Editing Flatulence (section)

==Management==

Since problems involving intestinal gas present as different (but sometimes combined) complaints, the management is cause-related.

===Pain and bloating===
{{Main|Abdominal distension|Bloating}}
While not affecting the production of the gases themselves, [[surfactants]] (agents that lower [[surface tension]]) can reduce the disagreeable sensations associated with flatulence, by aiding the dissolution of the gases into liquid and solid faecal matter.<ref name="brecevic">{{cite journal |vauthors=Brecević L, Bosan-Kilibarda I, Strajnar F |title=Mechanism of antifoaming action of simethicone |journal=[[Journal of Applied Toxicology]] |volume=14 |issue=3 |pages=207–11 |year=1994 |pmid=8083482 |doi=10.1002/jat.2550140311|s2cid=7453218 }}
</ref> Preparations containing [[simethicone]] reportedly operate by promoting the coalescence of smaller bubbles into larger ones more easily passed from the body, either by [[burp]]ing or flatulence. Such preparations do not decrease the total amount of gas generated in or passed from the colon, but make the bubbles larger and thereby allowing them to be passed more easily.<ref name="brecevic" />

Other drugs including [[prokinetics]], [[lubiprostone]], antibiotics and probiotics are also used to treat bloating in patients with functional bowel disorders such as irritable bowel syndrome, and there is some evidence that these measures may reduce symptoms.<ref name="Schmulson 2011">{{cite journal |last=Schmulson |first=M |author2=Chang, L |title=Review article: the treatment of functional abdominal bloating and distension |journal=Alimentary Pharmacology & Therapeutics |date=May 2011 |volume=33 |issue=10 |pages=1071–86 |pmid=21488913|doi=10.1111/j.1365-2036.2011.04637.x|s2cid=20718176 |doi-access=free }}</ref>

A flexible tube, inserted into the [[rectum]], can be used to collect intestinal gas in a flatus bag. This method is occasionally needed in a hospital setting, when the patient is unable to pass gas normally.<ref>{{cite web|title=Flatus tube|url=http://www.gastrotraining.com/product-information/colorectal/flatus-tube|website=Gastro Training|access-date=3 April 2016}}</ref>

===Volume===
{{Main|Antiflatulent|Carminative}}
One method of reducing the volume of flatus produced is dietary modification, reducing the amount of fermentable carbohydrates. This is the theory behind diets such as the [[low-FODMAP diet]] (a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, alcohols, and polyols).<ref name="Staudacher 2011">{{cite journal |last=Staudacher |first=HM |author2=Whelan, K |author3=Irving, PM |author4= Lomer, MC |title=Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome |journal=Journal of Human Nutrition and Dietetics |date=October 2011 |volume=24 |issue=5 |pages=487–95 |pmid=21615553 |doi=10.1111/j.1365-277X.2011.01162.x}}</ref>

Most starches, including potatoes, corn, noodles, and wheat, produce gas as they are broken down in the large intestine.<ref name="NIH Gas in the"/> Intestinal gas can be reduced by fermenting the beans, and making them less gas-inducing, or by cooking them in the liquor from a previous batch. For example, the fermented bean product [[miso]] is less likely to produce as much intestinal gas. Some [[legume]]s also stand up to prolonged cooking, which can help break down the oligosaccharides into simple sugars. Fermentative lactic acid bacteria such as ''[[Lactobacillus casei]]'' and ''[[Lactobacillus plantarum]]'' reduce flatulence in the human intestinal tract.<ref>{{cite web |title=Study shows secret to gas-free beans |url=http://reuters.myway.com/article/20060426/2006-04-26T170153Z_01_N25328545_RTRIDST_0_ODD-BEANS-DC-DC.html |date=2006-04-26|access-date=2007-09-10 |archive-url = https://web.archive.org/web/20060502110835/http://reuters.myway.com/article/20060426/2006-04-26T170153Z_01_N25328545_RTRIDST_0_ODD-BEANS-DC-DC.html |archive-date = 2006-05-02}}</ref>

[[Probiotic]]s ([[yogurt|live yogurt]], [[kefir]], etc.) are reputed to reduce flatulence when used to restore balance to the normal [[intestinal flora]].<ref>{{cite book |last=Rubin |first=Jordan S. |author-link=Jordan S. Rubin |author2=Joseph Brasco |title=Restoring Your Digestive Health |year=2003 |publisher=[[Kensington Books]] |isbn=978-0758202826 |url-access=registration |url=https://archive.org/details/restoringyourdig00rubi }}{{page needed|date=August 2015}}</ref> Live (bioactive) yogurt contains, among other lactic bacteria, ''[[Lactobacillus acidophilus]]'', which may be useful in reducing flatulence. ''L.&nbsp;acidophilus'' may make the intestinal environment more acidic, supporting a natural balance of the fermentative processes. ''L.&nbsp;acidophilus'' is available in supplements. [[Prebiotic (nutrition)|Prebiotics]], which generally are non-digestible oligosaccharides, such as [[fructooligosaccharide]], generally increase flatulence in a similar way as described for lactose intolerance.

