What causes bloating and how can it be managed. Why do hormones affect bloating. Can swallowing air lead to stomach discomfort. How do artificial sweeteners impact digestive health. Which foods are most likely to cause bloating. What is SIBO and how does it relate to bloating. How does IBS contribute to abdominal bloating. What role do food sensitivities play in bloating. How is celiac disease connected to chronic bloating.

The Complex Nature of Bloating: More Than Meets the Eye

Bloating is a common and often frustrating experience that many people face. It’s characterized by a feeling of fullness, tightness, or swelling in the abdomen. While occasional bloating is normal, frequent or severe bloating can be a sign of underlying issues. Dr. Carrie Leff, an internal medicine physician with Henry Ford Health System, emphasizes that bloating can have numerous causes, making it challenging to pinpoint a single solution for everyone.

Understanding the various factors that contribute to bloating is crucial for effective management. Let’s explore nine surprising causes of bloating and how they affect your digestive system.

Hormonal Fluctuations: The Hidden Culprit Behind Bloating

Many women experience bloating before their menstrual period, but why does this happen? Hormonal changes during the menstrual cycle can lead to:

• Salt cravings, resulting in increased water retention
• Rising progesterone levels, which may cause constipation

How can you manage hormone-related bloating? Dr. Leff recommends:

1. Regular exercise
2. Limiting salt and caffeine intake
3. Increasing water consumption
4. Using a period tracking app to identify symptom patterns

The Surprising Impact of Swallowed Air on Digestive Comfort

Did you know that everyday habits can lead to excess air in your gastrointestinal tract? Activities that may contribute to bloating include:

• Talking while eating
• Eating too quickly
• Chewing gum
• Drinking carbonated beverages
• Smoking

This swallowed air can cause bloating and may also lead to flatulence, although it’s usually odorless. Being mindful of these habits and making small changes can help reduce bloating caused by excess air.

Artificial Sweeteners: A Hidden Source of Digestive Discomfort

Many people turn to artificial sweeteners as a low-calorie alternative to sugar, but these substitutes may be contributing to bloating. Dr. Leff notes that restricting artificial sweeteners can often alleviate functional bloating – bloating not caused by an underlying condition.

Where are artificial sweeteners commonly found?

• Diet sodas
• ‘Light’ juices
• Artificial sweetener packets for coffee or tea

Instead of relying on artificial sweeteners, consider using small amounts of natural sweeteners like brown sugar. It’s worth noting that high fructose corn syrup can also cause bloating, so moderation is key when it comes to all types of sweeteners.

The Digestive Challenges of Legumes and Cruciferous Vegetables

While legumes and cruciferous vegetables are undoubtedly nutritious, they can be difficult for our bodies to digest, leading to bloating. These foods include:

• Beans and lentils
• Broccoli
• Cauliflower
• Brussels sprouts
• Cabbage
• Kale

How can you enjoy these nutritious foods without excessive bloating? Try these strategies:

1. Consume smaller portions
2. Gradually increase your intake to allow your body to adjust
3. Consider substitutions (e.g., swapping kale for spinach in salads)

Small Intestinal Bacterial Overgrowth (SIBO): An Overlooked Cause of Bloating

SIBO occurs when there’s an abnormal increase in the overall bacterial population in the small intestine. This condition can lead to various digestive issues, including:

• Bloating
• Stomach pain
• Malabsorption of food
• Other digestive discomforts

If you suspect you might have SIBO, consulting with a functional medicine physician can be beneficial. They can provide a comprehensive evaluation and develop a targeted treatment plan to address the bacterial overgrowth and alleviate symptoms.

Irritable Bowel Syndrome (IBS): A Common Culprit in Chronic Bloating

IBS is a functional gastrointestinal disorder characterized by recurrent abdominal pain and changes in bowel habits. Dr. Leff explains that IBS is diagnosed based on a pattern of symptoms after ruling out other underlying conditions. Common symptoms of IBS include:

• Bloating
• Diarrhea
• Constipation
• Abdominal pain

What triggers IBS symptoms? Triggers can vary widely between individuals and may include:

• Stress
• Certain foods
• Hormonal changes
• Sleep disturbances

Managing IBS often requires a multifaceted approach, including dietary modifications, stress management techniques, and sometimes medication. Working closely with a healthcare provider can help develop an effective management plan tailored to your specific needs.

Food Sensitivities, Allergies, and Intolerances: Unraveling the Mystery of Bloating

Undiagnosed food sensitivities, allergies, or intolerances can significantly contribute to bloating and other digestive issues. Common culprits include:

• Gluten
• Dairy
• Eggs
• Soy

How can you identify if food sensitivities are causing your bloating? Dr. Leff recommends:

1. Consulting with your doctor
2. Considering a trial elimination diet
3. Keeping a food diary to track symptoms
4. Gradually reintroducing foods to identify triggers

It’s important to note that food sensitivities can be complex, and working with a healthcare provider or registered dietitian can help ensure a safe and effective approach to identifying and managing food-related bloating.

Celiac Disease: When Gluten Becomes the Enemy

Celiac disease is an autoimmune condition triggered by gluten consumption, leading to damage in the small intestine. It’s important to distinguish between celiac disease and non-celiac gluten sensitivity, as they have different implications for long-term health.

What are the symptoms of celiac disease?

• Bloating
• Stomach pain
• Nausea
• Malabsorption of nutrients
• Constipation
• Weight loss
• Fatigue

How is celiac disease diagnosed? The process typically involves:

1. Blood tests to screen for celiac-specific antibodies
2. Endoscopy with biopsy of the small intestine for confirmation

If you suspect celiac disease, it’s crucial to consult with a healthcare provider before making any dietary changes. A proper diagnosis is essential for developing an appropriate treatment plan and ensuring long-term health.

Gastrointestinal Diseases: When Bloating Signals Something More Serious

While most cases of bloating are not cause for serious concern, persistent or severe bloating can sometimes indicate underlying gastrointestinal diseases. Dr. Leff advises seeking medical attention if you experience:

• Changes in stool consistency or frequency
• Blood in the stool
• Unexplained weight loss
• Increasing abdominal girth that doesn’t resolve
• Difficulty eating or loss of appetite

These symptoms may indicate more serious conditions such as:

• Inflammatory bowel disease (IBD)
• Gastrointestinal cancers
• Liver or pancreatic disorders
• Intestinal obstructions

Early detection and treatment of these conditions are crucial for better outcomes. If you’re experiencing persistent or concerning symptoms, don’t hesitate to consult with your healthcare provider for a thorough evaluation.

Strategies for Managing and Preventing Bloating

While the causes of bloating can be diverse, there are several general strategies that can help manage and prevent this uncomfortable symptom:

1. Keep a food diary to identify potential triggers
2. Practice mindful eating, chewing slowly and avoiding distractions
3. Stay hydrated with water and herbal teas
4. Incorporate regular physical activity into your routine
5. Manage stress through relaxation techniques or meditation
6. Consider probiotics to support gut health
7. Avoid tight-fitting clothing that can constrict your abdomen

Remember, what works for one person may not work for another. It’s important to be patient and persistent in finding the right combination of strategies that work best for your body.

