A little air in the abdomen is a normal phenomenon known in humans and animals alike. As a rule, the gases do not bother and, above all, do not cause pain. A little wind can only lead to interpersonal complications if it sees the light of day at the wrong moment.
Control of the airy phenomenon is considered a matter of course. If it does not succeed, the person concerned often becomes the target of irony and ridicule. So what usually only causes smirks or frowns in everyday life can, for some people, become a real illness that is not inconsiderably limiting.
Introduction video
Video
Mary - a second story
For Maria, a 54-year-old teacher, the subject is anything but amusing. For her, every day starts the same. In the morning, all is still right with the world. The stomach is flat and peaceful. But after breakfast at the latest, restlessness arises in the womb. Sometimes so loud that her husband makes joking remarks about it. At school, she can then follow how skirt or pants slowly tighten. The belly becomes increasingly thicker. Wise from experience, she wears stretchy clothes and conceals the figure with loose-fitting sweaters or jackets. Still, the changes are visible. By lunchtime, she has the feeling of being bloated. Pain sets in. Maria finds it increasingly difficult to concentrate on lessons. How can she deflate without becoming the laughingstock of the class? If she denies herself relief, however, her intestines protest with pain and sometimes with such violent cramps that she can hardly stand. Often she then only saves herself with difficulty to the break, where she can finally free herself from the gas.
It is true that Maria feels better in the afternoon, since she does not have to pay attention to sharp-tongued students at home. But by early evening at the latest, her belly looks as if she is 6 months pregnant. Then she has the impression as if she gets worse air, the thick belly hinders the breathing.
Maria has tried almost everything to get rid of the discomfort. Of course, she has eliminated all flatulence from her diet. With detective-like intuition, she tries to find out which foods her intestines react so excessively to. 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 limited. A cause had not been found in the numerous examinations including gastroscopy and colonoscopy. Medications for the bloating helped at best in the short term. "You'll have to put up with it," has finally been the statement of one doctor.
Facts
Strictly speaking, flatulence is only one symptom that can have very many backgrounds. Very often, these airy complaints are part of an irritable bowel syndrome. Therefore, it is helpful for a better understanding to read through the explanations on irritable bowel syndrome, or to watch films about it.
What is flatulence?
Flatulence, medically "meteorism", is an excessive or uncomfortable accumulation of gases in the digestive tract. They are particularly disturbing when they do not go away as winds, medically "flatus" or "flatulence".
In addition, a distinction must be made between two groups:
- In some patients, there is a clearly visible and measurable increase in the circumference of the abdomen. Pants become too tight in the afternoon/evening.
- The other group complains of symptoms such as feelings of tension, restlessness, pain, discomfort in the abdomen without noticeable swelling.
Gases are produced during every digestive process. They come from very different sources. Even when eating, people involuntarily swallow some air, and the more hastily food is ingested, the more. A good 2 liters of air can be ingested in this way during the course of the day. But what happens to this air subsequently varies. In people without complaints, it is quickly transported through the intestines. In patients with complaints, it is presumably retained.
But gases are also produced in the intestine. The source is the intestinal bacteria, which are at home here in an almost unimaginable quantity. Their number exceeds that of the body's cells by a factor of ten. Like our body cells, they have their own metabolism, absorb food and have excretions, e.g. methane, hydrogen, nitrogen and carbon dioxide. In smaller quantities, they also produce putrefactive gases such as hydrogen sulfide, whose rotten egg smell has gained sad notoriety.
How much gas can be produced?
How much gas our small fellow inhabitants produce is likely to be subject to strong fluctuations. Nor is the scientific evidence entirely clear. While some medical articles assume 2-3 liters, others speak of considerably larger quantities. The bacteria are said to produce around 10 liters of hydrogen and 5 liters of methane. Dozens of liters are said to be possible if the microbes are particularly industrious.
Compared to some animals, however, these are only small amounts. A full-grown cow is said to produce around 300 liters of methane gas per day. Given the number of dairy cattle, such quantities of the greenhouse gas methane can already be dangerous to the earth's climate.
Not all of the air that is ingested through food or that is produced as gas in the intestines has to escape naturally. Some of the air can be released by belching. Even more important, however, is the ability of the intestines to absorb gases. Most gases pass easily from the intestine into the blood, reach the lungs and are exhaled there. This explains why a bloated abdomen becomes flat again during the night: The intestinal gases have been disposed of through the lungs, which may then occasionally manifest as "bad" breath or an unpleasant taste in the mouth.
Only that which has not been absorbed by the intestinal mucosa is transported further and escapes into the open air as wind. Up to 2 liters is considered normal.
Frequency of complaints
Practically all people have a bloated abdomen at some point. It causes real discomfort in only 15-30%. In an American survey, 15% of all respondents complained of uncomfortable air in the abdomen in the past month alone. The number of those severely affected is unclear.
Diagnostics
Very simple: tape measure
To get to the bottom of the causes, it is advisable to measure the bloated belly as a first measure. A tape measure is useful here. Measure once each in the morning, at noon and finally in the evening, just above the belly button.
