Flatulence (abdominal bloating)

Flatulence – as a syndrome of excessive formation or accumulation of gaseous waste products from the digestion process – can occur when more than 600-700 cubic cm of gas are formed in the small and large intestines during the day.

According to the latest version of the International Classification of Diseases, flatulence ICD 10 is classified as class XVIII of symptoms and deviations from the norm that are observed during clinical examinations. In this class, bloating or flatulence occupies a place in the R14 heading, which unites the signs of pathologies of the digestive system.

There are three main complaints associated with "gas": excessive belching, bloating (flatulence), and excessive passing of gas through the anus.

The intestines normally contain gas, which enters through air ingestion (aerophagy), direct intestinal production, or diffusion from the blood into the intestinal lumen. Gas diffuses between the intestinal lumen and the blood in direct proportion to the difference in partial pressure. Thus, nitrogen (N) enters the intestinal lumen from the bloodstream, and hydrogen (H) enters the bloodstream from the intestinal lumen.

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Causes of flatulence

First of all, the causes of flatulence can be rooted in simple overeating, when the amount of food consumed simply does not have time to be properly processed by the body. Often, severe flatulence after eating occurs due to the products that a person eats. Products that increase gas formation in the intestines include complex carbohydrates, animal fats, milk, and various vegetable crops.

The causes of flatulence may be rooted in a congenital or acquired deficiency of digestive enzymes (dyspepsia), which leads to incomplete digestion of food. With this etiology, constant flatulence is accompanied by a feeling of heaviness and a feeling of increased intra-abdominal pressure (in the upper part of the cavity), and sometimes cramping pains. With enzyme deficiency, diarrhea and flatulence are very common. One example of enzyme deficiency is hypolactasia - intolerance to milk sugar due to a deficiency of the enzyme beta-galactosidase.

However, in the vast majority of cases, the causes of flatulence are functional disorders of the gastrointestinal tract and pathologies of the organs of the middle part of the digestive system: stomach, duodenum, pancreas, gallbladder, small and large intestines.

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For what diseases is flatulence one of the symptoms?

Flatulence in gastritis, that is, inflammation of the gastric mucosa, manifests itself as rumbling in the stomach, mainly during an exacerbation of the chronic form of the disease, occurring against the background of low acidity of the gastric juice. Most patients with this diagnosis complain of heaviness in the stomach and flatulence.

Nausea, belching, flatulence in the evenings and night pain in the hypochondrium are classic symptoms of duodenal ulcer. While irritable bowel syndrome and intestinal dyskinesia are characterized by flatulence in the mornings.

Flatulence in pancreatitis, caused by a malfunction of the pancreas, provokes bloating of the abdominal wall and rumbling, frequent loose stools with undigested food particles and fats. With this pathology, fetid flatulence is observed, which is associated with the predominance of hydrogen sulfide in intestinal gases (the smell of which is compared to the smell of rotten eggs), indole (it has the smell of naphthalene), skatole and thiols. 3-methylindole (skatole), released during the decomposition of amino acids, has a pronounced fecal odor, and sulfur-containing thiol (mercaptan) smells simply disgusting and is not for nothing included in the protective secretion of skunks.

By the way, odorless flatulence, in the sense of increased flatulence, as well as belching of air, most often occurs with aerophagia (physiological pneumatosis of the stomach) - increased swallowing of air when eating and drinking, poor grinding of food in the oral cavity, with the abuse of carbonated drinks, as well as with long-term disruption of nasal breathing. According to research, the air entering the intestinal lumen as a result of aerophagia makes up at least a third, or even half of the intestinal gases. In terms of chemical composition, flatus with odorless flatulence consists of nitrogen, carbon dioxide, hydrogen and methane.

Flatulence with cholecystitis – inflammation of the gallbladder – develops in parallel with nausea and bitter belching. Heartburn with flatulence constantly occurs in those who have increased acidity of gastric juice or gallstones. And flatulence and temperature above +37.5-38°C are recorded during exacerbation of inflammation of the gallbladder and the occurrence of cholangitis – an infectious inflammatory process in the bile ducts.

Flatulence after surgery accompanies almost all clinical cases of intracavitary surgical intervention, but especially operations on the stomach, duodenum and gall bladder. Flatulence after gall bladder removal (cholecystectomy) is a common and almost inevitable phenomenon, as are other symptoms of this clinical condition. Thus, patients after such surgery suffer from flatulence and pain in the lower back (girdle pain), pain in the right hypochondrium, nausea, diarrhea, duodenal reflux, etc. for at least another six months.

