Stomach Pain

WHEN TO SEE YOUR DOCTOR

* You experience sudden, severe abdominal pain.

* Pain persists for more than four days.

* You also have rectal bleeding or weight loss.

* You experience recurring abdominal pain and diarrhea.

What Your Symptom Is Telling You

If yet another hot night at José's House of Jalapeños has you moaning in a foreign language, take heart—you're probably just suffering from an old-fashioned upset stomach. In a few days (at the most) you'll be ready for another el scorcho of a meal.

But let's assume for a moment that you played it safe and opted for rice and beans, and you still have serious, lingering tummy trouble. What's causing it?

Don't bet the dinner check, but you could be suffering from an ulcer. Characterized by lesions on the inside of your digestive tract, ulcers come in all shapes and sizes—and locations. (In fact, stomach pain that is relieved for a short time by eating can be a symptom of a peptic or duodenal ulcer, which is located in your intestines.) Unlike a temporary upset stomach, however, ulcers keep coming back.

And while doctors aren't exactly sure what causes ulcers (recent evidence has linked them to pesky bacteria called Helicobacter pylori that live in your stomach), things like taking daily doses of aspirin or drinking too many cups of coffee each day could be making your ulcer worse.

"Certain medications—like aspirin—actually block the ability of the stomach to heal itself," says Jorge Herrera, M.D., assistant professor of medicine at the University of South Alabama College of Medicine in Mobile and member of the American Gastroenterological Association and the American College of Gastroenterology.

Then again, you might not have an ulcer. You could have plain old indigestion—your stomach lining's way of letting you know that it doesn't appreciate your dinner choices. Among the most common causes: spicy and acidic foods—like José's legendary jalapeños.

Another cause of abdominal pain—irritable bowel syndrome—is the mark of an angry digestive system. No ulcers here, just intestines having trouble moving your food through your body. A telltale sign of irritable bowel syndrome is abdominal pain accompanied by diarrhea or constipation and bloating. Pain relief follows a trip to the bathroom, but the pain returns again and again.

Food poisoning is another possible pain trigger. You might have absentmindedly eaten a chicken salad sandwich that's been sitting in your refrigerator a few too many days, but your intestines will know the difference.

And then there's gas. Air swallowed during chewing, or methane produced during digestion of foods like beans, can get trapped in your digestive system and cause discomfort until it's released by belching or breaking wind.

Unfortunately, a number of digestive diseases that can bring on sudden attacks of severe abdominal pain are also fairly common. These include ulcerative colitis, Crohn's disease, gallbladder disease, appendicitis, diverticulitis and pancreatitis.

Symptom Relief

You should see your doctor—soon—for any sharp, intense abdominal pains. The causes of sharp and recurring pain are often serious and should receive medical attention.

But there are a few things you can try on your own for a minor bout of abdominal discomfort.

Take some tea. The tannic acid in a cup of brewed tea apparently helps rid the body of some of the bacteria or chemicals that can cause stomach pain, especially if you also have diarrhea, says Thomas A. Gossel, R.Ph., Ph.D., professor of pharmacology and toxicology and associate dean of the College of Pharmacy at Ohio Northern University in Ada. "You should feel relief in about an hour or so," he says.

Try an antacid. Nearly all over-the-counter antacids contain ingredients that do a good job of neutralizing excess stomach acid, says Wendell Clarkston, M.D., an assistant professor and director of the Fellowship Training Program in Gastroenterology and Hepatology at Saint Louis University School of Medicine. (For other hints and tips on banishing stomach acid, see Heartburn on page 249.)

Banishing Ulcer Pain

Doctors may not be exactly sure what causes ulcers, but they have a good idea of how to get rid of them. Try these techniques.

Use the right medication. A variety of prescription H2 antagonists and other medications actually block the stomach's ability to produce or secrete acid, says Dr. Herrera. Research shows that these powerful drugs have a 95 to 98 percent healing rate over six to eight weeks. "I think most people should use this as their main therapy." he says.

