Question

I continue to pass a lot of gas off and on during the day. What can be done?

Answer

'Gas' is a difficult symptom to evaluate. Gastroenterologists very often see patients with this complaint. The difficulty lies in the fact that this symptom can be caused by many types of problems.

Excessive 'gas' means different things to different people. For some it is abdominal bloating associated with excessive eructations (burping). For some it is abdominal cramps and spasms, which often make them double over in pain. For others it is excessive release of gas from the rectum, as you have described.

Most people experience 'gas' at some time. A simple change in our eating habits can be the cause. When we eat foods high in carbonation (soft drinks, for example) this leads to excessive stomach and upper intestinal gas. Foods with large amounts of undigested carbohydrates (beans) cause lower intestinal gas as a result of the bacterial breakdown of their residue in the colon. Sometimes a change in diet occurs when we travel and can result in excessive gas. In areas of high altitude, excess intestinal gas can also occur. A very common cause of excess gas and bloating is intolerance to certain carbohydrates (usually lactose) as a result of deficiency of the enzyme required to handle them. Lactose intolerance occurs much more frequently with age; people with this deficiency have difficulty with most milk products.

Much less likely as a cause of excess gas are intestinal disorders characterized by the inability to absorb certain fats and carbohydrates. Patients with such diseases (e.g. pancreatic insufficiency and inflammatory diseases of the small intestine) can often complain of severe abdominal cramps and gas. Diarrhea and weight loss are often also seen with such disorders.

More common medical problems that cause excess gas include certain metabolic diseases that affect the way the intestinal tract contracts. A common example is diabetes. As a result of damage to the nerves of the intestinal tract, diabetics complain of constipation, bloating, gas, and sometimes diarrhea.

If a trial of various changes in your diet fail to help the problem, you can see if an over-the-counter drug such as simethicone (Gas-Ex, Flatulex) can help you. However, you may well need to see a gastroenterologist for an evaluation and further treatment.

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