The method is far from perfect, but it gives an initial indication of how much the circumference fluctuations actually are. If it is several centimeters, then this indicates increased gas production.
A physician taps the abdomen and can determine where the air is located by the typical hollow sound. Similarly, the sounds he hears with a stethoscope reveal a lot about the type of air in the intestine. This can be done more objectively with an ultrasound examination, which clearly shows air-filled intestinal loops.
A gastroscopy or colonoscopy is only helpful in specific cases, for example, to rule out the possibility that organic changes such as narrowing of the intestine are the cause of the symptoms.
Breath test
We ingest countless types of sugar every day. Not only the well-known household sugar, but also, for example, fructose or lactose, as well as many others.
For many of these types of sugar, we need special enzymes in the intestinal mucosa. If these are present, the respective sugar enters the blood without any problems.
If these enzymes are missing, then the sugar slips further through the intestine and reaches the lower small intestine and the large intestine, where hungry bacteria happily feed on it. They divide as fast as the yeast cells and produce various gases in the process. One of these is hydrogen gas. This is absorbed into the blood and exhaled through the lungs.
The following types of sugar can be examined in this way - each separately.
- Lactose
- Glucose
- Sorbitol
- Fructose
- Galactose
- Sucrose
- Xylose
- Lactulose
No findings
In many cases, neither abnormality is found in the breath tests nor relevant swelling of the abdomen in the evening. Nevertheless, those affected complain of considerable discomfort. What is the cause then? Are people just a little "sensitive"?
As in the case of irritable stomach syndrome and irritable bowel syndrome, an increased sensitivity to the perception of the digestive processes has a very essential and long underestimated significance. When processing food, the body is quite vigorous with it. It uses concentrated acid and alkali, kneads and waltzes. Nevertheless, these processes are usually ignored because we have become accustomed to them since the time in the womb.
However, some people perceive the processes more than others. They do not necessarily have to actually have more flatulence. However, as with the irritable stomach, the stimuli only reach the brain more immediately. Easily, a vicious cycle develops. The increased perception of bloating causes these people to pay more attention to their bowels. The attention lowers the stimulus threshold, etc.
It is important not to confuse the increased sensitivity with "imagination". What was said about "imagined pain" applies here.
Often the causes of flatulence are mixed, e.g. increased sensitivity can be present in addition to lactose intolerance.
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 it rumbles and bloats in the intestines, it's like in the kitchen when yeast cake is fermenting. Food, air and liquid form a foamy structure. The intestinal walls become overstretched, resulting in corresponding discomfort. The softer the intestinal and abdominal walls, the better the foam can expand. It is like a soft, pre-expanded balloon. It is easier to inflate.
But there is another way. Tight, muscular abdominal walls limit the expansion of the intestines and give them support. This increases the pressure in the intestines. But this also has its good side. The higher gas pressure improves the blood's ability to absorb the unwanted vapor. They enter the blood more easily and in larger quantities. The higher the pressure, the more gases go into the blood.
In short: Tight abdominal walls limit the expansion of the intestinal walls and improve gas absorption.
Risk: Constipation - constipation
Constipation: Similarly, a chronic tendency to constipation also worsens the bloated abdomen. Hard stool in the rectum leads to greater distension of the intestinal walls. The volume of the hollow organ increases, and at the same time the wall tension is reduced. The flatulent gases have an easier time.
Risk: Lactose intolerance
Carbohydrate intolerances: Many people have trouble absorbing certain types of sugar. The best known is lactose intolerance. During the digestion of milk sugar (med. lactose), an enzyme (lactase) splits it into two parts (galactose and glucose), which can then be absorbed and processed separately.
While babies always produce sufficient amounts of the sugar cleaver, this is much rarer in adults, as mankind did not consume milk beyond infancy in the past. Therefore, the majority of the world's population (especially in Africa, Asia, South America) is 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 fellow inhabitants ferment the lactose to lactic acid (smells sour), methane and hydrogen. This leads to flatulence and possibly diarrhea.
In countries that have been practicing dairy farming for a long time, a gene has become established that allows people to enjoy a cappuccino without consequences even at an older age. Here, too, this ability decreases the further we move away from babyhood. If there is a rumbling in the stomach beyond retirement age, one should therefore always think about lactose intolerance.
However, 15-25% of all Central Europeans would do better to do without milk. They can console themselves with 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, yogurt) are increasingly available on the market that show fewer or no undesirable consequences.
Risk: Fructose & Co.
There are a number of other types of sugar that can be poorly or not at all absorbed by some people. These include fructose (fruit sugar), wood sugar (xylose), sorbitol (sugar substitute) or maltose (malt sugar). They can equally lead to increased bowel sounds, flatulence and diarrhea. Here, too, avoidance or at least quantity limitation is the therapy of choice.
All of the above-mentioned intolerances can be diagnosed quite reliably by a breath test.