[[Digestive enzyme]] supplements may significantly reduce the amount of flatulence caused by some components of foods not being digested by the body and thereby promoting the action of microbes in the small and large [[intestines]]. It has been suggested that [[alpha-galactosidase]] enzymes, which can digest certain complex sugars, are effective in reducing the volume and frequency of flatus.<ref>{{cite journal| author=Ganiats TG |author2=Norcross WA |author3=Halverson AL |author4=Burford PA |author5=Palinkas LA | title=Does Beano prevent gas? A double-blind crossover study of oral alpha-galactosidase to treat dietary oligosaccharide intolerance| journal=The Journal of Family Practice | year=1994| volume=39| pages=441–45 |pmid=7964541| issue=5 }}</ref> The [[enzymes]] alpha-galactosidase, [[lactase]], [[amylase]], [[lipase]], [[protease]], [[cellulase]], [[Amylase#γ-Amylase|glucoamylase]], [[invertase]], malt [[diastase]], [[pectinase]], and [[bromelain]] are available, either individually or in combination blends, in commercial products.

The [[antibiotic]] [[rifaximin]], often used to treat [[diarrhea]] caused by the [[microorganism]] ''[[Escherichia coli|E.&nbsp;coli]]'', may reduce both the production of intestinal gas and the frequency of flatus events.<ref>{{cite journal| author=Di Stefano M |author2=Strocchi A |author3=Malservisi S |author4=Veneto G |author5=Ferrieri A |author6=Corazza GR | title=Non-absorbable antibiotics for managing intestinal gas production and gas-related symptoms| journal=[[Alimentary Pharmacology & Therapeutics]] | year=2000| volume=14| pages=1001–08| doi=10.1046/j.1365-2036.2000.00808.x |pmid=10930893 | issue=8|s2cid=19613386 | doi-access=free }}</ref>

===Odor===

'''Bismuth'''

