Peer Reviewed
Gastroenterology clinic

Minimising flatulence

Robyn Nagel
How do you deal with the patient who presents complaining of excessive flatulence? Here, Dr Nagel outlines her approach to this difficult management problem.
Key Points
    • There is a wide variation in the amount of flatus passed by normal individuals. On average, an adult passes 500 to 2000 mL of gas daily. This gas is passed in 50 ml to 200 mL aliquots, 10 to 20 times daily. Most patients who complain of excessive flatulence are passing quantities of flatus within the normal range.
    • Anxiety and irregular bowel habit often contribute to a perception of increased flatulence and/or abdominal bloating and pain. Pathological flatulence needs to be distinguished from physiological wind.
    • If excessive flatulence is accompanied by ‘alarm’ symptoms such as a change in bowel habit, loss of weight, abdominal pain or change in continence then organic pathology is more likely to be found. Lactase deficiency and coeliac disease are common ‘windy’ conditions in our community.
    • The presenting problem may not be that quantities of flatus are excessive but rather that the smell is offensive or that the passage of flatus cannot be controlled. One in 10 people in the community aged over 40 years suffer incontinence of faeces and/or flatus. This presentation may be an opportunity for the patient to discuss malodour or incontinence.
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