Constipation, when accompanied by severe abdominal pain, blood in the stool, unexplained weight loss, or sudden changes in bowel habits, may warrant a visit to the doctor.
Posted by Dr. Ronnie Mathew,
Senior Consultant Surgeon, Colorectal Care Specialists (CRCS)
Constipation is a common problem that affects people of all ages. It can mean that you’re not passing stools regularly or you’re unable to completely empty your bowel. Constipation in adults can affect the quality of life. It also may be associated with haemorrhoids, anal fissures, and serious underlying causes, such as colorectal cancer. There is some evidence that constipation may be associated with a modest reduction in survival.
Constipation is a common condition where bowel movements become infrequent or difficult, often caused by diet, lifestyle, or underlying health issues.
What is Constipation?
Constipation is common and can occur at any age. The word may mean different things to different people, as bowel habits (and the words they use to describe them) differ greatly between people. For some, it might mean not going to the toilet as often as usual; for others, it means their stools are very hard or painful to pass. This might mean people strain to force the stool out. For others, it might feel like they haven't emptied completely, and for some people, they only believe they are constipated when they have several of these symptoms at the same time. Sometimes, it occurs because of your body’s condition: Your large intestine might be sluggish and need help expelling waste, or perhaps the bowel muscles don't work effectively. Otherwise, it occurs because of another medical condition or medicines that you are taking.
A commonly used medical definition of constipation is having fewer than three spontaneous bowel movements per week.
Symptoms of Constipation
The severity of constipation varies from person to person. Many people experience it only for a short time, but for others, it can be a long-term (chronic) condition that causes significant pain and discomfort and affects quality of life. Chronic constipation means the problem has been present for at least 12 weeks out of the past 6 months.
If you are constipated, it may cause one or more of the following:
Stools (faeces) become hard and difficult or painful to pass.
The time between each bowel motion increases compared with your usual pattern. There is a large range of normal bowel habits. Some people usually go to the toilet to pass stools 2-3 times daily. For others, 2-3 times per week is normal. It is a change from your usual pattern that may mean you are constipated. Passing a soft stool at least three times a week is considered normal.
Sometimes, crampy pains occur in the lower part of your tummy (abdomen). You may also feel bloated and feel sick if you have severe constipation.
It does not feel like you have emptied your bowels or 'finished' after going to the toilet to pass a stool.
What are the causes of Constipation?
Some causes are known to lead to constipation, including the following:
Not eating enough fibre (roughage) can lead to constipation. Fibre is the part of plant food that is not digested. It remains in your gut. It adds bulk to the stools (faeces) and helps your bowels to work well. Foods high in fibre include fruit, vegetables, bran cereals, whole-meal bread, oats, etc. A daily intake of 30 g of fibre per day is recommended. However, you should consider your medical history and how well you can tolerate fibre.
Not drinking enough may lead to or worsen constipation. If you eat enough fibre and drink enough fluid, your stool is usually soft and easily passed. However, some people need more fluids than others to avoid constipation. For example, if you live in a hot country, spend most of your time outdoors, or exercise a lot, you may need more fluids.
Being less active for various reasons, for example:
Illness or injury.
Disability.
Frailty, or old age.
Depression.
Work patterns.
Obesity.
Some medicines can cause constipation as a side effect. Examples are painkillers (particularly those with codeine/morphine based), some antacids, some antidepressants (including amitriptyline), and iron tablets. These are only a few examples, and there are many others. If in doubt, check the medication label and its side effects.
Various medical conditions can cause constipation. For example: An
Pregnancy. About one in five pregnant women will become constipated. This is due to the hormonal changes that slow down gut movements during pregnancy. In later pregnancy, it can simply be due to the baby taking up a lot of room in the tummy and pushing the bowels to one side.
Unknown cause (idiopathic) Some people can get constipated despite having a good diet, drinking a lot of fluids, not having a disease, and not taking any medication that can cause constipation. Their bowels are said to be underactive. This is quite common and is sometimes called functional constipation or primary constipation. Most cases occur in women. This condition starts in childhood or early adulthood and persists throughout life.
Personal Toileting habits might also predispose to constipation. For example, people may develop the long-term habit of withholding or ignoring the urge to defecate. This can be due to a lack of access to the toilet at home or work or an avoidance of using public toilets. Issues of cleanliness and lack of privacy can also lead to these. People may also feel hurried or disturbed when trying to defecate.
Anxiety, depression, cognitive impairment, or an eating disorder. There are multiple causes of constipation, including over 30 factors. Sometimes, it can be a combination of these. This blog is unable to cover them all. If you need to seek a healthcare specialist assessment for personal health reasons, it is recommended that you seek one.
Can you improve your Constipation on your own?
There are several things that can be done to improve constipation symptoms.
Adequate dietary fibre: This includes fruits and vegetables. Certain fruits may especially help, but this can vary from person to person. Some of these fruits are prunes, kiwi fruit, papaya, pineapple, dragon fruit, and banana. You may need to adjust according to the seasons. Prunes, for example, don’t go out of season, as they are dried and usually available all year round.
Stay hydrated: Drink at least 8-10 glasses of liquids daily. This is even more important when you take fibre, as it needs liquid to help it bulk up and become soft. Otherwise, it can become hard. This is especially true in hot climates, if you exercise more, etc.
Stay active. Regular exercise and staying active are important to avoid constipation.
Probiotics. There is evidence that probiotics may help with reducing the risk of constipation.
Maintain good toilet habits: Go to the toilet when you need to, without delay. Some people also find the correct position helps while you are on the toilet.
Manage any stress, anxiety, or eating disorders. Learn and use relaxation techniques to manage stress. Seek expert help as required, including for eating disorders.
When should you seek expert professional help and treatment for Constipation?
It is not possible to be certain when to seek a review from a healthcare expert. Below are some of the general considerations when it is important to seek a health review for constipation:
Your constipation lasts longer than 14 days without improvement
You have a sudden change in your bowel habits
A feeling of incomplete bowel evacuation (you feel you have not passed all the stool even though you have gone to the toilet to do so)
You have blood in your stool or black stools
You have unexplained weight loss
You are over 40 years old
You have a family history of colon cancer
You have persistent tiredness
It makes it difficult to do everyday activities
You have stomach pain that doesn't stop
You have abdominal (tummy) bloating
You're vomiting stool or bile
You're taking medicine that's causing constipation
Important: Irrespective of the above general factors, seeking professional help is good practice when unsure or worried.
What are the possible investigations and treatment options for Constipation?
The list of investigations and management options is too vast and detailed to be included in this blog. This also considers the multiple causes of constipation, including over 30 factors. Sometimes, it can be a combination of these. It is enough to mention that some may need lifestyle changes, while others require more detailed investigations and treatment. The direction of the management approach is based on the likely causative factors. What is important is that you seek help from a specialist healthcare provider.
If you have any questions regarding constipation or what to do about it, then do get in touch with us today to have them answered.
Important Disclaimer: The information provided here is not specific and is meant for general information only. It does not constitute guidance for managing or treating any condition and does not replace information from your healthcare professional. Please consult your healthcare professional for more information and guidance.
Acknowledgments and References, for further reading:
patient.info/digestive-health/constipation
Attaluri A, Donahoe R, Valestin J, et al; Randomised clinical trial: dried plums (prunes) vs. psyllium for constipation. Aliment Pharmacol Ther. 2011 Apr;33(7):822-8. doi:
A Guide to Refractory Constipation: Diagnosis and Evidence-Based Management; British Society of Gastroenterology, 2020 - updated November 2021
Diaz S, Bittar K, Mendez MD; Constipation
Constipation; NICE CKS, January 2024
Cho YS, Lee YJ, Shin JE, et al; 2022 Seoul Consensus on Clinical Practice
Ford AC, Talley NJ; Laxatives for chronic constipation in adults. BMJ. 2012 Oct 1;345:e6168. doi: 10.1136/bmj.e6168.
Krogh K, Chiarioni G, Whitehead W; Management of chronic constipation in adults. United European Gastroenterol J. 2017 Jun;5(4):465-472. doi: 10.1177/2050640616663439. Epub 2016 Aug 2.
Lacy BE, Levenick JM, Crowell M; Chronic constipation: new diagnostic and treatment approaches. Therap Adv Gastroenterol. 2012 Jul;5(4):233-47. doi: 10.1177/1756283X12443093.
Written by Dr. Ronnie Mathew, Senior Consultant Surgeon, CRCS
What is Heartburn, and how does it occur?
Heartburn is a burning sensation that rises from the stomach or lower chest towards the neck. It is essentially due to gastro-oesophageal reflux disease (GERD), also called reflux oesophagitis.