When to Seek Professional Help for Bloating

While occasional bloating is normal, chronic or severe bloating may warrant professional medical attention. Consider consulting with a healthcare provider if:

• Bloating persists for several weeks
• You experience significant pain or discomfort
• Bloating is accompanied by other concerning symptoms
• Your quality of life is significantly impacted

A healthcare provider can help determine the underlying cause of your bloating and develop an appropriate treatment plan. This may involve:

1. Diagnostic tests to rule out underlying conditions
2. Referral to a gastroenterologist or other specialist if needed
3. Personalized dietary recommendations
4. Prescription medications to manage symptoms
5. Lifestyle modifications to support digestive health

Remember, everyone’s digestive system is unique, and what causes bloating in one person may not affect another. By working closely with your healthcare provider and paying attention to your body’s signals, you can develop an effective strategy to manage bloating and improve your overall digestive health.

The Role of Gut Health in Managing Bloating

Maintaining a healthy gut microbiome can play a crucial role in preventing and managing bloating. The gut microbiome refers to the trillions of microorganisms that inhabit your digestive tract. These microbes play a vital role in:

• Digesting food
• Producing vitamins
• Supporting immune function
• Regulating inflammation

How can you support a healthy gut microbiome?

1. Consume a diverse range of plant-based foods
2. Include fermented foods in your diet (e.g., yogurt, kefir, sauerkraut)
3. Limit processed foods and artificial additives
4. Consider prebiotic and probiotic supplements under medical guidance
5. Manage stress levels, as stress can impact gut health
6. Get adequate sleep to support overall health, including gut function

By nurturing a healthy gut microbiome, you may be able to reduce the frequency and severity of bloating episodes. However, it’s important to remember that gut health is complex, and what works for one person may not work for another. Consulting with a healthcare provider or registered dietitian can help you develop a personalized approach to optimizing your gut health and managing bloating.

Exploring Alternative Therapies for Bloating Relief

While conventional medical treatments are often effective for managing bloating, some individuals may find relief through alternative or complementary therapies. These approaches can be used alongside traditional treatments but should always be discussed with your healthcare provider. Some alternative therapies that may help with bloating include:

• Acupuncture
• Herbal remedies (e.g., peppermint, ginger, fennel)
• Abdominal massage
• Yoga or specific stretching exercises
• Mindfulness and meditation practices

It’s important to approach alternative therapies with a critical mindset and seek guidance from qualified practitioners. While some people may experience significant benefits from these approaches, scientific evidence supporting their effectiveness can vary. Always inform your healthcare provider about any alternative therapies you’re considering or using to ensure they don’t interfere with other treatments or underlying health conditions.

The Impact of Lifestyle Factors on Bloating

Beyond dietary considerations, various lifestyle factors can influence the occurrence and severity of bloating. Understanding and addressing these factors can be an important part of managing digestive discomfort. Key lifestyle factors to consider include:

1. Sleep patterns and quality
2. Physical activity levels
3. Stress management techniques
4. Smoking and alcohol consumption
5. Medication use (including over-the-counter drugs)

How can lifestyle modifications help reduce bloating?

• Establishing a regular sleep schedule can support digestive rhythm
• Engaging in moderate exercise can promote healthy digestion and reduce stress
• Practicing stress-reduction techniques like deep breathing or meditation
• Limiting or quitting smoking, which can introduce air into the digestive system
• Moderating alcohol intake, as alcohol can irritate the digestive tract
• Reviewing medications with your healthcare provider to identify potential contributors to bloating

Remember, making lifestyle changes can take time and effort, but the potential improvements in digestive comfort and overall health can be significant. It’s often helpful to focus on making small, sustainable changes rather than trying to overhaul your entire lifestyle at once.

Why Am I Bloated? | Henry Ford LiveWell

It happens to the best of us: you wake up feeling great, but as the day goes on, your stomach protrudes and becomes bloated. It can be incredibly frustrating, especially if it’s a frequent occurrence, and especially if it comes with discomfort and pain.  

“Equally frustrating is that there are so many causes of bloat—some being simple fixes and others being much more complicated,” says Carrie Leff, D.O., an internal medicine physician with Henry Ford Health System. “What causes one person to bloat might not be the cause of another person’s bloat. There’s not a one-size-fits-all approach to figuring out how to get rid of it. If you’re concerned, the best thing to do is share your concerns with your doctor.” 

That said, Dr. Leff shares several common culprits of bloat that you might not have known about: 

1. Hormone Fluctuations

Women often complain that they’re bloated before their period. Why? Hormonal changes can cause salt cravings, and salt leads to water retention. Also, rising progesterone levels during the second half of the menstrual cycle can cause constipation, which may improve when menstruation begins and hormone levels fall.

To ease PMS-related bloating, Dr. Leff recommends exercising, limiting salt and caffeine, and drinking lots of water. Using a period tracking app to be aware of the times when you have these symptoms (to understand the cause) can also be helpful. 

2. Swallowed Air 

If you ever talk while eating, eat too quickly, chew gum, drink carbonated beverages or smoke, your bloat could be caused by swallowed air in the gastrointestinal tract. (It can also lead to flatulence, although usually it’s odorless.) 

3. Fake Sugar 

“Many people with functional bloating (meaning bloat that’s not due to an underlying condition) can be cured by restricting artificial sweeteners,” says Dr. Leff. “Ease up on diet sodas, ‘light’ juices, and artificial sweetener packets that you mix into coffee or tea. Instead of artificial sugar, I use a little bit of brown granulated sugar in my coffee. ” (P.S. High fructose corn syrup can also cause bloating. If you want sugar, it’s usually best to go for the real thing—in small amounts!) 

4. Legumes And Cruciferous Veggies

Beans and lentils, along with cruciferous veggies like broccoli, cauliflower, Brussels sprouts, cabbage and kale, can cause bloating because they are more difficult for our bodies to digest. (It doesn’t mean they aren’t good for you—they are!) But if the bloat is bothering you, try eating them in smaller amounts and making substitutes, such as swapping a kale salad for spinach. 

5. Small Intestinal Bacterial Overgrowth (SIBO)

SIBO, or small intestinal bacterial overgrowth, occurs when there’s an overgrowth of gut bacteria in the small intestine. It can lead to bloating, stomach pain, malabsorption of food, and other digestive issues. If you suspect you might have SIBO, seeing a functional medicine physician may be helpful. Learn more about SIBO here.

6. Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome is a symptom-diagnosed condition that leads to bloating, diarrhea and constipation. “IBS is a diagnosis of exclusion, meaning all of the testing has failed to reveal any underlying disease and diagnosis,” says Dr. Leff. “The diagnosis is made based upon a pattern of symptoms. Many things (from stress to food) can trigger these symptoms, and triggers are different for every patient.”   

7. Food Sensitivities, Allergies And Intolerances

An undiagnosed food sensitivity, allergy, or intolerance can lead to bloating, diarrhea or nausea. (Gluten, dairy, eggs and soy are common foods that people react poorly to.) “If you suspect that a food sensitivity or intolerance is the cause of your bloat, see your doctor and consider a trial elimination diet,” says Dr. Leff.    

