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Symptoms


There are many different symptoms that affect people with varying degrees of seriousness for their gut health.

Review the categories following and click through to read further about each symptom.

Abdominal pain
Bad taste
Belching and burping
Black stools
Bloating
Blood in stool
Chest pain
Constipation
Diarrhoea
Dysphagia
Haematemesis
Halitosis
Hiccups
Indigestion
Jaundice
Malaena
Nausea
Pruritus ani
Rectal bleeding
Reflux
Vomiting
Wind/flatulence

Abdominal Pain


Many people suffer from stomach aches at one time or another. Research shows that 30% of Australian adults suffer stomach aches and cramps every few months or more. The key thing to remember is that pain is an important sign that something is wrong. So dealing with this pain in the most appropriate way (or consulting your doctor at the right time) is important so you avoid making the situation worse.
 
There are many available treatments that can be very effective in treating stomach pain. However, some more severe symptoms will indicate the need for medical intervention and you should make plans to see your doctor I these circumstances.
 
Do not consider self treatment if the pain is:
  • Severe and getting worse
  • Associated with weight loss
  • Associated with bleeding from the bowel
  • Associated with difficulty swallowing
  • Associated with persistent vomiting
 
There are many conditions that can contribute to stomach pain.
 

Common conditions that cause stomach pain

Gastroenteritis  
The pain can be caused by a range of things and can be felt at different parts of your stomach. Sometimes it might be higher up under your rib cage or at other times lower down in the lower regions of your stomach.
 

The location of pain can tell you a lot about its causes

If the pain is felt either all over your stomach area or low in your stomach:
  • The pain is likely to be coming from the bowel if it is associated with constipation, bloating, diarrhoea or wind.  This pain may be due to spasm in your muscles and may be relieved by antispasmodics such as Buscopan®, or Donnatab®.
  • The pain may be due to gas and may be dietary related.  It may be helped by gas reducers, such as Gasbusters®, or by dietary review (see an accredited practicing dietitian).
  • Period pain is low down, may radiate to the back and may be dull or crampy.  Anti-inflammatory medicines may be helpful for this condition.
  • However, in the case of stomach cramps and spasms associated with period pain, antispasmodics can also be used.
 
If the pain feels like it is coming from high up in your stomach ie, high up under your rib cage:
  • If it is associated with heartburn, belching; made worse or relieved by food, it may be caused by acid and may be related to reflux or an ulcer.  Acid related pain is best treated with antacids or acid lowering drugs.  Make sure you check with your pharmacist.
  • If you feel severe pain in the middle area of your stomach going through to your back, this raises the possibility of gall stones and you should check with your doctor.
 
Pain high up in your stomach which is made worse by exercise could be angina or heart pain and you should check with your doctor.
 
Note: If lower abdominal pain is:
  • Recent in onset
  • Associated with bleeding or a change of bowel habit and you are over 40…it could be a serious bowel disease, and you should check with your doctor.

Medication and stomach pain

Antispasmodics can be particularly useful in dealing with stomach aches and cramps.  Rather than simply mask the pain, the work to relax the stomach muscles that cause aches, cramps and discomfort.
 
Some medications can cause stomach pain as a side effect. If you are suffering from recurring stomach pain then it may be worth consulting your pharmacist or doctor to review the medicines you are using.
 
Some medications can cause abdominal pain such as:
  • Anti-inflammatories
  • Anti-dementia drugs
  • Aspirin

Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) are not safe to treat abdominal pain, except for period pain as they may cause or aggravate a stomach ulcer or bowel problem.
 
Some of these products are available in supermarkets in Australia (eg ibuprofen) and you should always check the warnings on the labels. If they cause side effects like stomach ulcers and tummy pain, it will warn you of this on the pack.

Bad taste


A bad taste in the mouth is also a common problem and often does not have a gastrointestinal cause.  It may occur acutely in a variety of diseases. It can disappear as quickly as it came.  At other times it can persist and this is particularly true in older people and may be due to damage to the nerves that line in the mouth and tongue.

Belching and burping


Belching and burping are common accompaniments of dysmotility. Repetitive burping may have a psychological cause.

Black stools


The passage of tarry black motions is usually due to bleeding high in the gastrointestinal tract, such as the stomach or duodenum the blood has been altered in colour by the action of the stomach acid.  Black stools may occur if the bleeding arises from the colon especially on the right side near the appendix and its slow passage through the colon allows time for its colour to be altered from red to black.  It has the same significance as haematemesis (vomiting blood) and warrants early investigation and replacement of blood loss if necessary.

