are living organisms thought to have good effects on one’s health. They are similar to bacteria that are normally found in the intestines that do not cause disease and are often designated “good bacteria.” The most common probiotics currently in practice contain a combination of Lactobacillus, Bifidobacterium, Streptococcus and other bacteria, or the yeast Saccharomycetes boulardii. Probiotics are present in some foods such as yogurt, fermented and unfermented milk, some juices and soy beverages. A large variety of probiotics are sold as supplements in capsule and powder form. Studies showing the utility of probiotics for immune health and gastrointestinal diseases are limited. Further discussion of the utility of probiotics for different conditions can be found in later chapters. However, it’s important to keep in mind that no generalizations can be made regarding the effectiveness of an untested probiotic for a specific condition. Furthermore, it is unknown if a probiotic good for one person will be helpful for another.
Probiotics are often given to a person on antibiotics for protection against the development of Clostridia difficile bacterial infection. This infection occurs after the antibiotics kill off other gut bacteria that might keep the C. difficile in check.
Here’s an interesting tidbit: One study in pregnant women published in preliminary form suggests that probiotics may be helpful in preventing pregnant women from developing obesity twelve months after the end of pregnancy. Further studies are needed to confirm this finding.
Prebiotics, meanwhile, are nutrients for the healthy bacteria. These nutrients, typically complex carbohydrates, are not digested by your gut and provide the bacteria a food source. Common prebiotics are inulin and oligofructose.
What are the most common stomach ailments?
Food poisoning is a biggie. It seems there’s always a new scare out there: Don’t eat raw eggs or undercooked chicken unless you want a nasty case of Salmonella or Campylobacter. Is a little taste of batter safe when you make a cake? (How many of us remember joyfully eating cake batter or cookie dough as kids?) There are warnings for raw meat, but fruit and veggies must be safe, right? Not so fast. Along comes the chance of food poisoning from contaminated spinach and tomatoes!
We’ll all get food poisoning at one time or another. Other common ailments are heartburn (GERD), constipation and diarrhea, irritable bowel syndrome (IBS), and colorectal cancer. But don’t panic. For most stomach issues, there’s a logical and highly treatable explanation. In fact, about thirty-five million people have IBS, belly pain or discomfort with a combination of gas, bloating, diarrhea or constipation. I’ll discuss this more in Chapter 3.
How do I know when to seek help?
Many people endure months or years of gas, constipation, diarrhea and/or abdominal pain. They live with it. But when is it important to seek medical attention to make sure that nothing is seriously wrong? No one wants cancer, of course, but colon cancer is usually curable if caught early. Therefore, even if you feel well and have no belly problems and no family history of colorectal cancer, it’s important to do routine screening starting at age fifty (forty-five for African-Americans). And know the warning signs below that could indicate cancer or other GI problems.
WARNING SIGNS: CONSULT YOUR DOCTOR IF YOU HAVE ANY OF THESE SYMPTOMS
1. Rectal bleeding
Any rectal bleeding is abnormal and must be checked out. Although blood only on the toilet tissue when you wipe may just indicate a local cause, such as hemorrhoids, any blood should result in you seeking attention and being examined, usually via colonoscopy.
2. New onset of abdominal pain
There are many causes of abdominal pain, some of which require immediate attention. Usually, troublesome abdominal pain surfaces suddenly, with or without fever. However, it can be present for a long time under the radar before it becomes more frequent or severe.
3. Unintentional weight loss
4. Dehydration
Symptoms can include decreased urine production, thirst, dry mouth and eyes and dizziness.
5. New onset or worsening of diarrhea
Diarrhea springing from a virus or a bacterial infection often goes away on its own but sometimes requires further treatment if it is severe, with many watery stools (with or without abdominal pain), or if the symptoms persist for a long period of time. If the diarrhea continues for more than three days, consult your doctor.
6. Sudden change in the appearance of the stools or new and persistent constipation
Pencil-like or thin stools may indicate a narrowing in the colon.
7. The sensation that you have a mass, or a hard area, in the abdomen
8. Weakness and dizziness
This could indicate dehydration or anemia.
9. Prolonged fever
10. Repeated vomiting over a short period of time
11. Sudden onset of bloating that won’t go away
Bloating can be due to gas, fluid in the abdomen, stool or sometimes a mass. If there is a blockage in the bowels, the abdomen can bloat up behind it, which usually causes pain. If you feel unusually bloated, consult your doctor.
Other problems, such as joint pain or a rash, can often be associated with gastrointestinal issues.
REMEMBER: You know your body better than anyone else. If you feel that something is wrong, check in with your doctor. Don’t be afraid!
Chapter 2
Endometriosis and Feminine GI Troubles: Symptoms Every Woman Should Understand
“Man endures pain as an undeserved punishment; woman accepts it as a natural heritage.”
—Anonymous
We women tend to feel stress in our guts more so than men, and we talk about it less, tending to bottle up our stress. We also have unique stomach issues, too, that simply don’t affect guys. In this chapter I’ll talk about women-only issues like endometriosis and infertility (5 percent of women suffer from endometriosis, and 25 percent of sufferers are infertile), and touch on some other female-centric ailments. You’ll meet two of my patients, Marci and Susan, both of whom went through excruciating journeys to finally get proper treatment. Their cases are extreme but instructive: if one is properly armed, endometriosis is treatable, but it can be very hard to detect.
Women don’t usually come to me thinking that endometriosis could be causing their gastrointestinal symptoms. In fact, many times women have either never heard of endometriosis or have had it in the past, and they certainly don’t connect this problem with any gastrointestinal symptoms, thinking it’s a purely gynecological issue. I’m not a gynecologist, and I don’t treat women for endometriosis. However, I have seen many women with GI symptoms caused by endometriosis, often erroneously diagnosed as irritable bowel syndrome. Once I suspect the diagnosis, I can refer the woman to an expert who can decide what tests should be done and what treatment should be recommended for the problem.
When I tell women that they may have endometriosis, the women usually have a laundry list of questions. This is good. I find too many doctors who are not gynecologists know very little about endometriosis, and most gastroenterologists don’t even suspect it as a possible cause of symptoms. They often settle on a diagnosis before their patient has been properly heard. In order to understand what endometriosis is, it’s helpful to review the anatomy of the gynecological tract and normal menstruation. (See Figure 2-1).
Figure 2-1. Menstruation is monthly bleeding from the uterus. The menstrual cycle is considered to start with the first day of bleeding. The next cycle begins at the time of first bleeding with the subsequent period. During the first half of the cycle (follicular phase) an egg in the ovary matures and the wall of the uterus thickens. At about day fourteen the egg is released from the ovary (ovulation) and travels through the fallopian tube to the uterus. The uterus lining continues