8. Celiac Disease

Gluten sensitivity and celiac disease are two different issues: celiac disease is an autoimmune condition that damages the lining of the gastrointestinal tract in the small bowel; a non-celiac gluten sensitivity doesn’t cause significant structural damage. Celiac disease not only causes bloating, but stomach pain, nausea, malabsorption of food, constipation, weight loss and fatigue.  You can get a blood test, which may indicate that there is a problem, but the diagnosis is made with a biopsy of the first part of the small intestine.

Cutting out gluten is the main method of treatment, however, talk to your doctor before making this change.

9. Gastrointestinal-Related Diseases

More significant diseases can cause bloating. “If you’re experiencing changes in your stool, blood in your stool, weight loss, an increasing abdominal girth that’s not going away, or if you’re unable to eat, you should talk to your doctor,” says Dr. Leff. “However, most of the bloating we see is likely related to what you’re eating and how you’re eating it.”

So, how to change the way you eat? Dr. Leff recommends starting with mindful eating. “Put down your fork in between each bite and don’t put more food in your mouth until you have finished chewing,” she says. “Give your body time to feel full. Eat when you’re hungry, not when you’re tired, thirsty or bored. If you’re not sure whether you’re thirsty or hungry—since the same part of the brain controls thirst and hunger—drink a glass of water, wait five to ten minutes and then if you’re still hungry, eat. You don’t have to starve, just eat with intention.” 

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To find a doctor at Henry Ford, visit henryford.com or call 1-800-HENRYFORD (436-7936).

Dr. Carrie Leff is an internist, pediatrician and a certified menopause provider with Henry Ford Health System. She sees patients at Henry Ford Medical Center in Bloomfield Township. 

Why Am I So Bloated?

Foods that contain certain types of fermentable fibers or sugars that can also create a “large amount of intestinal gas hours after being eaten when they encounter the bacteria living in the colon,” says Freuman. “The foods in this category are collectively known as ‘high FODMAP,’ and they range from foods we typically think of as ‘gassy,’ like beans and Brussels sprouts, to those that may surprise you, like cashews or watermelon.” There’s a twist, though: Freuman says that not every high-FODMAP food makes everyone gassy—it’s different for everyone. She suggests talking to a dietician trained in the low-FODMAP diet to identify which foods are triggers for bloating for you.

The list goes on: Soda and other fizzy drinks (sorry, LaCroix-lovers) shuttle gas that’s not burped out to the intestines. Artificial sweeteners can’t be digested, which makes them likely to cause bloat. If you have trouble with gluten or dairy, those can cause issues, too.

Honestly, it’s hard to avoid bloat-causing foods.

There are other culprits for bloat, too: If it’s getting near your period, then yes, your cycle can also have a lot to do with it: “Increased sodium levels lead to more water retention,” says Sonpal. “For those looking to reduce water retention and improve menstrual bloating, it’s best to avoid refined carbohydrates and high sodium foods.”
Regular exercise might help with bloating during your period, too.

How to De-Bloat

It’s annoying that something so frustrating to deal with can be caused by so much of what we ingest. The fix isn’t so much about preventing bloating 100% of the time, as it is from treating the symptoms when they show up.

If there’s a common thread you might be picking up on, it’s that bloating caused by foods has a lot to do with being gassy and having full intestines—and, well, there’s really only one thing to do about that. “Passing a bowel movement with flatulence helps to improve symptoms the most,” says Sonpal. If you’re looking for a quick way to get rid of that bloated feeling, get yourself secluded restroom and do the thing.

A walk can also help, erm, get things moving, suggests Sonpal: “Taking a walk after meals helps your abdominal muscles contract and expel the air,” he says. “Like Shrek says, ‘Better out than in.'” There’s also over-the-counter products that can help de-bloat you—he suggests simethicone, a.k.a. Gas-X.

“Yoga positions are only likely to help bloating if you are suffering from trapped intestinal gas and you can’t fart it out easily—sometimes the twisting can help things move along a bit,” Freuman says. However, “if you have bloating from acid reflux or a too-slow-to-empty-stomach, then inverted yoga positions could actually make you feel worse.”

Surprisingly, much-touted probiotics might not always help a case of bloating. “Contrary to what most people think, probiotics are not an effective remedy for most types of bloating, and in some cases, they can actually make it worse,” Freuman says. “If intestinal gas is the cause of your bloat, then adding more gas-producing bacteria into the mix could actually make you feel worse, not better.”

When to See a Doctor

Luckily, most cases of bloating disperse as quickly as they arrive. “Many people find that overnight sleep provides a bit of a ‘reset’ when it comes to food-related bloat: Having eight or more hours with nothing going into the GI tract allows for the intra-bowel contents (food volume and gas) to be whittled down a bit and for bloating to subside,” Freuman says. “Morning is typically a bloated person’s best time of day. ” There are exceptions: “People with slow-to-empty stomachs may wake up bloated if they ate a large or late dinner the night before. And people who suffer from chronic constipation and aren’t able to move their bowels sufficiently each day may struggle with a chronic, low-grade bloating that never really goes away.”

If you suspect the latter might be what you’re dealing with, it’s a good idea to make an appointment with your doctor, says Freuman. “Bloating that literally never goes away can be a point of concern and merit a trip to your doctor to rule out more serious causes, such as certain cancers (ovarian, colon) or celiac disease,” she says. “Also, bloating that’s accompanied by unintended weight loss, nutritional deficiencies (especially iron or Vitamin B12), or blood in the stool should be checked out by a gastroenterologist.”

Sonpal also suggests a trip to the doctor “if the gas takes more than a BM or lasts four to six hours, you should discuss with your doctor how to help,” he says.

Can dehydration cause bloating? | 9 reasons you’re bloating

Bloating, for many, can be a right royal pain. Whether you bloat around your time of the month, because of eating certain foods or as a physical response to stress, there can be a whole host of reasons as to why you’re regularly feeling puffy.

Unexpected bloat occurring more frequently can make you feel seriously grumpy, frustrated and low. That’s because it can actually be really painful, and prevent you from enjoying your normal day-to-day activities. If you’ve ever tried wearing tight jeans or smashing a HIIT session while bloated, then you’ll know what we mean.

So what is it that makes you bloat, and can things like dehydration actually cause bloating? To get the answer once and for all, we touched base with Dr Ayesha Akbar, consultant gastroenterologist at St Mark’s Hospital and the St Mark’s Institute for Bowel Disease.

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Here, she explains the many reasons you may sometimes look like you’re sporting a five-months-pregnant belly come the end of the day.

Once you’ve discovered what it actually is that could be causing your bloating, make sure to read our handy guide to how to stop your bloating. See—we’re always on hand to help, eh.

Possible causes of bloating:

1. Dehydration

You asked, we answered. Short answer: yes, dehydration can cause bloating.

How? “Drinking lots of water can potentially reduce the likelihood of bloating because dehydration and electrolyte imbalances can halt digestion,” explains Dr Akbar. She goes on to explain that when your body attempts to counter-balance the effects of being dehydrated, it holds on to excess water. Cue: a big round belly.

We’re always told to drink our two litres daily but who knew it could ward off the bloat, too?

2.

Lack of sleep

It turns out not getting enough kip at night doesn’t just make us grumpy the next day, but it can play havoc with our digestive systems, too.”With lack of sleep, our bodies release a stress hormone called cortisol,” says Dr Akbar. “Cortisol can disturb our digestive system to cause things like bloating and constipation.”

