Trust Your Gut

Everyone deals with gastrointestinal symptoms from time to time. But don’t ignore them—they may be a sign of a larger problem.

We’ve all had those days—your stomach is burbling and your abdomen aches. Food feels unfriendly. You want to keep a bathroom close at hand. Maybe you overindulged a bit or ate something that disagreed with you, or maybe you picked up something viral that will fix itself in the next day or two. (This is why you keep Pepto-Bismol in your medicine cabinet, after all.)

But if they persist, gastrointestinal (GI) symptoms create their own unique frustrations. For one, they’re very disruptive to day-to-day life and activities. For another, says Vikas Taneja, M.D., a gastroenterologist at the Jersey Shore University Medical Center in Neptune, there’s an overlap in symptoms between diagnoses. “The gut has a small ‘vocabulary,’” he explains. “Cramping, urgency, bloating or changed bowel habits can be symptoms of inflammation, infection, food intolerance, an oversensitive gut-brain connection or something else. The nerves from the intestine aren’t precise the way the nerves in our skin are.”

This can make the exact cause of your discomfort more difficult to nail down. According to Dr. Taneja, “For patients, that can mean months of uncertainty, repeat testing and feeling as if no one believes their symptoms are real.”

From dietary factors to emotional ones, we feel a lot in our gut. Here are some signals you should pay attention to:

• “Minor” misery—that deserves attention. “The gut and brain are wired together by a dense two-way nerve network,” says the doctor. “If you’re having symptoms, they shouldn’t be dismissed. Patients deserve a real diagnosis and a real plan.”

One of the most common explanations for these persistent symptoms is irritable bowel syndrome, or IBS. “It’s a disorder of gut-brain interaction,” says Dr. Taneja. It’s also very common; the American College of Gastroenterology estimates that 15 percent of the population of the United States has IBS. Symptoms include abdominal cramping, bloating, changes in bowel habits (diarrhea, constipation or both) and sometimes loss of appetite and nausea. Often, these symptoms will be exacerbated by stress or other environmental triggers.

Says Dr. Taneja: “IBS occurs when the signaling between gut and brain isn’t working right. Normal contractions become uncoordinated and move too fast or too slowly, and the gut nerves respond. This causes normal gas or stretching to register as pain.” IBS also very often ebbs and flows—a patient will have long periods of feeling all right, and then something will trigger symptoms to act up again. The doctor adds: “It doesn’t cause cancer or any permanent damage to the body, but it can take over someone’s life.”

IBS is a clinical diagnosis, meaning that is identified through symptoms and health history rather than a specific test, “because the intestine looks normal on a scope,” says Dr. Taneja. It is usually diagnosed in people under age 50. “I use what’s called the Rome IV criteria to diagnose it—they include recurring belly pain at least weekly for three months tied to bowel movements, or a change in stool with otherwise normal inflammatory markers,” Dr. Taneja says. He stresses that “IBS is not ‘all in your head,’ or simply a label we use when we can’t find anything else. A disorder that effects the brain-gut nerve network is as physical as an arrhythmia. Stress worsens IBS the same way it worsens asthma and migraines, and nobody tells a migraine patient their pain is imaginary.”

Just as for asthma and migraines, there are treatment options available for IBS, “and better ones than people expect,” says Dr. Taneja. “Diet can do real work. A 2024 Swedish trial found that structured dietary counseling was more effective than optimized medication, with roughly three-quarters of patients improving.” This diet plan is usually “lowFODMAP” (or “fermentable oligosaccharides, disaccharides, monosaccharides and polyols,” short-chain carbohydrates that the small intestine absorbs poorly) and avoids dairy, wheat and bread products, beans, lentils and certain fruits and vegetables. “It’s not a life sentence,” Dr. Taneja declares.

“Patients are on a supervised trial diet, with reintroduction of those foods as the goal.” Apart from that, “we target the main symptom with medication,” he says. “Prescription laxatives for constipation, bile acid binder for diarrhea and antispasmodics or peppermint oil for cramps.” Treatment options can also include connecting a patient with a mental health professional to help manage stress and anxiety symptoms.

