Wind and flatulence
Everyone has gas in their bowel, all the time. It is not a fault in the system but an ordinary by-product of digestion.
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Medicines commonly prescribed for Wind and flatulence
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: ORAL SOLUTION/SUSPENSION, 45 mg/5 mlActive substance: siliconesManufacturer: Laboratorio Estedi S.L.Prescription not requiredDosage form: CHEWABLE TABLET, 120 mgActive substance: siliconesManufacturer: Uriach Consumer Healthcare S.L.Prescription not requiredDosage form: CHEWABLE TABLET, 120 mgActive substance: siliconesManufacturer: Laboratorios Normon S.A.Prescription not required
Everyone has gas in their bowel, all the time. It is not a fault in the system but an ordinary by-product of digestion. It only becomes a subject worth discussing when there is too much of it, when it stretches the abdomen until it hurts, or when a person can no longer tell where normal ends. There are two quite different reasons to look into it. The first is everyday: nearly always the answer lies in what someone eats and how they eat it, and that can be sorted out. The second matters more: occasionally a rise in wind is not the problem itself but the visible tip of another illness, and in that case going on a diet simply wastes time.
How much wind is normal
A healthy adult passes wind roughly ten to twenty times a day and usually never notices. The spread between people is enormous, and there is no number that counts as the norm: the useful comparison is not with anyone else but with yourself a few months ago. What matters is not the tally but the change. If this was never an issue before and now the abdomen swells every evening, that is a signal in itself.
The same applies to smell. A strong smell comes from sulphur compounds that bacteria make out of protein: after meat, eggs, cabbage, onion or garlic it intensifies in anybody, and on its own it means nothing. It is also worth separating two sensations that are constantly confused. Bloating is the feeling of a tight, stretched abdomen, and it happens with a perfectly ordinary volume of gas when the bowel has become more sensitive to being stretched. Excess wind proper is passing gas unusually often and in unusual quantity. The mechanisms differ, and so does the approach.
Where the gas comes from
There are only two sources, and both are mundane.
- Swallowed air. Some of it comes back as a burp, the rest travels on through. The people who swallow most air are those who eat in a hurry, talk while eating, drink through a straw, chew gum, smoke, or wear poorly fitting dentures. Fizzy drinks add carbon dioxide directly.
- The work of gut bacteria. Carbohydrates the small bowel could not break down reach the colon and are handed over to the resident flora, which ferments them and produces hydrogen, carbon dioxide and, in some people, methane. This is a normal and useful process: those same fibres feed the flora and keep stools soft. The gas is a side effect.
That is why, in healthy people, the foods that produce most wind are precisely the good ones: pulses, cabbage and its relatives, onions, wholegrains, fresh vegetables. Switching abruptly to eating properly almost always brings a couple of weeks of vigorous wind, and that is no reason to give up. The bowel adapts if fibre is increased gradually and enough water goes with it.
What makes it worse
- Eating speed: the faster the meal, the more air is swallowed and the less well the food is broken up.
- The sweeteners sorbitol, xylitol, mannitol and maltitol, found in chewing gum, sugar-free sweets, diet drinks and some medicines. They are poorly absorbed and arrive intact as bacterial food.
- Large amounts of fructose: fruit juice, sugary fizzy drinks, honey, a lot of dried fruit at once.
- Dairy products in anyone who tolerates lactose poorly.
- Beer and sparkling drinks, which deliver gas and fermentable carbohydrate together.
- Constipation: the longer the contents sit in the colon, the more they ferment.
- Sitting still. Walking speeds gas along; a day spent lying down holds it up.
- Some medicines: laxatives, antifungals, statins, metformin, acarbose, iron preparations and non-steroidal anti-inflammatory drugs.
When it stops being just wind
There is a set of features that turn wind from a topic of conversation into a reason to see a doctor and be investigated, rather than to hunt for the right diet. Any one of them is enough on its own:
- weight loss you were not trying for;
- blood in your stool — bright, dark, or a black tarry motion. There is no need to wait three weeks to be sure: go after the first time;
- a change in your usual bowel habit that persists for more than a few weeks — looser or less frequent motions, a different shape, a feeling of not having finished;
- symptoms that wake you at night: pain or diarrhoea that pulls someone out of sleep is almost never functional;
- trouble that begins after the age of forty with nothing like it before. New bowel symptoms at that age are a reason to rule out something serious, not to blame the years;
- persistent bloating in a woman, on most days for several weeks, particularly alongside feeling full quickly and pain low in the abdomen: ovarian cancer can begin this way, and that alone justifies an examination;
- vomiting, fever, severe pain that will not settle, a distended abdomen and no wind passing at all;
- pallor, breathlessness and tiredness, which point to anaemia;
- pale, greasy stools that are hard to flush away;
- bowel cancer, coeliac disease or inflammatory bowel disease in close relatives.
