Flatulence is the accumulation of excess gases in the digestive tract due to their increased formation or insufficient discharge. Usually associated with dyspepsia, abdominal pain, constipation or diarrhea. More often it develops with malnutrition and diseases of the gastrointestinal tract, however, it can be observed with urogenital and acute abdominal pathology, failure of the abdominal cavity walls, functional disorders and endocrine diseases. To alleviate the condition of a patient with flatulence, in addition to correcting the diet, it is recommended to take carminatives, adsorbents, defoamers.
Usually, flatulence (bloating, tympania, swelling) is perceived as an uncomfortable feeling of heaviness, fullness, accompanied by rumbling, belching, sometimes diarrhea or constipation. Possible abdominal pain with intestinal spasm (colic) and gas retention in the intestine, which is more often observed in the second half of the day during the most active digestion. The condition is relieved after defecation. Less often, there is a constant painless release of gases with a different smell, which occurs imperceptibly or with a characteristic sound (flatulence).
With the accumulation of gases in a certain area of \u200b\u200bthe intestine (local flatulence), the pain syndrome has characteristic features. The retention of gases at the level of the splenic flexure of the intestine is accompanied by general bloating, pressure and pain in the left hypochondrium with irradiation to the region of the heart. Tympania, caused by the accumulation of gases in the subhepatic region, is manifested by a feeling of overcrowding and soreness in the right hypochondrium, radiating to the epigastrium, the right shoulder blade, shoulder, half of the neck. Less commonly, there is a syndrome of the caecum with pain in the right iliac region.
For small bowel flatulence, general bloating is typical, for large bowel flatulence, a feeling of fullness in the lateral flanges. In addition to swelling, patients may experience dyspepsia in the form of nausea, vomiting, and an unpleasant taste in the mouth. Sometimes digestive asthenia develops with a burning sensation in the precordial region, shortness of breath, complaints of frequent heartbeats, interruptions in the work of the heart, insomnia, general weakness, depressed mood. Long-term flatulence disrupts the patient's usual life, worsens the quality of communications and limits behavioral activity.
Although bloating often indicates the presence of diseases of the gastrointestinal tract, sometimes its occurrence is due to non-pathological factors. The accumulation of gases can be associated both with their excessive formation and with a delay in the intestine. The most common physiological causes of flatulence are:
Flatulence most often occurs in the second or third trimesters of gestational age and is associated with both increased gas formation and delayed evacuation of gases from the intestines. At least a third of pregnant women report an increase in bloating. In addition to swelling, patients complain of sour belching, heartburn, and constipation. Flatulence during pregnancy, more often than in other conditions, is combined with spastic pains in the lower abdomen and can provoke an increase in the tone of the uterus. The causes of tympania during gestation are:
Inflammatory changes occurring in the wall of the small and large intestines under the influence of pathogenic microorganisms are accompanied by a violation of the processes of parietal digestion and absorption. As a result, the diffusion of gases through the intestinal wall worsens, gas formation in the intestinal cavity increases. Flatulence may be accompanied by:
A prerequisite for the development of flatulence against the background of an infectious lesion of the intestine is often dysbacteriosis. The contamination of the colon with pathogenic microorganisms with a simultaneous reduction in the number of beneficial lacto- and bifidobacteria is accompanied by a violation of the natural processes of food fermentation and fermentation activation. As a result, gas formation increases and tympania develops.
Bloating is one of the characteristic symptoms of colon damage. Often, swelling is combined with constipation, abdominal pain - diffuse or localized in different parts of the abdomen. The development of flatulence in colonic diseases is usually caused by delayed evacuation or impaired fiber fermentation. Pathological tympania is manifested by:
Abdominal swelling is often observed with lesions of the upper digestive tract. Of the diseases of the esophagus, the occurrence of tympania is most affected by gastroesophageal reflux disease, especially due to hiatal hernia. Violation of the closing function of the cardia with the reflux of gastric contents into the esophagus is accompanied by a disorder in the autonomic regulation of gastrointestinal motility, a change in secretory and evacuation functions. In addition to flatulence, patients with GERD complain of heartburn, acid regurgitation.
Lack of digestion of foods in the stomach is the leading cause of bloating in gastritis. The entry of such chyme into the intestine provokes the development of maldigestion, affects the passage of intestinal contents and its further fermentation in the colon. With duodeno-gastric reflux, biliary reflux gastritis, an aggravating factor is increased gas formation due to the reaction of acidic gastric juice with alkaline duodenal contents. In such cases, local gastric tympania with intense epigastric pain may occur.
Similar chemical processes occur in the duodenum with gastritis with high acidity, NSAID gastropathy, however, gases accumulate in the small intestine, causing diffuse soreness in the navel and general bloating. In the development of flatulence in early dumping syndrome, the key role is played by the exclusion of the gastric phase of digestion and the violation of autonomic regulation. In diseases of the stomach and duodenum, tympania is combined with belching with air and acidic chyme, other signs of dyspepsia - nausea, vomiting, loss of appetite.
