Medical Matters:It's August and the living is easy. In our time-honoured morning after a bank holiday tradition, today's column will take a look at a lighter aspect of medicine, writes Muiris Houston.
Flatulence is a topic with both health and social contexts. A potential source of humour, especially beloved of schoolboys, it remains a taboo subject in many cultures. Never discussed in polite company, people go to extraordinary lengths to hold in their intestinal gas. And, despite a lack of scientific evidence to support the assertion, many women are adamant they never pass gas.
Doctors are rarely consulted by patients complaining of flatulence as an isolated symptom, although you would never think it given the use of the symptom as a key ingredient in doctor jokes: Ted goes to the doctor's surgery suffering from continual flatulence. The doctor asks him to take off his trousers and lie down on the couch. Then, to Ted's horror, he produces a six-foot pole. "What are you going to do with that?" asks Ted. "I'm going to open a window," says the doctor.
The unpleasant odour generated by passing wind can be blamed on less than 1 per cent of the gas we produce. The odourless element is made up of carbon dioxide, nitrogen and oxygen, much of which we swallow when we drink fizzy liquids, smoke or chew gum. However, the bacteria normally living in our colon (large bowel) ferments any undigested carbohydrates to form hydrogen sulphide, methanethiol and dimethyl sulphide.
Responsible, respectively, for the smell of rotten eggs, decomposing vegetables and a heavy, sweet odour, these gases are typically produced by eating eggs, cauliflower and meat.
Other foods that cause flatulence in some people include beans, cabbage, Brussels sprouts and artichokes. Leeks, onions and lentils have also been implicated. And sorbitol, used as a sweetener and present in apples, peaches, pears and prunes, is a source of excess intestinal gas.
The average person releases one to three pints of gas a day. This escapes from the body in 14-25 passes in 24 hours, some of the activity occurring while we are asleep. One case history published in 1976 described a person distressed by 34 emissions every day; this record may well have been surpassed since.
Another source of humour for some is the sound produced by passing flatus. When we emit intestinal gas, it causes the anal sphincter to vibrate, leading to a wide range of sounds depending on the force with which the gas is expelled and the resistance of the sphincter.
Cue another joke: A man walks into a doctor's surgery. "Doctor, I'm suffering from silent gas emissions. All day at work, I have these silent gas emissions. Last night during a movie, I had 10 silent gas emissions. On the way here I had five silent gas emissions. And while sitting in your waiting room I had three silent gas emissions. As a matter of fact, I've just had two more."
The doctor replies: "Well, the first thing we're going to do is check your hearing."
Film buffs will recall the rousing campfire scene in Blazing Saddles, in which a group of cowboys eat baked beans, causing extreme flatulence. The director, Mel Brookes, named one of the characters in the film, William J. Le Petomaine, (a role he played himself) after Le Petomane, a famous French performer from the 19th century. Known as the "Fartiste", Petomane's tour de force was an ability to reproduce La Marseillaise, the French National Anthem, by tunefully passing gas.
Another film scene much beloved of aficionados of "out-take" programmes is the Pink Panther/Mafia lift scene. A disguised Inspector Clouseau (Peter Sellers) is among a number of Mafiosi crowded into a small lift, eyeing each other suspiciously. But the atmosphere of silent menace is broken by the emission of gas by one of the occupants, resulting in an hilarious lift journey during which the actors obviously struggle to maintain a straight face.
It is possible to hold in flatus, with a view to releasing it discretely at a later time. There is no truth in the ancient belief that a person could be poisoned by retaining intestinal gas.
For those bothered by the odour, one solution is to use activated charcoal to soak up the gas. Activated charcoal pads suitable for use inside underwear are commercially available.
Gas reduction remedies include avoiding any food you know you are sensitive to; trying not to eat food too quickly - when you gulp down your meal, you swallow more air; avoid smoking and chewing gum; and cut down on your consumption of fizzy drinks and beer. Specific remedies include drinking two teaspoonfuls of peppermint water mixed in a small cup of hot water. Eating probiotic yoghurts, in an attempt to "balance" the gut bacteria, also has its proponents.
And while flatulence on its own is rarely indicative of disease, it may, in combination with other gastrointestinal symptoms, be a sign of irritable bowel syndrome, coeliac disease or diverticulitis.
Finally, for readers who still believe women do not pass wind I offer the following conversation from a dinner party: "How dare you break wind before my wife," says the host to his guest. "I'm sorry," replies the guest. "I didn't realise it was her turn."
Dr Houston is pleased to hear from readers with flatulence issues at mhouston@irish-times.ie but regrets he is unable to reply to individual medical queries.