3. Hormonal changes

“Premenstrual syndrome (PMS) can lead to a bloated stomach, as it makes you prone to constipation and fluid retention,” notes Dr Akbar. But it can occur at any stage before, during, or after the menstrual cycle, and for some women it doesn’t have an effect at all.

“In the early days of a women’s cycle, oestrogen levels rise while the uterine lining thickens. This can lead to bloating, which can become stronger as ovulation occurs and more fluids and blood build up. Usually, the bloating goes away when the excess fluid and blood is shed when the woman has her period,” explains Dr Akbar.

4. Food allergies (or sensitivities)

Food allergies, sensitives or intolerances can lead to bloating; the problem is, it’s just so damn hard to detect which foods are causing the problem. But as a heads up, “the two most common forms of food that lead to bloating are dairy products and foods containing gluten,” says Dr Akbar.

“Even people who are not officially diagnosed as being ‘gluten allergic’ (coeliac disease) can often experience sensitivity to these foods and can experience constipation and bloating.”

She also notes that other foods which frequently induce a bout of the bloat are apples and avocados, so you might have to bump those down your list of favourite foods. Read up on which foods help reduce bloating, now.

5. Constipation

“Constipation may be the most obvious reason as to why you have a bloated stomach,” notes Dr Akbar. “Constipation can lead to stool remaining in the intestines, therefore giving you a hard-feeling stomach, pain, discomfort and gas.”

But why do we become constipated in the first place? According to Dr Akbar, it could be:

• eating too little fibre
• not drinking enough water
• a lack of physical exercise
• side effects of medication
• stress-related.

6. Eating too fast

Raise your hand if you’re guilty of inhaling your food when you’ve got a delicious plate in front of you? Us, too.

“If we eat too quickly, it is possible that we inhale a lot of air. Therefore, we end up with large volumes of gas sitting in our stomach that can manifest as bloating,” says Dr Akbar. Who knew?

7. Stress

There’s been extensive discussion around the link between IBS and stress, and it’s all to do with how many nerves the guts contain. “The guts are very richly innervated, and stress can lead to a prolonged stimulation of the bowel. Even if not related to IBS, stress can put pressure on your stomach, leading to bloating,” says Dr Akbar.

8. Inflammatory bowel disease (IBD)

“Inflammatory bowel disease is a chronic inflammatory disorder of the gut, and includes Crohn’s disease and ulcerative colitis,” explains Dr Akbar.

If you’ve noticed symptoms such as:

• diarrhoea
• blood in the stool
• tummy pains
• weight loss
• chronic bloating.

Then you may be struggling with IBD. Dr Akbar says it’s worth going to get checked out, if you’re worried. IBD it can cause bloating thanks to scarring tissue caused by previous surgery and gas trapped in your bowels.

9. Irritable bowel syndrome (IBS)

Our digestive systems are made up of a complicated system of nerves, explains Dr Akbar. “IBS is caused by a loss of coordination within this system and the way the bowel works,” she adds.

While IBS sufferers have nothing structurally wrong – it all looks ok down there – they do have something functionally wrong. Like “constipation, diarrhoea, bloating and abdominal pain,” says our medical expert.

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Cat is Cosmopolitan UK’s features editor covering women’s issues, health and current affairs.

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Worsening Abdominal Pain and Bloating in a 30-Year-Old Woman

Editor’s Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 30-year-old woman presents with recurrent abdominal pain and loose stools. She states that she has experienced these symptoms since adolescence, with periods of improvement and worsening over the years. Over the past year, her symptoms have been occurring more frequently and with greater severity. For the past 6 months, she has been bothered by bloating. The bloating seems to worsen with food intake.

When questioned about abdominal pain, the patient describes it as 6 (on a scale of 10) at its worst. Acute worsening occurs immediately before defecation, with significant improvement after defecation. She has had this pain at least once every week for the past 6 months.

The patient has loose stools approximately one third of the time and often has two or three bowel movements per day (with a baseline of one bowel movement a day). She denied waking up at night to have a bowel movement and denied any blood in the stool. She has had no nausea, vomiting, or change in weight. No relationship was found between her symptoms and her diet, including milk products, spicy foods, alcohol, and processed meats. She denies excessive hunger or anorexia symptoms.

Other than her mentioned symptoms, the patient considers herself healthy. She has no chronic illnesses or prior surgeries. She has no family history of organic gastrointestinal diseases, such as inflammatory bowel disease, cancer, or celiac disease.

Medscape © 2019  WebMD, LLC

Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Mohammad Elbatta, Jason Schairer. Worsening Abdominal Pain and Bloating in a 30-Year-Old Woman – Medscape – Aug 12, 2019.

Bloating could be a sign of these FOUR serious illnesses

IT IS often dismissed as a harmless problem – caused by overeating or tucking in to something that doesn’t agree with you.

But bloating can actually be a sign of something more serious.

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Bloating is a painful, gassy swelling of the stomach that can be a sign of serious illnessCredit: Getty – Contributor

Bloating is an uncomfortable, gassy sensation in the abdomen that often makes your tummy appear swollen.

In most cases it’s just a side-effect of overindulging or guzzling too many fizzy drinks, but if you suffer long-term bloating or if you only get it when you eat specific foods, it could be a sign of four illnesses: irritable bowel syndrome, ovarian cancer, coeliac disease and bowel cancer.

Here’s what you need to know…

1. Irritable bowel syndrome

Irritable bowel syndrome (IBS) can be seriously painful – it can cause frequent tummy discomfort, bloating, constipation as well as bouts of diarrhoea.

The condition affects about 25 per cent of people in the UK.

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Irritable bowel syndrome can cause painful cramps and a sudden urge to go to the toiletCredit: Getty – Contributor

Three quarters of IBS sufferers describe the condition as “debilitating” because it affects their everyday life.

It can cause frequent episodes of diarrhoea which can leave sufferers nervous if they are not close enough to a bathroom, or can cause bouts of painful constipation.

Most people suffer flare-ups that last a few days but after this time, the symptoms usually improve, according to the NHS.

However, they may not disappear completely.

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BEAT THE BLOAT Irritable Bowel Syndrome affects millions but it’s often dismissed as period pain – here’s how to spot the signs of IBS

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Other symptoms include stomach pain and cramping, excessive wind, an urgent need to go to the toilet and passing mucus from your bottom.

IBS can also cause fatigue, nausea, pain during sex, social anxiety and depression.

The exact cause of IBS is not known, but many experts believe it is related to an increased sensitivity of the gut.

As there is no known cause, there is no cure for IBS.

But in many cases symptoms can be managed by learning what your triggers are and changing your diet and lifestyle accordingly.

In some cases, medication or psychological treatments may also be helpful.

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Ovarian cancer is one of the most common forms of women’s cancer in the UKCredit: Getty – Contributor

2. Ovarian cancer

About 7,000 women each year are diagnosed with ovarian cancer in the UK, making it one of the most common types of cancer in women.

Many symptoms of ovarian cancer are hard to recognise as they are similar to conditions such as IBS, discussed above.