The [[odor]] created by flatulence is commonly treated with [[bismuth subgallate]], available under the name Devrom. Bismuth subgallate is commonly used by individuals who have had [[ostomy]] surgery, [[bariatric surgery]], [[faecal incontinence]] and [[irritable bowel syndrome]].<ref>{{cite journal| author=Turnbull G| url=https://www.o-wm.com/content/the-issue-oral-medications-and-a-fecal-ostomy| title=The Ostomy Files:The Issue of Oral Medications and a Fecal Ostomy| journal=[[Ostomy Wound Management]]| year=2005| volume=51| pages=14–16| access-date=September 22, 2019| archive-date=September 22, 2019| archive-url=https://web.archive.org/web/20190922113523/https://www.o-wm.com/content/the-issue-oral-medications-and-a-fecal-ostomy| url-status=dead}}</ref><ref>{{cite web |url=http://www.cancer.org/docroot/CRI/content/CRI_2_6x_Colostomy.asp |title=Colostomy Guide |date=2006-01-04 |access-date=2007-09-10 |archive-date=September 22, 2007 |archive-url=https://web.archive.org/web/20070922170051/http://www.cancer.org/docroot/CRI/content/CRI_2_6x_Colostomy.asp |url-status=dead }}</ref> [[Bismuth subsalicylate]] is a compound that binds hydrogen sulfide, and one study reported a dose of 524&nbsp;mg four times a day for 3–7 days bismuth subsalicylate yielded a >95% reduction in faecal hydrogen sulfide release in both humans and rats.<ref name="SuarezFurne1998">{{cite journal|last1=Suarez|first1=F.L.|last2=Furne|first2=J.K.|last3=Springfield|first3=J.R.|last4=Levitt|first4=M.D.|title=Bismuth subsalicylate markedly decreases hydrogen sulfide release in the human colon|journal=Gastroenterology|volume=114|issue=5|year=1998|pages=923–29|pmid=9558280|doi=10.1016/S0016-5085(98)81700-9}}</ref>
Another bismuth compound, bismuth subnitrate was also shown to bind to hydrogen sulfide.<ref name="Levitt 2002">{{cite journal |last=Levitt |first=MD |author2=Springfield, J |author3=Furne, J |author4=Koenig, T |author5= Suarez, FL |title=Physiology of sulfide in the rat colon: use of bismuth to assess colonic sulfide production |journal=[[Journal of Applied Physiology]] |date=April 2002 |volume=92 |issue=4 |pages=1655–60 |pmid=11896034 |doi=10.1152/japplphysiol.00907.2001|s2cid=37217656 }}</ref> Another study showed that bismuth acted synergistically with various antibiotics to inhibit sulfate-reducing gut bacteria and sulfide production.<ref name="Ohge 2003">{{cite journal |last=Ohge |first=H |author2=Furne, JK |author3=Springfield, J |author4=Sueda, T |author5=Madoff, RD |author6= Levitt, MD |title=The effect of antibiotics and bismuth on fecal hydrogen sulfide and sulfate-reducing bacteria in the rat |journal=[[FEMS Microbiology Letters]] |date=November 7, 2003 |volume=228 |issue=1 |pages=137–42|pmid=14612249 |doi=10.1016/s0378-1097(03)00748-1|doi-access=free }}</ref> Some authors proposed a theory that hydrogen sulfide was involved in the development of [[ulcerative colitis]] and that bismuth might be helpful in the management of this condition.<ref name="Furne 2000">{{cite journal |last=Furne |first=JK |author2=Suarez, FL |author3=Ewing, SL |author4=Springfield, J |author5= Levitt, MD |title=Binding of hydrogen sulfide by bismuth does not prevent dextran sulfate-induced colitis in rats |journal=[[Digestive Diseases and Sciences]] |date=July 2000 |volume=45 |issue=7 |pages=1439–43 |pmid=10961726|doi=10.1023/A:1005580709390 |s2cid=740767 }}</ref> However, bismuth administration in rats did not prevent them from developing ulcerative colitis despite reduced hydrogen sulfide production.<ref name="Furne 2000" /> Also, evidence suggests that colonic hydrogen sulfide is largely present in bound forms, probably sulfides of iron and other metals.<ref name="Tangerman 2009" /> Rarely, serious bismuth toxicity may occur with higher doses.<ref name="Gordon 1995">{{cite journal |last=Gordon |first=MF |author2=Abrams, RI |author3=Rubin, DB |author4=Barr, WB |author5= Correa, DD |title=Bismuth subsalicylate toxicity as a cause of prolonged encephalopathy with myoclonus |journal=[[Movement Disorders (journal)|Movement Disorders]] |date=March 1995 |volume=10 |issue=2 |pages=220–22 |pmid=7753066 |doi=10.1002/mds.870100215|s2cid=11723220 }}</ref>

''' Activated charcoal'''

Despite being an ancient treatment for various digestive complaints, [[Activated Charcoal|activated charcoal]] did not produce reduction in both the total flatus volume nor the release of sulfur-containing gasses, and there was no reduction in abdominal symptoms (after 0.52{{nbsp}}g activated charcoal four times a day for one week).<ref name="Suarez 1999">{{cite journal |last=Suarez |first=FL |author2=Furne, J |author3=Springfield, J |author4= Levitt, MD |title=Failure of activated charcoal to reduce the release of gases produced by the colonic flora |journal=[[The American Journal of Gastroenterology]] |date=January 1999 |volume=94 |issue=1 |pages=208–12 |doi=10.1111/j.1572-0241.1999.00798.x |pmid=9934757|s2cid=20729051 }}</ref> The authors suggested that saturation of charcoal binding sites during its passage through the gut was the reason for this. A further study concluded that activated charcoal (4{{nbsp}}g) does not influence gas formation in vitro or in vivo.<ref name="Potter 1985">{{cite journal |last=Potter |first=T |author2=Ellis, C |author3=Levitt, M |title=Activated charcoal: in vivo and in vitro studies of effect on gas formation |journal=[[Gastroenterology (journal)|Gastroenterology]] |date=March 1985 |volume=88 |issue=3 |pages=620–24 |pmid=3917957 |doi=10.1016/0016-5085(85)90129-5|doi-access=free }}</ref> Other authors reported that activated charcoal was effective. A study in 8 dogs concluded activated charcoal (unknown oral dose) reduced hydrogen sulfide levels by 71%. In combination with yucca schidigera, and zinc acetate, this was increased to an 86% reduction in hydrogen sulfide, although flatus volume and number was unchanged.<ref name="Giffard 2001">{{cite journal |last=Giffard |first=CJ |author2=Collins, SB |author3=Stoodley, NC |author4=Butterwick, RF |author5= Batt, RM |title=Administration of charcoal, Yucca schidigera, and zinc acetate to reduce malodorous flatulence in dogs |journal=[[Journal of the American Veterinary Medical Association]] |date=March 15, 2001 |volume=218 |issue=6 |pages=892–96 |pmid=11294313 |doi=10.2460/javma.2001.218.892|doi-access=free }}</ref> An early study reported activated charcoal (unknown oral dose) prevented a large increase in the number of flatus events and increased breath hydrogen concentrations that normally occur following a gas-producing meal.<ref name="Hall 1981">{{cite journal |last=Hall RG |first=Jr |author2=Thompson, H |author3=Strother, A |title=Effects of orally administered activated charcoal on intestinal gas |journal=[[The American Journal of Gastroenterology]] |date=March 1981 |volume=75 |issue=3 |pages=192–96 |pmid=7015846}}</ref>

