What are some Common Lower Gastrointestinal Symptoms and how it can be treated in SIngapore | Dr David Ong - A respected Singapore Gastroenterologist

Lower GI Symptoms

Constipation

Constipation occurs when our bowel movements become less frequent, and our stools become more difficult to pass. It is important to note that there is no ‘normal’ number of bowel movements, many healthcare professionals agree that a normal frequency may range from 3 times a day to 3 times a week. Constipation happens most of the time due to changes in diet, routine, or poor intake of dietary fibre. A change in routine that may result in constipation would be dehydration, i.e., not drinking enough water. It is usually only of concern if you notice a decrease in frequency from your usual pattern or if this decrease in frequency comes alongside other symptoms. It is vital to let Dr Ong know what you mean by constipation if you suspect you are experiencing it.

Medical conditions that can cause constipation include:

– Irritable bowel syndrome (IBS)

– Endocrine problems such as hypothyroidism, diabetes, hypercalcaemia, uraemia

– Pregnancy

– Neurological disorders including stroke, multiple sclerosis, Parkinson’s disease

– Diverticular disease

– Intestinal obstruction

– Colorectal cancer

Bloatedness

Bloating is usually caused by too much gas production in your stomach as the result of the contents of your meal, or how you’ve consumed your meal. For example, eating too fast, eating too much, or eating foods that create gas in the digestive tract (such as beans and vegetables) may also result in the bloated feeling. Alternatively, it may be due to you ingesting air, be it through a straw, fizzy drinks, or chewing gum. Notably, certain intestinal disorders such as irritable bowel syndrome (IBS), lactose intolerance, or coeliac disease (gluten intolerance) also cause increased gas production and the feeling of bloatedness.

Diarrhoea

Watery stools, or diarrhoea, is when your bowel movements (or stools) are loose and watery. It is common and often not serious, usually lasting for 2-3 days. However, if there are recurrent patterns of diarrhoea, it may be something more long-term such as irritable bowel syndrome (IBS) or other medical causes. Poor intake of dietary fibre may also be a factor, as dietary fibre is important in maintaining gut health and regulating stools. People with lactose intolerance are also unable to fully digest the lactose found in dairy products acts as a laxative when ingested, resulting in diarrhoea. Allergies may also cause watery stools. Diarrhoea is a typical symptom of gastroenteritis, which is the inflammation and infection of the digestion tract and is sometimes accompanied by fever, nausea, vomiting, and abdominal pains.

Common causes that can cause diarrhoea include:

– Gastroenteritis

– Laxative abuse

– Irritable Bowel Syndrome (IBS)

– Lactose intolerance

– Stomach flu

– Allergies to certain foods

– Diabetes

– Inflammatory Bowel Disease (Crohn’s disease or ulcerative colitis)

– Medication

– Coeliac Disease (Gluten intolerance), uncommon in Asian demographics

It is important to remain hydrated if you experience diarrhoea because your body is not absorbing water properly, which often leads to dehydration.

In cases of bloody diarrhoea (dysentery), it is a medical emergency and you should seek medical attention as soon as possible.

Farting (Flatulence)

Flatulence, also known as farting, passing gas, or passing wind, is the medical

term for releasing gas from the digestive system through the anus. On average, people experience flatulence around 13-21 times a day. Causes of excessive flatulence include:

– Swallowing air (aerophagia) which occurs when chewing gum, smoking, wearing loose dentures, sucking on objects, drinking carbonated beverages, or eating/drinking too quickly.

– Dietary choices such as carbohydrates, beans, cabbage, broccoli, milk, processed foods, etc also could lead to excessive flatulence.

– Constipation

– Gastroenteritis

– Lactose intolerance

– Irritable bowel syndrome (IBS)

– Inflammatory bowel disease (IBD) including Crohn’s disease and ulcerative colitis

– Coeliac disease

– Diabetes

– Eating disorders

– Gastro-oesophageal reflux disease (GORD)

– Peptic ulcers

Stomach (Abdominal) Pain

Abdominal pain, sometimes called stomach pain, is frequently caused by problems in the digestive tract. However, it can also be caused by other organs in the abdomen such as the kidneys, pancreas, gallbladder, and liver. Abdominal pain can also be caused by some medicines. Causes of abdominal pain related to the gut include:

– Trapped wind (gas) or indigestion

– Constipation

– Diarrhoea

– Gastroenteritis or food poisoning

– Lactose intolerance

– Gastro-oesophageal reflux disease (GORD)

– Ulcers

– Irritable bowel syndrome (IBS)

– Inflammatory bowel disease (IBD)

– Diverticular disease

– Gallstones, gallbladder problems

– Liver disease

– Appendicitis

– Pancreatitis

– Bowel obstruction

Causes of abdominal pain not related to the gut include:

– Period pain

– Kidney stones

– Urinary tract infection (UTI)

– Pelvic inflammatory disease (PID)

– Heart problems including angina

– Pneumonia

– Anti-inflammatory medication

– Nonsteroidal anti-inflammatory drugs (NSAIDs) including Aspirin

Blood in Stool (Rectal Bleeding)

Rectal bleeding refers to any blood that passes from your anus. It is commonly observed on your toilet paper as you wipe, in the water of the toilet bowl, or in the colour of your stool.

If your stool is red in colour, it usually indicates bleeding towards the end of your digestive tract. This may be due to intestinal infections that damage the lining of your intestines or rectal/anal areas. It may co-occur with diarrhoea and result in bloody diarrhoea, which is characteristic of certain forms of gastroenteritis. Gastroenteritis, which is the inflammation and infection of the gastrointestinal tract, may be accompanied by nausea, vomiting, abdominal pains, or fever. This requires medical attention, and you should see a doctor immediately.

If your stool is black in colour, it usually indicates bleeding in the upper parts of your digestive tract. This appearance is because the blood has had time to be ‘digested’ by your digestive tract and has hence lost its colour. Any bleeding found in your stool should be investigated.

Rectal bleeding is a symptom of conditions including:

– Anal fissures

– Hemorrhoids

– Ulcers

– Inflammatory Bowel Disease (Crohn’s Disease, Ulcerative colitis)

– Anal or colorectal polyps

– Diverticular disease

– Damage/tears in the upper digestive tract including the stomach or esophagus.

– Colorectal cancer

Other symptoms