Areas of Expertise
Intestinal Diseases
Intestinal diseases can cause common complaints such as abdominal pain, bloating, constipation and diarrhea. This section gives a general overview of five frequently encountered conditions. The information is for general education only; diagnosis and treatment require evaluation by a physician.
01
Irritable bowel syndrome (IBS)
Irritable bowel syndrome is a disorder of gut-brain interaction that causes abdominal pain and altered bowel habits without structural damage to the bowel.
Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction marked by recurrent abdominal pain or discomfort and changes in bowel habits. No obvious structural damage is found in the bowel, but the symptoms are real. The brain and the gut communicate in both directions through nerves, hormones and the immune system. Stress, poor sleep and certain foods can worsen symptoms. It is more common in women.
Symptoms
- Recurrent abdominal pain or discomfort
- Abdominal bloating and gas
- Constipation, diarrhea or the two alternating
- Pain that eases or worsens with a bowel movement
- Changes in how often or how firm the stool is
- A feeling of incomplete emptying after a bowel movement
When to see a doctor
- When blood appears in the stool, especially if it recurs
- If unintentional weight loss or anemia has been found
- If diarrhea wakes you from sleep at night
- If symptoms start for the first time after age 50
- If there is a family history of colorectal cancer, celiac disease or inflammatory bowel disease
How is it diagnosed?
IBS is diagnosed by a physician who assesses symptoms against the Rome criteria. When there are no alarm features, limited testing, such as a blood count, CRP and a celiac test, is often enough. If alarm features are present, further tests such as colonoscopy may be needed. Colonoscopy is not routinely recommended for everyone.
Treatment and lifestyle
- Eat three regular meals without rushing; limit caffeine, alcohol, carbonated drinks and very fatty foods.
- Start soluble fiber in small amounts and increase slowly; bran-type insoluble fiber may worsen symptoms.
- Regular activity several days a week, steady sleep and stress management can help ease symptoms.
- The low FODMAP diet is a three-phase trial done with a dietitian, not a lifelong diet.
- IgG food intolerance tests and unnecessary gluten-free diets without celiac disease are not recommended.
- If symptoms persist, a physician may suggest symptom-targeted medicines or gut-directed behavioral therapies.
LifestyleRandomized trials have reported that regular physical activity may help reduce IBS symptoms.
Related article: The Restless Gut: Brain and Gut Share One Story →02
Chronic constipation
Chronic constipation means infrequent, difficult or incomplete bowel movements that continue over a long period.
Chronic constipation means infrequent bowel movements, hard stools, prolonged straining or a feeling of incomplete emptying that lasts for months. A low-fiber diet, too little fluid, inactivity, some medicines and conditions such as thyroid disease may contribute. In some people the bowel moves slowly, or the muscles around the anus do not coordinate during a bowel movement. The cause differs from person to person, so an evaluation is needed.
Symptoms
- Fewer than three bowel movements a week
- Hard, small, pellet-like stools
- Needing to strain for a long time
- A feeling of incomplete emptying
- Abdominal bloating and fullness
- Needing manual help to pass stool
When to see a doctor
- When blood appears in the stool or the stool becomes thin
- If there is unexplained weight loss or anemia
- If constipation starts for the first time after age 50
- If abdominal swelling and vomiting occur with it
- If it does not improve after a few weeks of lifestyle measures
How is it diagnosed?
The physician asks about symptoms, diet and medicines, and examines the abdomen and anal area. Blood tests may check for causes such as thyroid disease. Colonoscopy may be needed if alarm features are present. If a problem with the evacuation mechanism is suspected, special tests such as anorectal manometry may be done.
Treatment and lifestyle
- Increase fiber gradually with vegetables, fruit, legumes and whole grains.
- Drink enough fluid through the day.
- Regular movement such as walking supports normal bowel function.
- Set aside time for the toilet, especially after meals; do not put off the urge.
- Review medicines that may cause constipation together with your physician.
- Ask a physician before using laxatives or similar medicines for a long time.
LifestyleEnough fiber and fluid, along with regular meals, are the first-line measures for regulating bowel habits.
03
Chronic diarrhea
Chronic diarrhea means loose or frequent stools that last longer than four weeks.
Chronic diarrhea means loose or watery stools, or more frequent bowel movements, lasting longer than four weeks. Infections usually pass within a short time. When diarrhea persists, many causes are considered, including celiac disease, inflammatory bowel disease, lactose intolerance, some medicines, thyroid disease, bile acid problems and irritable bowel syndrome. Finding the cause guides treatment.
