Ask the Navigator: I have heard that intestinal gas is a big problem after surgery. What, if anything, can be done for this?

Dear Navigator,

Racheal Newmyer, RN

I have heard that intestinal gas is a big problem after surgery. What, if anything, can be done for this?

Good question, Jan! Many post-operative bariatric patients do indeed complain of gas. Here are some ways that I have learned over the years to treat and prevent this uncomfortable condition:

  1. Slow your food intake:  Due to the change in anatomy after surgery, food will already move quickly from the gastric pouch or sleeve stomach into the small bowel and then into the large intestine. When undigested food moves into the colon it can cause bloating, discomfort and unwanted gas. This is why we teach patients to take your time eating, rest your fork between each bite, and chew each bite 20-30 times before you swallow.
  2. Avoid trigger foods: These are usually the foods that made you bloated or uncomfortable before surgery, but their effects seem worse post-surgery. They include foods that are high in sugar and unrefined carbohydrates. Examples include white bread, pastas, cereals, and anything with added sugars (ice cream, cookies, candies, etc.). Many of these foods can stay undigested until they get into the colon, which increases the possibility of unwanted gas. Some vegetables and fruits can also create gas due to their fiber content, but if you are consistent with your fiber intake, the gas should subside over time. Sugars can also insight dumping syndrome, the “dumping” of food into the small intestine, which can increase the presence of gastrointestinal discomfort and promotion of gas. A good rule of thumb is if you find that your gas is getting worse, look at what you are eating. Chances are it may be the carbohydrate that you just had. If you are not sure, start journaling. Often times you can catch which foods are causing the gas and eliminate them.
  3. Check your CPAP or BIPAP: If you are finding that you experience gas in the morning, your sleep apnea treatment might be the culprit. The pressure that your system was originally set at was for the person you were before surgery. Not only will you lose the benefit of your CPAP or BIPAP if your mask doesn’t seal correctly because of weight loss, but your pressure may be set too high and cause a bunch of unwanted air to be blown into your gastrointestinal track. Follow up with your sleep specialist after surgery to get this evaluated.
  4. Try home remedies or over-the-counter medications: Some patients have found that ginger root, peppermint tea or warm lemon water helps to soothe the digestive track. Magnesium has also been shown to help move stool through the intestines and can promote the expulsion of gas. Probiotics are hugely popular for their ability to help add natural flora back into the gut and in turn cut down on the bacteria that causes gas. Products that contain simethicone like Mylanta have also been used to help eliminate gas. Ask your surgeon at your next appointment for some of his over-the-counter suggestions.
  5. Get up and move: Gas can be a byproduct of a faulty intestinal system. Movement has been shown to increase intestinal health. Taking a walk daily may just be the ticket for decreasing post-surgery gas for you.

Hope this helps, Jan. Thank you again for your question.

If you’d like to “Ask the Navigator,” email your questions to  metabolicsurgery@erlanger.org.