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A tricky topic

Bloating -  Flatulence

A little bit of air in the stomach is a normal phenomenon, which is known by humans and animals alike. As a rule, the gases do not interfere and above all do not cause pain. A little breeze can only lead to interpersonal complications if it sees the light of day at the wrong moment.

The control of the airy phenomenon is taken for granted. If it does not succeed, the person concerned often becomes the target of irony and ridicule. So what in everyday life usually only causes a smile or a frown can become a real illness for some people, which restricts not inconsiderably.

(Kopie 4)

[Translate to Englisch:] Einführung - Video

Maria

For Maria, a 54-year-old teacher, the subject is anything but amusing. For her, every day begins the same. In the morning the world is still in order. The stomach is flat and peaceful. But after breakfast at the latest, restlessness arises in the body. Sometimes so loud that her husband makes joking remarks about it. At school she can then watch her skirt or trousers slowly tightening. The stomach becomes increasingly fat. Smart from experience, she wears stretchy clothes and covers her figure with loose-fitting sweaters or jackets. Nevertheless the changes are visible. By lunchtime she has the feeling of being pompous. Pain sets in. Maria is increasingly unable to concentrate on her lessons. How can she let off the air without becoming the mockery of the class? But if she denies herself the relief, the intestines protest with pain and sometimes with such violent cramps that she can hardly stand. Often she then only rescues herself with difficulty into the break in which she can finally free herself from the gases.

Although Maria is better in the afternoon, as she does not have to show consideration for sharp-tongued students at home, she is still very well. But her belly looks as if she is 6 months pregnant in the early evening at the latest. Then she has the impression as if she gets bad air, the thick belly hinders her breathing.

Maria has tried almost everything to get the discomfort under control. Of course, she has removed all flatulence from her diet. She is meticulously trying to find out with detective intuition to which foods the intestines react so exaggeratedly. The result is sobering. Of course beans and other flatulent vegetables are taboo for her. But sometimes she tolerates a certain food better, then again not at all.

Medical help also proved to be limited. One cause could not be found in the numerous examinations including gastroscopy and colonoscopy. Drugs against flatulence help at best in the short term. "You have to come to terms with it", was after all the statement of a doctor.

Facts

Strictly speaking, flatulence is only one symptom, which can have many backgrounds. Very often these airy symptoms are part of an irritable bowel syndrome. For a better understanding, it is therefore helpful to read the information about irritable bowel syndrome or watch films about it.
What is flatulence?

Flatulence, medically "meteorism", is an excessive or unpleasant accumulation of gases in the digestive tract. They are particularly annoying if they do not come off as winds, medically "flatus" or "flatulence".

Gases are produced during every digestive process. They come from very different sources. Already when eating, a person swallows a little air involuntarily, the more hastily the food is taken in, the more. A good 2 litres of air can thus be absorbed in the course of the day.

But gases are also produced in the intestines. The source is the intestinal bacteria, which are at home here in a barely imaginable quantity. Their number exceeds the number of body cells by a factor of ten. Like our body cells, they have their own metabolism, take in food and have excretions, e.g. methane, hydrogen, nitrogen and carbon dioxide. In smaller quantities, they also produce fermentation gases such as hydrogen sulphide, whose smell of rotten eggs has become sadly famous.
How much gas can be produced?

How much gas our little roommates produce may be subject to strong fluctuations. The scientific findings are also not entirely clear. While some medical articles assume 2-3 litres, others speak of considerably larger quantities. The bacteria are said to produce about 10 litres of hydrogen and 5 litres of methane. Dozens of liters should be possible if the microbes are particularly industrious.

Compared to some animals, however, these are only minor quantities. An adult cow should be able to produce about 300 litres of methane gas per day. Such quantities of the greenhouse gas methane, can already be dangerous for the earth's climate, given the number of dairy cattle.

Not everything that is ingested in the air through food or that is produced as a gas in the intestines must escape naturally. Some of the air can be released by burping (belching). Even more important, however, is the ability of the intestine to absorb gases. Most gases pass easily from the intestine into the blood, reach the lungs and are breathed out. This explains why a bloated abdomen flattens out again during the night: The intestinal gases have been disposed of via the lungs, which may then occasionally manifest itself as "bad" breath or an unpleasant taste in the mouth.

Only that which was not absorbed by the intestinal mucosa is transported further and is released into the atmosphere as wind. Up to 2 litres are considered normal.
Frequency of complaints

Practically all people have a bloated stomach at some point. Real symptoms only occur in 15-30% of cases. In an American survey, 15% of all respondents complained about unpleasant air in the stomach last month alone. The number of those severely affected is unclear.

