All things gastro
Stomach and digestive problems are very common problems in General Practice. This article will explore some of the main causes and when you should go see your GP.
Abdominal (stomach) pain
Abdominal pain can be a sign of many different illnesses. If your symptoms persist it is really important that you see your GP to discuss them. Stomach pain that is short lived may simply be due to trapped wind or a change in diet. This can result in intestinal spasm which manifests as a crampy pain. Some over the counter antispasmodic/anti-cramping medication can help settle such symptoms.
Abdominal pain can be suggestive of a variety of conditions. The site, nature, severity and duration of pain can help us to diagnose the most likely cause. Conditions such as appendicitis, gastritis, stomach ulcers, gallstones, urinary tract infections, ovarian cysts tend to have quite specific pain patterns.
People who struggle with other stomach and digestive problems such as irritable bowel syndrome can have more vague, irregular abdominal pain symptoms and patterns.
Gastroenteritis & food poisoning
Illnesses such as gastroenteritis or food poisoning can present with quite severe abdominal pain, which reflects the bowel in a spasm reacting to the presence of a stomach bug. A common cause of gastroenteritis is Norovirus. This is also known as the Winter Vomiting Bug. It usually starts with sudden onset fever, nausea, abdominal pain, vomiting and diarrhoea and can be very debilitating but symptoms usually settle within 24-48 hours. You should avoid school/college/work for 2 days after your symptoms have stopped. This is during this period that people tend to be most infectious. It is important to try to keep well hydrated, oral electrolyte solutions are very helpful, and to get plenty of rest. You may not feel like eating and this is fine as it is wise to let the gut rest. It is best to avoid over the counter diarrhoea-slowing medication to let the infection work its way out of your system.
There are plenty of other bacteria that can be picked up from contaminated water or food both at home and while travelling abroad. They can be spread if food is not stored or prepared properly or if handled by someone who has not washed their hands correctly, potentially exposing others to germs. Often this type of infection settles without treatment after a few days. However, an antibiotic can be effective in certain cases. Certain bacteria may cause blood to appear in the stool. For persistent symptoms a stool sample may be sent to the laboratory to try to identify the culpable bacteria so that treatment, if required, can be more targeted.
Constipation is a common problem. It is can be related to various issues, such as Irritable Bowel Syndrome, dehydration and it can also be diet related, e.g. a diet low in vegetables, fruit, fibre. If your bowel habit keeps changing, for example more constipated, or looser bowel motions than your usual pattern, it is important to discuss this with your GP. It can indicate a more serious intestinal problem that a specialist may need to investigate.
Travelling can have an impact on your digestive system and people often complain of constipation whilst on holidays. This is often due to a change in your usual dietary habits, dehydration, lack of physical activity. It is so important to try to follow your usual routine in terms of meal times, keeping well hydrated and exercising regularly so as to keep you as ‘regular’ as possible.
Irritable Bowel Syndrome
Symptoms of Irritable Bowel Syndrome (IBS) include intermittent crampy abdominal pain, bloating, flatulence, diarrhoea, constipation. These reflect a disturbance in the manner in which the bowel ‘functions’, tending to be ‘overactive’ in IBS. It is important to talk to your GP to get proper guidance in terms of treatment, which can be wide-ranging. Depending on your symptoms, other tests may be done to rule out other potential bowel problems.
Managing IBS can be challenging. Lifestyle changes are an important factor in helping to get a handle on your symptoms. It can be helpful to keep a food and symptom diary to check if any correlation between the two. A trial of eliminating potential culprit foods can be beneficial. Peppermint oil, antispasmodic medication and even probiotics can have a positive impact.
Gastritis is the term used to describe inflammation of the lining of the stomach. This can have various possible causes such as infection with bacteria (H. Pylori), frequent use of medication such as ibuprofen or aspirin, excessive alcohol intake, heightened stress levels and can also be dietary related. Gastritis triggers acid secretion from the lining of the stomach and this can manifest as stomach pain, unpleasant upper abdominal pain, indigestion, vomiting or even chest pain.
As well as lifestyle changes such as stress reduction, reducing or avoiding alcohol intake and heavy spicy food, gastritis can be treated with medication that reduces stomach acid. A stool sample test can also be done to look for H. Pylori bacteria, which is treated with a specific course of antibiotics. Sometimes, if symptoms persist despite a full course of medication, referral on to see a Gastroenterologist for further investigation may be necessary. Stomach ulcers are raw, open areas in the stomach lining that can arise from untreated gastritis which is commonly caused by the reasons outlined above.
Symptoms that require urgent attention
There are certain symptoms which ring alarm bells more than others. If you find you are vomiting blood, you should see your doctor without delay or go straight to A&E. Bleeding from the back passage can be suggestive of common problems such as haemorrhoids, anal tear or fissure, colon conditions such as benign colon polyps, bowel inflammation or more sinister reasons like colon cancer.
Any bleeding from the rectum should be assessed by your doctor without delay. Common presentations such as haemorrhoids (small swellings which are inflamed veins around the anal area) anal tears (both of which can prove to be very uncomfortable, particularly when passing a bowel motion) can be treated with topical creams, or pessaries (small tablets that dissolve once inserted in to the anus). Passing blood from the back passage can also be a sign of something more serious, so this should never be ignored. Sometimes people require a camera test in to the back passage to determine the cause of bleeding. This would involve a referral to a specialist.
If you experience unintentional weight loss over a few months, i.e. if your clothes are becoming looser despite not dieting, you should discuss this with your GP without delay so that any potential digestive causes can be rule out.
How we can help
London Doctors Clinic provides a same day doctor service, seven days a week, catering for all your medical concerns, however big or small they may seem to you. It is important to be aware that there is always help available and not to ignore a health concern that you are worried about. Even if you may be a little embarrassed about discussing certain tummy issues, rest assured we have heard it all before and it is very much part of our day to day interactions with patients.
Article written by Dr Julianne Barry, General Practitioner
Published: November 2018
Review date: November 2021