Abdominal discomfort and its causes
By Dr Harold Gunatillake - Health Writer
Every person at some spell of his life-time will experience one or more bouts of abdominal discomforts and other symptoms that go with it according to the severity of the situation. Babies get more colicky discomfort and the mothers would give them gripe water a home remedy to give relief. Adults generally let the discomfort subside naturally, and in most situations they do.
Some individuals get more frequent bouts of discomfort with pain, nausea, vomiting, bloating and lose motions or constipation. It is important to remember that your gut is a sensitive organ, and slightest imbalance can cause upset stomach, constipation, heartburn, or gas among other symptoms.
The discussion is more about those chronic recurrent discomforts which are more serious and needs further investigations.
The inner lining of your gut is made up of millions of cells lining minute projections called villi. These form a tight barrier that acts as a security system to prevent toxins and other harmful chemicals entering the blood stream. However, when the gut becomes unhealthy this barrier becomes weakened and toxic material in food including bacteria can leak into the blood stream. This state of unhealthy gut is referred to as the ‘leaky gut’.
Abdo’ pains arise within the abdominal cavity, comes from organs within the cavity and adjacent to it. Colicky type of intermittent pains called ‘colic’ comes from the contractions of the smooth muscles of the small gut and gall bladder with calculi (stones). Excruciating pain comes from inflammations of organs, and pancreatitis is the best example. Nausea and vomiting are mainly from upper gastro-intestinal ailments, and abdominal distension with colic and constipation comes from the lower bowels. An exception is the inflammation of the appendix, when the earliest symptoms would be nausea and tenderness at the site of the appendix.
The common chronic diseases that cause symptoms are inflammation of the gut, and mainly refers to Crohn’s and Ulcerative colitis, quite common among Sri Lankans. The other disease to be suspected would be malignant disease of the large bowel
Others are-non-specific gastro-enteritis, bowel obstruction, gluten and lactose intolerances, irritable bowel syndrome (IBS), among others
Food affects your gut feeling
The food we eat contains additives and ultra-processed foods without much fibre. These affect the gut environment and increases the risk of bowel diseases. You will observe that such bowel changes are seen going on holidays and eating from way-side outlets and hotels when the food could be different to what your gut is accustomed to. Most ultra-processed foods such as fast foods are manufactured for extra taste by using ingredients or additives. They are found in soda, sugary or savory packaged snack foods, packaged breads, pastries and so on. Some examples of processed foods are canned such as salted meat products. Always take gut stabilizing drugs (Imodium) with you on such journeys.
Such situations could cause dysbiosis of the microbiota in your large gut, adding more disturbances in your gut. Most abdominal disorders start with similar symptoms like discomfort, colics, distension, lose motions and so on.
Doctors need to listen to the history carefully to clinch a diagnosis. In some situations many investigations would be required to diagnose the condition.
Most discomforts in the upper abdomen with distension, accompanied by nausea or vomiting could be related to a problem in the stomach, gall bladder and other upper visceral structures.
Natural sugars in fruits can create uncomfortable bloating
Eating fruits daily are good for you- with high antioxidants to rid those toxic free radicals formed in your body. But all fruits have a natural sugar called sorbitol, and if your gut cannot digest it may cause uncomfortable bloating, belly pain or have diarrhoea, gas or nausea. So next time when you eat fruits like apples, blue berries, plums, dried date, peaches and raisins, dried fruits, be aware what gut problems you can have, though fruits are good for you.
Watermelon, a fruit containing fructose and plenty of water is a God-given fruit when you travel in the dry zone areas in Sri Lanka. It is traditional to stop on the way and enjoy a couple of slices of water melon that refreshes you instantly.
The body can have trouble digesting it, so you might get gas. If you are diabetic, you are advised to restrict eating water melon because for some reason or other the glycaemic index is over 80.
Cooked potatoes though nutritious can cause gut bloating, Mushrooms have a natural sugar called mannitol that can give a bloated gut and too much of it can cause diarrhoea. Those nutritious peas have a chain of sugars called galacto-oligosaccharides that feeds gut bacteria and cause gas.
Also remember eating too many fruits daily can cause ‘non-alcoholic fatty livers’ from the high fructose content, which are metabolized, and the excess stored in the liver.
