Normally, people can control the release of gas with the rectal sphincter. However, ostomy patients cannot do this, as the stoma does not have a sphincter. Releasing gas at inadequate times can generate fear, anxiety, and embarrassment, causing avoidance of social situations.
Why Do We Produce Flatulences?
“The feeling of abdominal fullness, tightness, and movement of gas in the abdomen is a very uncomfortable condition. Flatulence is the passage of excessive amounts of gas and the feeling of abdominal fullness and bloating. Flatulence is one of the most common complaints of patients. […] Unfortunately, according to modern medicine, the cause of flatulence cannot be determined in many cases. It may occur due to functional gastrointestinal disorders, irritable bowel syndrome, psychological disorders, or because of aerophagia. Modern medicine offers a few methods to treat simple flatulence, such as the consumption of simethicone and its derivatives and some antibiotics.”1
As a natural digestive process, the buildup of gas causes light pressure on the stomach. Depending on the circumstances, a person might opt to release or suppress it, which is not the case for ostomy patients, who have to handle the consequences.
“Ostomy patients face an array of challenges due to the uniqueness and consequences of their procedure. Day-to-day life can be a struggle as patients deal with fears of excessive gas, bloating, constipation, spillage, and blockage, as well as changes in their self-image. A recent news headline described the humiliation experienced by one traveler with an ostomy during his airport security check. The pat-down procedure broke the seal on his urostomy with embarrassing results. Unfortunately, some situations may be out of our control, but patients can be taught certain nutritional tactics in order to control some ostomy-related concerns. This article reviews the effect ostomies have on nutrient absorption, outlines key nutrients for the ostomate, and provides tips to manage dietary concerns.”2
Causes of Flatulence in Ostomates
“Traditional practitioners believed that flatulence had different causes:
- Occurring cold abnormal temperament in the gastrointestinal tract, especially in the stomach, so that such coldness will weaken its function and digestion will be impaired. This maldigestion produces harmful gases, which will be concentrated in the cold gastrointestinal tract and therefore produce flatus.
- The amount of food that is eaten can be involved in the production of flatulence. If more than the usual amount of food is eaten, the gastrointestinal system will be weakened. Therefore, it cannot digest food properly, and flatulence will result.
- The type of food eaten can cause flatulence and bloating in several ways:
- The eaten food may have a wet and cold temperament, like squash and cucumber. Even when eaten in moderate amounts, such foods can produce dense gases as a result of the effect of the gastric temperature on them due to their high water content. In other words, the gastric temperature cannot impoverish these gases and thus, bloating and flatulence will occur.
- Food may have a flatulent nature, such as lentils and other beans.
- Food may be distasteful or malodorous. Traditional Persian scholars believed that the gastric sense is very strong, so the stomach will benefit from good-smelling substances and will suffer when malodorous edibles are consumed. It is obvious that if the stomach dislikes specific food, it cannot digest the food properly. Consequently, bloating and flatulence will emerge.
- Flatulence can be caused by the accumulation of improper humors (Khelt) in the gastrointestinal tract, such as phlegm or black bile.”3
Swallowing air while chewing or eating may also cause flatulence, especially if the ingested food or drinks tend to cause bloating. “We all swallow air during the process of eating. Individuals can have excess swallowing due to sucking on hard candies or chewing gum. Drinking carbonated beverages such as soda or beer can also generate excess gastric air. In addition, individuals who experience anxiety may swallow air excessively. Poorly fitting dentures and chronic postnasal ‘drip’ can also cause excess air swallowing. As a result, significant amounts of gas can enter the stomach and small bowel in 24 hours which can lead to belching, bloating or flatulence.
Some carbohydrates cannot be digested by the enzymes in the small intestine and reach the colon where bacteria metabolize them to hydrogen and carbon dioxide gasses. Examples of such food are bran, cabbage, cauliflower, broccoli, and beans. This can result in excess flatulence in some patients. Many patients experience abdominal cramps, bloating and flatulence when they ingest milk, certain cheeses or ice cream because they lack the enzyme (lactase) which is required to digest milk sugars (lactose). This condition, called lactose intolerance, is less common in people of northern European origin.”4
Food can affect our digestive system. Food can increase the production of gas due to their nature or the way humans digest it.
Increased gas-producing foods
- Vegetables of the brassica family (cabbages, broccoli, cauliflower)
- Leguminous foods (beans, peas)
- Carbonated drinks and beer
Incomplete digestion foods
Some foods are only partially digested, such as those high in fiber, which results in more flatulence. Some of these foods include:
- Cabbages, celery, and mushrooms
- Apple peels
- Dried fruits
Foods that contribute to higher stool liquidity
Stools higher in liquid content usually produce more flatulence. These foods include:
- Sugary foods and juices
- Foods with a high-fat content
- Spicy Foods
Although no absolute rule defines what to eat or not, knowing how the body responds to various foods will help ostomates plan their day.
“Modification of eating habits as follows can be used to prevent flatulence:
- Food should be chewed thoroughly, soaked with saliva, and then taken down to the stomach.
- Food should not be eaten before feeling hungry. In other words, only eat when you feel hungry. You should stop eating before feeling complete fullness.