The mouth and the stomach are connected by the oesophagus (food pipe). At the end of the oesophagus, where the stomach connects, there is a valve called the lower oesophagus sphincter (LES). The LES is a circular muscle that only opens when you swallow, burp, or have hiccups. It closes again to prevent the stomach acid from coming back up again. Acid reflux occurs when the LES weakens or relaxes, such as after a heavy meal. While the LES usually relaxes temporarily, GERD happens when the LES is weakened.
GERD is usually a chronic condition in which stomach contents (particularly acid, bile, and pepsin) reflux back into the oesophagus (food pipe) and irritate the lining of the lower end of the oesophagus. The predominant symptoms are heartburn and acid regurgitation. Atypical oropharynx and/or respiratory tract symptoms may occur, such as hoarseness, cough, asthma, and dental erosions.
Heartburn occurs when stomach acid irritates the lining of the oesophagus, causing inflammation and a burning sensation in the chest.
How common is Heartburn?
GERD affects 10-30% of the adult population in developed countries. Although heartburn/GERD can occur at any age, its prevalence increases with age, especially after age 40. It is slightly more common in women.
What causes Heartburn or GERD?
A certain amount of gastro-oesophageal reflux of acid is normal, and there is a natural protective mechanism of the lower oesophagus. Gastro-oesophageal reflux disease (GERD) describes prolonged or excessive reflux that may cause the breakdown of this protection with inflammation of the oesophagus (oesophagitis).
Several factors can predispose to reflux, including:
Increased intra-abdominal pressure
Smoking, alcohol, fat, chocolate, coffee
Pregnancy
Obesity
Stress and anxiety
Tight clothes
Big meals
Surgery in achalasia of the cardia
Systemic sclerosis
Hiatus hernia (this is a weakening of the sphincter at the lower end of the oesophagus/food pipe)
Family history
Drugs (examples include alpha-blockers, anticholinergics, benzodiazepines, beta-blockers, bisphosphonates, calcium-channel blockers, corticosteroids, nonsteroidal anti-inflammatory drugs, nitrates, theophyllines, and tricyclic antidepressants
Most of these predisposing factors increase intra-abdominal pressure. A fatty meal delays gastric emptying. The above-listed drugs and smoking relax the tone of the sphincter at the lower end of the oesophagus (also called the lower oesophageal sphincter or cardiac sphincter). Note that there is no proven relationship between Helicobacter pylori infection (which affects the stomach, causes gastritis, etc.) and GERD.
Bile is particularly caustic, and reflux of duodenal contents is more troublesome than reflux of gastric contents alone. There is little correlation between the severity of symptoms and findings on endoscopy.
What are the symptoms of Gastro-oesophageal Reflux Disease?
You may have GERD if you have experienced the following symptoms:
Heartburn
Backwash of food in the throat
Sensation of a lump in the throat
Nausea
Difficulty swallowing
Backwash
Breathing symptoms: chronic cough, shortness of breath, wheezing
Laryngitis
Sore throat
Chest pain not related to the heart
Upper abdominal pain/discomfort
How is GERD diagnosed?
A specialist (e.g., general surgeon/intestinal surgeon/gastroenterologist) will need to undertake a full assessment of symptoms and relevant history, followed by a physical examination. They then may decide to undertake diagnostic procedures like:
Upper gastrointestinal endoscopy (Oesophago-Gastro-Duodenoscopy, OGD): This diagnostic procedure involves inserting an endoscope through the mouth to examine the inside of the oesophagus, stomach, and part of the duodenum more closely.
Barium Swallow: This type of X-ray involves swallowing a chalky liquid (barium) and taking pictures of the oesophagus as you swallow.
Oesophageal manometry: This procedure uses pressure sensors planted in a nasogastric tube to measure the muscle activities in the oesophagus and determine whether the LES is functioning properly.
Oesophageal pH test: measures the acid content in the oesophagus.
Can certain foods cause worsening of the acid reflux?
In the presence of weakened LES (valve at the lower end of the oesophagus), certain foods can cause acid reflux. These foods include:
Certain beverages, like alcohol, coffee, carbonated beverages, and tea.
Certain fruits and vegetables include pineapple, citrus fruits, tomatoes, garlic, and onions.
High-fat foods
Spicy food.
What lifestyle changes can help to reduce the symptoms of heartburn/GERD?
Certain lifestyle changes could help the heartburn/GERD symptoms:
Eat slowly and in smaller portions, but more frequently
Reduce the intake of above-mentioned foods
Elevating your head when you sleep. You can use additional pillows for this or raise the headend of your bed
Wear loose clothes when you sleep, so that it doesn’t constrict your tummy
Eat your last meal of the day at least three hours before you go to bed
Maintaining a healthy weight. Lose weight if you are overweight
Reduce alcohol intake
Quitting smoking
How is GERD usually managed and treated?
There are various broad management approaches to help treat GERD symptoms:
Lifestyle changes
As mentioned above, adopting positive lifestyle changes, such as healthy eating habits and reducing alcohol can help manage GERD symptoms.
Medications
Antacids: neutralizes the acid that is already present in your stomach
Alginates: help create a barrier between the stomach acid and the oesophagus as the contents of the alginates float on top of the stomach acid.
Proton pump inhibitors reduce acid secretion into the stomach.
Histamine receptor antagonists (H2 blockers) reduce acid secretion into the stomach.
Potassium-competitive acid blockers reduce acid secretion into the stomach.
Baclofen: to reduce muscle spasms and the frequency of lower oesophageal sphincter relaxation, thereby reducing the occurrence of acid reflux.
Prokinetics: to strengthen the lower oesophageal sphincter and help the stomach empty faster
Please note: Medications have side effects and also interactions with other medications. Please consult your healthcare provider before you take any medications.
Fundoplication is a surgical procedure for GERD that involves wrapping the stomach around the oesophagus — with different methods tailored to individual needs.
Operative management
If lifestyle management along with medications are unable to control GERD symptoms, then surgery for gastro-oesophageal reflux disease (GERD) may be considered. Surgical options involve a few different procedures, including:
Fundoplication: Operation where the top of the stomach is wrapped at the junction of the oesophagus and stomach. This creates a new valve-like mechanism that prevents stomach acid from flowing back into the oesophagus. This is often performed laparoscopically, which means through small incisions and with the aid of a video monitor. There are mainly three types of fundoplication:
Nissens fundoplication
Anterior/Dor fundoplication
Toupet fundoplication
Transoral incisionless fundoplication (TIF): A procedure that reconstructs the valve between the stomach and oesophagus.
LINX Reflux Management System: A minimally invasive procedure that involves placing a ring of magnetic beads around the lower oesophageal sphincter. The beads help keep the sphincter closed, preventing stomach contents from flowing back into the oesophagus.
If you have any questions regarding heartburn, acid reflux or GERD, then do get in touch with us today to have them answered.
Important: Please note:The information provided here is not specific and is meant for general information only. It does not constitute guidance for the management or treatment of any condition and does not replace information from your healthcare professional. Please consult your healthcare professional for more information and guidance.
Cheung KS, Leung WK; Long-term use of proton-pump inhibitors and risk of gastric cancer: a review of the current evidence. Therap Adv Gastroenterol. 2019 Mar 11;12:1756284819834511. doi: 10.1177/1756284819834511. eCollection 2019.
Feinle-Bisset C, Azpiroz F; Dietary and lifestyle factors in functional dyspepsia. Nat Rev Gastroenterol Hepatol. 2013 Mar;10(3):150-7. doi: 10.1038/nrgastro.2012.246. Epub 2013 Jan 8.
Garg SK, Gurusamy KS; Laparoscopic fundoplication surgery versus medical management for gastro-oesophageal reflux disease (GORD) in adults. Cochrane Database Syst Rev. 2015 Nov 5;(11):CD003243. doi: 10.1002/14651858.CD003243.pub3.
Gyawali CP, Yadlapati R, Fass R, et al; Updates to the modern diagnosis of GERD: Lyon consensus 2.0. Gut. 2024 Jan 5;73(2):361-371. doi: 10.1136/gutjnl-2023-330616.
Liu L, Li S, Zhu K, et al; Relationship between esophageal motility and severity of gastroesophageal reflux disease according to the Los Angeles classification. Medicine (Baltimore). 2019 May;98(19):e15543. doi: 10.1097/MD.0000000000015543.
Katz PO, Dunbar KB, Schnoll-Sussman FH, et al; ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol. 2022 Jan 1;117(1):27-56. doi: 10.14309/ajg.0000000000001538.
Krause AJ, Walsh EH, Weissbrod PA, et al; An update on current treatment strategies for laryngopharyngeal reflux symptoms. Ann N Y Acad Sci. 2022 Apr;1510(1):5-17. doi: 10.1111/nyas.14728. Epub 2021 Dec 17.
