ASK DOC: Help, my stomach has been full of gas for years!

Dr Flo, my stomach is always full of gas and it growls. This has been the case for the past three years and my tummy has also grown in size. What can I do about it?

Daudi

Dear Daudi,

A lot of gas in the abdomen is referred to as bloating. The gas produces noises and makes your abdomen look big. It can also cause persistent belching and abdominal pain.

Half of the gas in our digestive systems comes from swallowed air, and the rest is produced by the bacteria in the gastrointestinal system that helps to digest food. If the food does not move through the intestines as it should, gas can build up. You can also get a buildup of gas if you eat too quickly, eat too much or when you eat fatty foods. You can also build up gas by drinking through a straw, chewing gum, sucking sweets and taking carbonated drinks like soda.

There are some foods that also increase the amount of gas in your intestines e.g. beans, lentils, whole grains, some vegetables (cabbage, cauliflower, and carrots), some fruits, artificial sweeteners, and dairy products, if your body has difficulty digesting them. Smoking has also been associated with bloating.

Hyperacidity, constipation, irritable bowel syndrome, functional gastrointestinal disorders, infections, food intolerance (e.g. lactose or gluten intolerance), side effects of some medicines, hormonal changes especially in women; excessive weight gain, eating disorders, stress, depression and anxiety; blockage of the intestines, impaired movement of the intestinal muscles, diseases of the pancreas, accumulation of fluid in the abdomen (ascites) due to other illnesses like kidney disease, liver disease, heart failure and cancer, can also cause recurrent bloating.

To manage it, avoid chewing gum and using drinking straws, eat slowly, avoid gassy foods, stop smoking, avoid carbonated drinks, and if you are lactose or gluten intolerant, avoid those foods. Medicines like simethicone, probiotics, anti-spasmodic medications and some anti-depressants can help ease the symptoms. Since you have had the problem for several years now, it would be advisable to get a proper checkup, preferably by a gastroenterologist (stomach specialist), so that if there is any underlying problem it can be addressed.

Dr Flo, I normally experience a burning sensation in my feet at night, and I am not able to sleep until they cool down. This occurrence has become so frequent lately, that I am starting to get worried. Please advise me. EMM

Dear EMM,

A burning sensation in the feet is usually a result of nerve damage. It may be mild or severe, and it may be accompanied by a tingling feeling or pins and needles.

The feet may also be overly sensitive to touch or pain. When nerves are damaged, they are more likely to become overactive and misfire.

The most common cause of nerve damage is diabetes. Other possible causes include excessive alcohol consumption, smoking, kidney disease, thyroid problems, nerve entrapment, vitamin deficiency (B12, B6, folate), poisoning by heavy metals (e.g. lead, mercury, arsenic), infections like herpes and HIV, some inflammatory conditions (e.g. Guillan Barre syndrome, vasculitis, sarcoidosis, etc), poor blood circulation in the feet, and as a side effect of chemotherapy medication, some anti-retrovirals, some TB medicines, etc. Fungal skin infection on the foot may cause a burning sensation in some people.

For some, the burning is simply due to overusing the feet, especially if you walk or stand a lot or if you are overweight.

Some tests including a blood sugar test, vitamin deficiency test, nerve conduction study, can be done to establish the cause, and if a particular illness is suspected, then there will be tests targeting that specific illness. If an underlying cause can be identified, then treating the cause will stop any further nerve damage.

For example, if the problem is diabetes, the best way to control the burning is by controlling blood sugar levels. Unfortunately, nerves do not heal easily and any damage they may have suffered already may not be reversible.

Medication is given to reduce the burning sensation and pain. These include painkillers, pregabalin, amitriptyline, gabapentin and other medications that help relieve nerve pain. Vitamin B supplements may also be given. At home, you can soak your feet in warm water, then massage them to relax the muscles and improve blood circulation. Wear good, comfortable shoes, with good insoles, wear cotton socks and rest your feet as often as possible.

Dr Flo, I am 26 years old. I’ve never enjoyed sex ever since I became sexually active eight years ago. I feel nothing and I fake it just to make my partner happy. I am afraid of telling him that I don’t enjoy intimacy. Can this problem be treated?

Miss W

Dear Miss W,

The normal sexual response cycle has four stages – arousal/excitement, plateau, orgasm and resolution. You might have a problem with desire or interest, a problem getting physically aroused, you might have difficulty reaching a climax or you might have pain or discomfort during sex.
This may be a result of physical or psychological issues. Physical issues include pelvic floor dysfunction, vulvodynia, vaginismus, inadequate lubrication, nerve diseases, problems with blood supply, hormonal diseases, alcohol and other drugs, side effects of some medications, and hormonal changes.

Psychological or emotional factors include stress, anxiety, depression, relationship problems, lack of trust, history of sexual abuse, poor self-esteem and sexual fears or guilt.

Treatment is possible and requires good communication and support from your partner. It is advisable to begin with a visit to a gynaecologist so that you can have a good evaluation and any physical problems can be identified and managed. Once that is done, you will benefit from seeing a sex therapist and/or a psychologist or counsellor to help deal with any emotional or psychological issues that may be affecting you.

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