Digestive Problems

Digestive Problems

Calming the Pain and Rumble

As if chocolate bars and cheese curls haven't caused us enough problems all these years, now we're getting grief from unassuming eats such as onions, tomatoes and even strawberries. What gives?

Apparently, your digestive tract.

You could understand why men have digestive problems; all you have to do is watch them eat. But lately, you've found yourself reaching for the Di-Gel or Pepto-Bismol a little more often. Why? Because of gas. Or heartburn. Or bloating. Or diarrhea or constipation. Or any number of these problems.

Well, you're in good company.

"Just as it takes longer to recover from a cold or an injury as you grow older, the same happens to your digestive system. Things just kind of slow down, and the repair mechanisms aren't quite the same as they used to be," says William B. Ruderman, M.D., chairman of the Department of Gastroenterology at the Cleveland Clinic Florida in Fort Lauderdale. "You can't tolerate certain foods or the effects of alcohol as well as you used to. It certainly makes you feel your own mortality."

All those belches, rumbles and other internal actions wear on more than just your digestive tract. "You may be hesitant to take a bus or go outdoors in case you have to go to the bathroom. You may not go to certain restaurants because you can't eat certain foods," says Devendra Mehta, M.D., a gastroenterologist and assistant professor of pediatrics at Hahnemann University Hospital in Philadelphia. "This can be very distressing at any age. But when you are young and have these problems, it disrupts your life."

Just because your innards may be out of kilter, however, it doesn't mean they have to stay that way. Whatever the problem, here's how to fix it.

Constipation: Get Yourself Moving

If you haven't been bothered by constipation, give yourself a few years. "Constipation gets a lot more common as you age," says Jorge Herrera, M.D., associate professor of medicine at the University of South Alabama College of Medicine in Mobile. "For one thing, as they get older, most people tend to eat less and become less active." And many medicines that people tend to take as they age for conditions such as heart disease and diabetes also cause constipation, says Dr. Herrera.

At any age, however, constipation can make you feel older. Whether you have to strain to move your bowels or simply don't feel the urge, constipation occupies your mind with thoughts of what you can't do, and because of that, your body may not feel like doing much of anything. Most women over age 30 can expect at least an occasional bout with constipation--and more as they get older. But here's how to keep problems to a minimum, no matter your age.

Eat in bulk. "If you're eating the typical Western diet with a lot of processed foods, that will lead to constipation," says Dr. Mehta. "But a diet with lots of roughage and fiber that centers on plenty of fresh fruits and vegetables is the most important thing you can do to treat or avoid constipation, especially as you get older."

Experts say you need at least five servings a day in order to get the recommended minimum of 25 grams of fiber--about twice what's actually consumed by the typical American. Besides fresh produce, good sources of dietary fiber include whole-grain breads and cereals, pastas, brown rice, beans and bran.

Work out. Any type of exercise speeds up gastrointestinal transit time, the length of time it takes food to get from your mouth through the stomach and intestines. But researchers at the University of Maryland College Park found that people who undergo strength training programs can improve their bowel transit times by about 56 percent compared with their pre-pumping days. It seems that the contractions of abdominal muscles done in weight lifting help "squeeze" the waste through the intestines more quickly. Researchers also believe that any type of exercise has an effect on motilin, a gastrointestinal hormone that's related to faster transit time. Exercise also improves blood flow to the intestines, which improves bowel movements.

Drink water. "One reason why constipation is more common as you age is that generally, the older people get, the less they drink," says Dr. Mehta. "And the less you drink, the harder and less frequent stools become." Even if you don't have a problem with constipation, you'll help keep yourself regular by drinking at least six glasses of water or other nonalcoholic beverages each day.

Meanwhile, try to limit your intake of coffee, tea and alcohol. While caffeinated beverages actually speed bowel transit time (alcohol has no effect), these beverages are diuretics that can leave you dehydrated, and you need fluids in your system to aid bowel movements. And those with frequent constipation should avoid milk, cheese and other dairy products, which contain casein, an insoluble protein that tends to plug up the intestinal tract.

