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 dayto-day life and activities. For another, says Elliot Coburn, M.D., a gastroenterologist at Gastroenterology Associates of New Jersey in Hackensack, “There’s a lot of overlap of symptoms between different diagnoses.” That can make the exact cause of your discomfort more difficult to nail down.
“There are also many different things that can influence the way your gut feels,” says Dr. Coburn. “From dietary factors to emotional ones—we feel a lot of things, literally, in our gut.”
•“Minor” misery—that deserves attention. Says Dr. Coburn: “Often, people—particularly young people—have their GI symptoms dismissed or blown off. They’ll hear, ‘Oh, it’s just stress. It’s hormonal. It’s nothing.’ But if you’re experiencing these symptoms regularly, it’s probably not nothing.” One of the most common explanations for persistent GI symptoms is irritable bowel syndrome, or IBS. “This is an incredibly common diagnosis,” the doctor explains. “We think about 15 percent of the population has IBS, at least.” He describes the symptoms as “a bit non-specific. You’ll get abdominal cramping and changes in bowel habits, either diarrhea or constipation. People also complain about a loss of appetite and nausea. Often, these symptoms will be exacerbated by stress or dietary triggers.”
Many of the body’s functions run through the gut. “There’s a reason that the gut is sometimes called the ‘second brain,’” says Dr. Coburn. “And sometimes the nervous system of the gut can behave independently of the rest of the nervous system. So you feel that abdominal cramping and urgency, often in response to increased stress or other environmental factors. It will also ebb and flow. You’ll have long periods of time when you’re feeling OK, and then you’ll start feeling really bad as the symptoms act up again.”
IBS is a clinical diagnosis, meaning that is identified through symptoms and health history rather than a specific test. It is usually diagnosed in people under age 50, and the process is also often a matter of ruling other things out—someone might have a colonoscopy or an endoscopy in response to these symptoms but, in the case of IBS, the results will likely be normal. “The underlying process that causes it, which is a nervous-system interaction and nerves behaving erratically, is not something that comes up on these diagnostic tests. We are trying to rule out other things as opposed to identifying it specifically,” says Dr. Coburn. But he’s also quick to stress that “IBS is a very real condition. It holds weight with doctors, and it’s something we can treat. Nobody is giving you a ‘wastebasket diagnosis’ by telling you that you have IBS.”
Treatment options are often multidisciplinary and can include connecting a patient with a mental health professional to manage stress and anxiety symptoms. “And then we have medications to help with the gut symptoms, from laxatives to address constipation to medications that help decrease sensitivity of the bowels, or decrease spasming. We have patients try cutting out dairy and other common food triggers. It can take a little trial and error, but it’s absolutely treatable,” explains our expert.
• A larger problem? “If you start seeing symptoms beyond cramping, changes in bowel habits and urgency—particularly blood in the stool, unintended weight loss or fevers—that’s something you shouldn’t ignore,” says Dr. Coburn. 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 about inflammation, not the neurological system,” explains the doctor. “Something is causing inflammation somewhere in the gut.” That inflammation is the cause of the fevers sometimes associated with these conditions. He continues: “Generally, this is used as an umbrella term for two specific diseases—Crohn’s disease and ulcerative colitis.” Though the two are very similar, ulcerative colitis is an inflammation restricted to the colon, while inflammation from Crohn’s disease can occur anywhere in your digestive tract. “These are conditions that are identified via colonoscopy and endoscopy, or biopsy,” Dr. Coburn says. Though often diagnosed in people between ages 20 and 30, they can appear at any age, and there’s also another peak in diagnoses in people between ages 50 and 60. IBD is caused by the body’s immune system attacking healthy bowel cells; exactly why this happens is still being studied. There are genetic aspects, says our expert, as the condition tends to run in families, and smoking puts you at a higher risk.
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. Coburn, “This is not a hopeless disease. I have people coming into my office panicked like they’ve gotten a cancer diagnosis. We have very good therapies and many, many patients with IBD live normal, healthy lives.” Biologic medications have been a game changer in the treatment of IBD, according to Dr. Coburn. These medications work to suppress the immune reaction and shut down the inflammation before it starts. “They are very safe medications,” he says, “with very safe side-effect profiles. Truly, it is not a doom-and-gloom diagnosis— we really can help you.”
Dr. Coburn stresses the need to pay attention to GI symptoms and to find a specialist if something feels wrong. “I see people who have ignored their symptoms and just lived with them for far too long, or have had others write it off as stress or bad food reactions,” he says. “Something serious could be going on, and even if it’s less serious, there’s no need to just endure it.”
TUMMY TROUBLE?
Elliot Coburn, M.D., a gastroenterologist at Gastroenterology Associates of New Jersey in Hackensack, explains conditions that could be causing persistent stomach pain:
• Celiac disease. This gluten allergy produces serious stomach upset. “It causes cramping, bloating and diarrhea,” says Dr. Coburn. Another step in identifying the cause of persistent GI symptoms is to try a gluten-free diet for a while and see if that makes any difference. 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 quickly feeling full when eating and anemia. “Particularly if you’re seeing blood in your stool, that’s a sign you need a workup and diagnosis panel from an expert,” Dr. Coburn says.
• 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. For mild cases, this is often treated with a short-term liquid diet and antibiotics. More severe cases require surgery.
• Inflammatory bowel disorder. “IBD is about inflammation,” says the doctor. An umbrella term for ulcerative colitis (when the inflammation is contained to the colon) and Crohn’s disease (which can happen anywhere in the GI tract), IBD also can cause blood in the stool, fevers and unexpected weight loss. It can be treated with biological medications.
• Irritable bowel syndrome (IBS). A clinical diagnosis related to how the nervous system in the gut responds to stimuli. Symptoms like abdominal cramping, feelings of urgency and changes in bowel habits, such as diarrhea or constipation, ebb and flow over time. “We have medications to help,” says the doctor, which may be combined with mental health care to manage stress.
• Lactose intolerance. “Some people have a real sensitivity to eating dairy,” says the doctor. He also says that one of the first steps in treating someone with these symptoms is to cut dairy products from the diet; doing so will ease symptoms with little other intervention. (And over-the-counter lactase enzyme supplements can help aid in the digestion of dairy, if you can’t resist the occasional cheese or ice cream.)
