Womens Health

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

Symptoms

• 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

• Diarrhea
• Constipation
• Alternating diarrhea and constipation
• Normal bowel habits alternating with either diarrhea and/or constipation

Diarrhea

• 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:
• heartburn
• difficulty with swallowing
• early satiety
• intermittent upper abdominal discomfort
• nausea
• non-cardiac chest pain
• Abdominal bloating
• Increased gas production in the form of flatulence or belching

Other symptoms

• Impaired sexual function
• Pain with menstruation
• Pain during intercourse
• General body and joint pain
• Fatigue

Alarm symptoms

• Loss of appetite
• Malnutrition
• 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

Diet

• 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.

Diet

• Breakfast!
• Add fibre (fresh fruit and veggies)
• Nuts
• Small regular meals
• Avoid certain gas producing foods if bloating is a problem
• Peppermint oil

Physical activity

• 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

Medication

• Only as adjunct
• Depends on symptoms
• Constipation

Conclusion

• 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.

Heartburn

Heartburn: Definition

• 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

Hiatus hernia

Typical symptoms

• Heartburn
• Reflux/regurgitation
• Difficulty in swallowing
• Less common:
• Water brash
• Burping
• Hiccups
• Nausea and vomiting

Atypical symptoms

• Chest pain
• Chronic cough
• Difficult-to-treat asthma
• Laryngeal symptoms
• Hoarseness
• Throat clearing
• Throat pain

GERD symptom triggers

• Dietary

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)

• Non-dietary
• Obesity
• Pregnency
• Smoking
• Tight clothing
• Recumbancy

Non-dietary

• NSAIDs & Disprin
• Anticholinergics
• Calcium channel blockers
• Theophylline
• Salbutamol
• Nitrates
• 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.

Meals

• 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.

Alcohol

• 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.

Stop smoking

• 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.