Common Gastro-Intestinal Complaints in Women
Irritable Bowel Syndrome
Irritable Bowel Syndrome (IBS), also known as "spastic colon," is one of the most common disorders seen in gastroenterology
- The main symptoms of IBS are abdominal pain accompanied by a change in bowel habits. This can include constipation, diarrhoea, or both.
- Gas and a visibly bloated abdomen are common.
- The condition does not cause damage to the digestive system, but the symptoms can interfere with everyday life and cause distress in many patients.
- We don’t know the exact cause of IBS.
- One theory is that the signals between the brain and intestines are somehow disrupted.
- This miscommunication may cause abnormal intestinal muscle contractions (seen on the right) that result in cramping, pain, and fluctuations in the speed of digestion.
- Patients have no sign of inflamed or damaged tissue or structural abnormalities in the digestive tract.
- Most common GIT disorder
- 25-50% of referrals to gastroenterologists
- Female predominance
- Younger patients
- Only 15% seek medical attention
- IBS accounts for a significant number of visits to primary care physicians
- Second highest cause of work absenteeism after the common cold
- Increased health care costs
- Wide array of symptoms
- Include both gastrointestinal and extra-intestinal complaints
- Symptom complex of chronic abdominal pain and altered bowel habits remains the primary characteristic of IBS
Chronic abdominal pain
- Usually described as crampy sensation with variable intensity and periodic exacerbations
- Location and type of pain can vary widely
- Severity may range from mildly annoying to debilitating
- Exacerbating factors: emotional stress, eating
- Defecation often provides some relief
Altered bowel habits
- Alternating diarrhea and constipation
- Normal bowel habits alternating with either diarrhea and/or constipation
- Frequent loose stools of small to moderate volume
- Stools generally occur during waking hours, most often in the morning or after meals
- Mostly preceded by lower abdominal cramps and urgency even to the point of fecal incontinence
- May be followed by a feeling of incomplete evacuation
- 50% will have mucus discharge with stools
Other GUT symptoms
- Upper GUT:
- difficulty with swallowing
- early satiety
- intermittent upper abdominal discomfort
- non-cardiac chest pain
- Abdominal bloating
- Increased gas production in the form of flatulence or belching
- Impaired sexual function
- Pain with menstruation
- Pain during intercourse
- General body and joint pain
- Loss of appetite
- Weight loss
- Pain that is progressive, awakens you from sleep, or prevents sleep
- Bloody stools, night time diarrhea, and greasy stools are NOT associated with IBS
- A family history of colorectal cancer, IBD, or gluten intolerance
- Late-onset symptoms
- Your treatment strategy will depend on your specific symptoms and triggers, but many people start with diet changes.
- You may find it helpful to avoid caffeine, alcohol, and fatty foods.
- Getting more fibre or water may also improve symptoms.
- Suspicious foods can be eliminated one at a time. It may take some trial and error to discover which changes provide the most relief.
- Add fibre (fresh fruit and veggies)
- Small regular meals
- Avoid certain gas producing foods if bloating is a problem
- Peppermint oil
- People with IBS may not feel like exercising, especially when symptoms flare up.
- But physical activity can help digestion, reduce stress, and induce an overall feeling of well-being.
- Opt for low-impact activities at first that won't jar the digestive tract, and use the bathroom before you start.
- Be sure to discuss your plans with your doctor first.
- 20 to 60 minutes of moderate to vigorous activity 3-5 days per week
- Only as adjunct
- Depends on symptoms
- IBS is a chronic condition, and patients may experience quieter periods followed by flare-ups.
- Keeping a personal diary of food, feelings, and symptoms can help uncover hidden triggers when people are first diagnosed - and if IBS begins to interfere with daily life again.
- Over time, the symptoms of IBS typically do not get worse.
- IBS is not life-threatening and does not lead to more serious conditions, such as inflammatory bowel disease or cancer.
- A burning sensation behind the breastbone rising up from the pit of the stomach or from the lower part of the breastbone towards the throat or neck
- Associated sour or bitter taste in the mouth, commonly occurring within 2 hours after a meal
- Often disturbs the sleep of affected individuals and significantly impairs people's quality of life
- Difficulty in swallowing
- Less common:
- Water brash
- Nausea and vomiting
- Chest pain
- Chronic cough
- Difficult-to-treat asthma
- Laryngeal symptoms
- Throat clearing
- Throat pain
GERD symptom triggers
Caffeine, large meals, meals within 2-3 hours of bedtime, excessive fluid intake with meals
Oesophageal irritants (eg. Citrus, vinegar, spicy high-fat meals)
Lower oesophageal sphincter relaxants (eg. Onion, garlic, mint, alcohol, chocolate)
- Tight clothing
- NSAIDs & Disprin
- Calcium channel blockers
- Exogenous oestrogen
Practice Points: Lifestyle Modifications
- Going to bed on a full stomach increases your risk of night-time heartburn.
- Try to eat at least three to four hours before bedtime to give your stomach time to empty.
- Try early dinners and avoiding snacks at night.
- Overeating is a common trigger for heartburn. It's better to eat small, frequent meals instead of large meals.
- Keep your meals small by limiting your portion sizes.
- Eat just until your appetite is satisfied but before you feel full.
- This reduces your risk of night-time heartburn and can help you maintain a healthy weight.
- Any type of alcohol can trigger heartburn. If you drink alcohol and have reflux at night, try to decrease your intake of wine or beer with dinner.
- Try to avoid any after-dinner drinks.
- Remember, drinking alcohol can cause you to overeat.
Watch your weight
- Being overweight or obese increases your risk of heartburn.
- One reason may be that excess weight adds pressure on the junction between the stomach and the oesophagus.
- Losing weight isn't easy, but even losing a little bit of weight could help quite a lot.
- And that may mean better sleep at night and less daytime sleepiness.
- Smoking worsens heartburn.
- Smoking relaxes the junction between the stomach and the oesophagus, allowing stomach contents to reflux into the oesophagus.
- If you smoke, try to quit.
- Talk to your doctor about medications and other aids that can help you break the nicotine habit.