Heartburn: Douse the Fire

You probably already know how heartburn makes you feel: lousy. Nothing can take the wind out of your sails--not to mention your appetite--faster than having to rest after each meal until the pain subsides or having to monitor your every bite in order to avoid the pain in the first place.

Heartburn occurs when stomach acids, in a process called reflux, splash up into the esophagus, says Sheila Rodriguez, Ph.D., gastrointestinal laboratory director for the Oklahoma Foundation for Digestive Research in Oklahoma City. Eating too fast or too much is one common cause, but pigging out isn't the only reason for this all-too-common after-dinner ailment. Heartburn can also be the primary symptom of other conditions, such as gastritis, an inflammation in the lining of the stomach.

"It's not that the natural aging process contributes to heartburn per se, but the condition does seem to be more of a problem as you get older," says Dr. Mehta. One reason is that there's a clear association between heartburn and being overweight--and most of us have gained a few pounds over the last few years.

But another, less obvious reason is bacteria. The same bacteria--Helicobacter pylori--that cause ulcers have been linked to heartburn symptoms in many women, says Dr. Mehta. Also, after age 40, our esophageal muscles start to weaken, which can contribute to reflux. But no matter the reason, here's how to take the fire out of heartburn.

Eat smaller. Many women with heartburn problems find that grazing helps extinguish that internal blaze. When you eat four or five smaller meals instead of three massive squares a day, your stomach churns out less acid, says Frank Hamilton, M.D., director of the Gastrointestinal Diseases Program at the National Institutes of Health in Bethesda, Maryland.

Down it with water. Drinking lots of water--especially with meals--helps wash stomach acids from the surface of the esophagus back into your stomach, says Ronald L. Hoffman, M.D., a physician in New York City and author of Seven Weeks to a Settled Stomach.

Know the offenders. Certain foods are more likely than others to bring on the symptoms of heartburn. According to Dr. Rodriguez, onions, chocolate and mints relax the lower esophageal sphincter, which allows stomach acids to wash up. Citrus fruits such as oranges and grapefruit, as well as tomato products, coffee and fried or fatty foods, can also cause trouble because they can irritate the esophageal lining, adds Dr. Hamilton.

Sleep on a slope. If heartburn troubles you often, place wooden or concrete blocks under the headboard of your bed so that you sleep on an incline, advises William Lipshultz, M.D., chief of gastroenterology at Pennsylvania Hospital in Philadelphia. By raising the head of your bed six inches higher, it's harder for stomach acid to flow. That's because it would have to go uphill.

If you must lie flat, lying on your left side might produce less heartburn, says Leo Katz, M.D., a gastroenterologist at Jefferson Medical College of Thomas Jefferson University in Philadelphia. In tests, he found that people who ate the same heartburn-producing meal usually got more heartburn when they lay on their right sides compared with their left sides. "We think it has something to do with the anatomy of the stomach and gravity," he says.

Lactose Intolerance: Drink Up--Safely

Dare to eat dairy? Perhaps not. As much as 70 percent of the world's population has some symptoms of lactose intolerance, meaning these people experience ill effects from milk, ice cream and other dairy products. Symptoms include bloating, gas, stomach cramping and diarrhea, which can curtail your activities and hamper your lifestyle. Besides making you feel older, the symptoms often get worse as you grow older.

By about age eight, many of us start losing an enzyme called lactase, which helps us digest lactose, the sugar that makes milk taste sweet. Without the lactase, much of the lactose passes along your digestive system undigested, possibly sending your colon into spasms and churning up gas. "By age 20, lactose-intolerant people pretty much lose the ability to digest milk," says Dr. Herrera.

Lactose intolerance varies from person to person. Some women may feel minor discomfort after a lot of dairy, while others may get major problems from just a sip or two of milk. So checking your individual tolerance, and staying within that range, is the best way to avoid trouble. While there are plenty of lactose-free products--you'll find them in your supermarket's dairy case--here's how you can have your (real) dairy and eat it, too.

Be a cocoa nut. Some research suggests that cocoa slows stomach emptying, which reduces the rate at which lactose reaches the colon, says Dennis A. Savaiano, Ph.D., professor of food science/nutrition and associate dean at the University of Minnesota College of Human Ecology in St. Paul. So by drinking chocolate milk or having chocolate ice cream, you may avoid, if not lessen, symptoms. But if you're making your own chocolate milk, use low-fat milk and powdered cocoa or chocolate syrup; both are low in fat.

