By Dr. W. Gifford Jones
It happens to Kings, Queens and the rest of us every day. Rectal gas (flatus) must be passed. Most of us wish we were alone in the middle of the Sahara Desert. But whether driving with friends or seated at a sedate dinner party, one unguarded moment means the eyes of the world seem to focus on the guilty. Flatus is a constant reminder that we're human. Some humans are unfortunate enough to pass astronomical amounts of flatus. They deserve commendation in the Guinness Book of Records. But how much flatus is normal? And can a computer help patients with this problem?
Flatus reaches mind-boggling amounts in patients unable to metabolize lactose, the sugar present in cow's milk. For instance, the medical record of one man who suffered lactose intolerance, shows he had 141 rectal expulsions in 4 hours after drinking two quarts of milk. I fervently hope he wasn't invited to a dinner party that evening!
Rectal gas is also potentially explosive. In one case a patient was undergoing sigmoidoscopic examination for removal of a polyp in the large bowel. When the base of the polyp was cauterized to control bleeding the collection of methane and hydrogen gas in the bowel caused an explosion. The result was a six inch tear in the intestine, the doctor blown across the room and the patient's head banging on the table. The patient had ignored the doctor's advice to take an enema before the procedure which would have reduced these gases to safer concentrations.
How much flatus collects in the lower bowel depends on the type of bacteria present, the speed at which gas reaches the rectum and the amount of undigested carbohydrate that reaches the lower bowel.
99 per cent of flatus is a mixture of oxygen, nitrogen, carbon-dioxide, methane and hydrogen. All of these gases are odourless. The disagreeable odour of flatus results from minute amounts of gas produced by fermentation. Some is so powerful that it can be detected by smell in levels as low as one part in a million.
Everyone at one time or another experiences a flatus problem. But it virtually never indicates the presence of serious disease in the gastrointestinal tract. The question is how to eliminate this human annoyance?
Drs. John Fardy and Stephen Sullivan are gastroenterologists at the University of Western Ontario. They did a computer search of medical literature to evaluate various therapies suggested over the years.
Some old-fashioned advice is still sound. Such as avoiding baked beans. They contain several sugars that can't be broken down by enzymes. The result? Baked beans increase flatus 10 times the normal amount. Corn, cauliflower, onions, brussel sprouts, cabbage and prune juice are also labelled as being "flatogenic".
Milk may be eliminated from the diet to test its effect. You may be the one in five who lacks the enzyme needed to digest lactose. If that's the case substitute yogurt which contains the enzyme.
The computer study proved the use of activated charcoal beneficial. It was shown to decrease the amount of flatus following a meal of beans. But the computer ruled out antibiotics as a way to change the intestinal bacteria and decrease flatus. In some cases flatus was reduced, but sometimes the antibiotic increased the amount of rectal gas.
The computer looked more favourably on the use of prokinetic drugs that help to stimulate a lazy bowel. But in the end it produced discouraging news. In spite of the common nature of this complaint it couldn't find one effective drug to control it.
I doubt it will ever find one. Passing flatus, like breathing, is part of being human. It only stops when we die. It's also impossible to fight genetics. If a Mother is "a methane producer" it's almost certain her children will also manufacture this gas. But don't try this experiment. A lighted match was once placed near the trowsers of a friend expelling gas. It turned royal blue. He was a methane producer.
One last tidbit. Dr. Wynne-Jones, a New Zealand doctor, believes we should all pass gas whenever necessary. He claims that holding onto flatus causes small herniations (diverticulosis) in the large bowel due to increased pressure. But he makes no mention of whether he's ever invited to dinner parties!
Fortunately his theory hasn't been scientifically proven. Until that time comes it appears to be prudent to politely excuse yourself for a short walk before your host serves the dessert.
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com
My book, �90 + How I Got There� can be obtained by sending $19.95 to:
Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1
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