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KNOW THE SIGNS What is ovarian cancer, what are the signs and symptoms, how is it treated, is there a blood test and who’s most at risk?

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The key signs to look out for are a swollen stomach, a frequent need to wee, discomfort in your tummy and pelvic area, feeling full quickly and bloating.

The treatment for ovarian cancer depends on the type and how far it has spread.

Surgery is often used to remove the tumour, which can often include removing the ovaries, the fallopian tubes and the womb – leaving a woman infertile.

Chemotherapy may also be used to kill off any remaining cancer cells in the body.

Women are over 50 are more at risk of ovarian cancer, as are women who are overweight, have a family history or have existing womb problems such as endometriosis.

5

Coeliac disease is caused by an intolerance to gluten and can stop the body absorbing essential nutrientsCredit: Getty – Contributor

3. Coeliac disease

Coeliac disease is a common digestive disease that affects one in 100 people in the UK.

It is an autoimmune condition where the intestines react to gluten  – a type of protein – and become inflamed.

Gluten is most commonly found in three cereals – wheat, barley and rye – which are used to make food such a bread.

In coeliacs, gluten damages the lining of the intestines, leaving the body unable to absorb important nutrients.

Symptoms include bloating, nausea and tiredness as well as mouth ulcers, extreme fatigue, stomach pain, regular diarrhoea, weight loss and indigestion.

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There is no cure for the condition, and it can only be managed by cutting gluten out of your diet.

However many shops and restaurants now offer gluten-free options, and once the protein is removed from a diet, those with the condition should start feeling better.

5

More than 41,000 people in the UK are diagnosed with the disease each yearCredit: Getty – Contributor

4. Bowel cancer

Bowel cancer, also known as colorectal cancer, is the fourth most common form of the disease in the UK, after breast, prostate and lung cancers.

More than 41,000 people in the UK are diagnosed with the disease each year, according to Bowel Cancer UK.

And a recent study has warned around one in five bowel cancer patients told they have the disease in A&E have suffered some of the “red flag” symptoms at least a year before their diagnosis.

Experts have warned doctors are therefore missing key opportunities to diagnose patients with bowel cancer – opportunities that could mean the difference between life and death.

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KNOW THE SIGNS What are the red flag signs of bowel cancer, how common is it, what are the risks and can it be treated? All you need to know

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The disease is more common in those over 50, but a rise in the number of younger being diagnosed has been noted over the past decade.

Key symptoms of bowel cancer include blood in your stool (poo), a change in your bowel movements, a lump in your back passage or abdomen, weight loss, pain in your abdomen, constipation and bloating.

Scientists do not know the cause of most forms of bowel cancer, but they do know a series of factors that can increase a person’s risk of the disease.

If you are aged over 50, have a family history of the disease, a history of non-cancerous growths called polyps in your bowel, have another bowel disease such as IBS, have type 2 diabetes or an unhealthy lifestyle you are more at risk of developing the cancer.

Bowel cancer is treatable and can be cured, particularly if it is diagnosed early enough.

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90,000 Abdominal pain during pregnancy 9,0001

Causes of abdominal pain during pregnancy

1. Power supply errors


It is likely that the discomfort appeared against a background of cramping or bloating. Pain in the lower abdomen during pregnancy can be due to chronic diseases of the digestive system. A heavy dinner, insufficiently cooked or not entirely fresh food put additional strain on the intestines.This can lead to increased gas production and a feeling of heaviness.

It is worth remembering that pregnancy is an additional burden on the digestive system. The uterus increases in volume and squeezes the intestines, which, even without that, against the background of hormonal changes, does not feel good: motility decreases, peristalsis is disturbed, constipation becomes a frequent occurrence.

To reduce the risk of constipation, you need to drink plenty of fluids, eat more fiber (vegetables, fruits, whole grain bread), walk more often, eat in small portions, and chew food as thoroughly as possible.

2. Load on the abdominal muscles and ligamentous apparatus

During pregnancy, the pressure on the muscles and ligaments in the abdomen also increases. You can feel discomfort with sudden movements, sneezing, change of position. The pain is sharp, but short-term. There is no need to take pain relievers: the muscles have a hard time adapting right away, so just be careful.

Also, abdominal pain in any of the trimesters can occur due to overstrain of the abdominal muscles.These pains occur during physical exertion, overexertion. For the pain to subside, just sit back and relax.

3. Exacerbation of diseases

In rare cases, pregnancy may exacerbate diseases such as pancreatitis or intestinal obstruction. Symptoms of appendicitis may also appear. The pain in such conditions is specific: it grows, accompanied by an increase in body temperature and nausea, dizziness.It is possible that the patient may require surgery. Therefore, in no case should you endure pain to the last, but as soon as possible consult a doctor or call an ambulance.

The Scandinavia clinic has everything you need to carry out surgery of any complexity, including for pregnant women. Skandinavia’s experienced surgeons can perform the operation even at the time of childbirth.

4. Gynecological problems

Threat of miscarriage

Pain during pregnancy can also mean a threat of miscarriage.At the same time, the sensations are not like something else:

• aching, cramping pain;

• pain radiating to the lower back;

• does not subside when taking painkillers;

• there is discharge from the genitals (from light brown to red)

• bleeding.

With such symptoms, it is imperative to consult an obstetrician-gynecologist. The doctor will send the patient to the hospital for examination and preservation of the pregnancy. The clinic “Scandinavia” has a department of pregnancy pathology. The specialists of the department work with special cases and accept pregnant women 24/7 until 22 weeks. In the clinic, a woman undergoes ultrasound monitoring of the fetus, tests for chorionic gonadotropin (hCG), infections, sexually transmitted diseases.All this will help to identify the cause of the acute condition.

In no case do not rely on “maybe” and the adoption of “no-shpa” on the advice of friends. The course of pregnancy is individual for each woman, and only timely medical assistance determines her successful bearing.

Ectopic pregnancy

An ectopic pregnancy develops when a fertilized egg does not descend into the uterine cavity, but gets stuck in the fallopian tube for various reasons. In this case, pregnancy tests give a positive result. However, during an ultrasound scan, the ovum is not observed in the uterus. An ectopic pregnancy is usually terminated at 5-7 weeks. This is accompanied by rupture of the fallopian tube and internal bleeding.

Symptoms:

In this case, the woman needs an urgent operation. You can’t wait: you need to urgently call an ambulance because of the threat to the woman’s life.

Modern diagnostic standards prescribe the first ultrasound diagnostics for a period of 4-6 weeks.This helps to reduce the risk of tubal rupture due to an ectopic pregnancy and to maintain full fertility.

If any of the above symptoms have occurred for more than 22 weeks, you should also see a specialist. It is especially important to urgently call an ambulance if you have bleeding, increased pressure, nausea or vomiting.

The Scandinavia Maternity Hospital has a prenatal ward, where you can always get the necessary treatment and undergo any examinations after 22 weeks of pregnancy. Our maternity hospital is part of a multidisciplinary clinic on Ilyushin Street, where we can attract any specialist and help every pregnant woman.

Abdominal pain during pregnancy in women always causes panic. But you shouldn’t do that. You need to take a deep breath, and … dial your doctor’s phone number! Your perinatologist will immediately schedule a consultation for you so that you know exactly what is happening to you and what can be done. In the clinic “Scandinavia” we will do our best to preserve your pregnancy and the birth of a healthy baby!