Symptoms
- Loose or watery stools lasting longer than four weeks
- Frequent bowel movements through the day
- Sudden, urgent need to pass stool
- Abdominal pain and cramping
- Abdominal bloating and gas
- Fatigue or weight loss
When to see a doctor
- When blood or pus appears in the stool
- If diarrhea wakes you from sleep at night
- If there is unintentional weight loss or anemia
- If high fever or severe abdominal pain occurs with it
- If there are signs of dehydration such as dry mouth, very little urine or dizziness
How is it diagnosed?
After taking a history and examining you, the physician may order a blood count, inflammation markers, a celiac test and stool tests. Colonoscopy may be needed if alarm features are present, and sometimes upper endoscopy and biopsy. Links with medicines, dairy products and other foods are also reviewed.
Treatment and lifestyle
- Drink enough fluid to replace what is lost.
- Note foods that worsen symptoms and share them with your physician.
- Reduce alcohol and excess caffeine.
- Do not use anti-diarrheal medicines without medical advice if the diarrhea is bloody or comes with fever.
- Do not start a gluten-free diet before celiac evaluation; testing is done while eating gluten.
- Once the cause is identified, treatment is planned together with your physician.
04
Diverticular disease and diverticulitis
Diverticula are small pouches in the wall of the large bowel; when they become inflamed, the condition is called diverticulitis.
Diverticula are small pocket-like outpouchings in the wall of the large bowel. They become more common with age, and most people have no symptoms. Sometimes these pouches become inflamed; this is called diverticulitis and usually causes lower left abdominal pain and fever. Most attacks are mild, but complications such as an abscess, a perforation of the bowel or bleeding can occur.
Symptoms
- Most people have no symptoms
- Pain and tenderness in the lower left abdomen
- Fever and chills
- Nausea and loss of appetite
- Bloating and changes in bowel habits
- Painless, sudden, noticeable fresh blood in the stool
When to see a doctor
- If abdominal pain continues together with fever
- If there is severe pain, a rigid abdomen and vomiting
- If noticeable blood or black stool appears
- If pain returns after a previous episode of diverticulitis
- If a change in bowel habits becomes persistent
How is it diagnosed?
Diverticula are often found by chance during a colonoscopy or imaging done for another reason. When diverticulitis is suspected, an examination, blood tests and an abdominal CT scan may be used. Colonoscopy is usually delayed during acute inflammation and, if needed, planned after recovery.
Treatment and lifestyle
- Eat a high-fiber diet with vegetables, fruit, legumes and whole grains.
- Avoiding nuts and seeds is not necessary when you have diverticula.
- Stay physically active and aim for a healthy weight.
- Stop smoking and cut down on or avoid alcohol.
- Do not take pain relievers regularly without medical advice.
- In an acute attack, the physician decides treatment by severity; antibiotics are not always needed.
LifestyleA high-fiber diet, physical activity, weight control and not smoking are linked to a lower risk of diverticulitis.
05
Colon polyps
Colon polyps are growths on the inner lining of the large bowel; most are harmless, but some can turn into cancer over time.
Colon polyps are growths that project from the inner lining of the large bowel into its cavity. Most cause no symptoms. Some types, especially adenomas, can turn into colorectal cancer over many years. For this reason, polyps are found and removed during colonoscopy. A pathology examination shows the type of polyp, and the physician decides the timing of follow-up accordingly.
Symptoms
- Often there are no symptoms at all
- Blood in the stool
- A change in bowel habits
- Anemia due to iron deficiency
- Abdominal pain or a blocked feeling with large polyps
When to see a doctor
- When blood appears in the stool
- If there is anemia with no identified cause
- If there is a family history of colorectal cancer or polyps
- If a change in bowel habits continues
- If a polyp was removed before and a check-up is due
How is it diagnosed?
Colonoscopy is the standard method for finding polyps and removing them in the same procedure; the removed polyp is sent for pathology. Methods such as the fecal occult blood test may also be used within colorectal cancer screening programs. The timing and method of screening are set by physician advice, according to the program and risk group.
Treatment and lifestyle
- Take part in colorectal cancer screening as your physician advises, according to the screening program and your risk group.
- If a polyp was removed, follow-up timing is set with your physician according to the pathology result.
- Eat plenty of vegetables, fruit and whole grains; limit red and processed meat.
- Stop smoking and reduce alcohol.
- Stay physically active and maintain a healthy weight.
- Follow bowel preparation instructions exactly before a colonoscopy.
LifestyleA high-fiber diet, regular activity, not smoking and cutting down on or avoiding alcohol are linked to a lower risk of colorectal cancer.