Nencioni M, Asti E, Saino G, et al; Magnetic oesophageal sphincter for the treatment of gastro-oesophageal reflux disease: results of a prospective clinical trial. Chir Ital. 2009 Mar-Apr;61(2):187-92.
Ness-Jensen E, Hveem K, El-Serag H, et al; Lifestyle Intervention in Gastroesophageal Reflux Disease. Clin Gastroenterol Hepatol. 2016 Feb;14(2):175-82.e1-3. doi: 10.1016/j.cgh.2015.04.176. Epub 2015 May 6.
Sigterman KE, van Pinxteren B, Bonis PA, et al; Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease. Cochrane Database Syst Rev. 2013 May 31;(5):CD002095. doi: 10.1002/14651858.CD002095.pub5.
Yuan LZ, Yi P, Wang GS, et al; Lifestyle intervention for gastroesophageal reflux disease: a national multicenter survey of lifestyle factor effects on gastroesophageal reflux disease in China. Therap Adv Gastroenterol. 2019 Sep 25;12:1756284819877788. doi: 10.1177/1756284819877788. eCollection 2019.
Written by Dr. Ronnie Mathew, Senior Consultant Surgeon, CRCS
What is the Gallbladder, and what does it do?
The gallbladder is a small, pear-shaped organ in the upper right side of the abdomen. Think of your gallbladder as a little storage pouch for bile, a digestive fluid made by your liver. When food is eaten, the stomach releases a hormone that causes the gallbladder to contract and release bile into the small intestine. The bile fluid helps break down fats in the food you eat.
What are Gallstones, and why do they occur?
Gallstones are small, hard deposits that form in your gallbladder. They can range in size from a grain of sand to a golf ball. These stones form when there's too much cholesterol, bile salts, or bilirubin in the bile. When this happens, the excess material hardens into stones. Gallstones are usually harmless, but they can sometimes block the flow of bile and cause pain, nausea, inflammation/infection, and other complications.
Gallstones are hardened deposits of digestive fluid that form in the gallbladder, and can sometimes cause pain or no symptoms at all.
Who is at risk of gallstones?
Generally, several groups are more likely to develop gallstones:
Age: As you age, your risk of developing gallstones increases. Men are more likely to get them after age 60, while women are more prone between the ages of 20 and 50.
Gender: Women have a higher risk of gallstones than men because of their naturally higher oestrogen hormone levels. Oestrogen increases cholesterol in bile, and another hormone, progesterone, can slow the gallbladder's emptying process.
Weight: Carrying extra weight is a major risk factor. Body fat releases oestrogen, which increases cholesterol levels in bile. Rapid weight loss can also trigger gallstones because it simultaneously dumps a lot of cholesterol into the bile.
Genetics: If gallstones run in your family, you’re also more likely to get them.
Hormones: Hormonal changes, such as those from pregnancy, hormone replacement therapy, or birth control pills, can raise the risk of gallstones by increasing oestrogen levels.
Cholesterol-lowering drugs: While these drugs lower cholesterol in your blood, they can increase the cholesterol in your bile, leading to a higher risk of gallstones.
Diabetes: People with diabetes often have high levels of fatty acids called triglycerides, which can contribute to the formation of gallstones.
Diet and lifestyle: Eating a diet high in fat and cholesterol and low in fibre, and a sedentary lifestyle can increase your risk of gallstones.
Can gallstones be prevented from forming in the first place?
There is some evidence that a healthy lifestyle, regular physical activity, and ideal body weight might prevent cholesterol stones and symptomatic gallstones. However, the evidence for this recommendation is not strong.
Medications with Ursodeoxycholic acid may be useful in preventing high-risk patients (e.g., morbidly obese patients undergoing rapid weight loss following bariatric (weight loss) surgery) from developing gallstones. However, studies suggest that ursodeoxycholic acid does not reduce biliary symptoms once the stones have formed.
What are the symptoms of gallstones?
Most people with gallstones don’t even know they have them because they don’t always cause symptoms. But if a gallstone gets stuck in the bile duct, it can cause sudden, severe pain in the upper right part of your abdomen. This pain is known as biliary colic. If the blockage isn't treated, it can lead to serious problems like infections or inflammation of the gallbladder.
If the bile does not drain well, it can cause:
jaundice
dark urine
light-coloured stools
What treatment options are there for gallstones?
Gallstones causing no symptoms or issues
Gallstones do not cause any symptoms in a majority of people. In such cases, there is no specific treatment apart from general diet control and treating any underlying causes that predispose gallstone formation.
These conditions require specific treatment for each condition. For example, painkillers for pain symptoms, antibiotics for infection/inflammation, clearing the bile duct when there is obstructive jaundice, drainage of gallbladder in certain conditions, specific treatment for pancreatitis, operation when bowel blockage due to gallstones, etc. These are only general suggestions, and usually, they require a combination of treatment strategies.
In addition, it would also usually require the removal of the gallbladder (called Cholecystectomy). Cholecystectomy is the most common treatment for gallstones. This is typically performed with a minimally invasive surgical operation. The gallbladder is not an essential organ, so people can live normal lives without it.
Medical or shockwave treatments (called lithotripsy) can be considered to dissolve the gallstones, but they may not be as effective.
Can there be other conditions mimicking symptoms similar to those due to gallstones?
Other conditions that mimic gallstone symptoms include:
Sometimes, the conditions can overlap. Hence, seeing a specialist and making a detailed assessment is important. Investigations are usually required to diagnose gallbladder/gallstone-related problems and as well as to exclude other conditions.
What investigations can be considered to diagnose gallstone-related problems?
Ultrasound Is one of the best ways to demonstrate stones, being 90-95% sensitive:
Sometimes, stones are not mobile, so they are not easy to differentiate from unimportant polyps, and very small ones may be missed or fail to throw a helpful acoustic shadow.
Ultrasonography can also allow measurement of the diameter of the common bile duct (CBD) and show the liver and hepatic bile ducts. Still, it can only identify about half of any stones in the CBD with certainty.
If the ultrasound scan findings are negative but there is a high level of suspicion, such as in a patient with upper abdominal pain and abnormal LFTs, it is worth repeating the investigation after an interval. This may pick up stones that were previously missed.
An MRI scan (magnetic resonance cholangiopancreatography) may often be helpful when further clarifications are needed.
Endoscopic retrograde cholangiopancreatography (ERCP) may be used for the diagnosis of CBD stones and has also evolved from a diagnostic to a therapeutic procedure for the removal of CBD stones.
Blood tests (to assess for infection markers, bilirubin levels, liver enzymes, and amylase/lipase to assess for pancreatitis), Urinalysis, Chest X-ray (CXR), Electrocardiogram (ECG), OGD/Endoscopy, and Colonoscopy may help exclude other diseases.
At CRCS, we provide expert assessment, diagnosis, and treatment to help restore your health.
If you have any questions regarding your Gallbladder or Gallstones, then do get in touch with us today to have them answered. https://www.thecrcs.com
Important: Please note:The information provided here is not specific and is meant for general information only. It does not constitute guidance for the management or treatment of any condition and does not replace information from your healthcare professional. Please consult your healthcare professional for more information and guidance.
Khan HN, Harrison M, Bassett EE, et al; A 10-Year Follow-up of a Longitudinal Study of Gallstone Prevalence at Necropsy in South East England. Dig Dis Sci. 2009 Jan 22.
Shojaiefard A, Esmaeilzadeh M, Ghafouri A, et al; Various techniques for the surgical treatment of common bile duct stones: a meta review. Gastroenterol Res Pract. 2009;2009:840208. Epub 2009 Aug 6.
Sakorafas GH, Milingos D, Peros G; Asymptomatic cholelithiasis: is cholecystectomy really needed? A critical reappraisal 15 years after the introduction of laparoscopic cholecystectomy. Dig Dis Sci. 2007 May;52(5):1313-25. Epub 2007 Mar 28.
Machado FHF, Castro Filho HF, Babadopulos RFAL, et al; Ursodeoxycholic acid in the prevention of gallstones in patients subjected to Roux-en-Y gastric bypass1. Acta Cir Bras. 2019 Feb 14;34(1):e20190010000009. doi: 10.1590/s0102-865020190010000009.
Posted by Dr. Ronnie Mathew, Senior Consultant Surgeon
A hernia occurs when an internal part of the body pushes through a weak spot in the surrounding muscle or tissue wall. There are many types of hernia, depending on the body's sites and the nature of hernia protrusion. Abdominal hernias occur when a weakness in the wall of the tummy (abdominal wall) results in some of the contents in the abdominal cavity bulging through. Inguinal hernias are the most common among the abdominal hernias.