We remind our address:

Department of pregnancy pathology

St. Petersburg, st.Ilyushin, 4, building 1

Commandant Avenue

tel: +7 (812) 600-77-77

OPERATING MODE

around the clock

Maternity hospital

St. Petersburg, st. Ilyushin, 4, building 2

Commandant Avenue

tel. /fax: + 7 (812) 600-7777, 600-78-75

OPERATING MODE

around the clock

visit: from 9:00 to 21:00

If you are concerned about abdominal pain, you can contact one of our doctors:

Obstetricians-gynecologists

Obstetricians-gynecologists, maternity ward

Chronic gastritis.5 questions to the gastroenterologist

At least one third of the world’s population complains of abdominal pain, nausea, and bloating today, however, not in every case we are talking about gastritis.

Chronic gastritis is much less common, and yet today the official WHO data for the Russian Federation report
about a figure of more than 3,000 cases per 100,000 population. It is necessary to clarify that we are talking about proven
inflammatory and dystrophic changes in the gastric mucosa.At the same time, a complaint of pain
in the abdomen, bloating and other symptoms characteristic of gastritis are much more common. This pathology
is functional dyspepsia.

What symptoms should alert you?

Symptoms of the disease differ slightly depending on the type of gastritis.

So, with an exacerbation of chronic gastritis type A (autoimmune), flatulence, diarrhea, rumbling in the abdomen,
loose stools after consuming dairy products and fats.

If we are talking about chronic type B gastritis (caused by the bacterium Helicobacter pylori), then this
the disease is more often manifested by constipation or a tendency to them. In addition, the disease is characterized by the severity
in the epigastric region, which most often appears after eating, belching, nausea, regurgitation, unpleasant
taste in the mouth (usually in the morning), heartburn.

Pain in the stomach is more often dull and usually appears after eating (especially,
after eating spicy foods, fried, smoked food).When walking and standing, pain with gastritis
are getting stronger.

The insidiousness of chronic gastritis is that it can take a long time, sometimes
for several years, be absolutely asymptomatic or with minor pain in the area
abdomen that do not particularly bother patients. Most often this disease occurs in adults.
men.

How much the onset of the disease depends on dietary habits, heredity, image
life?

Undoubtedly, irregular diet, the use of low-quality products, alcohol abuse, constant stress
reduce the body’s ability to resist any disease.However, the development of gastritis is also influenced by the use of
a number of drugs that cause damage to the stomach wall and require the simultaneous use of “protective”
medicines.

How often the bacterium Helicobacter pylori is to blame for the development of gastritis?

Helicobacter pylori-associated gastritis accounts for 85-90% of all cases, autoimmune gastritis –
5%. The rest of the gastritis, including chemically toxic-induced, lymphocytic, eosinophilic, granulomatous
and other rare forms of gastric lesions – 5-10%.

The bacterium Helicobacter pylori always leads to the development of chronic
inflammation in the wall of the stomach, which sometimes does not manifest itself as pain and dyspepsia. Besides,
Helicobacter pylori is an oncogenic factor and can lead to the development of stomach cancer.

How is gastritis treated?

There are several groups of drugs for the treatment of chronic gastritis, and their purpose depends on the type,
forms, localization of pathology, therefore, before prescribing a drug, it is necessary to undergo a course of examinations that
appointed by a specialist,
based on a specific clinical situation.In the absence of timely therapy
possible development of ulcerative defects, atrophy of the gastric mucosa (followed by “indigestion”)
and oncological diseases of the stomach.

In addition, patients diagnosed with chronic gastritis should adhere to the principles of rational
regular meals:

• Try to avoid prolonged periods of hunger and subsequent bulky meals
• Eat fractionally, every 3-4 hours, in small portions
• Avoid food that is too hot or, on the contrary, too cold
• Avoid food that is too hot or, on the contrary, too cold
• Arrange the right breakfast. It’s good to start the morning with fresh cottage cheese or soft (not fatty and not salty)
  cheese. Oatmeal, buckwheat, rice cereals are suitable – but only on water. The eggs should be
  cooked soft-boiled or in the form of omelets. You will have to give up coffee, strong tea and orange
  juices that irritate the mucous membranes and increase acidity. Berries and fruits on an empty stomach with gastritis too
  excluded, during the day they can be used only in a thermally processed form.

What is gastritis prevention?

Prevention of gastritis consists in maintaining a healthy lifestyle, proper and regular nutrition, refusal
from smoking and alcohol abuse. Of course, it is necessary to undergo an annual examination by a therapist,
standard blood tests, if necessary – esophagogastroscopy (examination of the gastric mucosa with
gastroscope).

If you have any questions, you can ask your gastroenterologist
online in the Doctis application.

90,000 17 leading causes of abdominal pain

Many people complain of abdominal pain but do not seek medical help. Someone does not like doctors and hospitals, someone avoids diagnostic procedures. Some are even afraid to find out about a far-fetched terrible diagnosis and therefore delay the trip to the doctor for a long time. What diseases and disorders can cause discomfort or pain in the abdomen?

Stones in the gallbladder and cholecystitis

The formed stones block the duct for the release of bile into the small intestine, which causes the gallbladder to hurt.As a rule, the upper right part of the abdomen hurts, especially after consuming fatty foods. If a person has cholecystitis, contractions of the gallbladder will also be accompanied by pain. Read more about this disease in the article “How to recognize the symptoms of cholecystitis.”

For the diagnosis of diseases of the gallbladder, ultrasound and blood tests are prescribed.

Pancreatitis

Inflammation of the pancreas causes severe, burning pain in the middle or upper abdomen.Sometimes the pain radiates to the back and chest. A person develops nausea, vomiting, fever. Among the main reasons for the development of pancreatitis is alcohol addiction, as well as the formation of stones in the gallbladder. Pancreatitis often requires hospitalization.

As in the case of diseases of the gallbladder, if pancreatitis is suspected, blood tests and ultrasound of the abdominal organs should be taken. For the appointment of appropriate studies, make an appointment with a gastroenterologist.

Gastritis

Gastritis is an inflammation of the stomach lining that causes pain in the upper abdomen just below the sternum.This pain is often described as a burning sensation. With gastritis, there is a feeling of a full stomach after eating, nausea, vomiting.

Stomach or duodenal ulcer

If you have a stomach ache, you may be suffering from a peptic ulcer. Most of the time, it hurts in the middle or upper abdomen. Sometimes pain occurs after eating. People with duodenal ulcers may wake up at night.

The main reasons for the development of ulcers are the bacterium Helicobacter pylori and the use of non-steroidal anti-inflammatory drugs (NSAIDs).

Gastroesophageal reflux disease (GERD)

When the valve that separates the stomach from the esophagus is weakened, food and acidic gastric juice travel in the opposite direction – up. In this case, pain occurs, known as heartburn. The localization of pain in GERD is the upper abdomen and lower chest.

If you suspect gastritis, peptic ulcer or GERD, you should consult a gastroenterologist. In most cases, the patient will be prescribed a gastroscopy procedure.You may need some additional research – a blood test and a breath test to detect the bacteria Helicobacter pylori.