Team up with Tagamet. Prescription-only drugs like Tagamet or Zantac actually shut off the production of the acid that provokes stomach ulcers, says William B. Ruderman, M.D., chairperson of the Department of Gastroenterology at the Cleveland Clinic­ Florida in Fort Lauderdale.

Ask for an antibiotic. If you have persistent abdominal pain and diarrhea, you may need a prescription antibiotic to help knock out the bacteria that has taken up residence in your stomach lining, says Dr. Clarkston.

Sip some milk. Drinking a glass of skim milk during an ulcer attack may provide quick relief. "Milk works like an antacid. When it gets to the stomach, it neutralizes the acid and the pain will go away," says Dr. Herrera. Use caution, however: Some people who drink milk for ulcer pain report feeling even worse a short time later, says Dr. Herrera.

Eat smart. Doctors learned long ago that spicy foods, like Mexican food, or acidic delights, like pickles, don't cause ulcers. But they can make an already angry ulcer feel worse. "The ulcer tissue is more sensitive and hurts more when you eat spicy or acidic foods," says Dr. Ruderman. You don't have to stick to a bland diet, but stay away from foods that turn on the burn.

Cut the cups. Once again, there's no hard evidence that big-time coffee drinkers are going to get an ulcer, but coffee can aggravate one, says Dr. Herrera. "As a rule, we tell patients to use caffeine in moderation—maybe no more than two or three cups of caffeine-containing drinks per day."

Avoid too much aspirin. Research shows that excessive use of the active ingredient in aspirin—salicylic acid—actually wears away the lining of the stomach and causes it to bleed, says Dr. Herrera. "If you take aspirin for two to three days because you have a cold or headache, you'll be okay. But if you take it on a daily basis for more than three months or so—that's when you run into problems," he says. Ask your doctor or pharmacist to recommend alternatives that won't irritate your stomach.

Stop smoking. Nicotine damages the lining of the stomach and makes ulcers worse, says Dr. Herrera. Get professional help to quit if you have to.

Dealing with Irritable Bowel Syndrome

The bad news about irritable bowel syndrome is that it's still a bit of a mystery. The good news is that by the time you're diagnosed with it, all serious health problems have already been ruled out, says Dr. Herrera. To manage the problem, try these tips.

Don't panic. Because it's often tough to determine the cause of irritable bowel syndrome, you need to be patient while your doctor searches for an explanation. "When all the tests are negative and no one can tell you what's going on, it's natural to get worried," says Dr. Herrera.

Fill up on fiber. Not only are vegetables and whole grains loaded with nutrients, they can also help prevent constipation and tame your irritable bowel. "You just don't get enough fiber every day from hamburgers," says Dr. Clarkston. If the thought of chewing all those veggies makes you feel like a rabbit, consider one of the many over-the-counter fiber supplements. From tablets and wafers to powders that you add to juice, most are available at drugstores and supermarkets.

Cut the fat. Fatty foods also have been linked to irritable bowel syndrome, says Dr. Herrera.

Give zip the slip. Spicy foods have been know to cause their share of problems, says Dr. Herrera.

Try the elimination diet. Although not all stomach doctors agree, some gastroenterologists believe that irritable bowel syndrome may be caused by an allergy to certain foods. You can try an elimination diet to determine whether a food allergy could be contributing to your problem, says Dr. Herrera. Milk, eggs, wheat, corn, soy, peanuts, citrus fruits, colas and chocolate are some of the most common foods that cause allergic reactions. During an elimination diet, you avoid one group of foods at a time, carefully monitoring yourself for symptoms. If your symptoms disappear, you may have found the culprit.

Ask about medication. If you suffer from persistent irritable bowel syndrome, ask your doctor about antispasmodics, which prevent spasms by relaxing intestinal muscles, for use during severe episodes, says Dr. Clarkston.