Abdominal Pain & Irritable Bowel Syndrome

Constipation is the infrequent and difficult passage of stool. The frequency of bowel movements among healthy people varies greatly, ranging from three movements a day to three a week.

As a rule, if more than three days pass without a bowel movement, the intestinal contents may harden and a person may have difficulty or even pain during elimination. Stool may harden and be painful to pass. Straining during bowel movements or the feeling of incomplete evacuation may also be reported as constipation.

Common Misconceptions About Constipation

A common misconception is that a bowel movement every day is necessary. Another common fallacy is that wastes stored in the body are absorbed and are dangerous to health or shorten the life span.

These misconceptions have led to a marked overuse and abuse of laxatives. Many are not needed and routine use of some stimulant laxatives can cause dependency.

Is Constipation Serious?

Although it may be extremely bothersome, constipation itself is usually not serious. However, it may be the initial symptom of a serious underlying disorder such as cancer. Constipation can lead hemorrhoids or fissures (caused by the hard stool stretching the sphincters). Bleeding can occur for either of these reasons and appears as bright red streaks on the surface of the stool. Fissures may be quite painful and can aggravate the constipation that originally caused them. Fecal impactions can occur (especially in young children and older adults) and may be accompanied by a loss of control of stool, with liquid stool flowing around the hard impaction. Chronic constipation my increase the risk for the development of diverticulosis.

Basics of Constipation

  • Most people experience occasional short bouts of constipation. If a laxative is necessary for longer than three weeks, seek medical advice.
  • Eat a well-balanced diet that includes unprocessed bran, whole-wheat grains, fresh fruits and vegetables.
  • Drink plenty of fluids.
  • Exercise regularly.
  • Set aside time after breakfast or dinner for undisturbed visits to the toilet.
  • Don’t ignore the urge to have a bowel movement.
  • Whenever there is a significant or prolonged change in bowel habits, see your doctor.

Causes of Constipation

Constipation is a symptom, not a disease. Like a fever, constipation can be caused by many different conditions. Most people have experienced an occasional brief bout of constipation that has corrected itself with diet and time. The following is a list of some of the most common causes of constipation:

Poor Diet

A main cause of constipation may be a diet high in animal fats (meats, dairy products, eggs) and refined sugar (rich desserts and other sweets), but low in fiber (vegetables, fruits, whole grains), especially insoluble dietary fiber, which helps move bulk through the intestines and promote bowel movements. Some studies have suggested that high-fiber diets result in larger stools, more frequent bowel movements.

Imaginary Constipation

This is very common and results from misconceptions about what is normal and what is not. If recognized early enough, this type of constipation can be cured by informing the sufferer that the frequency of his or her bowel movements is normal.

Irritable Bowel Syndrome (IBS)

Also known as spastic colon, IBS is one of the most common causes of constipation in the U.S. Some people develop spasms of the colon that delay the speed with which the contents of the intestine move through the digestive tract, leading to constipation.

Poor Bowel Habits

A person can initiate a cycle of constipation by ignoring the urge to have a bowel movement. Some people do this to avoid using public toilets, others because they are too busy. After a period of time, a person may stop feeling the urge. This leads to progressive constipation.

Laxative Abuse

People who habitually take stimulant laxatives become dependent upon them and may require increasing dosages until, finally, the intestine becomes insensitive and fails to work properly.


People often experience constipation when traveling long distances, which may relate to changes in lifestyle, schedule, diet and drinking water.

Hormonal Disturbances

Certain hormonal disturbances, such as an under active thyroid gland, can produce constipation.


Pregnancy is another common cause of constipation, which may be partly due to hormonal changes during pregnancy.

Fissures and Hemorrhoids

Painful conditions of the anus can produce a spasm of the anal sphincter muscle, which can delay a bowel movement.

Specific Diseases

Many diseases that affect the body tissues, such as scleroderma or lupus, and certain neurological or muscular diseases, such as multiple sclerosis, Parkinson’s disease and stroke, can be responsible for constipation.

Loss of Body Salts

The loss of body salts through the kidneys or through vomiting or diarrhea is another cause of constipation.

Mechanical Compression

Scarring, inflammation around diverticula, tumors and cancer can produce mechanical compression of the intestine and result in constipation.