Diagnostics

Very simple: Measuring tape

In order to get to the bottom of the causes, it is advisable to measure the bulging belly as a first measure. A measuring tape is useful here. Once in the morning, once at noon and once in the evening, the measurement is taken exactly above the navel.

The method is far from perfect, but it gives a first indication of how strong the circumferential variations actually are. If they are several centimetres, then this indicates increased gas production.

A doctor taps the stomach and can determine where the air is by the typical hollow noise. Likewise, the sounds he hears with a stethoscope tell him something about the type of air in the intestine. This can be done more objectively with an ultrasound examination, in which air-filled intestinal loops are clearly visible.

A gastroscopy or colonoscopy only helps with special questions, for example to rule out that organic changes such as constrictions are the cause of the complaints.
Breath test

We take in countless types of sugar every day. Not only the well-known household sugar but also, for example, fruit sugar (fructose) or milk sugar (lactose) and many others.

For many of these types of sugar we need special enzymes in the intestinal mucosa. If these are present, the respective sugar reaches the blood without any problems.

If these enzymes are missing, the sugar continues to slide through the intestine and reaches the lower small intestine and the large intestine, where hungry bacteria happil

Causes

As is so often the case in medicine, there is a whole bundle of different causes for the same phenomenon. The most important ones are mentioned here.

Abdominal muscles - a six-pack protects

Abdominal muscles and figure: When the intestines rumble and bloat, it's like in the kitchen when the yeast cake is fermenting. Food, air and liquid form a foamy structure. The intestinal walls are overstretched, resulting in corresponding complaints. The softer the walls of the intestines and stomach, the better the foam can expand. It is like a soft, pre-stretched balloon. It can be inflated more easily.

But there is another way. Tight, muscular abdominal walls limit the expansion of the intestines and give them support. Now the pressure in the intestines increases. But there's a bright side. The higher gas pressure improves the blood's ability to absorb the unwanted vapours. They enter the blood more easily and in larger quantities. The higher the pressure, the more gases enter the blood.

In short: Tight abdominal walls limit the expansion of the intestinal walls and improve gas absorption.
Risk: Constipation

Constipation: Similarly, a chronic tendency to constipation worsens the bloated abdomen. Hard stool in the rectum leads to a stronger expansion of the intestinal walls. The volume of the hollow organ increases, at the same time the wall tension is reduced. The flatulent gases have an easier time of it.
Risk: Lactose intolerance

Carbohydrate intolerances: Many people have trouble absorbing certain sugars. The best known is lactose intolerance. When milk sugar (med. lactose) is digested, an enzyme (lactase) splits it into two parts (galactose and glucose), which can then be absorbed and processed separately.

While babies always produce sufficient quantities of the sugar splitter, this is much rarer in adults, as humanity used to not consume milk beyond infancy. The majority of the world population (especially in Africa, Asia, South America) is therefore not able to digest lactose without problems.

If these people drink a glass of milk, the lactose cannot be absorbed and bacterial growth occurs. Our little roommates ferment the milk sugar to lactic acid (smells sour), methane and hydrogen. This leads to flatulence and possibly also diarrhoea.

In countries that have been engaged in dairy farming for a long time, a gene has become established that allows us to enjoy a cappuccino without any consequences even at an advanced age. Here, too, the ability to enjoy cappuccino diminishes the further away we are from babyhood. If there is a rumbling in the stomach beyond retirement age, you should therefore always think about lactose intolerance.

However, 15-25% of all Central Europeans would be better off without milk. They can take comfort in the fact that they are no better off than 90% of the world's population. Avoidance is the therapy of choice, although lactose-free products (milk, yoghurt) are increasingly available on the market, which have fewer or no undesirable consequences.
Risk: Fructose & Co.

There is a whole range of other types of sugar that some people can absorb poorly or not at all. These include fruit sugar (fructose), wood sugar (xylose), sorbitol (sugar substitute) or maltose (malt sugar). They can also lead to increased bowel sounds, flatulence and diarrhoea. Here too, avoidance or at least a quantity limitation is the therapy of choice.
All the above-mentioned intolerances can be diagnosed quite reliably by means of a breath test.

Risk: Hectic and swallowing air
During normal eating and drinking, some air can also get into the stomach. Those who hectically gobble down the food are particularly affected. Even a hidden inner tension can intensify the phenomenon. Smoking, carbonated drinks, chewing gum and poorly fitting third teeth are further risk factors for air swallowing, med. aerophagy.

Risk: Beans & Co.
Some foods contain substances that are indigestible for us and are only eaten by intestinal bacteria. As a result, gases are produced as in yeast fermentation.