Upper abdominal discomfort with heart burn is a specific condition related to incompetent valve system at the gastro- oesophageal junction. There may be a gastric hernias projecting into the chest cavity above the diaphragm disrupting the valve mechanism. Food and acid refluxes into the lower gullet mimicking a burn behind the heart, referred to as ‘heart burn’. This condition is referred to as ‘Gastro-Oesophageal Reflux Disorder’ (GERD) Treatment for heartburn and other signs and symptoms of GERD usually begins with over-the-counter medications that control acid. They are called antacids that have stood the test of time for decades.
Avoid eating food or drinks before you lay down to sleep. It is advisable that you have a light meal in the night about 2 hours before bedtime. Avoid foods that upset your stomach and give heartburn.
There are the H-2-receptor blockers like cimetidine, ranitidine and so on they too reduce the acid production in the stomach.
At present the most popular medication is Proton pump inhibitors. Long term continuation of this specific medication can cause kidney damage- a warning that your doctor will tell you.
Simple home remedy for heartburn when it occurs at dead of night is a cold glass of fresh milk and munching a few cut slides of cucumber from the fridge. Bet you’ll have a good night sleep after this home remedy. Sleeping upright with pillows also helps. Sleeping on your left side also helps. Losing weight is important.
Gall bladder disease
The gall bladder is a storage organ for bile secreted in the liver. When you enjoy your fatty food, it starts contracting and pumping the bile acid into the upper gut to mix with the churned and partly digested food from the stomach.
Did you know that bile is required for the absorption of cholesterol in your food? Cholesterol is not water mixable, so with bile cholesterol forms an emulsion to get absorbed.
Gallstones are common among the fat fertile forties females. The symptoms are similar to any upper abdominal disorder. Clinical examination by your doctor and X rays will clinch the diagnosis. Treatment is surgical.
These are called peptic ulcers. They are found in the distal segment of the stomach and the first few inches of the duodenal segment of the small gut. They were thought caused by stress and hyper-acidity in the stomach, and unnecessarily the vagus nerve fibres supplying the stomach lining that secretes acid juice is surgically de-nervated to reduce the acid content in your stomach to heal such ulcers.
They could be diagnosed through gastroscopy or having barium meal x rays. Today, it is believed that these ulcers are due to bacteria called helicobacter pylori and can be healed by giving antibiotics combined with other medications.
Ulcers in the stomach can be caused by anti-inflammatory drugs, aspirin and cortisone preparations and most of all stress situations and unknown causes
Ulcers in the body of the stomach can undergo malignant changes. Cancer of the lining of the stomach was common among tea-pluckers in tea estates in Sri Lanka.
When the author was surgeon Badulla General Hospital in the seventies found many cancerous ulcers among these people, drinking strong irritating home- made soup (pepper water), was supposed to cause such ulcerations in the stomach lining. Sub-total gastrectomy operation was the only solution for these unfortunate- mainly women.
Ulcers in the distal part of the stomach -the pylorus, were called pre-pyloric ulcers, and they don’t seem to undergo malignant changes. They are the ulcers that are caused by the helicobacter germ which is curable with medication.
Similar innocent ulcers are also found in the first part of the duodenum (duodenum is the first 1 inches of the small gut which surrounds the head of the pancreas).
Loss of appetite, losing weight and gastro-intestinal symptoms like nausea and vomiting could be the early symptoms of stomach ulcers. Vomiting blood (haemoptysis), could be a symptom if not diagnosed early. Diagnosis is through doing barium Meal X rays followed by endoscopy.
When depression is accompanied with abdominal discomfort, it may be a symptom of pancreatic cancer. Also, these ulcers can cause excruciating pain in the back of the stomach region or the spine. Diagnosis is through abdominal scans.
This is an inflammatory disease involving the entire wall of the bowel. It can involve the mouth to the large bowel. There are inflammatory segments of the gut interspersed with intervening normal segments.
Unlike Crohn’s in ulcerative colitis the inflammation involves the inner lining of the large bowel and the rectum. There are scattered minute ulcers or erosions and they may bleed occasionally. Abdominal pain and diarrhoea are common to both Crohn’s and Ulcerative colitis. Treatment is palliative- meaning with medicine.
Irritable Bowel Syndrome (IBS)
The symptoms are similar to any other inflammatory bowel disease; In IBS there is no inflammation of the bowel as in the previous two inflammatory diseases described. The cause is not known but it is believed to be dysfunction of the intestinal muscles, nerves and secretions and not inflammation. Stress could be a factor. IBS could mimic diverticulitis, celiac disease and colon cancer.