Nerve Damage

Injuries to the spinal cord and tumors pressing on the spinal cord can produce constipation by affecting the nerves that lead to the intestine.


Many medications can cause constipation. These include pain medications (especially narcotics), antacids that contain aluminum or calcium, antispasmodic drugs, antidepressant drugs, tranquilizers, iron supplements, anticonvulsants for epilepsy, antiparkinsonism drugs and calcium channel blockers for high blood pressure and heart conditions.

Colonic Motility Disorders

The peristaltic activity of the intestine may be ineffective resulting in colonic inertia or outlet obstruction.

Diagnostic Tests

Constipation may be caused by abnormalities or obstructions of the digestive system in some people. A doctor can perform tests to determine if constipation is the symptom of an underlying disorder.

In addition to routine blood, urine and stool tests, a flexible sigmoidoscopy or a colonoscopy may help detect problems in the rectum and colon.

Other highly specialized techniques are available for measuring pressures and movements within the colon and its sphincter muscles.


The first step in treating constipation is to understand that normal frequency varies widely, from three bowel movements a day to three a week. Each person must determine what is normal to avoid becoming dependent on laxatives.

For most people, dietary and lifestyle improvements can lessen the chances of constipation. A well-balanced diet that includes fiber-rich foods, such as unprocessed bran, whole-grain bread, and fresh fruits and vegetables, is recommended. Drinking plenty of fluids and exercising regularly will help to stimulate intestinal activity. Special exercises may be necessary to tone up abdominal muscles after pregnancy or whenever abdominal muscles are lax.

Bowel habits also are important. Sufficient time should be set aside to allow for undisturbed visits to the bathroom. In addition, the urge to have a bowel movement should not be ignored.

If an underlying disorder is causing constipation, treatment will be directed toward the specific cause. For example, if an under active thyroid is causing constipation, the doctor may prescribe thyroid hormone replacement therapy.

In most cases, stimulant laxatives should be the last resort and taken only under a doctor’s supervision. A doctor is best qualified to determine when a laxative is needed and which type is best. There are various types of oral laxatives and they work in different ways.

Above all, it is necessary to recognize that a successful treatment program requires persistent effort and time. Constipation does not occur overnight and it is not reasonable to expect that constipation can be relieved overnight.

The passing of gas is a normal bodily function.
Some people experience excessive gas which may make them feel uncomfortable.
Gas is caused by swallowed air and the food we eat.
People can often control their gassiness through diet.[/fancy_heading]

How to Reduce Gas in the Digestive Tract

The following suggestions may be helpful to reduce gas:

  • Avoid chewing gum or sucking on hard candies (especially sugarless gum or sugar free candies that contain sorbitol).
  • Increase the amount of fluid you drink, but eliminate carbonated drinks and alcoholic beverages and reduce foods containing high-fructose corn syrup from your diet.
  • If you have lactose intolerance, avoid milk and milk products, such as soft cheeses, or try milk in which the lactose is already broken down.
  • Eat less gas-producing foods such as cauliflower, brussel sprouts, bran, beans, broccoli and cabbage. When eating such foods, you may consider trying over-the-counter gas relief medicines (Beano), which may help breakdown the non-absorbable carbohydrates found in these foods.
  • Walking, jogging, calisthenics and other exercise help to stimulate the passage of gas through the digestive tract.
  • Do not smoke or use other tobacco products
  • If you wear denture, check with a dentist to make sure the dentures fit properly.
  • Keep calm. Tension and anxiety can lead to more air swallowing.


All of us have gas and must get rid of it in some way. Normally, gas passes out through the rectum or is belched through the mouth. These are both necessary functions of the body that allow us to eliminate gas.

When gas does not pass out of the body easily, it can collect in some part of the digestive tract, causing bloating and discomfort. Even normal amounts of gas in the body can bother people who are sensitive to this pressure. Although gas is usually not a sign of a medical problem, it can be.

The amount of gas that people produce varies. Most people produce between a pint and a half-gallon of gas each day. Oxygen, carbon dioxide and nitrogen from swallowed air make up a large part of flatus (gas). Fermenting foods in the colon produce hydrogen and methane as well as carbon dioxide and oxygen. All of these components of flatus are odorless. The unpleasant odor of some flatus is the result of trace gases, such as hydrogen sulfide, which are produced when foods decompose in the colon.