What can hide behind constant wind
- Irritable bowel syndrome. The commonest explanation. Abdominal pain linked to opening the bowels, together with bloating and alternating diarrhoea and constipation, while investigations find nothing. It is neither nerves nor invention: the bowel genuinely behaves differently and responds painfully to being stretched. The diagnosis is made once everything else has been excluded.
- Lactose intolerance. Bloating, rumbling, diarrhoea and wind an hour or two after milk, with fermented dairy and hard cheeses noticeably better tolerated. It usually develops in adulthood and can appear abruptly after a bowel infection.
- Coeliac disease. Gluten intolerance that damages the lining of the small bowel. It causes bloating, diarrhoea, weight loss and anaemia; in some people the only signs are tiredness and a low haemoglobin, with no bowel complaints at all. One rule here is worth committing to memory: testing for coeliac disease is done while you are still eating gluten normally. Cut out bread beforehand and the tests turn negative, and the diagnosis is missed for years.
- Small intestinal bacterial overgrowth. Seen after bowel surgery, in diabetes, and in conditions that slow the gut down.
- Pancreatic insufficiency. Food is not broken down, stools become bulky and greasy, and weight falls away.
- Inflammatory bowel disease — Crohn's disease and ulcerative colitis: diarrhoea with blood or mucus, pain, fever, weight loss.
- Giardiasis and other bowel infections, if it all started suddenly after travel or after drinking water of doubtful origin.
What you can try yourself
If none of the warning features are present, it is sensible to start simply and allow a few weeks for it to work.
- Eat more slowly and in smaller portions, without talking with your mouth full; put the phone down, because a hurried meal is nearly always a noisy one.
- Stop chewing gum and sucking sweets, stop smoking, and drink from the glass rather than a straw.
- Have loose dentures checked by a dentist.
- Drop fizzy drinks and very sweet juices, and read labels for sorbitol and xylitol.
- Deal with constipation: it keeps fermentation going, and clearing it often removes half the complaint.
- Move every day; half an hour of walking is enough, ideally after a meal.
- Keep a plain diary for a fortnight of what you ate and what followed. It beats guesswork and will be genuinely useful to a doctor.
Diets, pharmacy products and medicines
Elimination diets deserve their own paragraph, because they are where most time is lost. Plans that remove milk, gluten or fermentable carbohydrates step by step do work in some conditions, but they are a medical procedure with a start, a time limit and a compulsory reintroduction phase, and they are prescribed by a doctor or a dietitian. Striking foods off the list by yourself for months has three results: the diet gets narrower, the gut flora suffers, and — most importantly — the signs of an illness that has not yet been found are rubbed out. This is especially true of gluten, which must not be removed before coeliac testing.
From the pharmacy shelf, simeticone and digestive enzyme preparations are used for bloating, and lactase before dairy meals where lactose intolerance has been confirmed. Enteric-coated peppermint oil capsules help some people. Charcoal tablets are poorly studied here, no appreciable benefit should be expected from them, and they interfere with the absorption of other medicines. None of these treats the cause; they soften the symptom.
One last point: if wind increased soon after starting a new medicine, tell your doctor. The dose or the drug can be changed. But do not stop prescribed treatment on your own, particularly diabetes medication, statins or antibiotics.
Online consultation
The subject looks trivial right up until it turns out what was behind it. Remotely, a doctor can go through the essentials with you: whether this looks like an ordinary reaction to food, or whether the story contains something that needs investigating — weight, blood, night-time symptoms, a changed bowel habit, the age it began. They will suggest which tests are worth doing first and in what order, and warn you not to drop gluten before the coeliac test. They will help you read your food diary and spot what you had not connected. They will explain what the pharmacy products can and cannot do, and what to do about a medicine that appears to be the culprit. And they will name the features that mean stopping the conversation and being examined in person.
This material is for information only and does not replace medical advice.
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