Where do you feel gas pain?
Gas usually causes pain in the upper abdomen and lower chest. The pain results from gas trapped in the part of the large intestine that runs below the rib cage.
What is trapped gas?
Trapped gas or trapped wind refers to a pocket of gas in the part of the colon that runs horizontally below the lowest ribs. Trapped gas can cause spasms in the colonic wall and the distension of the ligaments that hold the colon in the position, which can both cause severe upper abdominal pain.
- Splenic flexure syndrome (the pain on the left side – near the spleen)
- Hepatic flexure syndrome (the pain on the right side – near the liver)
Picture 1. Splenic and hepatic flexure
(source: Wikipedia, CC license)
Causes and Triggers
The two main causes of gas pain are probably eating foods that irritate you and psychological stress.
Trapped gas often occurs in individuals with irritable bowel syndrome (IBS) and increased intestinal (visceral) sensitivity . The pain can be triggered by:
- Big meal
- Emotional stress
- Air swallowing during drinking through a straw, fast eating or chewing gum
- Eating foods high in soluble fiber, such as legumes, oatmeal, barley, apples, pears or cabbage
- Drinking carbonated drinks or alcohol
- Drugs: antacids, antibiotics, antidepressants, antihistamines, opiates (morphine, codeine)
- Supplements: psyllium husk
Serious underlying health disorders that can be associated with gas pains:
- Abdominal adhesions after abdominal surgery or infection or in endometriosis
- Diverticulosis or diverticulitis
- Ileus–temporary absence of the bowel motility, usually after surgery or in severe abdominal infection
- Bowel obstruction by a polyp, for example in Crohn’s disease or ulcerative colitis, or by colon cancer
Trapped wind can occur as a single event or as a recurrent or chronic problem. Symptoms may range from mild discomfort to debilitating pain and include:
- Constant pain (except at night) in the upper left or right abdomen or lower chest, on the side of the body or in the middle back lasting for several hours; it can be aggravated by sitting and deep breathing and eased by lying down, burping, passing gas or having a bowel movement 
- Distension (bloating) and tenderness in the upper left or right abdomen
Other symptoms, which may or may not appear along with abdominal pain, include referred pain in the tip of the left or right shoulder blade or down the inside of an arm, excessive belching, constipation, diarrhea, excessive gas (flatulence), nausea or dry heaving .
Trapped gas by itself does not cause fever.
A doctor can often make a diagnosis of trapped gas by a physical examination. An X-ray image may or may not show an abnormal pocket of gas in the colon.
To exclude other abdominal conditions, abdominal ultrasound, colonoscopy or MRI may be needed.
If your main symptom is constipation:
- You may have a sedentary lifestyle
- You may drink too little water or consume too little insoluble dietary fiber (from whole grains and vegetables)
- You may be under stress
If your main symptoms are abdominal bloating and diarrhea, you may have:
- Fructose malabsorption
- Lactose intolerance
- Celiac disease
- Food poisoning
- Allergic reaction to food
- Infection of the stomach by the bacterium H. pylori
- Intestinal parasites
- Small intestinal bacterial overgrowth (SIBO)
If your main symptoms are abdominal, chest or back pain and nausea, you may have:
- Acid reflux (gastroesophageal reflux disease or GERD)
- Gallbladder attack
- Biliary dyskinesia (either gallbladder dyskinesia or sphincter of Oddi dysfunction)
- Acute pancreatitis
- Acute appendicitis (pain near the belly button or in the lower right abdomen)
- Stomach or duodenal ulcer
- Gastroparesis (delayed stomach emptying)
- Kidney stones or other kidney disorder
- Disorders with enlarged spleen or liver
- Heart attack
- Low blood potassium level (hypokalemia) with painful cramps in the abdominal wall and calf muscles
- Shingles (Herpes zoster)
NOTE: The information about the treatments presented below comes mainly from anecdotal reports and has not been evaluated by clinical studies.