Causes of Gas & Belching

A common source of upper-intestinal gas is swallowed air. Each time we swallow, small amounts of air enter the stomach. This gas in the stomach is usually passed into the small intestine where part of it is absorbed. The rest travels into the colon (large intestine) to be passed out through the rectum.
Gas can be belched out instead of being passed from the stomach into the intestine. This happens for several reasons:

  • Beverages contain carbon dioxide, which can produce large amounts of gas when warmed in the stomach. People under a lot of stress often swallow large amounts of air.
  • Some people swallow air frequently because they have post-nasal drip, chew gum or smoke.
  • Rapid eating or poorly fitting dentures also may cause too much air to be swallowed.
  • Drinking beverages that contain carbonated water may increase gas in the digestive tract. Try to avoid carbonated or “sparkling” drinks.
  • Some people have a sluggish bowel that does not get rid of air readily. Others might have an irritable bowel or spastic colon, which means that they cannot tolerate gas accumulation inside of the intestines, so even small amounts of air feel uncomfortable.

Repetitive Belching

Some people experience frequent belching. This might occur after a person has swallowed air without realizing it. Sometimes belching accompanies the movement of stomach material back up (reflux) into the esophagus. To clear material from the esophagus, a person may swallow frequently, which leads to more intakes of air and further belching.

Another cause of repeated belching is gastritis (inflammation of the stomach lining). There are many causes of acute or chronic gastritis, but the most common cause is infection with a bacterium called Helicobacter pylori (H. pylori). This bacteria can be detected with a breath test, stool test, blood test or from a biopsy from the stomach obtained during an upper endoscopy.

Foods & Gas

The foods we eat can be a factor in the production of gas in the lower intestine. These foods include:

  • Cauliflower
  • Brussels sprouts
  • Dried beans
  • Broccoli
  • Cabbage
  • Bran
  • Fiber

Today, many people are trying to improve their nutrition and health by eating more fiber. However, some people discover that adding large amounts of fiber to their diets causes gassiness. This can happen when someone begins eating more whole-grain cereals, such as whole bran, oatmeal or oat bran, more whole-grain breads or more fresh fruits and vegetables. They get a feeling of being bloated when they first begin the high-fiber diet, but within three weeks or so, they may adapt to it. Some people, however, don’t adapt, and the bloating from eating a lot of fiber can be a permanent problem.

Milk & Dairy

A common cause of excess lower-intestinal gas is that a person’s body may not have enough lactase, an enzyme normally found in the small intestine. Lactase is needed to digest lactose, the sugar found in milk and other dairy products. When this sugar passes undigested into the colon, it is fermented by bacteria, and gas forms. This can be a cause of excessive flatulence.

If lactase deficiency is suspected of causing your gas, you can stop eating dairy products for a while to see if you have less gas. If you find milk causes gassiness, you may consider drinking milk in which the lactose has been broken down (Lactaid milk). You can also take lactase enzymes (Lactaid) with each bite or drink of dairy products for a week to see if your symptoms improve. Lastly, a breath test is available to find out if you are lactose intolerant.

Fruit & Sweeteners

Finally, ingestion of large quantities of foods that contain fructose, a sugar commonly found in fruits and processed foods in the form of high-fructose corn syrup, may also contribute to gassiness. The small intestine can only absorb a limited amount of fructose each day. As with undigested lactose, it passes into the colon where it is fermented by bacteria. Artificial sweeteners, such as sorbitol, found in diet food products are also poorly absorbed and a source of excessive gassiness.

Abdominal Pain & Bloating

Eating a lot of fatty food can cause bloating and discomfort because the fat delays stomach emptying, allowing gas to build up there. This problem can be avoided by eating less fatty meals.

Gas, in the upper abdomen, is often reduced by belching. Gas can collect anywhere in the lower intestine. It often collects in the left side of the colon, and when severe, the pain can be confused with heart disease. When gas collects in the right side of the colon, the pain can be confused with gallbladder disease or even appendicitis.

A bloated feeling is probably not anything to be concerned about, but it can be a symptom of a more serious problem. If your problem is chronic, or if you are experiencing a severe increase in gassiness, you should talk to your doctor.