'''Garments and external devices'''

In 1998, Chester "Buck" Weimer of [[Pueblo, Colorado]], received a patent for the first [[undergarment]] that contained a replaceable [[Activated carbon|charcoal filter]]. The undergarments are [[Hermetic seal|air-tight]] and provide a pocketed [[path of least resistance|escape hole]] in which a charcoal filter can be inserted.<ref name="weimer">{{cite web |last=Weimer |first=Chester |url=http://patft.uspto.gov/netacgi/nph-Parser?TERM1=5593398&u=/netahtml/srchnum.htm&Sect1=PTO1&Sect2=HITOFF&p=1&r=0&l=50&f=S&d=PALL |title=Protective underwear with malodorous flatus filter |date=1997-01-14 |access-date=2007-07-27 |archive-date=October 7, 2013 |archive-url=https://web.archive.org/web/20131007065218/http://patft.uspto.gov/netacgi/nph-Parser?TERM1=5593398&u=/netahtml/srchnum.htm&Sect1=PTO1&Sect2=HITOFF&p=1&r=0&l=50&f=S&d=PALL |url-status=dead }}</ref> In 2001 Weimer received the [[Ig Nobel Prize]] for Biology for his invention.<ref>{{cite web |url=http://www.improb.com/ig/ig-pastwinners.html#ig2001 |title=The 2001 Ig Nobel Prize Winners |access-date=June 22, 2010 |url-status=dead |archive-url=https://web.archive.org/web/20110225074430/http://www.improb.com/ig/ig-pastwinners.html#ig2001 |archive-date=February 25, 2011 |df=mdy-all }}</ref>

A similar product was released in 2002, but rather than an entire undergarment, consumers are able to purchase an insert similar to a [[pantiliner]] that contains activated charcoal.<ref>{{cite web |last= Conant |first= Brian J. |author2= Myra M. Conant |url= http://patft.uspto.gov/netacgi/nph-Parser?TERM1=6313371&u=/netahtml/srchnum.htm&Sect1=PTO1&Sect2=HITOFF&p=1&r=0&l=50&f=S&d=PALL |title= Flatulence deodorizer |date= 2001-11-06 |access-date= 2007-09-10 |archive-date= October 7, 2013 |archive-url= https://web.archive.org/web/20131007072913/http://patft.uspto.gov/netacgi/nph-Parser?TERM1=6313371&u=/netahtml/srchnum.htm&Sect1=PTO1&Sect2=HITOFF&p=1&r=0&l=50&f=S&d=PALL |url-status= dead }}</ref> The inventors, Myra and Brian Conant of [[Mililani, Hawaii]], still claim on their website to have discovered the undergarment product in 2002 (four years after Chester Weimer filed for a patent for his product), but state that their tests "concluded" that they should release an insert instead.<ref>{{cite web |url=http://www.flat-d.com/american-inventor.html |publisher=Flat-D Innovations Inc. |title=About the Inventor |access-date=2007-09-10}}</ref>

===Incontinence===
{{Main|Faecal incontinence}}
Flatus incontinence where there is involuntary passage of gas, is a type of [[faecal incontinence]], and is managed similarly.