Pulses contain the sugar molecules rhamnose and stachyose. Both are not usable for us, which shows the well-known consequences ("Every little bean gives a little sound").

  •     onions| Brussels sprouts|wheat bran
  •     celery|garlic|wholemeal bread
  •     Cabbage|carrots|crispbread
  •     Pulses|Raisins|Lentils
  •     eggs|bananas|beans
  •     Sauerkraut|Plums|
  •     Peas|Apricots|

Risk: intestinal bacteria - too much of a good thing

Although the food concentration is highest in the small intestine, it is almost free of bacteria. With 1000 to 10,000 bacteria per gram, it contains fewer germs than some foods.

The large intestine is a real breeding ground. One trillion bacteria (1,000,000,000,000) are found here in a single gram of stool.

In some cases, however, the small intestine is increasingly inhabited by bacteria. In medical terms, this is known as a surveillance growth syndrome ("overgrowth"). Even in such cases there is increased gas formation.

Further risk factors
Diseases of the pancreas: An inflammation of the pancreas (pancreatitis) leads to a massive restriction of digestion and is a serious, not harmless disease. Both in the acute phase and afterwards, diarrhoea due to flatulence can occur.

Other diseases can also lead to increased intestinal gas formation (biliary diseases, virus infections, etc.).

[Translate to Englisch:] Therapie

Therapy

Many simple therapeutic measures can easily be deduced from the explanations about the causes of flatulence.

Sixpack !
Abdominal muscles: Training your abdominal muscles is an excellent measure against the annoying winds. It does not necessarily have to be a washboard abdomen, but the more stable the muscles are, the less the foamy gases inside the abdomen can expand.

The build-up of the abdominal muscles often happens faster than you might think. Try a few specific exercises for a few minutes in the morning and evening for 4 weeks. There are many ways to find out which exercises are suitable on the Internet.
Psyllium/Linseed

Regulated digestion: Those who suffer from constipation can do something about it. As a first measure, it is recommended to use linseed or - better - flea seed, which can be bought at the pharmacy.

Sugar & Co.
Anyone suffering from an intolerance should of course avoid the corresponding types of sugar. Taking the missing enzyme (lactase) for lactose intolerance in tablet form is usually of little help. Switching to lactose-free milk products usually proves to be more effective.

It is more difficult to avoid fructose because it is not only present in fruit but also in vegetables, juice, beer and wine.

But here is a little trick. There are two ways to transport fruit sugar. On the one, only the fructose is transported into the blood. On the second, it is carried "piggyback" by other types of sugar and also protein components. As a result, some types of fruit (grapes, pears) are better tolerated if they are additionally sprinkled with sugar.

Rest and relaxation

The quieter and more enjoyable a meal is, the less air is swallowed involuntarily. A bread roll hastily choked off while standing during the lunch break takes its revenge through subsequent complaints.

A pleasant, relaxed atmosphere during the meal, perhaps a short relaxation exercise before the meal, is recommended if increased burping after the meal is a problem.

Breathing therapy
Regular breathing therapy aims in the same direction. The more relaxed the diaphragm, the calmer the respiratory flow, the higher (!) the carbon dioxide content of the blood, the more the gastrointestinal tract relaxes.

Colon massage
If the gas formation is more or less normal, but the perception of intestinal movement or stretching is excessively sensitive, a change in diet is usually not sufficient. Although a temporary period of a light diet provides relief from abdominal irritation, further measures are necessary to raise the irritation threshold. As a rule, it is not only reduced with regard to the digestive tract, but also affects other areas.

Numerous procedures can be used to reduce this increased irritability. The so-called "colon massage" (colon = large intestine) has long been known in physiotherapy. It is a gentle stroking massage in which a therapist performs circular massage movements around the navel. A doctor can prescribe these massages.
Abdominal wrap

A warm wrap can be a relief. You need two large and one small towel. Dip the small towel into very hot water and wring it out carefully until no more water drips out. As soon as the temperature on the skin is bearable, the hot towel is placed on the stomach and the large towel is wrapped tightly around the body. The second bath towel ensures that the mattress does not get wet. Now cover yourself with a blanket and relax for 15-30 minutes.

Multimodal therapy
Sometimes those affected have already tried everything. They only eat nonflatulent foods, do not drink carbonated drinks, try to relax, avoid milk, etc. Nevertheless, the belly is unimpressed by all these efforts; it pinches and hurts, women have the impression that they are in the last months of pregnancy.

In these cases, a combination of different therapy methods is usually necessary, i.e. multimodal therapy.

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