Flatulence and rumbling in the stomach, as well as diarrhea and flatulence are among the symptoms of inflammation of the small intestine - enteritis, in which digestion in the small intestine is significantly impaired, as well as chronic enterocolitis and gastric ulcers with low acidity.

Flatulence in colitis (inflammation of the colon), especially chronic, is closely related to digestive pathology. Gastroenterologists emphasize that this disease is characterized by constant belching, bitterness in the mouth, nausea, flatulence and temperature (up to fever), constipation and flatulence, diarrhea and flatulence with tenesmus - false urge to defecate.

Dull aching abdominal pain with flatulence in patients with chronic colitis is felt in the lower abdomen and on the sides of the abdominal cavity, they become more intense after eating, when walking, and also before defecation. Flatulence and mucus in the stool are also characteristic of an exacerbation of chronic colitis, especially for the mucous-membranous variety of this disease.

Many women experience flatulence before their period, which is explained by the specific changes in hormonal levels during the premenstrual period. Nervous flatulence, the so-called psychogenic flatulence, is associated by experts with increased stress loads, which increase adrenaline synthesis and, as a result, disruptions in the functioning of the intestines, in particular, disruption of its normal motility.

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Dysbacteriosis and flatulence

The issue of dysbacteriosis and flatulence deserves separate consideration because the imbalance of the obligate microbiological environment of the large intestine is one of the key causes of pathological gas formation.

Formation of intestinal gases is a natural, biochemically conditioned process, in which colonies of microorganisms living in the intestines participate, performing enzymatic functions. These are gram-positive bifidobacteria (Bifidobacterium), lactobacilli (Lactobacillus), gram-negative bacteria – Escherichia coli (E. coli), Eubacteria, Fusobacteria, as well as various types of bacteroids (Acidifaciens, Biacutis, Distasonis, Gracilis, Fragilis, Ovatus, Putredinis, etc.).

In addition, the normal microbiological climate of the intestine is maintained by opportunistic gram-positive bacteria of the genus Peptostreptococcus anaerobius - peptostreptococci Clostridia, enterobacteria Enterobacter aerogenes, Klebsiella, anaerobes of the Propionibacterium family (propionobacteria), etc.

Dysbacteriosis is expressed, on the one hand, in the disappearance or significant reduction of the number of bifido- and lactobacilli and E. coli. On the other hand, the proportion of opportunistic bacteria increases. If dysbacteriosis and flatulence occur, this means that:

• due to a lack of bifidobacteria, the intensity of enzymatic parietal digestion in the small intestine decreases, the volume of undigested carbohydrates and amino acids and unabsorbed nutrients increases;
• a deficiency of lactobacilli leads to alkalization of the intestinal environment, and, therefore, the activity of putrefactive processes increases, accompanied by the release of hydrogen and methane;
• the breakdown of lactose in the intestines is impaired, which is facilitated by E. coli.

It should be taken into account that if all the gases formed during the digestion of food were to exit the intestines through the rectum, it would not be 600-700 cubic cm, but on average no less than 25,000-40,000 cubic cm per day...

But, fortunately, the intestinal microflora contains not only bacteria that produce carbon dioxide, nitrogen, hydrogen and methane, but also microorganisms that absorb these gases. And when the biological balance of their symbiotic relationships is disrupted, we are talking about the occurrence of flatulence.

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Pathogenesis of bloating

It has been suggested that recurrent periods of crying in infants aged 2–4 months are due to pain, termed “colic,” the occurrence of which has been attributed to intermittent intestinal spasms or gas formation. However, studies of colicky infants have shown no increase in H2 production or oral-cecal transit time. Consequently, the cause of infantile colic remains unclear.

Excessive belching

Belching (eructation) is caused by swallowed air or gas from carbonated drinks. Aerophagia is usually observed in small amounts during eating and drinking, but some people subconsciously swallow air constantly while eating, smoking, and in other situations, especially when excited. Excessive salivation increases aerophagia and can be associated with various gastrointestinal disorders (gastroesophageal reflux disease), ill-fitting dentures, certain medications, chewing gum, or nausea of any etiology.

The most common cause of belching is swallowed air. Only a small amount of this enters the small intestine; the amount of air probably depends on body position. In the upright position, a person belches air freely; in the supine position, the air is located above the fluid level in the stomach, which facilitates its movement into the duodenum. Excessive belching may also be involuntary; patients who belch after taking antacids may attribute the improvement to the belching rather than to the antacids, and may therefore deliberately induce belching in the hope of reducing symptoms.

