Go With Your Gut: When a Stomach Ache Is Something More...
Because we all experience abdominal discomfort or pain at some time or other, deciding whether or not to see a doctor for these symptoms can be perplexing. If the symptoms are intermittent and not present during a physical exam, they may also be difficult to describe. Fortunately, there are some general rules of thumb that can be helpful.
Barbara O'Brien, MD, assistant professor of medicine at the University of South Alabama in Mobile and a member of the American College of Gastroenterology says that, in general, younger people may experience more severe abdominal pain than older ones, but, with exceptions, the pain is usually of a less serious nature in younger folks. The most common causes of periodic abdominal discomfort or pain, she adds, include ]]>irritable bowel syndrome]]> ("spastic colon"), ]]>gastroesophageal reflux]]> , ]]>peptic ulcer disease]]> , and ]]>gallstones]]> . Other possible causes, although less frequent, include inflammatory bowel disease, colorectal cancer, and hepatitis. Sometimes symptoms of abdominal pain, especially if related to exertion, may point to heart problems, rather than gastrointestinal problems.
When Should You Seek a Professional Opinion?
You've got an upset stomach. Maybe you ate too much. Or maybe you have food poisoning. How can you be sure that nothing serious is wrong?
O'Brien says you should see a doctor if you are experiencing abdominal symptoms AND any of the following:
1. Pain that is steady, severe in intensity, or recurring
2. Inability to perform routine activities
3. Weight loss or loss of appetite
4. Nausea and vomiting
6. Drastic changes in bowel habits
7. Difficulty in swallowing
8. Nighttime awakening due to pain
9. A previous history of stomach disorders or intestinal surgery
10. A medical condition which requires the use of ]]>aspirin]]> or anti-inflammatory medications.
In general, a single episode of pain that goes away within 24-48 hours does not warrant further medical treatment.
The Exam: What to Expect
First, says O'Brien, your doctor will review your history in detail. He or she will be especially interested in any previous gastrointestinal problems or heart problems, as certain symptoms can overlap. Be prepared to tell your doctor about any medications you are taking, particularly non-steroidal anti-inflammatory medications such as ]]>Ibuprofen]]> . It is also important to be candid with him or her about any herbal remedies you may be taking, as some herbal medications can affect the liver and the gastrointestinal tract. You will be asked whether you have been treated before for the same symptoms, or if the pain is new.
Be sure to let your doctor know if there is a history of gastrointestinal disease in your family. While there is currently no evidence that irritable bowel syndrome has a genetic link, other conditions like inflammatory bowel disease have genetic links, says O'Brien, as does ]]>colon cancer]]> .
To determine whether your symptoms may be gynecological in nature, your doctor will most likely ask whether you are sexually active, what type of birth control you use, the regularity of your cycle, and if there is any possibility you may be pregnant.
You'll then be asked about the nature of your pain such as:
- Is it constant?
- Does it come and go, and is it crampy?
- How long does it last?
- What time of day does it occur, is it random, or does it occur after meals, etc.?
- Where is the pain located?
- Are there any measures that cause the pain or that relieve it?
- Are you experiencing any other symptoms?
Since pain descriptions are very cultural, says O'Brien, just do the best you can to describe it in detail and in your own words. It is often helpful to write down what you've experienced before seeing the doctor, as you may leave out important details if you get nervous during the examination.
Next, your doctor will perform a general examination, including an abdominal exam during which he or she will listen for bowel sounds, look at the overall appearance of your abdomen, and perform different maneuvers to examine for the type of pain. Most of the time, O'Brien adds, this examination will include a rectal exam, and a stool sample will be taken. A pelvic exam may also be performed. In some cases, especially if abdominal pain is high up, or related to exertion, your doctor may perform tests to check on the health of your heart.
Most gastrointestinal disorders can be readily treated by your primary care practitioner. Some recurring or more serious problems may require the care of a gastroenterologist who has been specially trained to treat such disorders.
"You need to walk away from your doctor's office with a game plan," stresses O'Brien. "Ask your practitioner, 'Where are we going from here?'" she says. Have your physician map out his or her impressions and a plan of action for your treatment, whether it is further testing, changes in your diet, medication, or referral to a specialist.
The Stress Factor
Everybody may experience abdominal symptoms as a result of stress, O'Brien adds. If your doctor determines that your pain is a result of stress, and your lifestyle is being affected by the pain, "you certainly need to do something to reduce the stress." If, however, you are uncomfortable with your physician or your diagnosis, seek a second opinion.
Looking for Info? Consumer Beware!
If you or a loved one is diagnosed with a gastrointestinal disorder or disease and you look to the Internet for information on a disease or treatment options, beware. A study presented at the Annual Scientific Meeting of the American College of Gastroenterology showed that "10% of Internet sites offering treatment advice for gastrointestinal diseases posted remedies that are of no proven benefit." Researchers also found that sites sponsored by government agencies, universities, medical organizations, and noncommercial consumer health sites are far more likely to be accurate. If you come across information online that interests you or you feel may be helpful, share the information with your doctor before trying any remedy.
American College of Gastroenterology
National Institutes of Health
South Denver Gastroenterology
The College of Family Physicians
Last reviewed June 2008 by ]]>Daus Mahnke, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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