Some common abdominal Hernias:
An abdominal hernia occurs when an organ or tissue pushes through a weak spot in our abdominal wall, creating a visible bulge and causing discomfort.
What are the main causes for Hernia?
There are many contributing factors that can cause a hernia to occur:
Congenital (i.e., present at birth):
An opening or weak spot that’s present at birth.
Congenital differences in the strength of your connective tissue (collagen).
Acquired (due to the below risk factors):
Chronic persistent cough
Chronic straining on the toilet
Frequent lifting, carrying or pushing of heavy loads
Being overweight
Pregnancy
Previous abdominal surgery, that can lead to an opening or weak spot
Why do Hernias need treatment?
Although having a hernia is not usually a serious condition, treatment to fix it is usually advised for two reasons:
It may gradually become bigger and more uncomfortable.
The contents of the hernia may become trapped in the weak point in the abdominal wall. This can cause bowel obstruction with severe pain, nausea and vomiting (incarcerated hernia).
There is a small chance the hernia might strangulate:
This happens when the bowel (intestine) that comes through the gap in the weak spot becomes squeezed. This can cut off the blood supply to the portion of intestine in the hernia.
This can lead to severe pain and some damage to the part of the intestines in the hernia.
A strangulated hernia is uncommon and is usually dealt with by emergency surgery.
The risk of strangulation is greater with a femoral hernia than with an inguinal hernia. The risk is also greater with smaller hernias. In some areas, NHS funding for hernia repair is not automatically given and your GP or surgeon may need to apply for this.
Do you need an operation to repair the Hernia?
Most hernias do not need immediate treatment (unless it is an emergency hernia presentation). Although hernias can be managed conservatively (without an operation), it is generally advisable to repair them for the above-mentioned reasons. Surgery is the most common treatment for a hernia.
What are the types of surgical approaches for Hernia operation?
The three main types of hernia surgery are open, laparoscopic (minimally invasive), and robotic repair (minimally invasive). In all three approaches, the surgeon puts the contents of the hernia back into its original position and then repairs the hernia defect. Synthetic or biological meshes are then used to repair the defect.
Your surgery and recovery will depend on multiple factors, including the type of hernia you have and how complex the surgery will be.
Open (conventional): This is usually done by a cut over the hernia swelling.
Laparoscopic: This is done by usually three tiny cuts (half to one cm cuts). Then, a video camera (laparoscope) is inserted to view the area.
Robotic: The cuts on the skin are similar to laparoscopic surgery’s. The surgeon then controls the robotic instruments to perform the operation.
Kockerling F, Simons MP; Current Concepts of Inguinal Hernia Repair. Visc Med. 2018 Apr;34(2):145-150. doi: 10.1159/000487278. Epub 2018 Mar 26.
Posted By Dr. Ronnie Mathew, Senior Consultant and Director of Colorectal Care Specialists
Colorectal cancer is increasingly affecting younger adults. This concerning scenario has been noted for some time in the recent past (1-3). This is further highlighted in a recent article in December 2024 from Lancet Oncology (4), where there seems to be a worrying trend of rising cases sharply among those in their 20s to 50s: amongst Generation Z, Millennials, and Generation X.
Many of these individuals have no family history or traditional risk factors like obesity, making this trend especially concerning. This surge remains a perplexing medical mystery for clinicians (5), as noted in an opinion piece from the American College of Surgeons. Traditionally, family history/hereditary factors were the attributed factors causing colorectal cancers amongst younger populations. However, this persistent trend is unlikely due to familial/hereditary factors alone. There are likely to be more factors at play here for this global rise.
Although it could be due to the usual culprits of diet and lifestyle, etc., epigenetic factors may be more likely to be the cause. In simple terms, epigenetics refers to how behaviors and environment can cause changes that affect the way our genes work. An essential factor to note is that unlike genetic changes (mutations), epigenetic changes are reversible (in effect, they do not change the sequence of DNA bases). This reversibility potential gives hope that if we can find these factors, we could potentially halt or decrease this trend of rising colorectal cancers in our younger population.
Until then, it is prudent for the national population screening programs for colorectal cancer detection to start from an earlier age. Currently, most countries in the Western world start this at the age of 50. Dr. Ronnie Mathew, Director of Colorectal Care Specialists, is one of the proponents, amongst other global experts, calling on all colorectal societies/ associations globally to consider revising the guidelines for population screening age from current 50 years old to at least 45 years (or even 40 years for any particular country that has a higher statistic for cancer rise in even younger people).
Colorectal polyps, often benign growths in the colon, can gradually turn cancerous over time as abnormal cells accumulate, leading to colorectal cancer if left untreated. Most of the colorectal cancers develop from polyps.
In the meantime, we need to continue to reduce or modify the already known risk factors for colorectal cancers, such as:
Limiting consumption of red meat, fats
Eating a diet rich in fruit, vegetables, and whole grains.
Stopping smoking
Limiting alcohol consumption.
Active lifestyle with regular exercise
Reducing obesity
Control of diabetes
In addition, those with higher risk need surveillance:
Older age— the risk of colorectal cancer starts to rise after the age of 50 years
Medical history — previous history of colorectal polyps or colorectal cancer
Genetic predisposition — family history of colorectal cancer or hereditary conditions
Inflammatory bowel diseases — inflammatory bowel diseases, such as ulcerative colitis or Crohn’s disease
Immunosuppression — individuals with chronic low immunity
Symptoms such as rectal bleeding, abdominal pain, changes in bowel habits and weight loss, and feeling tired (if caused by low haemoglobin in the blood) are often overlooked or dismissed. This could lead to delayed diagnoses and more advanced stages of the disease. If any of these symptoms are present, it is advisable to see a doctor as soon as possible. Raising awareness about these red flags and encouraging timely action can save lives.
Notably, there are usually no symptoms in the earlier stages of colorectal cancer. Hence, early detection through screenings, like colonoscopies, or participation in national screenings (like stool occult blood/immunochemical testing) is essential.
Colonoscopy allows for early detection and removal of precancerous polyps, effectively preventing colorectal cancer and improving survival rates.
Colorectal cancer is one of the few cancers that can often be prevented. Colonoscopy has consistently shown itself to be the ideal option among all interventions/tests to diagnose or reduce/avoid the risk of colorectal cancer. The latter is because most colorectal cancers develop from polyps, and such polyps can be found and removed at colonoscopy. Removal of polyps is essential before they have the chance to become cancerous.
References
Global patterns and trends in colorectal cancer incidence in young adults. Siegel, RL ∙ Torre, LA ∙ Soerjomataram, I ∙ et al. Gut. 2019; 68:2179-2185 Crossref PubMed Google Scholar
Changes in colorectal cancer incidence in seven high-income countries: a population-based study Araghi, M ∙ Soerjomataram, I ∙ Bardot, A ∙ et al. Lancet Gastroenterol Hepatol. 2019; 4:511-518 Full Text (PDF) PubMed Google Scholar
Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years Vuik, FE ∙ Nieuwenburg, SA ∙ Bardou, M ∙ et al. Gut. 2019; 68:1820-1826 Crossref PubMed Google Scholar
Abscesses can appear anywhere on the body, but an abscess on your buttocks can be particularly painful and disruptive, interfering with your usual daily activities — from sitting down to walking. If you’ve ever experienced pain and discomfort around your butt, or even bleeding from the anus, you may have a buttock abscess.
Understandably, due to the location of the lesion, it can also be embarrassing to seek medical attention. However, it is important to get the abscess treated as soon as possible to avoid further complications with your infection.
What is a Buttock Abscess?
An abscess is a lump filled with pus caused by an infection. Put simply, a buttock abscess, or perianal abscess, just means that the abscess forms on the buttocks.
Common areas on the buttocks where abscesses can form are:
Anorectal region — These can be [1, 2]:
perianal abscesses – Infection spreads downwards from the anal sphincters, to the subcutaneous tissue near the anus.
ischiorectal abscesses – Infection spreads outwards from the anal sphincters, to the surrounding fat and fibrous tissue.
intersphincteric abscesses – Located between the internal and external anal sphincters.
supralevator abscesses – Infection in the rectal walls, above the levators.
submucosal abscesses – Located in the mucosal lining of the anal canal or rectum
Pilonidal region (more commonly known as the “butt crack”) — Sometimes cysts called pilonidal cysts also form in the area.