The occurrence of flatulence may be a consequence of various gastrointestinal diseases (e.g., aerophagia, non-ulcer dyspepsia, gastrostasis, irritable bowel syndrome) as well as disorders not related to the gastrointestinal tract (e.g., myocardial ischemia). However, excessive intestinal gas formation is not directly related to these complaints. In most healthy people, 1 L/h of gas can be introduced into the intestine with minimal symptoms. Probably, many symptoms are mistakenly associated with "too much gas accumulation."

On the other hand, some patients with recurrent gastrointestinal symptoms are often intolerant to even small amounts of gas: retrograde distension of the colon by air inflation or balloon distension or insufflation of air during colonoscopy often causes severe discomfort in some patients (e.g., patients with irritable bowel syndrome) but minimal discomfort in others. Similarly, patients with eating disorders (e.g., anorexia, bulimia) are often sensitive and particularly distressed by symptoms such as bloating. Thus, the underlying disorder in patients with "gas" complaints may be due to an excessively sensitive bowel. Modifying motility may be effective in symptomatic treatment.

Excessive flatus (excessive gas production from the intestines)

There is great variability in the amount and frequency of flatus produced by the rectum. As with increased stool frequency, some people complain of frequent flatus, with a misconception of what is normal. The average number of flatuses is approximately 13-21 per day. Objective recording of flatus by the patient (using a patient diary) is the first step in assessing the disorder.

Flatus is a by-product of intestinal bacterial metabolism; none of the flatus is produced by swallowed air or by back-diffusion of gases (primarily N) from the bloodstream. Bacterial metabolism produces substantial amounts of H, methane (CH), and is produced in large quantities after ingestion of certain fruits and vegetables containing indigestible carbohydrates (e.g., baked beans) and in patients with malabsorption syndromes. In patients with disaccharidase deficiency (usually lactase deficiency), large amounts of disaccharides enter the colon and are fermented to N. Celiac disease, sprue, pancreatic insufficiency, and other causes of carbohydrate malabsorption should also be considered as cases of excessive colonic gas production.

SN is formed when bacteria metabolize exogenous (dietary fiber) and endogenous (intestinal mucus) substances in the colon; the amount of gas produced depends on the nature of the food. Some people constantly excrete large amounts of SN. The tendency to produce large amounts of gas is hereditary, appearing in infancy and persisting throughout life.

It is also formed during the metabolism of bacteria in the reaction of HCO3 ^and H2. The source of H2 can be HCI in gastric juice or fatty acids; H2 is released during the digestion of fats, sometimes forming several hundred meq.

Acid residues formed by bacterial fermentation of unabsorbed carbohydrates in the colon can also react with HCO ^_ to form CO ₂. This can sometimes cause bloating, but rapid absorption of CO ₂ into the blood prevents flatulence.

Diet plays a major role in determining gas production patterns among individuals, but other factors that are not yet fully understood (e.g. differences in colonic motility and bacterial flora) may also play a role.

Despite the flammable nature of H and CH4 _, there is no danger from a nearby open flame when gases are released to the outside. However, gas explosions, even fatal ones, have been reported during small and large bowel surgery and when diathermy is used in colonoscopy; these procedures have been performed on patients with inadequate bowel preparation.

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Symptoms of flatulence

The symptoms of flatulence – in terms of severity and accompanying factors – depend on the disease that causes this phenomenon.

When there are problems with the gastrointestinal tract, the following symptoms of flatulence appear:

• feelings of fullness and increased intra-abdominal pressure;
• feeling of discomfort in the epigastrium;
• bloating or intestinal distension;
• borborygmi (rumbling in the stomach);
• increased flatulence (increased frequency and volume of gases passed through the rectum);
• belching;
• nausea;
• diarrhea or constipation;
• stomach ache.

It is worth dwelling a little more on abdominal pain during flatulence. When gases accumulate, the intestines are compressed and unevenly stretched, which irritates the parasympathetic pain receptors. They transmit signals to the axons of the peripheral nervous system of the spinal cord, and they, in turn, convey this signal to the brain.

It happens that pains with increased gas formation are felt not in the stomach, but in the chest on the left - as if the heart aches with angina. In clinical medicine, such pains are clearly distinguished with flatulence associated with the accumulation of gas in the formed left-sided (splenic) flexure of the colon under the diaphragm itself. By the way, such an anatomical anomaly can appear in those who wear too tight clothes or have problems with posture.

