Bloating is becoming a major contemporary health issue largely because of the social stigma attached to a gaseous expulsion that Western culture refuses to accept is a normal part of our digestive process.

A study of university students found the majority were embarrassed by their flatulence.

We spend a lot of time looking at what we take in, i.e. quantities of sugar, fat, alcohol but virtually no time examining what we put out.

Some authors suggest that between 10 -20 farts per day is the usual range with a volume of anywhere between two and six glasses worth.

But in the absence of a robust observational study expulsion of air is considered a problem – a study of university students found the majority were embarrassed by their flatulence regardless of whether they had brothers or it was accepted.

As our intestinal muscles age, the transit of what we eat and drink changes. Gases accumulate more and the abdomen blows up like a balloon. If you’re a man it’s generally culturally permissible to fart but if you’re a woman you’ll most likely seek medical help for excess wind, and that’s a worry because you’re problem is cultural not medical.

Victorian society made farting impermissible – a social law that prevails today. Freud labeled air trapped under the rib cage by fashionably tight corsets, hypochondriasis. But the term has evolved into something more psychiatric and, therefore, socially unacceptable, which is why a medical euphemism has taken its place: irritable bowel disease. As in Victorian times the condition is more common in women than men because it is acceptable for men to tighten their belts under not over their bellies.

Expansion in a confined space is painful. With metres of bowel to twist around the air bubbles it is no wonder that bloating occurs and is difficult to shift. Even when it does shift the bowel has been stretched and distended. Like any muscle it is bound to be painful making the bowel irritable, perhaps even chronically irritable as in irritable bowel disease, which is hard to treat let alone cure.

Normal bodily functions change during our lifetime. Labelling them as a disease, particularly one that is hard to treat with medications, only increases the stigma and the physical problem. Sometimes it is good to go back to basics – evidence that is provided by deduction and treatment according to common sense. This is a lesson for both clinicians and patients.

 Not everything can be dissected and remodeled in an evidence framework and conversely nothing is beyond careful scrutiny. But what happens when medicine has no evidence and detrimental societal conventions prevail? In this era where forces of evidence are in their ascendancy the battle is between those who seek to gain as much territory for evidence as possible and those who vehemently resist this new order. In the end nobody wins.