Despite the fear of gastroscopy, after this procedure by our specialists, many patients feel great relief. The majority cease to be afraid of gastroscopy altogether. This is because in Persomed we carry out this procedure very quickly and painlessly.

Inflammatory Bowel Disease (IBD)

If you have bowel pain, you may be suffering from inflammation of the bowel walls.This group of diseases includes Crohn’s disease and ulcerative colitis.

Inflammatory bowel disease can lead to scarring, abdominal abscesses (peritonitis), and intestinal obstruction. These severe changes manifest as abdominal pain along with diarrhea and rectal bleeding. Symptoms of IBD are chronic, but occur in cycles, flaring up and fading away. For this reason, it can be difficult to diagnose the disease.

IBD must be constantly monitored, because they lead to very serious consequences.Advanced stages of inflammatory bowel disease can lead to cancer.

Irritable bowel syndrome ( IBS )

People with irritable bowel syndrome suffer from abdominal pain, cramps and bloating. At the same time, some are tormented by constipation, others by diarrhea, and in others, periods of constipation and diarrhea alternate. Usually, the feeling of discomfort or cramping disappears after you have a bowel movement.Unlike inflammatory diseases, IBS does not harm the intestines, although it gives the patient great discomfort.

Diverticulitis

Inflammation of the pockets that form in the intestinal mucosa is called diverticulitis. The disease manifests itself in the form of pain in the lower abdomen – on the left side of it. Associated symptoms include low-grade fever, nausea, vomiting, constipation, or diarrhea.

People who ignore diverticulitis may face serious complications such as peritonitis, bleeding, and the formation of holes in the intestine.In some cases, the patient needs surgery.

In case of diseases and disorders of the intestine, it is necessary to visit a gastroenterologist as soon as possible. Remember, the sooner you seek medical attention, the lower your risk of complications.

Kidney stones

Acute pain that appears in the back and seems to move around the abdomen, reaching the groin area, may signal kidney stones. The pain appears and disappears when the stone leaves the body.During the act of urination, a person may experience pain and detect blood in the urine.

The main diagnostic procedure for detecting kidney stones is an ultrasound of the urinary system, which can be done in our center. A urine sample is also taken from the patient for testing.

Endometriosis

This disease affects only women and is often asymptomatic. Sometimes endometriosis manifests itself as pain in the lower abdomen before the onset of menstruation.Pain and cramping can occur during urination, bowel movements, and during intercourse.

In endometriosis, the cells of the uterine mucosa – the endometrium – grow outside the uterus. Typically, cells spread to the ovaries, fallopian tubes, and other areas of the pelvis. If you suspect endometriosis, you should contact your gynecologist.

Appendicitis

Inflammation of appendicitis is manifested by sudden pain in the center of the abdomen, which goes to its lower right side.Mainly, appendicitis worries children and young people. It is extremely dangerous to ignore the inflammation of the appendix, because it can burst and cause peritonitis.

If you notice symptoms of appendicitis in yourself or your loved ones, urgently call an ambulance!

Cancer

This disease can affect any of the abdominal organs – liver, pancreas, stomach, gall bladder, ovaries. Painful sensations, as a rule, appear at later stages.Other symptoms include loss of appetite and weight, persistent vomiting, and bloating.

Parasites in intestines

Parasites can live in the intestines for years without causing any symptoms. When they make themselves felt, the person not only has a sore bowel, but can also be observed:

• Diarrhea
• Nausea and vomiting
• Bloating
• Stool with blood and mucus
• Rash or itching around the rectum or vulva
• Feeling tired
• Weight loss

To check if a person has parasites, a stool test and / or tests for antibodies to lamblia, trichinella, roundworm, echinococcus and other parasites are ordered.All these studies are carried out in our medical center.

Lactose intolerance

Millions of people suffer from this type of food intolerance. Among her symptoms:

• Moderate abdominal pain
• Flatulence
• Belching
• Diarrhea

There is only one solution – complete or partial rejection of dairy products.

Gluten Intolerance

Gluten is a protein found in wheat, barley and rye.In people with intolerances, this protein damages the walls of the small intestine. As a result, its ability to absorb nutrients obtained from food is lost.

A person with an intolerance has a stomach ache, flatulence and a feeling of fatigue. The most severe form of gluten intolerance is called celiac disease.

Diseases of the spine

Up to 62% of patients with diseases of the spine suffer from abdominal pain, bloating, constipation, hemorrhoids.Such data were provided by American experts from the University of Medicine in 2012.

Some patients who do not suffer from diseases of the gastrointestinal tract complain of abdominal pain due to orthopedic problems. If you belong to this category of people, an experienced orthopedic traumatologist will do everything possible to improve the health of your spine. Perhaps it is the problems with the spine that cause pain in the abdomen.

Stress and depression

Constant stress can also cause abdominal pain.If a person develops depression, they are more likely to experience irritable bowel syndrome.

When to seek medical attention:

• Abdominal discomfort lasting 1 week or longer
• Abdominal pain that does not subside within 24-48 hours or gets worse
• Pain with nausea and vomiting
• Bloating stomach for more than two days
• Burning sensation during urination or frequent trips to the toilet
• Diarrhea that lasts several days
• Pain in the abdominal region with fever
• Prolonged vaginal bleeding
• Unexplained weight loss

B when you need to call the doctor immediately:

• A person suffers from cancer and has a stomach ache
• Constipation, accompanied by vomiting
• Vomiting of blood or blood in the stool
• Black or tarry stools
• Sudden, sharp pain inabdomen
• Pain between the shoulder blades, which is accompanied by nausea
• Sensitive and painful abdomen, or vice versa – hard and hard to the touch abdomen
• Pain in the abdomen during pregnancy
• Recent abdominal trauma

Why it is important to contact for help as early as possible

Almost each of the diseases considered does not just cause pain and unnecessary worries.

If medical attention is not received in time, serious and sometimes life-threatening complications can develop. Do not delay, make an appointment through the electronic registration form or call the phones listed at the top of the site.

Sources:

1. 18 Reasons Why Your Stomach Hurts, Health.com,
2. 5 Reasons Your Stomach May Hurt, The Johns Hopkins Hospital,
3. Abdominal Pain, U.S. National Library of Medicine,
4. Abdominal Pain, Patient.info,
5. Irritable Bowel Syndrome, U.S. National Library of Medicine,
6. Symptoms & Causes of Diverticulosis and Diverticulitis, The National Institute of Diabetes and Digestive and Kidney Diseases,
7. Endometriosis, Mayo Clinic,
8. E. Ebert, Gastrointestinal Involvement in Spinal Cord Injury: A Clinical Perspective. University of Medicine and Dentistry New Jersey, Robert Wood Johnson Medical School,
9. Intestinal parasites, University of Maryland Medical Center (UMMC).

Early and delayed food intake to reduce complications after gynecological surgery.

Review question

What are the risks and benefits of early meals versus at least 24 hours delayed after gynecological surgery?

Relevance

Doctors often postpone food and fluid intake for women after abdominal gynecological surgery (uterine fibroids – fibroids, endometriosis, ovarian cysts, uterine and ovarian cancers) until bowel function is restored (usually 24 hours after surgery).This is done to reduce the risk of complications such as vomiting, gastrointestinal disturbances, dehiscence (sutures) of the wound, or leakage of the wound. However, it has been suggested that some women might recover faster if they started eating earlier. We analyzed evidence from randomized controlled trials of early and delayed feeding after gynecological surgery.