And flatulence and pain in the lower back on the right, in the back and right hypochondrium can occur in the presence of a similar bend in the colon, but between the diaphragm and the liver.

Diagnosis of flatulence

In patients with complaints of belching, the immediate cause of aerophagia, especially dietary, should be determined from the anamnesis. Patients with complaints of gas and bloating require clarification of the anamnesis of somatic (organic) causes (especially cardiac causes in patients with risk factors). A long history of belching in young patients without signs of weight loss is unlikely to be caused by a serious somatic disease, although an eating disorder should be considered, especially in young women. Older patients, especially with the appearance of new symptoms, deserve a complete evaluation before initiating treatment for increased real or imaginary gas.

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Physical examination

Examination is rarely informative in patients with belching or flatus. Patients with complaints of bloating, gas formation and pain in the left side require a more detailed objective assessment of symptoms caused by gastrointestinal diseases or other pathology.

Study

In the absence of suspicion of a specific somatic etiology, the investigation is limited. A rare cause may be an extremely rapid proliferation of bacteria in the small intestine, diagnosed by the H-breath test (hydrogen breath test).

Flatulence, which can be the cause of great psychosocial stress, is informally described according to its characteristic features: the "crawler" (the "crowded elevator" type), which is released slowly and silently, sometimes with harmful effect; the open sphincter or "fu" type, in which the higher the temperature, the more odorous the flatus; the staccato or drumming type, pleasantly spent in solitude; and the "bark" type (described in a personal communication), characterized by a sharp, noisy eruption that can be quickly interrupted (and often ends) by conversation. The character of the odor is not a noticeable feature. Le Pétomane, a French flatulent entertainer, was known for his phenomenal control of the abdominal muscles, which allowed him to control the emission of intestinal gas. He played melodies with gas from his rectum on the stage of the Moulin Rouge.

Which doctor should I see for flatulence? Clarification of the etiology of this symptom complex, diagnostics of flatulence, as well as recommendations for treatment are the competence of gastroenterologists.

First of all, the doctor will study the patient’s medical history in detail and also find out how and what he eats.

To determine the cause of flatulence, an examination should be carried out, which includes:

• complete blood count:
• urine analysis;
• stool analysis for helminths;
• physicochemical and bacteriological examination of feces (coprogram);
• analysis of the acidity level of gastric juice;
• gastroscopy or colonoscopy;
• X-ray of abdominal organs;
• Ultrasound of the abdominal cavity and pelvis.

Treatment of bloating

Belching and flatulence are difficult to reduce because they are usually caused by unconscious aerophagia or hypersensitivity to normal gas accumulation in the intestine. To reduce aerophagia, the patient should avoid habits such as chewing gum or smoking. Upper gastrointestinal diseases (e.g. peptic ulcer) that can cause reflex increased salivation may be suspected. Carbonated drinks or antacids should be avoided if they are associated with belching. Foods containing indigestible carbohydrates should be avoided. Dairy products should be eliminated from the diet in case of lactose intolerance.

The mechanism of frequent belching needs to be explained and proven. If aerophagia is unpleasant for the patient, biofeedback and relaxation therapy can help them learn to swallow and chew more efficiently and change the pathological cycle of aerophagia - discomfort - belching - relief.

Medications are not very effective. The drug simethicone destroys small gas bubbles, and various anticholinergic drugs have not been shown to be effective enough. Some patients with dyspepsia and a feeling of postprandial fullness in the upper abdomen often find that antacids help.

Treatment for complaints of increased flatus is aimed at eliminating trigger factors. Rough food (e.g. bran, flaxseed) may be added to the diet to speed up passage through the colon; however, in some patients, symptoms may worsen. Activated charcoal helps reduce gas formation and unpleasant odor, but its ability to stain clothing and the oral mucosa makes it undesirable to use. Chlorophyll tablets reduce odor and are better accepted by patients.

Thus, functional bloating, flatulence and flatus indicate an intermittent, chronic course that is only partially treatable. It is important to convince the patient that these manifestations are not harmful to health.

Intoxication

Intoxication is extremely rare. Zinc intake in the range of 100-150 mg/day disrupts copper metabolism and leads to decreased blood copper levels, microcytosis, neutropenia, and weakened immunity. Ingestion of large amounts of zinc (200-800 mg/day), usually from food and beverages stored in galvanized containers, causes vomiting and diarrhea. Metal fume fever, also called foundry fever or zinc chills, is caused by inhalation of industrial zinc oxide fumes; it leads to neurological disorders. Symptoms resolve after 12-24 hours in a zinc-free environment.