Recent studies suggest that the balance between the good and bad bacteria when disrupted, may cause the disease. Other diseases caused by such disruptions are asthma, obesity, metabolic syndrome, diabetes and cognitive and mood problems not discussed in this article.
Increasing dietary fibre can help with symptoms
Bloating among women
Many women experience bloating during the monthly menses cycle, but if it occurs more regularly you need to consult your doctor, Sign of ovarian cancer include bloating and other digestive discomforts. Your doctor after palpation of your tummy will order a CT scan and perform blood tests to aid in diagnosis.
Sometimes indigestion with abdominal discomfort and change of bowel habits could be early cancer of some part of the gut-oesophagus, stomach or throat.
Cancer of the colon and rectum
This cancer seems to be common among adults, more in men than women. It starts with a growth starting on the inner lining of the gut. Most of these cancers grow from an innocent polyp. Symptoms are similar to other lower abdominal conditions. Change of bowel habits seems to be an early symptom. Rectal bleeding or blood in the stool, or dark coloured stools, change in consistency of stool is all early symptoms of the disease.
Diagnosis is made by endoscopic examination and biopsy confirmation of the cancer tissue.
A diverticulum is a finger like bulge that can form mainly in a segment of the large gut, in the sigmoid colon. These diverticular can get inflamed like the appendix getting inflamed. One could get abdominal distension with lose motions and fever. Diverticula per se don’t give problems. They may get abdominal cramps, bloating and abdominal swelling, rectal pain and diarrhea.
Leaky Gut Syndrome
This is a condition where there is increased permeability in the inner lining of the small gut, may be due to several chronic and autoimmune conditions like coeliac and type 1 diabetes.
In this syndrome harmful substances like bacteria, toxins and undigested food particles may enter the blood stream and cause certain diseases.
Keeping your gut healthy by consuming good food may help prevent this condition.
Keep your bowels healthy to avoid disruptions
Avoid eating packaged and processed foods you invariably purchase from your super-market. As mentioned earlier, they contain additives and preservatives that disrupt the healthy bacteria in the gut causing diseases.
Eat plenty of veggies and fruits, and fibre containing whole grains, legumes (lentils) in your diet.
Include probiotic rich food which contains cultures of beneficial bacteria, such as plain yogurt (Greek type) and no added sugar. Add plenty of fermented foods containing the cultures like kefir, sauerkraut, kimchi, Misso soup and drink kombucha.
Most fermented foods are probiotic foods. These foods go through a process of lacto-fermentation in which natural bacteria feed on the sugar and starch in the food, creating lactic acid.
Eat less red meat, poultry, and include more sea food.
Eating good food means good health. But some people may suffer from allergic reactions even with good food. Some people may suffer from food intolerance even with good food due to lack of enzymes.
'Organic food is the product of a farming system which avoids the use of man-made fertilisers, pesticides; growth regulators and livestock feed additives. Irradiation and the use of genetically modified organisms (GMOs) or products produced from or by GMOs are generally prohibited by organic legislation. (Google)
Studies have shown that consumption of organic foods reduce cancer risk. A French study showed that consumption of organic foods reduced the incidence of cancer. Such organic foods include fruit and veggies, ready to eat meals, among others.
Eat your meals regularly which assists your circadian rhythms. Chinese do eat every two hours a small cup-full of noodles or rice which keeps them slim and healthy.
Bottomline: Be aware that when you suffer from continuous gastro-intestinal upsets you need to see you doctor for evaluation and investigations to detect any disease process brewing in your gut and other visceral organs.
Hope this article was helpful.
Dr Gunatillake-Health editor is a member of the Academy of Medicine, Singapore. Member of the Australian Association of Cosmetic Surgery. Fellow of the Royal College of Surgeons (UK), Corresponding Fellow of the American Academy of Cosmetic Surgery, Member of the International Societies of Cosmetic surgery, Fellow of the International College of Surgery (US), Australian diplomat for the International Society of Plastic, Aesthetic & Reconstructive Surgery, Board member of the International Society of Aesthetic Surgery, Member of the American Academy of Aesthetic & restorative Surgery, Life Member of the College of Surgeons, Sri Lanka, Batchelor of Medicine & Surgery (Cey): Government scholar to UK for further studies.
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