Research characteristics

We assessed the evidence for the following outcomes:

1.Nausea, vomiting, cramping abdominal pain, bloating, complications of the wound process, deep vein thrombosis, urinary tract infection, pneumonia.

2. Time before the appearance of the first: sounds of intestines, gas, stool, the beginning of a normal diet.

3. Length of hospital stay

Early feeding was defined as the intake of food or liquid within 24 hours after surgery.
Delayed feeding was defined as eating or drinking 24 hours after surgery and only when bowel sounds, gas, stool, or hunger were present.

Evidence is current to April 2014.

Key findings

We included five published studies involving 631 women, mostly diagnosed with genital cancer.

Restoration of bowel function was observed earlier in those who started feeding earlier. There were no differences in the incidence of nausea or vomiting, abdominal distention, the need for a postoperative nasogastric tube, or differences in time before the first bowel movement.But early feeding was associated with a more rapid return of bowel sounds and gas production. The early meal group resumed solid food intake 1 ½ days earlier than the delayed meal group. The length of hospital stay was also one day shorter. In addition, patients in the early feeding group were more satisfied with the feeding regimen, although this was reported in only one study.

Early feeding was found to be safe, with no increase in postoperative complications and with a lower incidence of infectious complications in general.

Quality of evidence

Most of the evidence was of moderate quality. The main limitation was the lack of blinding, which could affect the results of subjective outcomes such as self-assessment by patients of their condition (symptoms), hospital stay, satisfaction and quality of life of patients.

Conclusions

This evidence suggests that food and water ingestion on the first day after gynecologic surgery is safe and may reduce the length of hospital stay.

Diarrhea in case of coronavirus infection

Those infected with the coronavirus are often “tormented by the stomach” when there may be no other manifestations of covid. Gastroenterologist Viktoria Malozemova explained how the virus enters the gastrointestinal tract, whether it is possible to check that it has damaged, and then fix it all.

– Victoria Anatolyevna, Rospotrebnadzor reported that the gastrointestinal tract, like the upper respiratory tract, is the gateway for coronavirus.How does it pass through the natural powerful barrier against harmful microorganisms – the stomach?

– On the mucous membrane of the gastrointestinal tract, as well as on the bronchi, there are specific receptors that are sensitive to coronavirus, this is an established fact. They are found in the stomach, duodenum, rectum. Nature has created barriers in our body that protect against the effects of foreign agents such as viruses and bacteria. For example, protective immunoglobulins work on the oral mucosa, then, entering the stomach, the virus meets with gastric juice, which is a rather aggressive acidic environment.

Our defense mechanism can be weakened against the background of chronic diseases (not only of the gastrointestinal tract), against the background of taking medications that reduce the protective barrier of the mucous membranes, against the background of stress, chronic fatigue, and malnutrition.

For example, in patients with chronic diseases of the stomach, the acidity of the gastric juice decreases, which leads to a weakening of the protection against the penetration of viruses.

In gastroenterology, this is called a hypoacid or anacid state.The virus binds to receptors on the gastrointestinal mucosa and causes the syndrome of increased epithelial permeability: normally, our epithelial cells in the mucous membrane are connected by tight contacts, they interfere with the penetration of hazardous substances and particles. The virus disrupts these contacts, and the sensitivity of the mucous membrane changes – the work of the stomach and intestines is disrupted.

– How does gastric covid appear?

– The leading symptom in this situation is diarrhea, followed by bloating, cramping pains, nausea and vomiting.Both we in the hospital and our colleagues at home and abroad observe that diarrhea is becoming one of the leading symptoms in covid disease. We have had patients with severe diarrhea that does not respond well to treatment and underwent a colonoscopy (a visual examination of the intestines with an endoscope) to understand what was going on. We found erosive and ulcerative damage to the stomach and intestines, which are caused precisely by the virus. In some, they can become the first manifestation of the disease, in others, they arise later, in others they become a consequence of the effects of drugs used in treatment.

– And if a person suffers from irritable bowel syndrome (IBS), how can he understand why he is vilifying: because of his chronic illness or because of infection with coronavirus?

– Only for PCR testing for coronavirus. But in the hospital, we see such exacerbations caused by the coronavirus. That is, everything is connected here. There are also combinations of coronavirus with other serious – autoimmune bowel diseases: ulcerative colitis (UC), Crohn’s disease.

– Why most often changes during and after covid are detected in the duodenum?

– Because the duodenum is part of the small intestine, and, as I said, there are many receptors with which the coronavirus can bind. A complete examination of the intestines is rarely done – they are sent for colonoscopy in extreme cases, and a 12-finger can be examined for FGDS. But if we see erosive changes in the duodenum with coronavirus, we can assume that there are such changes in the whole intestine too.

– Is it true that when the manifestations of the disease begin with the gastrointestinal tract, there is a great chance that it will proceed relatively easily – without a threat to life.

– True, if the virus involved only the intestines in the pathological process. The problem is that most often the liver suffers in parallel. Its defeat is usually manifested by nausea, bitterness in the mouth, vomiting of bile. But often with a coronavirus infection, it happens that these symptoms are absent, and we see the defeat according to laboratory indicators.

– Therefore, those who undergo medical examination after undergoing covid are prescribed a biochemical blood test for the so-called liver indicators – ALT and AST? Why are they being examined six months after the illness?

– When the patient is admitted to the hospital, a complete biochemical study is performed, including liver parameters. And when they are discharged, we check them again and prescribe the necessary medications. And on outpatient treatment, this study is not included in the clinical guidelines, so it is carried out if the patient has specific complaints.I would, frankly, recommend doing such a study either during illness or immediately after receiving a negative test.

The liver is a kind of blood depot, in which it is, as it were, filtered, all viral particles that enter the blood pass through it. In addition, there is an extensive network of capillaries in the liver that infects the virus and its toxins (this is a feature of the coronavirus, we do not see such changes in the liver with ordinary ARVI or flu). And the analysis of liver indicators demonstrates how intensively the process of intoxication that the coronavirus causes is going on.And if they are not normal, then the inflammatory process continues against the background of toxicological effects.

– What to do if the indicators exceed the norm?

– There are agents that protect the mucous membrane and promote its healing when there are ulcers or erosion. And there are medications recommended to correct liver readings. Usually, if a person turns to a doctor on time and fulfills his appointment, the condition will return to normal, but this may not happen quickly.

– How to understand if the stomach hurts due to the fact that the coronavirus has violated it, or due to taking medications that are prescribed for covid?

– If this is a treatment for mild to moderate coronavirus, then the therapy regimens do not include antibacterial drugs or others that can lead to diarrhea and other symptoms. Therefore, we can say for sure that these are manifestations of the coronavirus influence. And if pneumonia joins, which cannot be immediately dealt with, antibiotics and other medications are prescribed.Then, indeed, we cannot determine what is primary, but this is not important – the symptoms indicate that the gastrointestinal tract suffers, there is a drug damage to the liver, and we prescribe complex therapy.

.