I have suffered from excess flatulence for some time and it is very annoying – I feel like I need to go to the loo all the time. Is there anything that can be done about it? Or is it something I’ll have to live with?
Flatulence can be a transient thing – but for some sufferers it’s a medical condition
Dr Ellie Cannon replies: Flatulence is normal, of course. But when somebody suffers excessive flatulence it can be very uncomfortable and socially embarrassing. So how much is normal? It’s difficult to give an exact number of times a person ‘should’ pass gas, but a rule of thumb would be if it becomes markedly more frequent than a person is used to, it could be considered excessive.
Sometimes it’s a transient thing, caused by eating fibrous foods such as beans, pulses and vegetables. Gut bacteria help break these down and a by-product of the process is gas.
But for some, it’s a medical condition. Irritable bowel syndrome can cause excessive bloating and wind alongside tummy pain and diarrhoea or constipation. Peppermint oil capsules can be given on prescription to reduce symptoms. Avoiding certain food groups under medical supervision can help as well.
Excess wind may also be caused by bowel problems including constipation, coeliac disease and lactose intolerance. Less commonly diagnosed would be a condition called small intestinal bacterial overgrowth (SIBO), when excess bacteria builds up in the gut. Flatulence may be caused by a food intolerance. They are difficult to diagnose and rely on you keeping a meal diary to see which foods are linked to the problem. Some medications may cause excessive wind, such as statins and anti-inflammatories like ibuprofen. Laxatives are also known to cause the problem.
I had a mini-stroke in my 50s and take ramipril, pravastatin and clopidogrel to prevent another. Now my doctor wants me to take yet another drug, lansoprazole, to prevent stomach bleeds caused by the other meds. But if it’s the tablets causing the problem, couldn’t I take fewer?
Dr Ellie replies: It is usual after a mini stroke – also known as a transient ischaemic attack (TIA) – to be prescribed medication to prevent a further one. This will typically be blood pressure tablets and a statin, to lower cholesterol, plus a blood thinner or anti-clotting drug.
Clopidogrel is one of these: it prevents certain cells in the blood – platelets – from clumping together and making a clot. And it is blood clots travelling to the brain that can cause TIAs.
One of the side effects of clopidogrel is bleeding, however. Bleeding from the stomach can happen to anyone, particularly people with stomach irritation or ulcers. The worry with someone on clopidogrel is that this bleeding could become excessive and dangerous. Therefore if
someone is on an anti-clot drug they will often be recommended something to protect their stomach from irritation and potential bleeding. Lansoprazole is a medication that protects the stomach to make any irritation or bleeding unlikely.
If clopidogrel is working and not causing any problems, there is no reason to stop it. At 77 the risk of a further TIA is higher than at 57 purely due to age, so it would not make sense to stop clopidogrel unless it was causing problems.
I am in my 80s and fit. But recently, I’ve found my legs become numb and difficult to control after about 10 minutes of walking. My GP suggested it’s due to nerve problems in my back and has referred me for an X-ray. But I have no back pain. What do you think?
Dr Ellie replies: Numbness and problems walking could be a neurological issue – conditions that affect the nerves. But symptoms such as those you describe could also be down to a problem with blood circulation to the legs.
It’s called peripheral vascular disease and it causes a very distinct pain after walking, which disappears when you rest.It can lead to a painful ache in both legs and there may also be skin colour changes – the legs or feet may appear blue or purple – numbness or weakness. Peripheral vascular disease is more common in people suffering from heart disease. And anyone with high blood pressure, obesity or high cholesterol is also at risk.
Smoking is the biggest cause. However a doctor might think this less likely in someone with a healthy lifestyle reporting these symptoms. Checking the pulse and blood pressure in the feet and legs can be done as a first check to see if there is a vascular issue – this can be carried out in your local GP’s surgery. That being said, numbness in the legs is also often caused by problems in the spine – and there may not be any accompanying back pain.
The nerves which supply the legs are all connected to the spine, and any swelling or damage caused by conditions such as arthritis can lead to pressure on the back nerves.
This can then lead to numbness as well as possibly tingling, pins and needles or even weakness in the legs. It might happen only in certain positions, such as when you are walking and the pressure on the nerves is at its highest. It could stop when you move, sit or lie down, and the pressure is released.
Danger of slapped cheek syndrome
Parvovirus is known as ‘slapped cheek syndrome’
Have you heard of parvovirus? It’s the cause of ‘slapped cheek syndrome’ in children – and is mostly harmless despite the rash.
However if a pregnant woman catches the virus it can, in one in eight cases, trigger miscarriage. And, worryingly, the number of women of childbearing age testing positive for parvovirus has surged since Covid.
I’ve heard stories of women losing babies as a result of the infection. We don’t have a vaccine at the moment, so it’s really something to watch out for.
I was never shy in voicing my concern about never-ending lockdowns and the knock-on effects it would have on our health. Many common infections were suppressed for years while we isolated and now seem to be circulating with a vengeance. I’m sad to say this seems to be another example.
How you can help our A&Es
The seemingly intractable problems with A&E are depressing. Departments are so inundated with patients that hundreds of thousands are waiting more than 12 hours to be seen – in the most extreme case, according to recent data, one waited ten days.
The situation just gets worse and worse. GPs not being able to see patients fast enough is often blamed. In reality, people are clogging up emergency services with things such as mouth ulcers and coughs – things they really shouldn’t need medical help for.
A patient of mine this week who had collapsed never made it into hospital – the A&E was too busy, so he was treated in the ambulance outside. Thankfully, that ended well.
Others haven’t been so lucky. I read of one disabled woman with severe asthma who died after waiting 39 hours in A&E.
How is your local hospital coping? Write and let me know.
Do you have a question for Dr Ellie Cannon? Email DrEllie@mailonsunday.co.uk
Dr Cannon cannot enter into personal correspondence and her replies should be taken in a general context.