Bloating


Bloating is a common problem, especially in women.

it is usually consists of distension of the lower abdomen, so that while the abdomen might be flat in the morning, by the end of the day it is distended and uncomfortable, often requiring a change of clothes to something looser.  It may or may not be accompanied by constipation. 

The distension is often aggravated by high fibre foods which generate gas.  Women with the complain of bloating have a bowel that is easier to distend and this gives the appearance of containing more gas.

Blood in stool


Blood in the stool can be either bright or dark. Where the blood is bright red or drips or sprays at the end of defaecation or is seen only on toilet paper, the source of bleeding is in the last half metre of the bowel and commonly due to haemorrhoids or local ano-rectal conditions. Proctoscopy and colonoscopy are required.

When the blood is dark or mixed with the stool full investigation of the bowel with colonoscopy is required.  Red blood with diarrhoea or rusty mucus may accompany inflammatory bowel disease.

Chest pain


Chest pain arising from the oesophagus may mimic that of heart pain and occur behind the breast bone.  It is commonly due to acid reflux or spasm of the muscles in the oesophagus and may be accompanied by dysphagia.  It can also occur when there is obstruction to solids during the process of eating.  Discomfort with hot and cold drinks (odynophagia) this represents inflammation of the oesophagus (oesophagitis).

Constipation


Constipation is common and almost one person in five over the age of 30 has constipation at some stage during their life.

Constipation refers to the consistency of the stools and any difficulty in passing them, as well as the frequency of bowel movements. Normal bowel function ranges from one to two stools a day to one stool every three to four days. Not everyone who has infrequent stoools will have other symptoms of constipation such as bloating or discomfort.

The medical definition of constipation is the infrequent passage of small or hard stools with or without straining.

What an individual believes is constipation may not match this definition. Symptoms commonly reported as constipation include:
  • Straining
  • Hard or lumpy stools
  • Incomplete evacuation
  • Unproductive calls to stool
  • Abdominal bloating/distension
  • Infrequent stools

Diarrhoea


Diarrhoea is the too frequent passage of a too liquid stool. It is the result of an increase in the excretion of water and usually electrolytes from the bowel and is perceived as excessive by the patient even though it might be only one stool per day. There are severe social consequences, especially when accompanied by abdominal pain, urgency and incontinence.  Should diarrhoea usually has an infectious basis and is short lived, lasting 24-48 hours. Persistent diarrhoea for weeks or months has a variety of causes that warrant investigation, common conditions include Irritable Bowel Syndrome, diverticular disease, adult coeliac disease and microscopic colitis. When occurring after the age of 40 it always requires exclusion of bowel cancer.

Dysphagia


Dysphagia may be either for solids or liquids or both.  Dysphagia of solids usually occurs with some element of obstruction in the oesophagus, often secondary to acid reflux and narrowing of the oesophagus, but can be due to cancer.  When there is difficulty in swallowing liquids it usually indicates a muscular disorder of the oesophagus. When fluid refluxes through the nose when swallowing this is usually associated with a brain or spinal cord problem. The site of the dysphagia may be poorly located in terms of where the obstruction occurs.  There is often a choking sensation in the pharynx when there is poor muscular activity. Dysphagia always warrants investigation, particularly if there has been associated weight loss.

Haematemesis


Haematemesis is the vomiting of blood from the upper gastro-intestinal tract although the bleeding site may be either in the oesophagus, stomach or duodenum. The blood may be bright red, dark red or the colour of coffee grounds because it has been altered by acid in the stomach. It is a highly significant symptom that is usually considered to be a medical emergency. If the bleeding is of such severity it may cause loss of blood volume with faintness, a fall in blood pressure, sweating, palpitations, facial pallor and even loss of consciousness. Common causes are bleeding from ulcers, splits in the lining of the oesophagus and less frequently gastric cancer and sometimes from oesophageal varices.

Halitosis


Halitosis or bad breath – this is common and may be persistent or recurrent.  While the usual factors include gum disease, rhinitis, laryngitis, chronic tonsillitis and some tumours in the pharynx and commonly the cause is not due to acid reflux. Analysis of the gases that cause halitosis show that they are volatile sulphides which can arise either from the mouth or the colon. When produced in the colon these gases are reabsorbed and expired on the breath.  Some sulphur gases that originate in the mouth disappear shortly after teeth cleansing only to return over the next hour.  In contrast other gases which originate in the gut are largely unaffected by brushing of the teeth. Garlic is a good example of the cause of bad breath with early bad breath being due to garlic in the stomach but garlic breath in the morning is due to gases generated from the colon.

