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Intestinal Fortitude
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A change of eating habits and exercise can head off the kind of trouble that starts deep in the bowels
By Marie Berry
 Until something goes wrong, the bowel, or gastrointestinal tract, is a part of the body we usually take for granted. Luckily, the bowel is autoregulating — we don’t have to think about it for it to work. When it doesn’t work properly, a lot can go wrong. Indigestion is just the tip of the iceberg.
The bowel is responsible for digesting the food we eat while continually supplying our bodies with water, electrolytes and nutrition. Basically a 15-foot tube, it extends from mouth to anus, with muscles called sphincters at the esophagus and small bowel, which open and close to help keep the flow moving in the right direction.
It takes about eight to 10 hours for an average meal to move through the bowel. Once swallowed, food passes through the esophagus to the stomach, where acid and enzymes begin to break it down. The partially digested food, or chyme, then moves into the small intestine, where peristaltic contractions mix it and more secretions are added. Through the small intestine, the body begins to absorb the food, broken into even smaller molecules of nutrients. When the food reaches the large intestine, the body reabsorbs both water and minerals, and excretes the waste rectally as feces.
Glitch-free, that’s the way the gastrointestinal tract is supposed to operate, without drawing attention to itself. But after, say, a large, rich dinner, you may certainly notice your gastrointestinal tract. That queasy feeling is dyspepsia, more commonly known as indigestion. Some foods, like alcohol and those with caffeine, are often linked to it. So are some antibiotics, such as the erythromycins. Indigestion can also accompany pregnancy, diabetes and plain old overeating.
Here are more of the possible health problems that confront us when something goes wrong with our bowels.
Upset stomach
Nausea and vomiting are controlled both by the stomach and the vomiting centre in the brain. An intensely disagreeable feeling, they can result from overeating or specific foods or beverages, like alcohol. Nausea and vomiting are also related to motion sickness, pregnancy or infections like the flu. Antinauseants like dimenhydrinate and scopolamine patches are able to alleviate the discomfort, however, lost fluids may have to be replenished with clear liquids.
Constipation
When stools are too hard, too small or too infrequent, we become constipated — a condition often linked to pregnancy and the use of some drugs, like narcotic analgesics, and which can lead to diverticular disease. What’s too infrequent? Three to 12 bowel movements per week is considered average, but everyone has a different average. Regular toilet habits, dietary fibre, fluid intake and an active lifestyle will prevent constipation, which is usually self-limiting. If a laxative is necessary, it should only be used for a short term of two to three days, and stool softeners such as docusate or bulk-forming laxatives such as psyllium are preferred.
Gas
Everyone has gas, generally five to 21 times a day and characterized as flatulence or bloating. Flatulence, specifically burping, is almost always a result of swallowing air, common when chewing gum, drinking carbonated beverages, breathing deeply, sighing or wearing ill-fitting dentures. Avoid gas by choosing foods that don’t produce it and trying not to swallow air.
• Flatulence in the lower bowel is most often related to the metabolism of carbohydrates, like baked beans, which produces carbon dioxide, hydrogen, methane, nitrogen and oxygen gases, and small quantities of sulfur, accounting for the associated odour. Simethicone, an ingredient in nonprescription products, breaks up gas bubbles in the bowel. Products like Beano promote the digestion of carbohydrates, leaving fewer indigestible carbohydrates, reducing gas.
• Overeating and lack of bowel mobility usually lead to bloating, or a buildup of gas. To treat, apply external heat such as a hot water bottle, take a walk to physically move the bowel, eat fibre to keep the bowel moving and opt for small meals over large.
Diarrhea
Diarrhea is the increased frequency or liquidity of stools, and may be a sign of an infection or it may be related to the ingestion of some antibiotics or foods. Cramping, the dilation of the bowel from excess fluid and air, often occurs along with diarrhea. It’s important to treat diarrhea in infants aggressively because of the risk of dehydration. Check with your doctor before taking Loperamide, an effective antidiarrheal that can have side effects, but fluids are still needed to compensate for dehydration. Diarrhea is a symptom of two specific bowel conditions: inflammatory bowel disease and milk intolerance.