The following activities may relieve gas pain:
- Right after an onset of pain lie down, relax and massage the painful area with a hand.
- Pass gas or have a bowel movement.
- Deliberately change the speed of breathing.
- Drink warm water or hot peppermint or chamomile tea.
- Apply a heat pad for 10-20 minutes, several times a day.
Medications and Procedures
- Dicyclomine , hyoscyamine, propantheline and chlordiazepoxide/clidinium bromide  (antispasmodics) can relieve the spasms .
- Mild laxatives, such as magnesium citrate, or enemas, can resolve constipation.
- Digestive enzymes (lactase, lipase, amylase) can help in individuals with lack of digestive enzymes but not likely in others.
- Visceral manipulation (massage) performed by a physical therapist may result in prolonged pain relief.
- Colonoscopy can help release trapped gas.
There is no or insufficient evidence about the effectiveness of the following in relieving gas pain:
- Simethicone [2,5]
- Nonsteroidal anti-inflammatory drugs (NSAIDs): aspirin, diclofenac, ibuprofen, naproxen
- Bismuth salicylate
- Ginger 
- Activated charcoal [5,7]
- Stool softeners
- Apple cider vinegar
- Gripe water (for infant colic pain)
Antacids (calcium carbonate), prokinetic drugs (domperidone, metoclopramide), prebiotics and raw food diet can aggravate gas pain.
1. Be Active and Avoid Unnecessary Stress
Concentrate on work you believe is right for you and brings peace to your heart. In your desire to be successful with your work, you will feel the need to arrange your sleeping and eating habits and your relationships, which might greatly reduce stress and thus gas pain.
Physical activity often helps with bowel regularity. Walking can be fine; no need to go to the gym.
Try to avoid:
- Large amounts of foods high in soluble fiber, such as beans and peas, oats, barley, passion fruit, figs, bananas, broccoli, cabbage, cauliflower, onions, artichokes and sweet potatoes
- Artificial sweeteners sorbitol, mannitol, maltitol and xylitol found in sugar-free chewing gum and soft drinks
- Foods high in lactose, such as milk, yogurt and ice cream (if you have lactose intolerance) or foods high in fructose, such as honey, apples, pears and mangoes (if you have fructose malabsorption)
- Anything you believe may trigger pain: alcohol, caffeine, fried foods or other foods
If you are constipated:
- Eat more foods high in insoluble fiber, such as whole-grain bread and green vegetables (NOTE: in some individuals with IBS, insoluble fiber may aggravate symptoms).
- Avoid foods that may constipate you: soda, chocolate, desserts, cheese, ice cream, caffeine (coffee, tea, cola), white bread and other foods low in fiber .
- Drink enough water.
If you suffer from abdominal bloating and excessive gas, you may want to try a low-FODMAP diet.
Gluten-free diet helps to individuals with celiac disease but not likely to others.
During or after treatment with antibiotics, probiotics help maintain beneficial bacteria in your bowel (intestinal flora) and thus prevent bloating or constipation. Probiotics may not be helpful in other circumstances.
- Gas pain probably occurs as a reaction to emotional stress and certain foods.
- Avoid unnecessary stress and foods, be physically active and adopt regular eating, working and sleeping pattern.
- It is easy to confuse gas pain, which comes from the intestine, with pain that comes from the gallbladder, so before considering gallbladder removal, ask for an abdominal ultrasound or other investigations to get the exact diagnosis.
- Lehrer JK, Irritable bowel syndrome, clinical presentation Emedicine
- Simethicone Drugs.com
- Dicyclomine Drugs.com
- IBS triggers and how to avoid them WebMD
- Gas and gas pains, treatment and drugs Mayo Clinic
- Shafar J, 1965, The splenic flexure syndrome PubMed Central
- Suarez FL et al, 1999, Failure of activated charcoal to reduce the release of gases produced by the colonic flora PubMed
- Ginger WebMD
- Librax (with clidinium) WebMD