Combine dining with dairy. Some people find they can go symptom-free if they have their dairy products with meals. That's because having food in your stomach slows the release of lactose into your intestines, says Douglas B. McGill, M.D., professor of medicine at Mayo Medical School/Mayo Clinic in Rochester, Minnesota. Still, it's not advisable to load up on several dairy products at one meal.

Choose the right yogurt. Yogurt may be one milk product you can eat without worry. But don't assume that all yogurt products are the same. "Some commercial brands add milk products, which can cause you problems," says Dr. Mehta. "The best thing is to make your own yogurt." You can find yogurt-making machines at cooking supply stores.

If you're buying yogurt, make sure you choose a brand whose label says it contains live active cultures. "As soon as the yogurt cultures pass into the intestine, they become active and start to break down the lactose," says Dr. McGill. Sorry, but frozen yogurt won't help, since there are too few bacteria to be helpful.

Diverticular Disease: Spare Your Colon

It's fine to act refined at the dinner table, but when you eat that way, don't count on your colon to keep its good manners. After decades of living off refined and processed foods and other low-fiber fare and trying to pass the hard, dry stools they create, the colon walls weaken and often develop tiny pouches called diverticula. While this condition, called diverticulosis, won't cause any symptoms for many people, some people may develop gas, cramping, severe indigestion or even constipation or diarrhea.

Since diverticulosis is the result of years of neglecting the needs of your colon, it usually strikes us after age 40--but it can make you feel decades older. Some women change their diets to avoid foods such as popcorn, seeds and nuts, since these can get caught in the pouches and cause pain. Other women, hampered by abdominal pain, reduce their physical activities or make other lifestyle changes.

About 5 percent of cases develop into the worse-case scenario, when diverticula rupture and cause serious infection or when they bleed, which can result in a significant hemorrhage. However, most of us with diverticulosis can control the problem ourselves and stay as young as we should feel. Here's how.

Bulk up. Eat more vegetables, more fresh fruits, more whole grains. If you don't eat much fiber now, you should work up to it gradually. "Eating too much fiber too soon can make symptoms worse," says Alex Aslan, M.D., a gastroenterologist in private practice in Fairfield, California. Start by adding a few small servings of fiber-rich foods--fruits, vegetables, pastas, brown rice, beans, bran or whole-grain cereals and breads--to your diet, and gradually include more each day for about six weeks until you consume at least 25 grams of fiber daily. If you can't eat that much fiber, consider taking an over-the-counter fiber concentrate (such as Metamucil).

Don't smoke. Besides being the single worst thing for your overall health, smoking is terrible for those with diverticulosis, says Stephen B. Hanauer, M.D., professor of medicine in the Section of Gastroenterology at the University of Chicago Medical Center. Smoking may increase movement in your intestines, but the nicotine decreases blood supply, which causes or increases cramps.

Work it out. Any type of exercise helps by increasing activity in your intestines, which improves bowel function, says Dr. Aslan. Shoot for at least 20 minutes of continuous exercise no less than three times a week.

Irritable Bowel: Take Control

Here's a disease that some experts say might be as widespread as the common cold--and that causes even more misery. Doctors aren't sure what specifically causes irritable bowel syndrome (IBS) or even how to treat it. But IBS--sometimes called a spastic colon--is the diagnosis for people who are regularly annoyed with constipation, diarrhea, bloating, nausea or abdominal cramps, either singly or in some combination and usually with abdominal pain.

The good news (if there is any) is that you will probably outgrow your problem. "IBS is more of a problem in those in their twenties to fifties," says Dr. Mehta. "But at any age, it has some significant aging effects." Many patients find themselves planning their lives around these symptoms, he says. "You don't know whether you'll suddenly need to rush to the bathroom, so you plan your day-to-day activities with this in mind."

But having an irritable bowel doesn't have to put you in that mind-set. While you should see a doctor if you suspect that you have IBS, there are plenty of things you can do to lessen its symptoms.