Abscesses can also form anywhere on the skin of the buttocks, like a pimple. Symptoms of buttock abscesses differ according to the location of the lesion. Abscesses near to the surface of the skin can appear to have:
A lump filled with pus
Redness
Swelling
Pain and discomfort on the lump
Deeper abscesses can present the following:
Pus-like discharge from the anus
Bleeding from the anus
Constipation
Painful bowel movements
Irritated skin around the anus
Buttocks abscesses are usually caused by a bacterial infection that leads to a pocket of pus forming beneath the skin.
What causes a Buttock Abscess?
Anorectal abscesses
Anorectal abscesses form due to inflammation of the subcutaneous tissues, usually caused by clogged and infected anal glands. Bacteria start to grow in these clogged anal glands, which cause the body to produce an inflammatory response.
A pocket of pus forms as a result of this inflammatory response, which subsequently causes pain and discomfort. Common bacteria that cause these infections include Escherichia Coli, Staphylococcus aureus, Streptococcus, and Enterococcus. Risk factors that can lead to anorectal abscesses include[3, 4]:
Smoking
Liquid stool entering the duct
Dilated duct which leads to improper bowel emptying
Infections (HIV or other STDs)
Crohn's disease
Trauma
Cancer
Ingrown hairs
Skin injuries or friction
Pilonidal abscess
Pilonidal abscess usually stem from pilonidal cysts, which usually happens when hair is stuck or embedded between folds of skin of the pilonidal region, the spot just above the buttock cracks. This can happen due to friction from clothing, rubbing of the skin, or sitting for long periods of time. This pocket of hair gradually collects dead skin cells, debris, or other matter and forms a cyst.
If left untreated, the cyst may be infected and form into an abscess. Common risk factors for pilonidal cyst formation are:
Excess weight
Sedentary lifestyle
Male sex
Ingrown hairs
Skin injuries or friction
Pilonidal abscesses form from infected pilonidal cysts
What can happen to a Buttock Abscess if left untreated?
If left untreated, complications can occur, such as:
Further infection — A buttock abscess can infect surrounding tissue (cellulitis) or even the bloodstream. In the case of a systemic spread, sepsis can occur, causing fever or even organ failure.
Fistula — A fistula is an abnormal connection between the rectum or the anus, causing discomfort and may require surgical intervention.
Chronic abscess — A chronic abscess is one that continues to recur as a result of improper treatment or healing.
Scarring — Prolonged presence of an untreated abscess can lead to scar tissue formation.
How are Buttock Abscesses treated?
Treating buttock abscesses require medical intervention. Popping abscesses yourself can be painful and may lead to complications such as the abscess forming again, or further infections. Buttock abscesses are surgically removed through the following steps:
Local anaesthesia – Local anaesthesia is usually applied to minimise patient pain and discomfort
Incision – A cut is made on the abscess, sometimes in the shape of an ‘X’
Drainage – The pus and debris are drained out from the incision, but the wound is left open to heal
Packing – Wound packing can be applied to encourage further draining. The packing may need to be changed throughout the healing period
Postoperative care – After the surgery patients will be given pain relief and laxatives to avoid constipation and further irritation. A sitz bath is also recommended for pain relief. Antibiotics may be prescribed by doctors, and patients will require a follow-up visit 3 to 8 weeks after the procedure to ensure proper and complete healing.
However, depending on the location of the abscess, some may be more complicated that others to treat. When consulting your doctor, they will inform you on the course of treatment that you may need to undergo.
Summary
Hopefully this guide helped you understand what buttock abscesses are and how they form. A buttock abscess can be frustrating and embarrassing to deal with, but it is entirely treatable. Getting it treated early will be less complicated and also reduces the risk for other issues to develop. Book a consultation with us today if you have any concerns about buttock abscesses and how to treat them.
More about Buttock Abscesses
Will buttock abscesses go away on their own?
Buttock abscesses rarely go away on their own. It’s also advised to avoid popping the abscess on your own as this can make the abscess even worse or spread the infection. Your doctor will help you remove the abscess safely and effectively.
How long does recovery take after surgery?
Recovery can take anywhere from 3 to 8 weeks after surgery.
Can a buttock abscess come back?
Yes, a buttock abscess can recur, especially if its underlying cause has not been addressed. Proper treatment, hygiene and adhering to your doctor’s advice can help prevent recurrence.
When do I need to see a doctor?
You should see a doctor if you experience any of the following:
Pain and discomfort on the buttock
Bleeding from the anus
Fever and chills (may indicate an infection)
A bump in your rectal area
References
Hogan AM, Mannion M, Ryan RS, Khan W, Waldron R, Barry K. Beware the ischiorectal abscess. Int J Surg Case Rep. 2013;4(3):299-301. doi: 10.1016/j.ijscr.2012.08.005. Epub 2012 Sep 1. PMID: 23396392; PMCID: PMC3604705.
Klein JW. Common anal problems. Med Clin North Am. 2014 May;98(3):609-23. doi: 10.1016/j.mcna.2014.01.011. Epub 2014 Mar 21. PMID: 24758964.
Martín-Lagos Maldonado A, Herrera Mercader MDC, Lozano Cejudo C. Proctitis and perirectal abscesses: is there anything else to think about? Rev Esp Enferm Dig. 2018 Jun;110(6):410. doi: 10.17235/reed.2018.5500/2018. PMID: 29722270.
The digestive system is a vital part of our overall health, yet it is often overlooked until problems arise. From occasional indigestion to more serious issues like chronic abdominal pain or unexplained weight loss, digestive concerns can significantly affect your quality of life. In many cases, diagnosing these issues requires a closer look inside the digestive tract to understand what’s going on beneath the surface.
This is where procedures like colonoscopy, gastroscopy, and endoscopy come into play. While the names might sound daunting or confusing, each of these diagnostic tools is designed to examine different parts of your digestive system, which helps doctors detect and treat a variety of gastrointestinal problems. These procedures not only provide valuable insights into conditions such as polyps, ulcers and inflammation, but they also play a critical role in the early detection of more severe diseases like cancer.
In this blog, we will break down the differences between a colonoscopy, gastroscopy, and endoscopy. We’ll explore how each procedure works, why they are recommended and what you can expect during and after. By the end, you’ll have a clearer understanding of these essential diagnostic tools, helping to ease any concerns or questions you may have about your digestive health.
The digestive system consists of a number of organs, each playing a pivotal role in ensuring the efficiency and functionality of the system.
Understanding the Procedures: Colonoscopy, Gastroscopy, and Endoscopy
While the terms colonoscopy, gastroscopy, and endoscopy are often used interchangeably, they each refer to distinct procedures that examine different parts of the digestive tract. Let’s take a closer look at what each involves:
1. Colonoscopy
A colonoscopy is a procedure used to examine the large intestine (colon) and rectum. During this procedure, a flexible tube called a colonoscope, equipped with a small camera, is inserted through the rectum and guided along the length of the colon. This allows doctors to visualise the inner lining of the colon to check for any abnormalities such as polyps, tumours, inflammation, or signs of cancer.
Why it’s done: Colonoscopies are often recommended for patients experiencing unexplained changes in bowel habits, rectal bleeding, or abdominal pain. They are also used as a preventative screening tool for colon cancer, especially in individuals over the age of 50 or those with a family history of the disease.
What to expect: Prior to the procedure, patients are required to undergo bowel preparation, which involves consuming a special solution to cleanse the colon. During the colonoscopy, sedation is typically administered to ensure comfort, and the procedure usually lasts about 30 to 60 minutes. Any polyps found can be removed during the same session for further examination.
A colonoscopy is a vital procedure that allows doctors to examine the inner lining of the colon for early detection of abnormalities.
2. Gastroscopy
A gastroscopy, sometimes referred to as an upper endoscopy, focuses on examining the upper part of the digestive system, including the oesophagus, stomach and the first part of the small intestine (duodenum). A thin, flexible tube called a gastroscope is passed through the mouth and down the throat to allow the doctor to inspect these areas for issues such as ulcers, inflammation, tumours, or infections.
Why it’s done: Gastroscopies are recommended for patients experiencing symptoms like persistent heartburn, difficulty swallowing, unexplained nausea, or upper abdominal pain. It is also used to investigate the cause of bleeding in the upper digestive tract.
What to expect: Patients are typically given a mild sedative or local anesthetic to numb the throat. The procedure is quick, lasting around 15 to 30 minutes, and most patients experience minimal discomfort. A biopsy may be taken if abnormal tissue is found.
A gastroscopy is a diagnostic procedure that enables healthcare professionals to visualise the oesophagus, stomach and the beginning of the small intestine to diagnose gastrointestinal issues.
3. Endoscopy
The term “endoscopy” is more general and refers to any procedure that uses an endoscope to examine the inside of the body. While both colonoscopy and gastroscopy are types of endoscopy, the term is most commonly used to describe procedures involving the upper digestive tract (gastroscopy) or lower digestive tract (colonoscopy). However, endoscopy can also refer to other types of procedures used to examine different organs, depending on the part of the body being assessed.
