I seem to have a lot of gas in my pouch. What is the best way to manage it?
The production of gas through a stoma depends on two major factors: swallowed air and gas formed by the bacteria in the colon. Gas production is normal and amounts will vary depending on types of foods eaten, how often food is eaten, eating habits and the motility of the bowel. Managing gas production and the release of gas from the pouch is achieved through multiple techniques.
Swallowed air can result in gas production through a stoma. Common causes of swallowed air include:
- chewing gum or sucking on candies,
- sucking on drinks through a straw,
- talking while eating,
- eating and drinking quickly (“gulping”), and
Altering these habits may decrease the amount gas entering the pouch.
Gas can also result from eating certain foods and is part of the normal digestive process. Certain foods may be difficult to chew into small pieces such as some lettuces (romaine) or cabbage. More air may be swallowed with these types of foods, causing more gas. Some beverages like pop, mineral water, and beer will increase gas in the pouch. Other foods that tend to cause more gas production include:
- dried beans,
- vegetables from the cabbage family (onions, sprouts, broccoli, cauliflower,),
- corn, and
While these foods may contribute to gas formation, do not eliminate from your diet. Simply be aware that eating these items may result in gas production. You can choose when to include these items in your diet based on social circumstances and personal preferences. Some commercially available products that are available through pharmacies without a prescription, such as Beano®, may help to reduce gas production when taken with these foods. Lactose intolerance, or the inability to tolerate the sugar in dairy products, may be another source of gas production. Lactose intolerance may be accompanied by other symptoms such as bloating, cramps, and loose stools. Supplements, such as Lactaid®, are readily available at pharmacies and will help with the digestion of dairy products. Click here to read more about Intestinal Gas. Dietary review and changes can also be discussed with a dietitian.
Managing gas once it is in your pouch is somewhat dependent upon the type of stoma and the type of appliance used. Some pouches have integrated gas filters. These filters are located at the top of the pouch and contain charcoal. The charcoal deodorizes the gas as it escapes from the pouch. Most of the charcoal filters are part of the pouch and cannot be removed or changed. There are some pouches still available that have removable charcoal filters. These filters can be changed if required. The efficiency and effectiveness of the filters are variable, and are not always appropriate for all types of stomas. In general, there needs to be external pressure on the pouch (either from clothes or from gentle pressure with a hand) to help expel the gas through the filter. Large volumes of gas may take time to pass through the filter. The filters also tend to clog or fail with looser stool, causing some odor breakthrough or even tiny leaks of stool through the filter itself. As a result, filtered pouches are usually not recommended for people with ileostomies. Filters can work well for patients with colostomies and who have formed stool. Filters should also be covered with a small adhesive patch (usually included with the product) when showering or swimming. Moisture from the outside can also cause the filter to fail.
An option for releasing gas that does not require a charcoal filter is the Osto-EZ-Vent™. This product is a simple disposable nipple valve that can be attached to any pouching system. The valve can be opened and closed repeatedly to allow for the easy release of gas. Further information about the product can be obtained through the website: www.kemonline.com.
For people who wear two-piece appliances, gas can easily be released by “burping” the pouch. Slightly separate the pouch from the flange at the top of the appliance (complete removal of the pouch is not required) to allow the gas to escape. Once the pouch is empty, reattach the pouch to the flange. For those who use a 1-piece system without a filter, empty the gas by removing the clip. Poking holes into the pouch to allow for the release of gas is not recommended. Once the pouch has been punctured, the pouch is no longer odor free or leak proof.
If you need assistance to help review dietary changes for the management of intestinal gas, or would like to consider alternate pouching options for managing gas, contact your ET.