How to treat flatulence?

To the question of how to get rid of flatulence and where to start treatment, any doctor will answer: you need to eat right, cure gastrointestinal diseases, establish normal functioning of the digestive system, including the intestines. This requires combined etiotropic and pathogenetic therapy.

But flatulence is most often treated with symptomatic medications, trying to reduce excess gas formation and, if possible, prevent it.

How to treat flatulence? By limiting certain foods and taking medications: sorbents, gas suppressants, antifoams, and carminatives that speed up the evacuation of gases from the intestines.

You can reduce the intensity of gas formation and bloating by taking the most popular adsorbent - activated carbon tablets. But it has the ability to absorb not only harmful substances, but also vitamins, minerals and beneficial intestinal microbes necessary for the body.

The drug Smecta is a dioctahedral smectite (double silicate of magnesium and aluminum) - it is used as a symptomatic remedy for chronic diarrhea, it has absorbent properties. The dose for an adult is 2-3 sachets of powder (for the preparation of a suspension) per day, and the recommended duration of treatment is no more than 7 days. Side effects of Smecta include constipation, vomiting and... flatulence.

The adsorbents also include the drug Polyphepan (375 mg tablets containing hydrolytic lignin), which is recommended for use in diseases of the gastrointestinal tract, the symptoms of which include diarrhea and flatulence. The tablets are taken orally (1-1.5 hours before meals); for adults, the daily dose is 12-16 tablets; in chronic pathologies, the intake is carried out for 10-15 days with breaks of 7-10 days. As a rule, Polyphepan is well tolerated and does not lead to dysbacteriosis. However, it is contraindicated for patients with anacid gastritis, intestinal atony and in case of exacerbation of gastric ulcer and duodenal ulcer.

The drug Almagel (other trade names - Alumag, Maalox, Gestid, Gastal, Palmagel) contains aluminum and magnesium hydroxides, which neutralize the hydrochloric acid of the gastric juice. This drug is used in the treatment of gastrointestinal diseases associated with increased acidity of the gastric juice. In addition, due to the content of benzocaine, it acts as a local anesthetic for stomach pain; has an adsorbent, laxative and choleretic effect. Almagel is prescribed to adults 1-2 teaspoons 4 times a day (half an hour before meals and before bedtime). The course of treatment is 10-12 days.

Among the antifoaming carminatives, doctors single out (and most often recommend) Simethicone (trade names - Espumisan, Simekon, Espuzin, Alverin, Pepfiz, Sab simplex, Disflatil, Kolikid, Meteospasmil, Bobotik) - in the form of an emulsion, suspension and capsules. The therapeutic action of this drug is based on the organosilicon polymer polydimethylsiloxane, which is a surface-active substance (surfactant). It breaks the bubbles of gases accumulated in the intestines, and they are freely absorbed through the mucous membranes of the intestines or excreted from the body during defecation. Dosage of the drug for adults: 1-2 capsules, or 1-2 teaspoons of emulsion, or 25-50 drops of suspension per dose (after meals, with water); should be taken 3 to 5 times during the day.

Many doctors suggest treating severe flatulence after eating with Motilium, which is a drug that stimulates intestinal motility and stops vomiting, as well as reduces belching and bloating. A quickly dissolving tablet of the drug should be placed on the tongue and swallowed without anything. The active substance of Motilium - domperidone - acts as an antipsychotic (neuroleptic), and its side effect is expressed in increased production of the hormone prolactin by the pituitary gland, so that undesirable neuroendocrine effects are possible: galactorrhea, gynecomastia, amenorrhea. In the presence of problems with the liver, kidneys, cardiovascular system, as well as during pregnancy, this drug is contraindicated.

Finally, flatulence and rumbling in the stomach are successfully treated with carminative medicinal plants: infusions and decoctions of chamomile, dill fruits, fennel or caraway. In the famous medieval medical treatise "The Salerno Code of Health" you can read the following: "Fennel seed brings out the accumulation of gases." And today, the fruits and essential oil of fennel (a relative of dill) are widely used for flatulence - in the form of dill water and infusions. To prepare a medicinal infusion, take 2 tablespoons of seeds, brew a glass of boiling water, cover the container with a lid and leave for at least 60 minutes. Drink the infusion several times a day, 50 ml at a time.

