When I wake up, my stomach is bloated and full of gas. The gas I pass is loud and long, and embarrassing, but it hurts if I hold it in. What can I do about it?

When I wake up, my stomach is bloated and full of gas. The gas I pass is loud and long, and embarrassing, but it hurts if I hold it in. What can I do about it?

Dr. Benjamin Krevsky is a professor of medicine and director of gastrointestinal endoscopy at Temple University School of Medicine.

First, some gas in the gastrointestinal tract is absolutely normal. It is estimated the average healthy person passes gas around 10 to 20 times a day!

Gas in the small and large intestines usually comes from the action of bacteria on one's food. Bacteria use food for energy and produce various gases such as methane, hydrogen, and carbon dioxide.

A very common cause is lactose intolerance - when milk products are not digested by enzymes in the small intestine. Drinking skim milk does not prevent this. Many vegetables are also poorly digested, such as beans and cabbage. Again, bacteria digest what the intestines can't.

Start with a simple approach. Remember that everyone does it sometimes. If it seems like a lot of gas, try eliminating common culprits, such as dairy products, beans, and whole grains.

A short trial of some over-the-counter remedies may help. I sometimes suggest Beano or simethicone to my patients with similar issues. If this does not make you feel better, or there is pain from the gas, it may be the sign of a more serious disorder or that prescription medications may be needed. In that case, see your doctor.

- Benjamin Krevsky with Inquirer staff writer Curtis Skinner.