Dear doctor

A troubled stomach

QI have suffered from nightly flatulence for some years. People treat this as a great joke but trapped wind can keep me awake, makes my stomach look distended and is also very uncomfortable. I have tried various commercial preparations but their effect seems short-lived. During the day, my normal bowel motions prevent the wind from building up, but at night, I can hear the bubbles gurgling away. I am beginning to feel a little desperate. My GP suggests cutting down on my fibre intake but I don't eat excessive amounts and a low-fibre diet has its own hazards, doesn't it?

A Flatulence is indeed the butt of many a bad joke (apologies) but, as you say, it can be uncomfortable and embarrassing. I read in the Guardian a while ago that most people fart an average of 15 times a day. Another source claims that we expel 400-1,300ml of gas a day from our backsides, which suggests that some of us pass over three times as much wind as others - a fact born out in my own household, though I'm not naming names.

In itself, excess wind is never a sign of underlying disease except if accompanied by other symptoms such as losing blood from your back passage, abnormal weight loss, a change of bowel habit or passing slimy stools that won't flush away.

The key to controlling excess wind is to watch what you're eating and take aerobic exercise. The first stops gas forming, the second allows you to pass it easily without it building up.

Eat slowly to prevent you from swallowing air. Eat a medium-fibre diet but not excessively high in fibre - brown bread and pasta but no added bran, for instance. Avoid gas-forming foods such as cabbage and broccoli if you find that they trigger off excess wind. Drink plenty so you don't get constipated.

Avoid diets that make you starving hungry as they are likely to make you constipated. Constipating drugs, such as painkillers containing codeine, can also exacerbate the problem.

Brisk walking and other forms of intensive aerobic exercise stimulate you to pass wind so that it doesn't build up. Drugs to stop wind are OK in dire cases but it's far better to adapt your eating and exercise to avoid the problem in the first place.

I daren't show my body

QI am a 37-year-old male. As a teenager, I had severe weight problems, which left me with stretch marks around my stomach. They have not disappeared, although I am now fairly slim - 6ft 3in and around 14 stone. However, I have problems forming sexual relationships because of my reluctance to expose my body to women. I am sure you understand that this is not doing a great deal for my confidence, self-esteem or quality of life. Is there anything I can do?

A It sounds as though your self-confidence took a battering when you were a teenager and perhaps never recovered fully. I doubt that it's just the stretch marks holding you back from exposing yourself physically or emotionally. This may be something you want to talk through with a skilled counselllor.

The stretch marks are due to damage in the deeper layers of your skin where the collagen and elastin that keep skin stretchy have been damaged. Stretch marks are red or purple at first as deep blood vessels show through the stretched skin, and this is the time to get them treated, although it's almost certainly too late for you now. Laser treatment can be used to break up the red colour, though the skin may not appear normal afterwards but have streaky whitish lines.

As the stretch marks fade, they look white or yellowish as the fat in the skin shows through. Laser treatment is often disappointing once stretch marks have faded, and creams and oils marketed as being good at treating them often make extravagant claims. But trying to keep your skin well moisturised may be useful. And using camouflage make-up or fake tanning may do the trick sufficiently well for you to brave the beach this year.

• These answers are intended to be as accurate and full as possible, but should never be used as a substitute for visiting a doctor and seeking medical help. If you have a question for Dr Robinson, email or write to her c/o The Health Editor, The Guardian, 119 Farringdon Road, London EC1R 3ER. She regrets that she cannot enter into personal correspondence.

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