Exercises for flatulence

Doctors warn those who like to lie down after a heavy lunch: you can "lie down" and have a lot of intestinal problems, including flatulence. And those who want to improve their well-being are advised to do the following exercises daily for flatulence.

• Lie on your back, bend your knees, lift them off the floor and “pedal” an imaginary bicycle – 20 seconds three times with breaks of several seconds in between.
• Remain in the supine position, bend your knees and place them shoulder-width apart, extend your straight arms along your body. Leaning on your feet and shoulder blades, lift your pelvis off the floor, hold this position for a count of 1-2-3-4, and then slowly lower yourself to the starting position. Number of repetitions: 10.
• Lie on your stomach; straight legs at the knees and feet pressed together; arms bent at the elbows are placed along the chest. Raise the body from the floor, leaning on the palms of straightened arms, arch the back, throwing the head back. Stay in this position for 5 seconds, then smoothly lower to the starting position. Number of repetitions - 10.
• Stand up straight, place your feet shoulder-width apart, raise your bent arms, clasped together, behind your head. As you inhale, bend forward (without bending your knees), as you exhale, straighten up and bend backwards. Repeat 8-12 times.
• Starting position, as in the previous exercise, but hands on the waist. On the count of 1 – raise your hands up, on the count of 2-3 perform a springy forward bend with your fingers touching the floor. On the count of 4 – return to the starting position. Number of repetitions – 8-10.

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Foods for flatulence: what can and cannot be eaten?

Some of the things that you should not eat when you have flatulence have already been mentioned above (see the section Causes of Flatulence), but we will once again list the foods that increase gas formation.

This is rye bread and fresh white bread (as well as all baked goods); all legumes (beans, beans, peas, lentils); millet, oats, pearl barley and semolina; fatty meat, all sweets (except natural honey); whole milk (including dry milk); pasta; all carbonated drinks.

Vegetables for flatulence that cause gas formation: cabbage (white cabbage, cauliflower, Brussels sprouts, broccoli), potatoes, corn, raw onions, radishes, horseradish, cucumbers, peppers, spinach, asparagus, artichokes.

Fruits for flatulence that promote increased flatulence: pears, apples, apricots, peaches, grapes, cherries, gooseberries, figs, dates, prunes.

In addition, nutritionists say that some products simply cannot be combined with each other in case of flatulence, so as not to increase gas formation in the intestines. For example, you should not mix dairy products with anything, eat grain products and sour fruits and berries at the same time, any raw vegetables should not be mixed with any fruits, and potatoes should not be used as a side dish for meat.

A natural question arises: what can you eat with flatulence? Everything, except what you can’t. That is, you can have fermented milk products, cheese, cottage cheese, crumbly cereal side dishes (buckwheat, rice), chicken eggs, boiled or stewed vegetables and lean meat, fruit and berry juices, vegetable and butter, wheat bread, preferably stale or dried.

Prevention of flatulence

Prevention of flatulence includes several points, namely:

1. It is necessary to eat properly (see the section Products for flatulence).
2. Avoid intestinal dysbacteriosis (systematically consume foods with probiotics Lactobacillus and Bifidobacterium).
3. Treat existing pathologies of the gastrointestinal tract.
4. Maintain physical activity in any form – walking, cycling, swimming, jogging and, of course, daily exercise (see the section Exercises for flatulence).

And finally, take note of the conspiracy against flatulence, which should be done at dawn or sunset.

Pour holy water into a large vessel and throw in a pinch of salt; prepare clean cutlery - a spoon, fork and knife, a church candle, a sheet of white paper and an empty glass jar. The patient should sit nearby.

Next, light a candle, set the paper on fire and while it burns, read the prayer "Our Father". After that, the burning paper should be placed in an empty jar and, turning it upside down, placed in a container with water.

The following actions: take the vessel with the jar in your left hand and hold it over the stomach of the person being charmed, read the words of the spell against flatulence and simultaneously cross the water - with a knife, fork and spoon - in turn. After the spell is finished, the patient needs to breathe over the container several times.

The words of the spell should be pronounced only once: “The midnight sleeper is brewed, spoken from bones, from relics, from veins, from half-veins, from a white body, from red blood, from a zealous heart, from a wild head. You will not be in a white body, in red blood, in a wild head, do not get sick, do not prick, do not swell. It is not I who pronounce, but I call upon the twelve apostles and all the saints. Save, Lord, preserve, Lord, cover, protect from all sorrows and illnesses, from the midnight sleeper. Amen.”