  • Additional Treatment Options
  • Activated charcoal may decrease odor from gas.
  • Miralax and other stool softeners may help people who are also constipated.
  • Simethicone (Gas-X) and digestive enzymes, such as the lactase enzymes.
  • Amitiza a prescriptio medication that increases fluid secretion and motility in the intestines
  • Supplements that break down the non-absorbable carbohydrates responsible for gas caused by beans and some vegetables, such beano, may be helpful.

Acute Diarrhea

Acute diarrhea is one of the most commonly reported illnesses in the United States.

What is Acute Diarrhea?

An increased number of stools or looser form than is customary for the patient, lasting less than 2 weeks, and often associated with abdominal symptoms such as cramping, bloating, and gas. Although often mild, acute diarrhea can lead to severe dehydration as a result of large fluid and electrolyte losses.

Causes of Acute Diarrhea

Acute, watery diarrhea is usually caused by a virus (viral gastroenteritis.) Medications such as antibiotics and drugs that contain magnesium products are also common offenders. Recent dietary changes can also lead to acute diarrhea. These including intake of coffee, tea, colas, dietetic foods, gums or mints that contain poorly absorbable sugars. Acute bloody diarrhea suggests a bacterial cause like Campylobacter, Salmonella or Shigella. Eating contaminated foods such as ground beef or fresh fruit can cause diarrhea due to E.coli 0157:H7. Diarrhea associated with recent antibiotic use suggests an infection with Clostridium difficile.

Most episodes of acute diarrhea resolve quickly and without antibiotic therapy with simple dietary modifications. See a doctor if you feel ill, have bloody diarrhea, severe abdominal pain or diarrhea lasting more than 48 hours.

Tests for Acute Diarrhea

In patients with mild acute diarrhea, no laboratory evaluation is needed because the illness generally resolves quickly. Your doctor may perform stool cultures or parasite exams if your diarrhea is severe or bloody or if you traveled to an area where infections are common.

Treatment for Acute Diarrhea

It is important to take plenty of fluid and salt to avoid dehydration. Milk and dairy products should be avoided for 24 to 48 hours as they can make diarrhea worse. Initial dietary choices should begin with soups and broth. This should be followed by a low residue (low fiber diet) until the diarrhea resolves. Probiotics may be helpful.

Anti-diarrheal drug therapy can help control severe symptoms, and includes bismuth subsalicylate (Peptobismol, Kaopectate) and antimotility agents such as loperamide (Imodium). These, however, should be avoided in people with high fever or bloody diarrhea.

An antibiotic is usually necessary for patients with a high fever, dysentery, or moderate to severe traveler’s diarrhea.

Chronic Diarrhea

If diarrhea lasts more than two weeks, it is called chronic diarrhea.

Causes of Chronic Bloody Diarrhea

Chronic bloody diarrhea is most likely due to Inflammatory Bowel Disease (IBD). These include ulcerative colitis or Crohn’s disease. Other less common causes include ischemia (decreased blood flow) of the colon, infections, radiation therapy and colon cancer or polyps.

Causes of Chronic Oily or Fatty Diarrhea

Maldigestion or malabsorption syndromes are the cause of fatty stools. The stools may also be greasy or very bad smelling. Chronic pancreatitis is a cause of pancreatic insufficiency, which leads to maldigestion and fatty stools. Alcohol abuse is a common cause of chronic pancreatitis in the United States. Other causes of chronic pancreatitis include cystic fibrosis, hereditary pancreatitis, trauma to the pancreas and pancreatic cancer.

Biliary tract obstruction, cholestatic liver disease, and bacterial overgrowth can also lead to maldigestion problems. Gluten sensitive enteropathy (celiac disease, celiac sprue) is the most common small bowel disease causing fat malabsorption. Additional common causes of malabsorption in the United States are other small bowel mucosal diseases or surgical resection of the small bowel. Whipple’s disease, tropical sprue and Zollinger-Ellison syndrome are very uncommon conditions that can lead to malabsorption.

Causes of Chronic Watery Diarrhea

There are may causes of watery diarrhea, including carbohydrate malabsorption such as lactose, sorbitol, and fructose intolerance, intestinal infections or Irritable Bowel Syndrome. Certain medications such as NSAIDs, antacids, antihypertensives, antibiotics and antiarrhythmics can cause diarrhea in some people.