Control your sweet tooth. Limiting the amount of sugar you eat is a key to putting the bite on IBS-triggered diarrhea. That's because sugars--especially fructose and the artificial sweetener sorbitol--aren't easily digested, which can cause the runs, says Dr. Hanauer. These sweeteners are in most sugar-free or low-calorie candy and gums as well as store-bought fruit juices. So if you like juice, make your own with a juicer.

Chill out. Being under stress makes IBS symptoms worse, and conversely, not being stressed out can help, adds Dr. Hanauer. He suggests that women under the gun manage their stress with the help of relaxation therapy techniques such as meditation, self-hypnosis, biofeedback and regular exercise. You can also keep a "stress diary" to help you determine the source of your difficulties.

Warm up. Abdominal cramps may be relieved with a heating pad placed directly on the painful area, says Arvey I. Rogers, M.D., chief of gastroenterology at the Veterans Administration Medical Center in Miami. Just be sure to place it on the low setting to prevent burning your skin.

Cramps from an irritable gut may not respond to heat. See a doctor if your symptoms are persistent.

Watch what you drink. Coffee and other caffeinated drinks can aggravate IBS by speeding up motility, the pace at which stools move through the bowels--bad news if you're prone to diarrhea. Besides that, there's a chemical in coffee that can cause cramping, says Dr. Aslan. Meanwhile, milk may not be much better, because some people with IBS also have lactose intolerance.

Feast on fiber. A high-fiber diet tends to quiet that kvetching colon. Fiber increases stool production and reduces intestinal pressure, which can benefit those with either constipation or diarrhea (or both), says Dr. Hanauer. People with IBS are advised to eat up to 35 to 50 grams of fiber a day. Start by adding about three tablespoons of pure bran to your cereal each morning and eating at least four servings of fruits and vegetables each day. Grains and beans are great sources of fiber. Shoot for a cup of beans or other legumes a day. Other fiber-rich foods include whole-grain breads and cereals, pastas and brown rice. But add fiber to your diet gradually to help avoid its gassy side effects.

Ax fat. Fatty foods can make your stomach empty more slowly, causing nausea and bloating, says Dr. Aslan. So avoid cheeses, ice cream, rich desserts, fried foods and fatty meats such as hot dogs, sausage and bacon.

Inþammatory Bowel: Calm the Intestines

Inflammatory bowel disease is a catch-all name for two similar conditions: Crohn's disease, a chronic inflammation of the intestinal tract; and ulcerative colitis, in which the large intestine gets inflamed and riddled with ulcers. In each case, the main complaints consist of some combination of abdominal pain, rectal bleeding, cramps, weight loss, diarrhea and sometimes fever along with malabsorption, or the inability to take up and use nutrients from food. This, of course, can leave you feeling weak and fatigued, especially when you consider that a bout with inflammatory bowel disease (IBD) can last two to three weeks or longer.

So what causes IBD? Most research points to either a glitch in the immune system or an inherited genetic defect or weakness in the gut, since IBD tends to run in families. But IBD doesn't have to cost you your youthful vitality. With appropriate measures, you can still stay in the game. Here's how.

Eat light. "Avoid great blowout meals," advises Sidney Phillips, M.D., director of the gastroenterology research unit at the Mayo Clinic. The more you eat, the harder your already inflamed intestines have to work.

Grab some shut-eye. Never pass up an opportunity to nap. While your symptoms are acting up, it's important to get as much sleep as possible to keep you from getting excessively tired, mentally or physically, says Dr. Phillips.

Know when to ease off. If your symptoms are mild, a high-fiber diet is important. Eating plenty of fruits, vegetables and whole-grain breads and pastas can help control constipation and diarrhea by absorbing the extra water in your intestines, says Samuel Meyers, M.D., clinical professor of medicine at Mount Sinai School of Medicine of the City University of New York. But when symptoms get severe, hold off on fiber until things improve. Too much fiber during a bout with IBD can actually make things worse.

Soothe your symptoms with nonprescription medication. Many IBD symptoms can be kept in check with over-the-counter antacids and diarrhea medications, says Dr. Phillips. Of course, most women with IBD also need prescription medications to see them through the worst days.