further evaluation. However, if the flatus is accompanied by other troublesome symptoms and interferes with the person’s daily life and activities, lab investigations and imaging studies may be needed to establish the cause of abnormal flatulence.

• Stool test to identify disorders such as lactose intolerance, malabsorption syndrome, and celiac disease.
• X-Ray Abdomen helps visualize the internal organs of the abdomen and assesses the presence of gas in the stomach or intestines.
• USG Abdomen and Dual Phase CT Abdomen provide detailed visualization of the internal organs of the abdomen to diagnose any abnormalities.
• Barium Meal Follow Through and Barium Swallow tests help identify abnormalities or obstructions of the esophagus, stomach, or intestines.
• Endoscopy and Colonoscopy are invasive procedures that allow real-time visualization of the inner structures of the digestive tract via the mouth (endoscopy) or the rectum (colonoscopy).
• Laboratory studies have a limited role in diagnosing conditions associated with flatulence. Certain tests, such as Allergy, Individual Marker, and Gluten tests, can help identify if the patient’s symptoms are due to gluten allergy, also known as celiac disease.

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Passing gas every day is not considered abnormal. Gas formation in certain health conditions, such as GERD, IBD, lactose intolerance, and gluten allergy, can be limited by specific lifestyle modifications. You can prevent excessive gas formation and improve your digestion by making the following lifestyle changes:

• Eat fresh, home-cooked food that is simple and easy to digest.
• Consume smaller portions throughout the day rather than large meals all at once.
• Limit the consumption of aerated beverages.
• Quit smoking.
• Engage in light exercises, such as walking after consuming heavy meals, to aid the digestion process.
• Drink plenty of water and fluids throughout the day.
• Avoid foods to which you are allergic.
• Establish a healthy bowel routine by going to the restroom at the same time every day and attempting to empty your bowels.

The treatment aims to relieve symptoms and address the underlying causative agent.

Symptomatic Relief

• Simethicone preparations are prescribed for bloating and abdominal distension. They help break down gas bubbles and facilitate the easy passage of gas. Some studies indicate that activated charcoal, when used in conjunction with simethicone, is more effective in reducing bloating.
• Digestive enzymes and probiotics assist in alleviating symptoms of indigestion and enhancing the body’s digestive system.

Treatment of Underlying Cause

• If symptoms of gas stem from an underlying cause, it is essential to address the causative condition for complete relief.
• Lactase enzyme preparations are utilized for patients with lactose intolerance.
• Mesalazine formulations are prescribed for Crohn’s Disease and ulcerative colitis.
• Antacids and prokinetic agents are employed in the treatment of gastroesophageal reflux disease (GERD).

Most often, symptoms of excess gas, such as flatulence or belching, can be managed at home with simple remedies and lifestyle changes. To reduce bloating and gas, consider the following:

• Take OTC preparations containing simethicone for faster relief of symptoms.
• Perform mild exercise, such as walking, to help pass gas and reduce bloating.
• Drink liquids with a straw and limit consumption of aerated beverages and smoking to prevent increased swallowing of air.
• Gently massage the abdomen to ease the passing of gas and reduce abdominal cramps and bloating.
• Change your diet to include fewer fatty foods and gas-producing foods. Increase your consumption of fiber-rich foods, such as fresh fruits and vegetables.

The average human being can pass gas about 20 times a day. It is an ordinary phenomenon, but it may be embarrassing and occasionally painful. If you have excess gas, you may also experience the following:

• Flatus or passing gas through the intestine very frequently, which may have a foul-smelling odor.
• Passing gas through the windpipe by either belching or burping, which may be accompanied by an abnormal taste sensation in the mouth.
• A feeling of fullness or a sensation of bloating in the abdomen.
• Abdominal cramps.
• Pain along the sides of the stomach.
• Hyperacidity.

What if bloating is left ignored?

Symptoms like excessive gas, flatulence, and belching do not cause any major complications on their own. However, the underlying disease may worsen and cause health complications such as:

• Ulceration and bleeding in the gastrointestinal tract due to worsening of GERD.
• Malnutrition due to the inability of the body to absorb nutrients.
• Increased risk of gastrointestinal cancers.
• Anal fissures and fistula.
• Intestinal obstruction.

Alternative Therapies Of Bloating

Apart from prescription medications and OTC preparations, there are alternative therapies that may help provide relief from chronic gas, such as:

• Diet Modifications: A diet rich in fresh fruits and vegetables while limiting spicy foods, fatty foods, and allergens can improve digestive health and reduce excessive gas formation. For patients who do not experience significant improvement despite avoiding gas-producing foods, doctors may recommend a low FODMAP diet, which is low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.
• Exercise and Yoga: Light exercises like walking and yoga asanas, such as Pawanmuktasana, can facilitate gas passage, alleviate symptoms, and enhance digestion. Pawanmuktasana involves lying flat on the back, bending the knees, and bringing them close to the chest, holding the position for 30-45 seconds before returning to the starting position. Vajrasana is another beneficial yoga pose that can be performed after meals to aid digestion. To perform Vajrasana, sit on the floor in a kneeling position with hands resting on the thighs, maintaining the position for as long as comfortable.
• Massage Therapy: Gentle abdominal massage may help relieve abdominal cramps and facilitate the passage of gas. It can also alleviate constipation.
• Ayurveda: According to Ayurveda, gas is attributed to an imbalance of Vatta and Pitta Doshas. Natural herbs and spices such as cinnamon (dalchini), carom (ajwain) seeds, cumin (jeera) seeds, ginger (adrak), asafoetida (hing), and fenugreek (methi) can strengthen the digestive system and provide relief from flatulence and belching.