Symptoms of abdominal bloating and excessive gas after consuming dairy products suggest lactose intolerance. This condition is more common in African-Americans and Asian-Americans. Certain soft drinks, juices, dried fruits and gums contain sorbitol and fructose, which can lead to watery diarrhea in people with sorbitol and fructose intolerance.

Intestinal infections such as giardiasis, opportunistic infections in someone with HIV can cause chronic watery diarrhea. Diabetes mellitus may be associated with diarrhea due to nerve damage and bacterial overgrowth; this occurs mainly in patients with long-standing, poorly-controlled diabetes.

Irritable Bowel Syndrome (IBS) is a condition often associated with frequent stools, alteration in bowel habits, and abdominal pain. These symptoms are key features of this syndrome, though many with IBS have constipation rather than diarrhea. Emotional or physiologic distress can worsen IBS symptoms. IBS is recognized as a motility disorder where no anatomic or organic diseases are found to account for the symptoms.

Tests to Evaluate Diarrhea

Your doctor will want to further assess etiologic factors or complications of diarrhea by obtaining several tests. These include blood tests. A stool sample may help define the type of diarrhea. The presence of fat, occult blood and white blood cells will help determine if a watery, inflammatory, or fatty diarrhea is present. A bacterial culture and ova/parasite studies of a stool specimen will also help determine if an infectious etiology is present.

Radiographic studies are not routinely performed in the evaluation of chronic diarrhea, as findings seen in radiographic studies are fairly non-specific, but occasionally can be helpful. Ultrasound and CT scan of the abdomen can be helpful to evaluate the pancreas or other intra-abdominal organs.

Endoscopic examination of the colon with flexible sigmoidoscopy and colonoscopy is more specific than radiographic studies in detecting the etiology of chronic diarrhea, as this allows direct examination of the bowel mucosa and the ability to obtain biopsies for microscopic evaluation as is upper endoscopy for evaluation of the upper GI tract. Small bowel capsule endoscopy is sometimes used to examine the lining of the entire small intestine.

Treatment for Chronic Diarrhea

The treatment depends on the etiology of the chronic diarrhea. Often, empiric treatment can be provided for symptomatic relief.

Irritable bowel syndrome (IBS) is a common disorder of the intestines that leads to crampy abdominal pain, gassiness, bloating and changes in bowel pattern. Some people with IBS have constipation (difficult or infrequent bowel movements), others have diarrhea (frequent loose stools, often with an urgent need to move the bowels) and some people experience both. Sometimes the person with IBS has a crampy urge to move the bowels but cannot do so. ibs-1Through the years, IBS has been called by many names – colitis, spastic colon, spastic bowel and functional bowel disease. IBS should not be confused for colitis. Colitis means inflammation of the large intestine (colon), and in IBS, there is no inflammation. IBS does not lead to any more serious organic diseases such as cancer, celiac disease or inflammatory bowel disease (ulcerative colitis or Crohn’s disease). Bleeding, fever, weight loss and persistent severe pain are not symptoms of IBS, and may indicate other problems.

ibs-2The colon, which is about six feet long, connects the small intestine with the rectum and anus. Colon motility (contraction of intestinal muscles and movement of its contents) is controlled by nerves and hormones and by electrical activity in the colon muscle. The electrical activity serves as a “pacemaker” similar to the mechanism that controls heart function.

The colon muscle of a person with IBS begins to spasm after only mild stimulation. The person with IBS seems to have a colon that is more sensitive and reactive than usual, so it responds strongly to stimuli that would not bother most people. Many people believe that emotional conflict or stress plays an important role in IBS. While stress may worsen IBS symptoms, other factors also are important.

IBS Triggers

  • Certain medicines and foods may trigger spasms in some people. Sometimes the spasm delays the passage of stool, leading to constipation.
  • Chocolate milk products or large amounts of alcohol are frequent offenders and can trigger attacks.
  • Caffeine causes loose stools in many people, but it is more likely to affect those with IBS.
  • Women with IBS may have more symptoms during their menstrual periods, suggesting that reproductive hormones can increase IBS symptoms.
  • It is important to realize that normal bowel function varies from person to person.
  • Normal bowel movements range from as many as three stools a day to as few as three a week. A normal movement is one that is formed but not hard, contains no blood, and is passed without cramps or pain.

