For For the past two years I have been suffering from very severe flatulence, which is embarrassing. I recently read that it could be a sign of something called SIBO. What is that?
J. Macey, Salisbury, Wiltshire.
Dr. Martin Scurr replies: SIBO – or Bacterial overgrowth in the small intestine – is where too much, or an abnormal mix of, bacteria normally found in the colon move into the small intestine.
These ferment the carbohydrates from your food, leading to the formation of gases including hydrogen, methane and hydrogen sulfide. This causes abnormal bloating and malodorous flatulence.
The cause of SIBO is not yet fully understood, but it is often due to another problem (for example, surgery or disease) that damages the cells involved in intestinal motility.
Besides SIBO, excess gas could also be due to diverticular disease – which you have, as you say in your longer letter. This is where small pouches form in the colon, usually due to age and lack of fiber. Any material in these bags ferments and produces gas.
Your flatulence may even be due to the extra fiber you have been advised to consume to combat the constipation caused by diverticular disease.
For this reason, I often suggest that patients increase fiber intake – from bran, grains and vegetables, for example – slowly, over several weeks and months, rather than overnight.
SIBO – or small intestinal bacterial overgrowth – causes bacteria normally found in the colon to move into the small intestine, where they ferment carbohydrates and cause gases
I suggest you discuss your gas problems with your doctor so you can get tested for SIBO.
This involves performing a breath test to measure the levels of hydrogen and methane.
If SIBO is diagnosed, you may need to consult a dietitian for advice (one approach is a low FODMAP diet – which gradually identifies and then eliminates foods that are not well absorbed by the small intestine and can cause gas).
In exceptional cases, GPs may prescribe antibiotics to reduce bacteria in the intestine.
In the meantime, try a more soluble form of fiber, such as psyllium husk. It is available in health food stores and is better tolerated than, for example, wheat bran, because it undergoes only minimal fermentation by intestinal bacteria, which produces less gas.
I I have (self-diagnosed) crepitus in my neck – and neck exercises hurt every time. Is this just something to accept at age 74, or is there something that can ease the stiffness and pain?
Debra Arnell, Alicante, Spain.
Dr. Martin Scurr replies: ‘Crepitus’ is the term for cracking, rasping or cracking sounds in a joint.
In the neck it is most often caused by cervical spondylosis – age-related arthritis that affects the small joints between the vertebrae. Small bony spurs (osteophytes) often develop as part of the body’s response to the inflammation in the arthritic joints. The grinding or grating sound is caused by the bones rubbing against each other.
You don’t mention how much pain you experience and there is a difference between mild pain during exercise that subsides quickly, and constant, more severe pain – the latter being a sign you need to see a doctor.
Applying heat, such as a hot water bottle wrapped in a towel, for 20 minutes before exercise can help, and taking two 500mg paracetamol tablets at the same time can also ease things.
You might also consider the Alexander Technique, a postural approach to improving movement and posture through guided exercises and breathing.
There is encouraging evidence for chronic neck pain. It won’t reverse the arthritic changes, but it can reduce muscle tension and improve the way you move.
An MRI scan is only necessary if the pain gets worse, spreads to your arm – or if your hands become less dexterous. This may be a sign that the nerves are irritated and should be investigated.
You should certainly not simply ‘accept’ this discomfort. There are measures you can take to improve the situation.
In the neck, crepitus is usually caused by cervical spondylosis – age-related arthritis that affects the small joints between the vertebrae
In my opinion…why GPs should work for the NHS
Did Did you know that GPs are not NHS workers? Unlike hospital doctors, each general practice is a state subcontractor, a small company responsible for revenues and expenses and contracted to provide services.
Each GP is a partner and receives a salary from the profits of that small business.
According to a report by the charity the Health Foundation, a GP practice receives £219 per year per patient, which makes up the majority of its income – there are 18,000 GP partners in England and 1,000 pay themselves more than £300,000 annually; 4,000 attract over £200,000. That is an astonishing amount.
As with any owner-operated small business, surely there is an incentive to minimize expenses to maximize profits?
Take the example of the fact that general practitioners no longer provide care outside office hours; seven days and nights cover was expensive and reducing it to a five day day only service inevitably meant that every GP company now has the money for higher salaries.
If GPs were deployed as hospital consultants, we might see a return to out-of-hours cover offered by consultants. This system needs to be changed.
- Write to Dr. Scurr from Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email: drmartin@dailymail. co.uk. Answers should be taken in a general context. Always consult your own doctor if you have health problems.
