Q: I have the most embarrassing problem in my family I need to deal with. My dad, who is in his late 80s, is actually quite a healthy individual. He takes only a few medications and usually sees his doctor once or twice a year. He and my mom live alone without much help. They are fighting with the rest of the family to stay independent. They consistently refuse any help other than grocery shopping and driving to see their doctor.

About two to three months ago, we all started noticing something we were very uncomfortable with. It is hard to even write about it, but my dad has an awfully large amount of gas. He does not realize this at all. The whole problem is actually quite loud and also smelly. You can imagine how difficult it is for all the kids and grandkids. We had a large family gathering two weeks ago and no one wanted to sit next to my parents. It is incredible, but both of them are totally unaware of what is going on. My dad seems not to even notice the "event." We have tried joking about it. We tried to talk with my mom about it. We approached my dad as well, but to no avail. Is there a way to handle this unusual situation?


A: Oh boy, what a situation to be in! I do believe that the problem can be helped, but I also know that since the situation keeps the family away, you will need to make your parents aware that this is not just a joke. I assure you, they want you and your kids around. Use this as a motivation to give the conversation a serious tone.

Passing gas, also known as flatulence, is a normal part of the functioning of the digestive system. Gas is a byproduct of digestion or a breakdown of food in the gut. We all pass gas and doctors, especially surgeons, worry if we do not. For all of you who have ever had abdominal surgery, you might remember that ever day after the operation, the doctor asked if you were passing gas.

Gas collects in all parts of the digestive tract. In the stomach, much of it may be from swallowing air. We deal with that gas by burping (just remind yourself of the last time you had a soda). When it comes to the lower parts of the bowels, gas mostly comes from bacteria breaking down the food. We have a tremendous spectrum of how much gas and how often different people pass it every day. Some have a little; some a lot. It is generally considered that if you pass gas more than 20 times a day, that is probably excessive.

Many patients complain about bloating and abdominal distension. For some patients, this can be very painful and unpleasant. Believe it or not, the newest research about this subject indicates that bloating is not actually caused by too much gas. More often than not, it is caused by the normal amount of gas localizing in the wrong part of the bowel at the wrong time.

There are three main reasons for excessive gas. One is swallowing air, which we already mentioned. This may be due to anxiety, excessive saliva, carbonated drinks or gastro esophageal reflux, also known as GERD. Another potential cause is bacteria making way too much gas in the gut. This is usually related to the type of food one eats. Complex carbohydrates in certain vegetables and legumes are the culprit. We are talking beans, cabbage, cauliflower, broccoli, onions, leeks and others. There is also the commonly forgotten lactose intolerance. Lactose, a sugar that is in all dairy products, gets tougher to digest as we get older. This is probably the easiest disorder to control with the usage of lactose-free milk and going easy on the cheese and yogurt.

Partially or totally impaired food absorption through dysfunctional gut lining is another reason for gas. Some bowel infections can cause gas, but they are rarely chronic problems.

Irritable bowel syndrome is a quite common problem of the motility of the gut. In this disease, the bowel does not contract sequentially, but rather chaotically causing pain, bloating and excessive gas. IBS is a disease of younger patients -- it is virtually unheard of to get it at age 75 and older.

Chronic constipation can contribute to passing gas, as well as some medications for it, especially fiber. Fiber and fruits stimulating the gut, such as prunes, when taken without the proper amount of liquid can cause abdominal distention and gas.

And rarely, medications can cause gas. Some medications for cholesterol and for weight loss come to mind, but there are others as well.

Some drugs can be used to minimize gas, but they are hit-or-miss in their likelihood of success. Simethicone is one such drug. Bismuth preparations can be used to help with the smell. Some people have had great results with herbal preparations, such as fennel or chamomile tea, and spices, such as cumin, coriander, caraway and turmeric.

If there are no specific symptoms with the excessive gas, then we are talking more about the social aspect of the problem. Believe it or not, 99 percent of the gas we produce does not smell. As for the rest, well, countless jokes have been made on that subject. There is also the sound the gas makes. A loud sound with gas passing is considered by some specialists to be the very early (and benign) stage of bowel incontinence, as it is due to a lack of control of the anal sphincter -- the protector muscle at the very end of the digestive track.

Let's go back to our reader and her story. I worry that her dad may not even hear the embarrassing sound he is responsible for. Many people at this age are somewhat hard of hearing. As I expressed before, the gas can be limited by altering the diet and limiting dairy products. The primary doctor can look at the medications. Constipation can be dealt with by a stool softener. The first step, however, is to try to make both parents realize that the family is embarrassed. If this strategy does not work, then a decision will have to be made. There may be some wisdom to putting the social context on the back burner and allow some of the embarrassing behavior to continue for the sake of spending time together, smelly or not.

Dr. Beata Skudlarska is a Bridgeport geriatrician. Send questions to Bridgeport Hospital Center for Geriatrics, 95 Armory Road, Stratford CT 06614 or geriatricmd@aol.com.