Gastrointestinal distress? You’re not alone

Did you ever have a day where you leave the house and your clothes fit just fine but by the end of the day your buttons are ready to burst? About three months ago, I had one of those days. I was so uncomfortable that I actually changed from slacks into scrubs at about 5pm (it was a late night and I had about 3 more hours of patients to see). The bloating was causing abdominal pain and cramping and my belly was bloated out to here (gesturing with my hand about a foot in front of me.)

Despite drinking enough water and exercising regularly, I would occasionally experience this discomfort that I had heard so many patients complain about before. Women especially (due to longer, more tortuous intestines that allow increased water absorption during pregnancy) have been coming to me for years with complaints of bloating, gas, abdominal discomfort; sometimes related to food, sometimes not. Stress, travel, poor diet make it worse. Laxativesmake it better, temporarily. Symptoms seem to always return and they often don’t know where to begin to help themselves.

Gastrointestinal complaints are embarrassing to talk about, yes. Most people cringe when I start asking what their stools look like or how often they go. But conditions such as irritable bowel, constipation, diarrhea, bloating, can have such a tremendous effect of quality of life, that I’ve actually made it part of my screening questionnaire.

The environment inside the gut changes multiple times from the entrance all the way to the exit. For example, digestion begins from the moment you realize you are hungry. Saliva production begins which is the crucial beginning to the breakdown/digest/absorb cycle of gut function. The muscular structure of the esophagus changes three times from mouth to stomach to allow proper forward propulsion of food. The harshly acidic environment of the stomach allows for food to be broken down to digestable size. The three parts of the small intestine all have different structure and function. Chemical digestion begins here as bile and digestive enzymes are delivered by the gallbladder and pancreas respectively. Absorption of water, nutrients and some minerals also begins in the small intestine. The large intestine is largely responsible for absorbing water and creating formed stool so that waste can be eliminated. Its inner surface is lined with finger-like projections which help maximize surface area for the absorption of water and the muscular rectum allows propulsion to the outside world of the septic system. Meanwhile, good bacteria inhabit the GI tract and play a crucial role in the breakdown and digestion of food.

Believe it or not, the answers to those questions oftentimes lead to a simple cure. Typical American diets and lifestyles wreak havoc on the very temperamental gastrointestinal tract. Antibiotics, anti-inflammatories, processed foods, sugars, dairy, gluten, artificial sweeteners, alcohol and carbonated beverages can all irritate the essential lining of the intestinal wall. They can also disturb the delicate balance of bacteria that help with digestion of foods and absorption of nutrients. Stress, lack of sleep and exercise also impair intestinal motility, absorption and bacterial balance. Some researchers and scientists believe that a damaged intestinal lining allows unexpected materials to be absorbed into the bloodstream. This could possibly be the impetus behind autoimmune diseases as our bodies will naturally attack non-native materials once outside the gastrointestinal tract. Therefore a healthy gut lining seems to be essential is maintaining proper bacterial balance, normal absorption and motility.

So, the treatment for symptoms of gastrointestinal imbalance really begins with prevention, as it does with so many conditions. Modifications to diet, sleep and exercise can truly make a difference to patients suffering with bloating, gas, abdominal pain. Directed elimination of the food classes listed above can help identify which substances triggers an individual’s symptoms. Occasionally a digestive enzyme, pre- or probiotic may be suggested to help restore normal function and flora and allow the gut lining to heal.

Of course, while we are working on making crucial lifestyle changes, we are also doing a workup to rule out organic and mechanical medical conditions of the GI tract which affect organs like the gallbladder, pancreas, stomach, small and large intestine. Infection, inflammation, polyps, stones, abnormal blood vessels or outpocketings of the wall can all cause similar symptoms. Occasionally diseases of the bladder or pelvic reproductive organs can cause intraabdominal distention and pain. Bloodwork, imaging and colonoscopy or laparoscopy may be warranted in the workup. But in the meantime, education about therapeutic lifestyle changes can get the ball rolling.

Unfortunately, caring for your body is oftentimes not convenient, cheap or easy. Results don’t often come quickly. We are a nation that values quick and easy because that allows us to get more done and faster. In my mind, perhaps that’s where our problems begin. Changing your lifestyle incrementally can make it more feasible and patience is clearly key. Recognizing the crucial mind-body connection will only help you on your way to a healthier life. Patients who make time to meditate, de-stress and decompress usually have better control of their health and well-being.

Though yoga has helped me deal with stress and insomnia, what changed my gut health for the better was eliminating as much gluten as possible. Bloating and gas virtually disappeared. For others it’s yeast overgrowth that causes their symptoms and therefore reduction in sugar is what works. If you’re plagued with gut discomfort, make sure you speak to your primary care doctor who can make sure you’re up to date with screenings, begin a workup, counsel you on necessary lifestyle modifications and refer you to a gastroenterologist or colorectal surgeon if necessary. In the meantime, check out the book entitled Gutbliss by Robynne Chutkan, M.D. It’s a very easy-to-read roadmap to your intestines and includes an action plan to help identify your individual problem areas.

As always, feel free to email me at drhugelmeyer@thesuahcenter.com

Alexis Hugelmeyer, D.O. is the wife of Michael, mother of Isabella, 5, and Lance, 3, and a family physician whose passion is hands-on manipulation for treatment and healing of any and every type of medical problem. She is the director of community outreach education at Peconic Bay Medical Center and also a private practitioner in Riverhead, where she has founded The Suah Center for Natural Healthcare. A graduate of Villanova University and New York College of Osteopathic Medicine, she lives in Baiting Hollow.