Digestive health changes: When to seek medical care

It's been an eventful year in the world, and if it seems like it's been a bumpy ride for your gastrointestinal tract, too — with bouts of heartburn, diarrhea, or constipation — this is a good time to consider whether you've been experiencing temporary symptoms or signs of something more serious or chronic.

Identify your distress

The first step in understanding gastrointestinal distress is putting a name to the problem.

Heartburn. This fiery feeling in your chest is usually caused by stomach acid that leaks upward into the esophagus (the tube connecting your mouth and stomach). It occurs when the ring of muscles that normally stop leakage temporarily loosen or aren't working well. Heartburn might also cause a sore throat, a cough, or a metallic taste after meals.

Constipation. If you're not having a bowel movement at least three times a week, that's considered constipation. Or if your stool is hard and lumpy and you strain to get it out or you have the feeling you aren't evacuating completely, that's also constipation.

Diarrhea. Diarrhea is watery, unformed stool. It usually doesn't feel great as it's brewing in your gut, and it's often uncomfortable to pass it.

What's causing the trouble?

The digestive tract is a sophisticated yet sensitive system that can be disrupted anywhere along its route from the mouth to the anus—and it doesn't take much to cause temporary discomfort.

For example, stress can slow digestion and cause constipation, increase acid production and trigger heartburn, or speed digestion and send you running for the bathroom with diarrhea. "We call the gastrointestinal tract the 'second nervous system.' There are many nerve endings going to all parts of it, including the stomach, small intestine, and large intestine. Stress might result in the brain telling the tract how to react, even when there might not be anything wrong structurally," says Dr. Alexander Goldowsky, a gastroenterologist at Harvard-affiliated Beth Israel Deaconess Medical Center.

Other possible causes of occasional gastrointestinal problems include your diet, weight gain, an infection, or a medication side effect.

Coping with occasional bouts

If you've been experiencing new digestive issues, try making a few changes to see if symptoms go away in a few days or weeks.

For heartburn. Two approaches can help. One is using over-the-counter medications. Dr. Goldowsky recommends taking a fast-acting drug that targets stomach acid. Examples include calcium carbonate (Tums), aluminum hydroxide (Mylanta), and H2 blockers such as famotidine (Pepcid) and cimetidine (Tagamet).

The other approach is making lifestyle changes. Avoid foods and drinks that seem to trigger your heartburn, such as spicy, fatty, or tomato-based foods; citrus; garlic; onion; peppermint; and anything with caffeine, such as chocolate, tea, or coffee.

Also: eat smaller meals, stay upright for at least two hours after meals, avoid drinking alcohol or eating late at night, and sleep on a wedge pillow.

For constipation. To combat constipation, Dr. Goldowsky advises taking a powdered fiber supplement that you add to food or drinks, such as Metamucil, Benefiber, or Citrucel. "Fiber is a miracle. It helps stool form a shape and get out, so you feel empty," Dr. Goldowsky says.

He also recommends increasing fiber in your diet (great sources include beans, lentils, peas, whole grains, berries, nuts, seeds, artichokes, pumpkin, and brussels sprouts). "Your total goal should be around 30 grams of fiber per day," he says, "but it's hard to reach that goal with food. That's why the supplement is important."

Other ways to fight constipation include drinking more fluids to help stool move along, and exercising every day (which keeps the muscles in your intestines strong).

For diarrhea. Dr. Goldowsky recommends using a fiber supplement for this problem, too, since fiber helps stool form properly. It's also essential to stay hydrated to replace fluids you're losing through diarrhea.

Additionally, it's a good idea to keep track of foods that might be triggering diarrhea. Common culprits include dairy foods; foods that contain gluten, artificial sweeteners, or caffeine; fried, fatty, spicy, or sugary foods; and foods with natural sugars that are difficult for some people to digest, such as those in wheat, rye, onions, garlic, legumes (chickpeas, lentils, beans), honey, pistachios, cashews, asparagus, artichokes, and sun-dried tomatoes.

It might also help to take an anti­diarrheal medication such as loperamide (Imodium).

"Medications for diarrhea are helpful, but they can overdo it and cause constipation. Take a few doses and see how you feel, then gradually reduce the amount you're taking," Dr. Goldowsky says.

When to call your doctor

Call your doctor immediately if your symptoms include bloody stools, fever, loss of bowel control, severe pain, or severe dehydration. If you don't have those symptoms but you do have heartburn, diarrhea, or constipation that isn't going away after a week or two of home remedies, it's time to see your doctor. "We don't want to miss colon cancer or inflammatory bowel disease," Dr. Goldowsky says. "These are unlikely causes of such symptoms, but we need to rule them out."

Your physician will also rule out other disorders that can cause gastrointestinal problems (such as low thyroid function), gut changes that affect how fast food moves through the digestive tract, and medication side effects that might be causing trouble.

The encouraging news is that there's usually a way to treat the problem, including specialized diets, physical therapy, or medications. "Don't give up. We can get you feeling better," Dr. Goldowsky says. "My goal is for you to be able to control or eliminate your symptoms so you can function well and have a better quality of life."

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