Hiccups


A hiccup is due to irritation of the diaphragm perhaps from an over inflated stomach.  It rarely has a gastrointestinal cause.

Indigestion


Indigestion or heartburn is a sense of burning discomfort usually high in the abdomen under the rib cage or behind the breastbone. Indigestion is usually and often related to acid - the common causes being hiatus hernia with acid reflux, or peptic ulceration.  The indigestion may or may not be precipitated by food.

Jaundice


Jaundice is a yellow appearance of the whites of the eyes or skin that occurs in association with bile duct or liver disease.

Malaena


Melaena is a passage of tarry black motions usually due to bleeding high in the gastro-intestinal tract, such as the stomach or duodenum the blood has been altered in colour by the action of the stomach acid. 

Melaena may occur if the bleeding arises from the colon especially on the right side near the appendix and its slow passage through the colon allows time for its colour to be altered from red to black.  It has the same significance as haematemesis and warrants early investigation and replacement of blood loss if necessary.

Nausea


Nausea is a common symptom which can be due to a wide variety of causes including gastrointestinal, neurological, hormonal disorders and as a side effect of medications. In older people it often represents poor muscular contractions and may be accompanied by some difficulty in swallowing, a choking sensation in the throat, inability to eat large meals, epigastric bloating and burping.

Pruritus Ani


Pruritus Ani is itchiness around the outside of the anus between the buttocks. 


Itching in the anal area of Puritis Ani can range from an occasional irritation to a socially disabling discomfort of sufficient intensity to prevent sleep and disrupt daily living.
 
There are 3 key factors to consider:-
 
  1. The major underlying problem is moisture in the anal area. Unless this can be corrected no long term solution is possible.
  2. Secondary chemical dermatitis. Once the soggy, mildly inflamed skin as a result of perianal moisture starts to itch, scratching, toilet paper use etc will result in micro abrasions and skin splitting.  This allows chemical to penetrate through the skin. This results in a progressively worsening downward spiral of chemical dermatitis. This will not be solved until ALL chemicals are removed from the area.
  3. The continuous or long term use of steroid creams leads to atrophy and fragility and of the perianal skin exacerbating all of the above problems.
 

Rectal bleeding


Rectal bleeding Can be either bright or dark re where the blood is bright red or drips or sprays at the end of defaecation or is seen only on toilet paper, the source of bleeding is in the last half metre of the bowel commonly due to haemorrhoids or local ano-rectal conditions. Proctoscopy and colonoscopy are required.


When the blood is dark or mixed with the stool full investigation of the bowel with colonoscopy is required.  Red blood with diarrhoea or rusty mucus may accompany inflammatory bowel disease.

Reflux


Reflux occurs when gastric contents that flow upwards into the oesophagus and perhaps into the mouth.  It may have an acid taste or contain bile. It can occur acutely in gastrointestinal infections or be a secondary to a hiatus hernia or gastric dysmotility.

Vomiting


Vomiting may be due to a variety of diseases, particularly in the upper gastro-intestinal tract and these include gastric and duodenal ulcers and reflux oesaphagitis. Vomiting may also be a feature of gastro oesophageal reflux.  If vomiting occurs soon after swallowing and consists of fresh food there may be obstruction in the oesophagus.  Vomiting may also occur in the older population when dysmotility is present. It can occur when there is obstruction in the small intestine or the colon, the vomitus usually is bile stained and contains mucus and altered food.  When the obstruction is lower down in the bowel there may be a smell suggesting faeces in the vomit. Medication is another cause of vomiting.

Wind/flatulence


Between 500 and 1500 mL of flatus is produced every 24 hours.  There are no reports of significant differences in the volumes generated by men and women.  However, men report more emissions than women (12 times a day for men and 7 times a day for women; with a range for both sexes of between 2 and 30).

The number of emissions depends on the fibre content of the diet, with higher fibre levels generatin more flatus.  The usual emission volume is 90 mL.

There is little relationship between the number of times a person passes flatus and the total volume, suggesting that the size of emissions varies among individuals because of different sensitivities to gaseous distension of the rectum.
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