The symptom of swelling is a characteristic sign of a violation of the processes of cavity and parietal digestion. In addition to stomach diseases, maldigestion is provoked by violations of pancreatic secretion (enzymatic pancreatic insufficiency, Shwachman-Diamond syndrome, pancreatitis - reactive, biliary, autoimmune, etc.), inflammation of the intestinal wall (chronic enteritis, sprue), changes in the composition and secretion of bile in cholecystitis, gallstone disease , biliary dyskinesia, liver pathology (Gilbert's syndrome, portal hypertension).
Often, flatulence develops in patients suffering from lactase deficiency, celiac disease, and other fermentopathies. The inability to digest certain food components leads to a change in the chemical composition of the intestinal contents, disrupts its absorption and fermentation by saprophytic flora, and activates fermentation processes. Tympania in maldigestion syndrome is often combined with diffuse abdominal pain, stool instability, changes in color and consistency of feces. Characteristic signs of damage to individual organs are revealed.
Bloating caused by inhibition of intestinal motility is observed with diffuse and local peritonitis. Increasing flatulence against the background of intense diffuse pain in the abdomen, hyperthermia and paretic intestinal obstruction is observed in the complicated course of the postoperative period, after childbirth (with obstetric peritonitis). In local purulent-inflammatory processes (chronic appendicitis, inter-intestinal abscess, adhesions in the small pelvis), the situation is aggravated by the occurrence of mechanical obstacles to the movement of chyme.
In some patients, autonomic regulation disorders and psycho-emotional causes contribute to the development of tympania. Local forms of neurosis of the gastrointestinal tract, in the clinic of which swelling of the abdomen is observed, are irritable bowel syndrome and functional diarrhea. Usually, in such pathological conditions, bloating, pain, and stool changes are associated with increased intestinal motility. Functional swelling is possible with neurasthenia, vegetovascular dystonia. The combination of flatulence, pain in the heart and rhythm disturbances is characteristic of the gastrocardiac syndrome.
The likelihood of swelling increases with changes in the anatomical structures that limit the abdominal cavity. Tympania against the background of visible defects of the abdominal wall (stretching, local protrusions) is possible with diastasis of the rectus abdominis muscles, hernia of the white line, postoperative hernias. Flatulence with nausea, vomiting, acute epigastric pain after eating is characteristic of the digestive syndrome with relaxation of the diaphragm. The occurrence of bloating in these cases contributes to a violation of intestinal motility, leading to the development of constipation.
The proximity of the intestines and pelvic organs contributes to reflex disturbance of peristalsis in urogenital pathology. Complaints of bloating are presented by patients with acute prostatitis and salpingitis. Making the correct diagnosis is facilitated by the combination of swelling of the abdomen with characteristic discharge from the genital organs, pain in the pelvic area. Reflex-induced swelling on the background of back pain occurs in acute pyelonephritis, renal colic. With fusion of the kidneys, an additional factor contributing to tympania is intestinal compression.
In women with premenstrual syndrome, swelling, combined with constipation, swelling and characteristic psycho-emotional disorders, is due to the relaxing effect of progesterone on the smooth muscles of the intestines and biliary tract. With hypothyroidism, tympania, nausea, vomiting occur due to hypotension of the muscles of the intestinal wall and a decrease in the secretion of enzymes. The sudden onset of spasmodic abdominal pain, intractable nausea, flatulence, and loose bloody stools is typical of the gastrointestinal form of acute adrenal insufficiency.
Diagnostic search is often difficult due to the variety of pathological conditions in which flatulence is observed. Primary treatment with this problem is recommended to the local therapist or gastroenterologist. Since bloating is detected in 80-85% of patients with a gastroenterological profile, a comprehensive examination begins with methods that allow you to quickly localize the level of damage to the gastrointestinal tract, and only after that consultations of other specialists are recommended. The most informative are:
With flatulence, you should abandon products that cause gas formation
Flatulence of alimentary origin noticeably decreases or completely disappears after the correction of the diet with a restriction in the diet of legumes, cabbage, black bread, and other products that increase gas formation in a particular person. Recommended regular meals in a calm environment, thorough chewing of food, refusal to eat dry food, feasible physical education. Until the reasons that provoked tympania are clarified, with severe bloating, the use of carminative charges is effective. adsorbents, surface-active defoamers.
Frequent swelling, especially combined with colicky pain, dyspepsia and stool disorders, is an indication for consulting a gastroenterologist or proctologist. With severe flatulence with increasing pain, gas and stool retention, or intractable diarrhea, urgent medical attention is needed.