Why it’s done: Endoscopy is used for a variety of diagnostic purposes, depending on which part of the body is being examined. When referring to the gastrointestinal tract, it is often a first-line test for unexplained digestive symptoms.
What to expect: The specifics of the procedure vary depending on which part of the digestive tract is being examined, but all forms of endoscopy involve the insertion of a flexible tube with a camera into the body to allow visualization of the area.
An endoscopy is a general term to refer to a minimally invasive procedure that allows doctors to examine the interior of a patient's digestive tract using a flexible tube with a camera, which provides essential insights for diagnosis and treatment.
Key Differences and Similarities Between Colonoscopy, Gastroscopy, and Endoscopy
Though colonoscopy, gastroscopy, and endoscopy share the common goal of examining the digestive system, they target different areas and have specific roles in diagnosing various conditions. To help clarify the distinctions, here’s a simple breakdown of the key differences and similarities between these procedures:
Procedure
Focus Area
Purpose
Preparation
Procedure Time
Colonoscopy
Large intestine (colon) and rectum
Used to detect polyps, tumours, inflammation, and signs of colon cancer. Often used as a cancer screening tool.
Requires bowel preparation with a cleansing solution to empty the colon.
Typically lasts 30 to 60 minutes.
Gastroscopy
Esophagus, stomach, and duodenum
Detects issues like ulcers, inflammation, tumours, or bleeding in the upper digestive tract.
Fasting for 6-8 hours before the procedure.
Quick, usually 15 to 30 minutes.
Endoscopy
General term, most often referring to upper or lower GI tract examination
Allows visual inspection of the digestive tract for diagnostic purposes, including biopsies.
Varies depending on the type of endoscopy performed.
Varies depending on the procedure, typically 15 to 60 minutes.
Similarities
Use of an Endoscope: All three procedures involve the use of a thin, flexible tube called an endoscope with a camera attached to examine internal organs.
Sedation: In most cases, patients are sedated to ensure comfort throughout the procedure.
Diagnostic Value: Each procedure allows for the detection of abnormalities such as inflammation, tumours, or bleeding, as well as the removal of polyps or tissue for biopsy when necessary.
Low Risk: These procedures are considered minimally invasive and have low complication rates when performed by experienced medical professionals.
Colonoscopy, gastroscopy, and endoscopy are procedures that use an endoscope to examine different parts of the digestive system, with each focusing on a specific area.
What to Expect During and After the Procedures
Knowing what happens during and after a colonoscopy, gastroscopy, or endoscopy can help reduce any anxiety and make the process smoother. Here’s a table outlining the main steps involved in each procedure, what you can expect during the procedure itself, and what happens afterward.
Procedure
During the Procedure
After the Procedure
Colonoscopy
Sedation is provided to ensure comfort.A colonoscope is inserted through the rectum to examine the colon.Polyps or tissue samples may be removed.
Mild bloating or cramping may occur.You will need someone to drive you home due to sedation.Results may be discussed immediately, but biopsy results may take a few days.
Gastroscopy
A gastroscope is inserted through the mouth and passed down the throat.Your throat will be numbed with local anesthetic.The doctor will inspect the esophagus, stomach, and duodenum.
You may have a sore throat temporarily.Similar sedation recovery as colonoscopy.Immediate results with possible biopsy report after a few days.
Endoscopy
Varies depending on the type of endoscopy (upper or lower GI).Sedation is typically provided.The doctor examines the area and may take biopsies or perform minor treatments.
Minimal discomfort after the procedure.Sedation recovery will require a companion to drive you home.Results depend on the procedure and any biopsies taken.
Common Recovery Tips
Rest: It’s essential to rest for the remainder of the day, avoiding any strenuous activities.
Diet: You can typically resume eating a normal diet unless your doctor advises otherwise. Start with lighter meals if you experience discomfort.
Follow-up: Always follow your doctor's instructions, especially if a biopsy was taken or if additional treatment is needed.
Why Are These Procedures Important?
Colonoscopy, gastroscopy, and endoscopy are essential tools for diagnosing and preventing serious health issues in the digestive system. These procedures allow doctors to detect early signs of conditions like cancer, ulcers, and inflammation, often before symptoms become severe. Below is a table that highlights when each procedure might be recommended and why it’s important for your health.
Procedure
Why It’s Important
When It’s Recommended
Colonoscopy
Detects and removes polyps before they turn into cancer.Diagnoses causes of chronic bowel issues.
Routine screening for colorectal cancer, especially for individuals over 50 or with family history.Chronic diarrhea, rectal bleeding, unexplained weight loss, or changes in bowel habits.
Gastroscopy
Detects ulcers, tumours, and inflammation in the upper digestive tract.Helps diagnose GERD and other upper GI issues.
Provides a closer look at specific areas of the digestive tract.Detects causes of unexplained digestive symptoms.
Further investigation when other tests are inconclusive.Abdominal pain, bleeding, or difficulty swallowing.
Why Early Detection Matters
Early detection is a cornerstone of modern medicine, especially when it comes to digestive health. Procedures like colonoscopy, gastroscopy, and endoscopy provide an opportunity to diagnose potential issues long before they become serious or life-threatening. This can make a significant difference in patient outcomes, and help transform what could have been a complex medical challenge into a manageable condition.
One of the most critical advantages of early detection is the ability to prevent diseases like cancer. For instance, during a colonoscopy, polyps—small growths in the lining of the colon—can be identified and removed on the spot. While polyps themselves are benign, certain types can develop into colorectal cancer over time if left untreated. By removing them early, doctors can effectively eliminate the risk of cancer before it even begins.
Similarly, a gastroscopy can help detect ulcers, inflammation, and even early signs of gastric cancer. These conditions often develop without obvious symptoms in the initial stages, which makes them difficult to detect through routine exams. By using a gastroscopy to closely examine the upper digestive tract, doctors can identify subtle abnormalities that may otherwise go unnoticed. For instance, an ulcer that’s caught early can be treated with medication, which can prevent it from worsening into a bleeding ulcer or a more severe condition.
Another major benefit of early detection is the ability to diagnose and manage chronic digestive diseases such as inflammatory bowel disease (IBD) and gastroesophageal reflux disease (GERD). While these conditions may not be immediately life-threatening, they can significantly impact your quality of life if left untreated. An endoscopy can reveal the extent of the inflammation and damage caused by these diseases, which can allow doctors to tailor treatment plans to prevent further complications and improve patient comfort.
Early detection doesn’t just mean catching life-threatening diseases—it also means finding answers for unexplained symptoms. Many digestive issues can present with vague symptoms like bloating, pain, or discomfort, which might be dismissed as minor. However, these can sometimes signal a deeper issue that requires medical attention. Procedures like endoscopy help to rule out more serious conditions, providing both reassurance and clarity to patients.
Timely check-ups and routine screenings are vital for preserving digestive health and preventing potential issues before they become serious.
Medical Conditions Diagnosed Through Colonoscopy, Gastroscopy and Endoscopy.
These diagnostic procedures are essential in detecting a wide range of medical conditions, many of which may not show obvious symptoms in the early stages. By providing a detailed view of different parts of the digestive system, colonoscopy, gastroscopy, and endoscopy help doctors diagnose and treat various conditions more effectively. Below is a table outlining the most common conditions diagnosed through these procedures.
Procedure
Commonly Diagnosed Condition
Description of the Condition
Colonoscopy
Colorectal cancer
A type of cancer that starts in the colon or rectum. Often develops from precancerous polyps, which can be detected and removed during a colonoscopy.
Colonic polyps
Small clumps of cells that form on the lining of the colon [6]. While most polyps are harmless, some can develop into cancer if not removed.
Inflammatory Bowel Disease (IBD)
A group of conditions, including Crohn’s disease and ulcerative colitis, that cause chronic inflammation of the gastrointestinal tract.
Diverticulosis
A condition where small pouches (diverticula) form in the walls of the colon, which can sometimes become inflamed or infected (diverticulitis) [8].
A chronic condition where stomach acid flows back into the oesophagus, causing irritation and sometimes damage to the oesophagal lining.
Stomach cancer
A malignant tumour that originates in the lining of the stomach. Early detection through gastroscopy is crucial for effective treatment.
Esophagitis
Inflammation of the esophagus, often caused by acid reflux, infections, or certain medications.
Hiatal Hernia
A condition where part of the stomach pushes upwards through the diaphragm and into the chest cavity.
Endoscopy
Barrett’s esophagus
A condition where the esophagus lining is damaged by stomach acid, leading to abnormal changes in its cells. This can increase the risk of esophageal cancer [1].