Inflammatory bowel disease
There are two types of inflammatory bowel disease: ulcerative colitis and Crohn’s disease. Ulcerative colitis occurs mainly in the colon and rectal areas, while Crohn’s disease, usually localized, can strike any part of the bowel. Diarrhea and cramping are common symptoms.
The most common treatments are 5-aminosalicylic acid derivatives and corticosteroids, taken by mouth or rectally.
Milk intolerance
Milk intolerance is common in older people because with age, levels of the lactase enzyme diminish. Without the enzyme, the milk sugar, or lactose, isn’t digested and remains in the bowel causing cramping and diarrhea. Avoiding milk and milk products will prevent the problem, however, lactase supplements like Lactaid are readily available.
Heartburn
Heartburn, or gastroesophagal reflux disease (GERD), occurs when the sphincter that connects the stomach to the esophagus relaxes and acidic stomach contents are able to move back up the esophagus. With age, the sphincter muscles weaken, causing older people to get heartburn more often. But drugs can also relax the sphincter — like beta blockers, anticholnergics, benzodiazepines, calcium channel blockers, opiates and theophylline. Heartburn symptoms also occur with pill-induced esophagitis, so don’t take pills while lying down and take them with lots of water.
Ulcers
Ulcers are erosions in the stomach or intestine wall, much like potholes are erosions in a road surface. About 10 percent of the population will get them, either gastric ulcers in the stomach or duodenal ulcers in the small intestine, and there is a family tendency. Antacids provide immediate relief, but H2 blockers or acid reducers and proton pump inhibitors such as omperazole reduce acid content to stop the erosion. Since H. pylori is implicated in many ulcers and the bacteria is everywhere and it’s easy to pick up, antibacterial drugs are used to eradicate it and control the ulcer. Alcohol and anti-inflammatory drugs used to treat conditions like arthritis can exacerbate or cause an ulcer.
Irritable bowel syndrome
Irritable bowel syndrome, also known as spastic or irritable colon, is characterized by abdominal pain, changes in bowel frequency, bloating and distension. Help prevent it by eating plenty of fibre, avoiding the specific foods that cause you problems, eating smaller more frequent meals and drinking more water. Laxatives treat constipation and antidiarrheals treat diarrhea, two common symptoms.
Diverticulitis
Diverticulitis is inflammation of the diverticuli, saclike pouches that develop over time and line the bowel. About one-third of people by age 60 have diverticuli, but not all have symptoms of inflammation. Debris accumulates in these pouches, which may become inflamed and infected. Eating fibre creates a bulkier stool that opens the bowel wider, easing stress and possibly preventing further divertcula from forming.
Antibiotics treat associated infections.
Polyps
Polyps are discrete lesions that protrude into the intestine. They occur with age, although there is a family tendency. Polyps may be cancerous and need to be evaluated carefully. There may be no symptoms, but once diagnosed, they may have to be surgically removed. Ask your doctor if you should be screened for polyps.
Hemorrhoids
Often a result of constipation or heavy lifting, hemorrhoids are dilated veins in swollen tissue at the anus or inside the rectum. The first sign may be bleeding when defecating, but pain during a bowel movement usually indicates an anal fissure rather than hemorrhoids. Creams and suppositories can alleviate symptoms, however, suppositories may slip too high past the affected area. Applying a hemorrhoidal cream is sometimes beneficial, but the best prevention is keeping stools soft through a high fibre and high fluid diet.
• Quit smoking; it interferes with proper bowel functioning.
• Avoid food or beverages that don’t “agree with you.” Problems are more common with coffee, chocolate, milk, dairy products, fatty and spicy foods.
• Try to maintain suitable body weight. Being overweight means your bowel may have to work harder.
• A good fibre and fluid intake, along with an active lifestyle are needed for normal bowel activity.
• Snacking before bed increases risk for GERD. Small, frequent meals can alleviate symptoms.
• Ask your pharmacist to check your medications for those that can lead to or complicate bowel problems.
• If you have a bowel problem and it persists or worsens seek medical attention.
Marie Berry is a pharmacist based in Winnipeg.
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