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It’s the food that causes the pain

Von Marta Campbell und Isabel Weinert / Many people feel embarrassed to talk openly about flatulence at the pharmacy. Instead, they often refer to it as »digestion problems«. During the consultation, it soon becomes perfectly clear to the pharma­ceutical assistant and the chemist what the customer’s real problem is.




If there is an excessive amount of gas in the bowels, pressure on the intestinal wall causes a pain sensation. The belly bulges and feels tight. Rumbling bowel sounds and strong bubbling in the abdomen are also characteristic.

The affected persons often com­plain of a feeling of fullness and of being »bloated«. In severe cases, colicky pains can develop. In rare cases, heart anxiety and breathing difficulties – the so-called Roemheld syndrome – can also be observed with flatulence.

Medical professionals use two medical terms to specify flatulence more precisely: meteorism and flatu­lence. The term »meteorism« is used if large quantities of gas inflate the abdomen. »Flatulence« describes the strong escape of excessively produced intestinal gases.

It is quite natural that gases develop in the intestines. Especially the intestinal bacteria form gases, which are carbon dioxide, methane and others, when utilising nutrients. Also nitrogen from swallowed air is a part of the intestinal gases. The majority of the gases is absorbed by the blood through the intestinal mucosa and is then breathed out through the lungs. A small amount escapes quietly before or during a bowel movement. From some food, for example onions and leeks, the intestinal bacteria release sulphur compounds and indoles, which are foul-smelling.

Foto: iStock/stevecoleimages

The amount of the produced gases largely depends on the composition of the food. The formation of gas increases, for example, after the consumption of bloating meals such as cabbage, pulses and wholemeal products. These food products contain relatively large amounts of fibres, which cannot be digested in a human’s small intestines. The fibres reach the colon and there they serve as food for certain intestinal bacteria. Equally, an excessive intake of sugars can cause a fermentation dyspepsia through an increased microbial degradation. Large quantities of carbonated beverages, such as sparkling mineral water or beer can also noticeably increase the amount of intestinal gases. Frequent additional causes are compiled in the table. Especially when travelling, people often have to struggle with meteorism. Unaccustomed food, particularly limited movement capacity on long bus journeys or long-distance flights, can lead to trapped digestive gases. In such cases the first-aid kit should include medicines for flatulence. Sensitive persons should, already at the onset of their journey, begin taking the medicine as a prophylaxis.

As burdensome and perhaps even painful flatulence may be, it does not in itself pose a health risk. Slight symptoms can easily be treated by self-medication. Various medicines are available, in particular defoaming sili­cone preparations and herbal medi­cines.

Dimethicone and Simethicone are macromolecules which reduce the surface tension of gas foams in the bowels, thereby allowing the intestinal gases to be better resorbed and to be easier removed in the form of small bubbles. The substances themselves are not resorbed and are very well tolerated. The medicines need to be taken regularly with or after meals. In the case of chewable tablets, it is important that these are finely chewed and then quickly swallowed. As drops, dimethicone and simethicone prepara­tions are also suitable for babies.

A large number of medicinal plants contains ethereal oils which, due to their spasmolytic, digestive and fermentation-repressive effect, can be effectively used for meteorism and flatulence. Peppermint, aniseed, fennel and caraway seeds as tea and tinctures have a long tradition as carminatives. Drugs containing bitter substances such as bitter orange peel, condurango rind, wormwood and gentian root stimulate the appetite and the production of gastric juices and bile. Many preparations and teas contain bitter substances as well as carmina­tives.

Camomile or peppermint tea as well as hot compresses can provide relief from light spasmodic symptoms. For severe spasms butyl scopolamine can be helpful – in the case of recurring spasms and severe complaints, however, it is absolutely necessary to have this examined by a doctor as flatulence can also be a symptom of an illness.

For example, flatulence often occurs in connection with an irritable bowel syndrome, constipation, or if certain sugars, such as lactose, fructose or sorbitol cannot be digested or resorbed by endogenous enzymes. Pharma­ceutical assistants and pharmacists can advise the customer to keep a symptoms diary. In this it should be recorded when the symptoms occur, which food has been previously consumed, if there was a bowel movement and if there were any peculiarities in the course of the day. The patient is thereby helping the doctor to find the cause of those symptoms. If it is successfully treated, the pressure in the abdomen and the embarrassing gases will disappear.

If a lack of pancreatic enzymes underlie the digestive disorders, enzyme preparations can be helpful. They are also available in firm combination with defoaming active substances. After an antibiotics therapy or a therapy with acarbose, a disorder of the intestinal flora can occur and impede the enzyme α-glycosidase and thus the degrada­tion of carbohydrates. It is hoped this will only slowly increase the blood glucose level after a meal. But sub­sequently undigested carbo­hydrates increasingly enter the colon resulting in an increased gas formation after a microbial decomposition. The symptoms will turn out milder if medication is dosed gradually in small quantities. As serious illnesses such as intestinal obstruction, pancreatitis, peritonitis, liver cirrhosis or cardiac insufficiency show similar symptoms to meteorism, those concerned should always seek the advice of a doctor if the complaints are severe and persist. /

Atembeklemmung breathing difficulty 
Bauch belly 
Bauchspeicheldrüse pancreas 
Bittermittel bitter substances 
Blähungen flatulence, bloating 
Carminativa carminatives 
Darmbakterien intestinal bacteria 
Darmgeräusche bowel sounds 
entschäumen defoaming 
Flatulenz flatulence 
Herzbeklemmung heart anxiety 
Kolik colic 
Meteorismus meteorism 
Oberflächenspannung surface tension 
Pankreasenzyme pancreatic enzyme 
Prophylaxe prophylaxis 
Reiseapotheke first-aid kit 
Reizdarmsyndrom irritable bowel syndrome 
Unverträglichkeit intolerance 
Verdauungsprobleme digestion problems 

Beitrag erschienen in Ausgabe 03/2019


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