Celiac disease
An autoimmune disorder where the ingestion of gluten leads to damage in the small intestine, causing digestive issues and nutrient absorption problems [2].
Esophageal cancer
Cancer that forms in the tissues of the oesophagus. Endoscopy is used to detect tumours or abnormal growths in the oesophagus early.
Peptic ulcers
Sores that develop on the inner lining of the stomach, esophagus, or small intestine due to stomach acid, often causing pain and discomfort.
How to Prepare for a Colonoscopy, Gastroscopy, or Endoscopy
Proper preparation is key to ensuring the success of your procedure, whether it’s a colonoscopy, gastroscopy, or endoscopy. Each procedure requires different steps to prepare your digestive tract, and following these instructions carefully will help ensure accurate results. Below is a table outlining the preparation steps for each procedure.
Procedure
Preparation Steps
Additional Tips
Colonoscopy
Follow a low-fibre diet a few days before the procedure.Switch to a clear liquid diet 24 hours before.Take a prescribed laxative to cleanse the colon the night before.
Drink plenty of clear fluids to stay hydrated.Arrange for someone to drive you home as you will be sedated.Stop certain medications if instructed by your doctor.
Gastroscopy
Fast for at least 6-8 hours before the procedure to ensure the upper digestive tract is empty.
Wear loose, comfortable clothing on the day of the procedure.Let your doctor know if you are on blood-thinning medications.Arrange for transportation home after sedation.
Endoscopy
Follow similar guidelines as for gastroscopy (for upper endoscopy).For lower endoscopy (colonoscopy), follow the bowel cleansing and dietary restrictions.
As with other procedures, fasting or bowel prep is key depending on the type of endoscopy.Always inform your doctor about any medications you are taking.
General Tips for All Procedures
Comfortable Clothing: Wear loose, comfortable clothes for the procedure since you will be sedated and may feel groggy afterwards.
Hydration: Staying hydrated with clear fluids before your fasting period starts can make the preparation more comfortable.
Ask Questions: If you have any uncertainties or concerns, don’t hesitate to ask your doctor beforehand for clarification.
Final Thoughts: Understanding These Essential Diagnostic Procedures
Colonoscopy, gastroscopy, and endoscopy are more than just medical tests; they are vital procedures that help safeguard your digestive health. Each procedure serves a specific purpose, whether it’s screening for colorectal cancer, diagnosing conditions like GERD or ulcers, or detecting abnormalities that might otherwise go unnoticed. By providing doctors with a clear view of your digestive system, these procedures enable early detection, prompt treatment, and ultimately, better health outcomes.
Understanding the differences between these procedures and knowing what to expect can reduce anxiety and empower you to take an active role in your health care. Whether you’re undergoing one of these procedures for a routine checkup or to investigate specific symptoms, they offer invaluable insight that can lead to timely and effective medical intervention. Prioritising your digestive health through these tests is an important step toward maintaining your overall well-being.
We've all been there—feeling perfectly fine one moment and then suddenly our stomach swells up like a balloon, leaving us uncomfortable and often in pain. Stomach bloating is a common issue that affects millions of people worldwide, yet its causes are often misunderstood. It’s that tight, full feeling you get in your abdomen that can make your clothes feel snug and can sometimes be downright painful. This sensation can occur at the most inconvenient times, whether you’re about to give an important presentation, enjoying a meal with friends, or simply relaxing at home.
For some, bloating is a minor inconvenience that passes quickly. But for others, it can be a recurring problem that significantly impacts their daily lives, leading to a constant search for relief. The unpredictability of bloating can make it even more frustrating, as it seems to strike without warning or clear cause. But why does this happen? Is it something we ate, a sign of a more serious health issue, or just our bodies being unpredictable?
In this blog, we will explore the common triggers and underlying factors that lead to stomach bloating. By discovering these reasons, we aim to provide you with a better understanding of this uncomfortable condition and offer practical advice on how to manage it. Whether you experience occasional bloating or it’s a regular occurrence, gaining insight into the causes can help you take control and find relief.
1. Dietary Causes of Bloating
Understanding the dietary causes of bloating is crucial in managing and preventing this uncomfortable condition. Here’s how these common dietary factors cause bloating and affect your digestive system.
Common Gas-Producing Foods Certain foods are known to produce more gas during digestion, which may result in bloating. These include:
Beans and lentils: rich in fibre and complex carbohydrates, beans [1] and lentils [2] can be difficult for the digestive system to break down completely. They contain oligosaccharides, which are fermented by gut bacteria, producing gas as a byproduct.
Cruciferous vegetables:vegetables like broccoli, cauliflower, cabbage, and Brussels sprouts are high in fibre and sulfur compounds [3]. While they are highly nutritious, their fermentation process in the gut can result in significant gas production.
Carbonated drinks: sodas and sparkling waters [4] contain dissolved carbon dioxide, which can lead to gas build-up in the stomach. This excess gas can cause a bloated feeling as it accumulates in the digestive tract.
Artificial sweeteners: sweeteners such as sorbitol, mannitol, and xylitol [5], found in sugar-free gum, candies, and some diet foods, are not fully absorbed by the body. As they pass into the colon, they are fermented by bacteria, producing gas and leading to bloating.
Cruciferous vegetables can cause bloating and gas due to the fermentation process in the gut.
Food Intolerances Food intolerances can cause significant digestive distress and bloating. Two common intolerances are:
Lactose intolerance: lactose intolerance occurs when the body lacks the enzyme lactase, which is needed to break down lactose, the sugar found in milk and dairy products. Consuming lactose can lead to bloating, gas, diarrhoea, and abdominal pain as undigested lactose ferments in the colon [6].
Gluten intolerance and celiac disease: Non-celiac gluten sensitivity can cause bloating, gas, and discomfort after consuming gluten-containing foods like wheat, barley, and rye [7]. Celiac diseaseisan autoimmune disorder where ingestion of gluten leads to damage in the small intestine [8]. Symptoms include severe bloating, diarrhoea, and malabsorption of nutrients.
2. Lifestyle Factors That Cause Bloating
Our lifestyle choices play a significant role in our overall digestive health and may contribute to the frequency and severity of bloating. These are some common lifestyle factors that may result in digestive issues, such as bloating:
Stress and digestion: the gut and brain are connected through the gut-brain axis, which means that psychological stress can directly impact gastrointestinal function [9]. Stress can lead to various digestive issues [10], including bloating, by causing the stomach to produce more acid, altering gut motility, and increasing gut sensitivity. Moreover, stress can exacerbate conditions like Irritable Bowel Syndrome (IBS) [11], where bloating is a common symptom.
Sedentary lifestyle: regular physical activity helps stimulate the natural contractions of your intestinal muscles, which helps facilitate efficient movement of food and gas through the digestive tract. A sedentary lifestyle can slow down these contractions, which can result in sluggish digestion and increased bloating.
Eating Irregularly and Its Impact on Bloating
Certain eating behaviours can increase the likelihood of one developing consistent bloating. These include;
Inconsistent meal times: skipping meals or eating at irregular times can disrupt the body's natural digestive rhythm. Your digestive system functions best when it operates on a regular schedule and processes food predictably. Irregular eating patterns can cause digestive disturbances, which may result in bloating.
Mindless eating and overeating: eating while distracted, such as watching TV or working, can lead to overeating and swallowing excess air, both of which can contribute to bloating. Contrary to this, eating mindfully, paying attention to your food, and chewing thoroughly can improve digestion and reduce the likelihood of bloating.
Large meals and late-night eating: consuming large meals or eating late at night can overload the digestive system and slow down digestion. On the other hand, more frequent meals can help keep your digestive system functioning smoothly and prevent bloating.
Mindless eating and overeating can lead to bloating by overwhelming the digestive system and causing excess gas.
3. Medical Conditions That Present Symptoms of Bloating
While diet and lifestyle factors are common contributors to bloating, certain medical conditions can also play a significant role. Here are some key medical conditions associated with bloating:
Irritable Bowel Syndrome (IBS): IBS is a chronic digestive disorder characterised by symptoms such as abdominal pain, cramping, diarrhoea, constipation, and bloating. The exact cause of IBS is unknown, but it is believed to involve a combination of gut-brain axis dysfunction, increased gut sensitivity, and irregular gut motility. These factors can lead to excessive gas production and irregular bowel movements, which may contribute to bloating [12]. Managing IBS-related bloating often involves dietary modifications, stress management, and sometimes medication.
Small Intestinal Bacterial Overgrowth (SIBO): SIBO occurs when there is an abnormal increase in the number of bacteria in the small intestine. This overgrowth can interfere with nutrient absorption and lead to digestive issues. The excess bacteria ferment ingested food, producing gas that accumulates in the intestines, which may cause bloating [13], abdominal pain, and discomfort.