• A larger problem? “I look for ‘red flag’ symptoms,” says Dr. Taneja. “Bleeding and blood in the stool, weight loss, anemia and symptoms that wake you up at night are on that list.” Symptoms persisting consistently for long periods, as opposed to getting better and worse depending on the day, are also a sign that you should reach out to a specialist as soon as possible. One such possibility is inflammatory bowel disease, or IBD, which—according to an estimate from the National Institute of Diabetes and Digestive and Kidney Diseases— affects some 12 percent of Americans. “IBD is the immune system attacking the intestine,” explains the doctor. “There is visible, measurable inflammation from that attack.” This inflammation is the core of all the symptoms; it can also cause fevers.

IBD is generally used as the umbrella term for two specific maladies: Crohn’s disease and ulcerative colitis. “Ulcerative colitis always starts at the rectum and extends upward through the colon only,” says Dr. Taneja. “Crohn’s can appear anywhere from mouth to anus. Diagnosing it involves lab work— including blood counts, iron studies, C-reactive protein [CRP, a protein that indicates inflammation in the body] and fecal calprotectin [also a measure of inflammation], which is very useful for separating IBD from IBS,” says the doctor. That is followed, the doctor says, by “a colonoscopy with biopsies to confirm inflammation and map its extent.” Though often diagnosed in people between ages 20 and 30, these conditions can appear at any age. The exact cause of IBS is still being studied. There are genetic aspects, says our expert; the condition tends to run in families. Smoking puts you at a higher risk, as does heavy antibiotic use in childhood, a diet heavy in ultra-processed foods and prior bouts of gastroenteritis.

Besides persistent GI symptoms such as cramping and urgency, IBD can also cause dehydration, difficulty in absorbing essential nutrients, joint pain, anemia and reduced bone density, and can put you at a higher risk for colon cancer and other complications. It is also chronic. But, says Dr. Taneja, treatments are not only effective, but “targeted in a way that means a healed mucosa [intestine lining] and a normal calprotectin level, not just feeling better.” Biologic medications, which work to suppress the immune reaction and shut down the inflammation before it starts, are effective in treating this condition. “People get nervous about biologics, but these are safe medications, and uncontrolled inflammation is much more dangerous than any medication that stops it,” says Dr. Taneja.

More than anything, Dr. Taneja says to pay attention to GI symptoms and to find a specialist if something feels wrong. “Sometimes the gap between the first symptoms and the right diagnosis is significant,” he says. “It can stretch on for years. If your symptoms have been dismissed and never objectively evaluated, don’t be afraid to ask for more tests or get a second opinion.”

TUMMY TROUBLE?

Vikas Taneja, M.D., a gastroenterologist at the Jersey Shore University Medical Center in Neptune, explains conditions that could be causing persistent stomach pain:

• Celiac disease. This gluten allergy produces serious stomach upset, and Dr. Taneja describes it as something that can be misdiagnosed as IBS or IBD. A step in identifying the cause of persistent GI symptoms is often to try a gluten-free diet to see if that eases things. The only way to manage this allergy is to strictly avoid gluten in foods.

• Colon cancer. Persistent abdominal discomfort, a change in bowel habits and blood in the stool are all also signs of colon cancer, particularly when combined with anemia and quickly feeling full when eating. “Do not skip a colon cancer screening at 45,” urges Dr. Taneja. “You may catch it before any symptoms exist at all.”

• Diverticulitis. Common in adults over age 50, this condition occurs when an irregular, bulging pouch develops in the colon wall and then becomes inflamed. It can cause abdominal pain, fever, irregular bowel movements and nausea. Mild cases are often treated with a short-term liquid diet and antibiotics. More severe cases require surgery.

• Inflammatory bowel disorder. “IBD is the immune system attacking the intestine,” explains the doctor. An umbrella term for ulcerative colitis (when the inflammation is limited to the colon) and Crohn’s disease (which can develop anywhere in the GI tract), IBD also can cause blood in the stool, fevers and unexpected weight loss.

• Irritable bowel syndrome (IBS). A clinical diagnosis related to how the nervous system in the gut responds to stimuli. Symptoms such as abdominal cramping, feelings of urgency and changes in bowel habits, such as diarrhea or constipation, ebb and flow over time.

• Lactose intolerance. Some people have a sensitivity to dairy that causes persistent GI symptoms. Dr. Taneja says this is something that can be mistaken for IBS. Cutting dairy products from the diet will ease symptoms with little other intervention. (Over-the-counter lactase enzyme supplements can aid in the digestion of dairy products, if you can’t resist the occasional cheese or ice cream.