Risk: Hectic eating and swallowing air
During normal eating and drinking, some air can also get into the stomach. Those who gulp down food in a hectic manner are particularly affected. A hidden inner tension can also increase the phenomenon. Smoking, carbonated drinks, chewing gum and poorly fitted third teeth are further risk factors for air swallowing, med. aerophagy.
Air swallowing (aerophagy) is presented as a major problem in some medical textbooks. The largest amount of gas would be produced this way. But recent work contradicts this. For one thing, swallowed air would be largely removed again by burping. On the other hand, the gases oxygen and carbon dioxide are rapidly absorbed in the small intestine and the remaining nitrogen is rapidly transported through the entire intestine in healthy individuals to be excreted naturally as wind.
In experiments, air artificially introduced into the intestine in this way was practically completely excreted again in a short time by healthy individuals. However, this was not the case with people suffering from irritable bowel syndrome. Here, air was retained in the intestine.
Risk: Beans & Co.
Some foods contain for us indigestible substances, which fall only the intestine bacteria to the grub. In the consequence then gases develop as with the 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 tint").
- Onions|Cauliflower|Wheat bran
- celery|garlic|wholemeal bread
- Cabbage|carrots|crispbread
- Legumes|raisins|lentils
- Eggs|Bananas|Beans
- Sauerkraut|plums|
- Peas|apricots|
Risk: Fat
Fat leads to a slowing down of the intestinal transit. Thus also increased gas is retained. This would explain why symptoms increase in response to high-fat foods.
Risk: Intestinal bacteria - too much of a good thing
Although the concentration of food 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, on the other hand, is a real breeding ground. A trillion bacteria (1,000,000,000) 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 referred to as overgrowth syndrome. In such cases, increased gas formation also occurs.
Other risk factors
Pancreatic diseases: Inflammation of the pancreas (pancreatitis) leads to a massive restriction of digestion and is a serious, not harmless disease. Diarrhea due to flatulence can occur both in the acute phase and afterwards.
Other diseases can also lead to increased intestinal gas formation (bilious diseases, viral infections, etc.).
Therapy
Many simple therapeutic measures can be easily derived from what has been said about the causes of flatulence.
Six pack !
Abdominal muscles: To train yourself plenty of abdominal muscles is an excellent measure against the annoying winds. It doesn't have to be a washboard stomach, but the more solid the muscles, the less the foamy gases inside the abdomen can expand.
Building abdominal muscles is often faster than you might think. Try a few targeted exercises for a few minutes in the morning and evening for 4 weeks. You can find a wide variety of suitable exercises on the Internet.
Psyllium/flaxseed
Regulated digestion: If you suffer from constipation, you can do something about it. As a first measure, it is recommended to use flaxseed or - better - psyllium, which can be bought in pharmacies.
Sugar & Co.
Anyone suffering from an intolerance should naturally avoid the corresponding types of sugar. Taking the missing enzyme (lactase) in tablet form for lactose intolerance is usually of little help. Avoiding lactose-free dairy products usually proves more effective.
It is more difficult to avoid fructose, since it is present not only in fruit but also in vegetables, juice, beer and wine.
However, there is a little trick here. There are two transport routes for fructose. On one, only the fructose is transported into the blood. On the second, it is "piggybacked" by other types of sugar and also protein building blocks. This is why some types of fruit (grapes, pears) are better tolerated when they are additionally sprinkled with sugar.
Rest and relaxation
The calmer and more enjoyable a meal is, the less air is involuntarily swallowed. A bread roll hastily choked down while standing during the lunch break will be avenged by subsequent complaints.
A pleasant, relaxed atmosphere while eating, perhaps a short relaxation exercise before the meal, are recommended if increased belching after eating is a problem.
Breathing therapy
Regular breathing therapy aims in the same direction. The more relaxed the diaphragm, the calmer the flow of breath, 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 distension is overly sensitive, then a change in diet is usually not enough. Although a temporary period of light diet provides relief from stimuli from the abdomen, further measures are necessary to raise the stimulus threshold. As a rule, it is not only reduced in relation to the digestive tract, but also affects other areas.
Numerous methods can be used to reduce this increased irritability. For a long time, the so-called "colon massage" (colon = large intestine) has been known in physiotherapy. This is a gentle stroking massage in which a therapist performs circular massage movements around the navel. A physician may prescribe these massages.
Belly wrap
A warm poultice can be a boon. It requires two large towels and one small towel. Dip the small towel in very hot water and gently wring it out 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 wrapped tightly around the body with the large towel. The second bath towel ensures that the mattress does not get wet. Now you cover yourself with a blanket and can relax quietly for 15-30 min.
Multimodal therapy
Sometimes sufferers have already tried everything. They eat only non-flatulent foods, do not drink carbonated drinks, try to relax, avoid milk, etc. Nevertheless, the abdomen is unimpressed by all these efforts; it presses and hurts, women have the impression they are in the last months of pregnancy.
In these cases, a combination of different therapeutic methods is usually necessary, i.e. multimodal therapy.