Hormonal changes: hormonal changes, particularly in women, can also lead to bloating. Many women experience bloating as a symptom of premenstrual syndrome (PMS) due to hormonal fluctuations that cause the body to retain more water and salt. Conditions like polycystic ovary syndrome (PCOS) and menopause can also cause hormonal imbalances affecting digestion and fluid retention [14]. Managing hormone-related bloating often involves lifestyle changes, dietary adjustments, and sometimes medication to address the underlying hormonal imbalance.
IBS often causes bloating due to irregular bowel movements and increased gas production.
Practical Tips to Manage and Prevent Bloating
Managing and preventing bloating effectively often requires a combination of dietary adjustments, lifestyle changes, and improved eating habits. Here are some practical tips to help you beat the bloat and maintain a comfortable digestive system.
Over-the-counter medication: luckily, most of the causes of stomach bloating listed can be treated easily. A doctor may prescribe over-the-counter antacids [15] as bloating relief when your bloated stomach is caused by certain food intolerances and excessive gas. If your stomach pain and bloating are caused by constipation, fibre supplements or laxatives may be prescribed to help ease bowel movement and reduce bloating.
Over-the-counter antacids can help relieve bloating by neutralising stomach acid and reducing gas.
Change in diet: attempting to identify your bloating triggers can help you navigate recurring bloating issues with a sense of predictability. For patients with celiac disease, removing gluten [16] from their diet completely is often advised by medical professionals to prevent exacerbating their condition. If you have been diagnosed with IBS, avoiding high-gas food (carbonated and alcoholic beverages) and abiding by a low-FODMAPS diet [17] can prove efficient in reducing bloating.
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. This diet guides on to identify and avoid hard-to-digest carbohydrates that can be found in certain grains, vegetables, fruits, and dairy products, including fructose, fructans, and lactose. A low-FODMAP diet cuts out some or all of the following:
FODMAPs in foods like onions, garlic, and apples can cause bloating and digestive discomfort.
Abdominal massage: massaging your abdomen gently [18] can relieve bloating by softening your stomach muscles and speeding up digestion. It allows gas to pass through your digestive tract more easily and helps to move stool along the inside of your colon.
Physical activity: being physically active including practising yoga can stimulate digestion [19] and reduce bloating. Physical activities work by improving blood flow to the digestive organs and promoting relaxation which helps to ease gas and enhance gut motility.
Hero's Pose (Virasana) yoga can help with bloating by promoting relaxation and aiding digestion.
Herbal teas: research [20] suggests that herbal teas, such as peppermint and ginger tea, can be effective in reducing bloating. These teas help relax the digestive muscles, reduce gas, and improve overall digestion, offering a natural remedy for bloating relief.
Herbal teas like peppermint, ginger, chamomile, fennel, and dandelion can help relieve bloating by soothing the digestive system and reducing gas.
When to Seek Medical Advice
While occasional bloating is common and usually not a cause for concern, there are times when it may signal a more serious underlying issue that requires professional attention. Recognising the red flags and understanding the diagnostic tests and treatment options can help you take the necessary steps towards better health. It isimportant to know when bloating goes beyond a simple digestive inconvenience.
If you experience persistent bloating that doesn’t improve with dietary and lifestyle changes, or if it’s accompanied by severe abdominal pain, weight loss, vomiting, or changes in bowel habits such as chronic diarrhoea or constipation, it’s time to seek medical advice. Other symptoms that warrant a doctor’s visit include blood in the stool, fever, and difficulty swallowing. These could be signs of more serious conditions such as gastrointestinal infections, inflammatory bowel disease, or even certain cancers.
When you consult a healthcare professional about persistent bloating, they may recommend a variety of diagnostic tests to determine the underlying cause. These can include gut screenings to check for infections and inflammation or stool tests to identify parasites or further investigate the presence of blood. Imaging tests such as ultrasounds, CT scans, or endoscopy (insert link to service page) may also be used to get a closer look at your digestive tract.
Based on the results, your doctor will suggest appropriate treatment options. These may range from dietary modifications and medications to manage symptoms to more specific treatments for conditions like IBS, SIBO, or celiac disease. In some cases, referral to a gastroenterologist for specialised care may be necessary.
Conclusion
Bloating can be a persistent issue that affects both comfort and quality of life, but it’s often within our power to manage effectively. By making thoughtful dietary choices—such as steering clear of known gas producers and embracing gut-friendly foods—you can significantly reduce bloating incidents. Likewise, adopting healthy lifestyle habits, including regular exercise and effective stress management, supports optimal digestion.
However, if bloating becomes severe or chronic, it’s crucial to seek medical advice, as it may indicate a more serious underlying condition. With the right approach, you can achieve a more comfortable and balanced digestive system, which can help ensure a healthier and more enjoyable life.
Bellini, Massimo, et al. “Low Fermentable Oligo- Di- and Mono-Saccharides and Polyols (FODMAPs) or Gluten Free Diet: What Is Best for Irritable Bowel Syndrome?” Nutrients, vol. 12, no. 11, Nov. 2020, p. 3368. PubMed Central, https://doi.org/10.3390/nu12113368.
Lenhart, Adrienne, and William D. Chey. “A Systematic Review of the Effects of Polyols on Gastrointestinal Health and Irritable Bowel Syndrome.” Advances in Nutrition, vol. 8, no. 4, July 2017, pp. 587–96. PubMed Central, https://doi.org/10.3945/an.117.015560.
Robles, Luelle, and Ronny Priefer. “Lactose Intolerance: What Your Breath Can Tell You.” Diagnostics, vol. 10, no. 6, June 2020, p. 412. www.mdpi.com, https://doi.org/10.3390/diagnostics10060412.
Roszkowska, Anna, et al. “Non-Celiac Gluten Sensitivity: A Review.” Medicina, vol. 55, no. 6, June 2019, p. 222. www.mdpi.com, https://doi.org/10.3390/medicina55060222.
Lebwohl, Benjamin, and Alberto Rubio-Tapia. “Epidemiology, Presentation, and Diagnosis of Celiac Disease.” Gastroenterology, vol. 160, no. 1, Jan. 2021, pp. 63–75. ScienceDirect, https://doi.org/10.1053/j.gastro.2020.06.098.
Labanski, Alexandra, et al. “Stress and the Brain-Gut Axis in Functional and Chronic-Inflammatory Gastrointestinal Diseases: A Transdisciplinary Challenge.” Psychoneuroendocrinology, vol. 111, Jan. 2020, p. 104501. ScienceDirect, https://doi.org/10.1016/j.psyneuen.2019.104501.
Oroian, Bianca Augusta, et al. “New Metabolic, Digestive, and Oxidative Stress-Related Manifestations Associated with Posttraumatic Stress Disorder.” Oxidative Medicine and Cellular Longevity, edited by Juan F. Santibanez, vol. 2021, Dec. 2021, pp. 1–18. DOI.org (Crossref), https://doi.org/10.1155/2021/5599265.
Balmus, Ioana-Miruna, et al. “Irritable Bowel Syndrome and Neurological Deficiencies: Is There A Relationship? The Possible Relevance of the Oxidative Stress Status.” Medicina, vol. 56, no. 4, Apr. 2020, p. 175. www.mdpi.com, https://doi.org/10.3390/medicina56040175.
Serra, Jordi. “Management of Bloating.” Neurogastroenterology & Motility, vol. 34, no. 3, Mar. 2022, p. e14333. DOI.org (Crossref), https://doi.org/10.1111/nmo.14333.
Takakura, Will, and Mark Pimentel. “Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome – An Update.” Frontiers in Psychiatry, vol. 11, July 2020. Frontiers, https://doi.org/10.3389/fpsyt.2020.00664.
Kałużna, Małgorzata, et al. “Are Patients with Polycystic Ovary Syndrome More Prone to Irritable Bowel Syndrome?” Endocrine Connections, vol. 11, no. 4, Apr. 2022. ec.bioscientifica.com, https://doi.org/10.1530/EC-21-0309.
D’Silva, Adrijana, et al. “Yoga as a Therapy for Irritable Bowel Syndrome.” Digestive Diseases and Sciences, vol. 65, no. 9, Sept. 2020, pp. 2503–14. Springer Link, https://doi.org/10.1007/s10620-019-05989-6.
Sattar, Tabinda. “Would Some Herbal Teas Play a Medicating Role for Certain Diseases?” Current Nutrition & Food Science, vol. 17, no. 2, Feb. 2021, pp. 176–88. IngentaConnect, https://doi.org/10.2174/1573401316666200514224433.
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