- Food should be eaten slowly and calmly.
- Pleasurable and funny subjects should be talked about while sitting around the table to eat food.
- Drinking beverages while eating food or immediately after should be avoided.
- Eating salad, yogurt, and other side dishes along with the main food should be discouraged.
- Beverages, vegetables, and fruits should be consumed at least 1 – 1.5 hours after the main food.
- To prevent flatulence, some kinds of foods should be avoided:
Fatty and fried foods, very sour, spicy and chilly foods, coffee and cacao, strong tea, ice and beverages cooled by it, pasty foods, flatulent cereals, such as beans (Phaseolus vulgaris L.) and lentils (Lens culinaris Medikus) and vegetables including cabbage (Brassica oleracea L.), raw beets (Beta vulgaris L.), turnips (Brassica rapa var. rapa L.), garlic (Allium sativum L.) and onions (Allium cepa L.), and fruits like peaches (Prunus persica (L.) Stokes), plums (Prunus spp.), cucumbers (Cucumis sativus L.), and squash (Cucurbita pepo Mill.), oranges (Citrus × sinensis (L.) Osbeck), and tangerines (Citrus tangerine Tanaka).”5
Even though each person responds to food in different ways, ostomates should avoid certain drinks and foods that upset the stomach. “Patients should eliminate carbonated beverages such as soda and beer. Foods such as cauliflower, broccoli, cabbage, beans, and bran should be avoided. Milk and other dairy foods should be avoided. Lactaid milk or non-dairy milk such as soy or almond milk can be used. Chewing gum and sucking on hard candies should be avoided. Sugar-free gum and hard candies should be avoided as they may have mannitol or sorbitol as sweeteners which can cause flatulence. To ensure that only potentially symptom causing foods are eliminated without resulting in marked dietary restrictions, patients should eliminate food items one by one and keep a symptom diary. Simethicone products have been promoted as a treatment for gaseousness but their efficacy has not been convincing. Charcoal tablets have also been used to reduce flatulence without convincing benefit. Bismuth subsalicylate has been used to reduce the noxious odor of some sulfa-containing rectal gasses. Alpha-d-galactosidase, an over the counter product, has been used to help in the digestion of complex carbohydrates. Some patients may benefit from this strategy.
Individuals with IBS may benefit from symptomatic therapy for “gas pains” by using antispasmodic therapy such as dicyclomine or hyoscyamine under the tongue. Some patients with bacterial overgrowth may see improvement from the occasional use of antibiotics to reduce the number of bacteria in the small bowel, thereby reducing gas production. If weak abdominal muscles are suspected as a cause for abdominal distension, abdominal-tensing exercises may be helpful, although very difficult to achieve when patients are middle-aged and older. If symptoms fail to respond to the dietary strategies noted above, medical help should be sought to be confident that no other underlying abnormalities are present.”6
Suppress flatulence with stiflers
Stoma stiflers are specially made polyurethane foam products that attach themselves to a stoma cup. It muffs and suppresses the noise from the stoma and adapts to hold the changing consistency of stool. This adjustment does not require a restroom; patients can do it discreetly in public. The stifler also offers protection to the stoma thanks to its cup-shape.
Coping with those embarrassing moments
Despite taking precautions to reduce flatulence and its sounds, it is impossible to reduce them completely
New ostomates can be overly conscious and embarrassed to a point where it might affect their lives negatively.
Patient education helps understand they can lead a full life like anyone else and engage in various activities, such as:
- Performing home chores.
- Sports (non-body combative activities).
- Sex and intimacy.
- Multiple social activities.
“Gas, or flatulence, occurs just as frequently in an individual with an ostomy as it does for a person with a normal, functioning digestive tract. The only difference is that an ostomate has no control over the passage of gas. Foods such as carbonated beverages, beans, soy, cabbage, dairy products, nuts, and onions are known to be gas-producing foods and may increase flatus. Additional behavior modifications also may help reduce flatulence. Patients with this complaint should be advised to avoid talking while eating, chewing gum, drinking with a straw, and smoking. The common thread between these activities is that they may all lead to swallowing air, which, in turn, can increase flatulence.”7
Joining a support group can also help the patient face the situation more confidently. Developing a sense of humor helps minimize the embarrassment when the stoma makes noises in public.
(1, 3, 5) Prevention and Treatment of Flatulence From a Traditional Persian Medicine Perspective. Larijani, B., Esfahani, M., Moghimi, M., Shams Ardakani, M., Keshavarz, M., Kordafshari, G., Nazem, E., Hasani Ranjbar, S., Mohammadi Kenari, H., & Zargaran, A. Iranian Red Crescent Medical Journal. 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4893422/
(2, 7) Nutritional Care of the Ostomy Patient. Collins, N., & Sulewski, C. Ostomy Wound Management. 2011. https://www.o-wm.com/files/owm/pdfs/10-12_OWM0111_Nutrition411_Layout%201.pdf
(4, 6) Belching, Bloating, and Flatulence. Levitt, M., & Szarka, L. American College of Gastroenterology. 2004. https://gi.org/topics/belching-bloating-and-flatulence/