IBS is usually diagnosed after more serious organic diseases are excluded. The evaluation includes a complete medical history, a physical examination and laboratory tests. Diagnostic procedures such as a flexible sigmoidoscopy or colonoscopy may be recommended for further evalution.

There is no standard way of treating IBS. When lifestyle & dietary modifications and stress management do not provide adequate improvement, a number of different natural and prescription medications are available.

Abdominal pain is common. Severe pain or pain that is associated with red flags should be discussed with your doctor right away. An urgent office visit or even an emergency room visit may be necessary depending upon your specific complaints. Red flags that should prompt discussion with your doctor include fever, diarrhea, persistent constipation, blood in the stools, persistent nausea or vomiting, vomiting blood, severe tenderness of the abdomen or pelvis, jaabdominal-painundice (yellowish discoloration of the skin) or swelling of the abdomen.

A diagnosis for the abdominal pain is often made by the doctor after obtaining a history and performing a physical exam. In other circumstances diagnostic tests are used to confirm or to exclude a specific diagnosis. Many tests can be ordered for these purposes. They may include analysis of blood, urine and stool samples, x-rays of the abdomen, upper endoscopy, colonoscopy and small bowel capsule endoscopy.

The location of your pain can help narrow the list. But, it’s very difficult to know the cause of the abdominal pain solely by its location, even for an experienced doctor.

Navel area
Pain near your bellybutton can be related to a small intestine disorder or an inflammation of your appendix (appendicitis).

Upper middle abdomen
The epigastric area is located in the upper middle section of the abdomen. Stomach disorders such as ulcers and gastritis can cause pain in this region. Problems with the pancreas or gallbladder may also be associated with pain in this area.

Upper left abdomen
It is uncommon to experience pain here. Gas can collect in the colon, under the spleen, and lead to pain.

Upper right abdomen
Pain in this area may signify a gallbladder problem. Occasionally, an inflamed pancreas, colon or duodenum can cause pain in this area. A less serious problem is gas that collects in the colon, under the liver.

Lower middle abdomen
Pain below the navel that spreads to either side may signify a colon disorder. Pain in this area may also be a symptom of kidney stones or a urinary tract infection. For women, pain in this area may also indicate pelvic inflammatory disease.

Left lower abdomen
Pain here often suggests a problem in the lower colon. Possible causes include diverticulitis, inflammatory bowel disease (ulcerative colitis or Crohn’s disease), and severe constipation. In women, pain in this area may result from a ruptured ovarian cyst or pelvic inflammatory disease.

Right lower abdomen
Pain in this area can occur from appendicitis, Crohn’s disease, and in women, ovarian cyst or pelvic inflammatory bowel disease.

Navel area
Pain near your bellybutton can be related to a small intestine disorder or an inflammation of your appendix (appendicitis).

Upper middle abdomen
The epigastric area is located in the upper middle section of the abdomen. Stomach disorders such as ulcers and gastritis can cause pain in this region. Problems with the pancreas or gallbladder may also be associated with pain in this area.

Upper left abdomen
It is uncommon to experience pain here. Gas can collect in the colon, under the spleen, and lead to pain.

Upper right abdomen
Pain in this area may signify a gallbladder problem. Occasionally, an inflamed pancreas, colon or duodenum can cause pain in this area. A less serious problem is gas that collects in the colon, under the liver.

Lower middle abdomen
Pain below the navel that spreads to either side may signify a colon disorder. Pain in this area may also be a symptom of kidney stones or a urinary tract infection. For women, pain in this area may also indicate pelvic inflammatory disease.

Left lower abdomen
Pain here often suggests a problem in the lower colon. Possible causes include diverticulitis, inflammatory bowel disease (ulcerative colitis or Crohn’s disease), and severe constipation. In women, pain in this area may result from a ruptured ovarian cyst or pelvic inflammatory disease.

Right lower abdomen
Pain in this area can occur from appendicitis, Crohn’s disease, and in women, ovarian cyst or pelvic inflammatory bowel disease.