Ballooning: Why it Happens and How to Manage it
By Diane Mirlocca RN, WOCN, IIWCC
Gas—we all have it! Gas is a normal part of our lives. While we might not like to admit it, each of us makes anywhere from 500mL – 1500mL of gas every day and will pass gas through our rectum at least 10 times per day.
What causes Gas?
Gas in the bowel (intestine) is normally caused by breakdown of our food as it travels through the stomach and bowel. The foods we eat are the cause of this gas buildup, however, not everyone produces gas from the same foods. So, gas production is something each individual has to control by their eating habits.
There are a number of foods we know to increase gas in most people (see below). While this list is not complete, remember--if a food (or foods) caused you to have gas before you had surgery for your ostomy it will likely produce gas after surgery too. It does not mean you have to avoid these foods rather be aware they can increase gas formation.
Gas producing foods:
- Pulses—beans, lentils, peas, chickpeas, broad beans
- Dairy products
- Artificial sweeteners (e.g. aspartame)
- Cruciferous veggies: broccoli, Brussel sprouts, cabbage, cauliflower
- Carbonated drinks
How Can I reduce gas build-up?
Swallowing air while chewing gum, talking when eating, drinking from a straw or carbonated drinks causes gas. On the flip side, eating slower, minimizing the amount of carbonated drinks you consume and stop chewing gum may help.
What Specifically Causes Ballooning?
Persons with an ostomy (colostomy or ileostomy) cannot control the gas because there isn’t a muscle or control valve. The result: gas comes out freely into the pouch. Since gas is essentially air, it will ‘balloon’ the pouch when gas is passed. This in turn can put pressure on the pouch causing it to lift from the skin, there may be bowel content leakage onto the skin (worst case scenario) or a bump in your clothing at the site of the ostomy (embarrassing...!)
How to Manage Ballooning
A key factor in managing gas build up is regarding the thickness of the bowel movement. The Goldilocks theory prevails: too thin or too thick stool may contribute to gas build-up.
Some ostomy products have built-in charcoal gas filters to decrease odour and allow the slow release of gas. These work great on colostomies because the bowel movements are more formed and the filter does not become wet. Once the filter is wet the charcoal filter is no longer effective and a wet filter can block gas from escaping. Applying gentle pressure to the pouch either from your clothing or your hand evenly pressing on the pouch will help expel gas. Remember that large amounts of gas take time to pass through the filter.
Another option that doesn’t have a charcoal filter is the Osto-EZ-Vent™. This is a simple disposable nipple valve that can attach to any pouch and be opened and closed repeatedly to allow easy release of gas.
If you wear a two-piece appliance separating the pouch from the flange will release gas--better known as “burping” the pouch.
If you wear a one-piece appliance, without filter, releasing the bottom clamp will expel the gas. It is recommended to do this over a toilet in case some of the movement is released at the same time.
What not to do:
Poking a hole with a pin at the top of the pouch and leave it uncovered. While technically it will release the gas; it allows everything to come out of the hole—gas, odour, and perhaps stool. Pouch vent adhesive discs are available that will neutralize odour and prevent leakage.
How do I Manage odour?
Gas odour can be quite embarrassing if it leaks out of your stoma. There are certain foods known to increase gas odour:
- Baked beans,
- Cruciferous veggies (see the list above)
- Garlic, onions,
- Strong cheeses and surprise,
- Peanut butter (now that’s a surprise!)
On the flip-side, there are a number of foods that help neutralize or control odour. These include: buttermilk, yogurt, cranberry juice, orange juice, tomato juice, parsley and mint.
Deodorant drops may be added to the pouch and these are known to work: examples of products available are: Hollister m9 Odor Eliminating Drops, Smelleez™ Odour Eliminator Granules, Freshwave® products or Na'Scent™ drops.
While gas is a normal part of every day life, it can be an embarrassing challenge for persons with ostomies. By following the suggestions provided here, ballooning can be well managed. If you have questions or need more advice, please contact a nurse specializing in ostomy care (NSWOC or WOCN).