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A Healthier Stomach

By JOANNE PALLOTTA, Beth Israel Deaconess Medical Center Correspondent

Pain, constipation, bloating, gas and other digestive issues – definitely not dinner table talk in most homes. But, they are common, and in some cases, very serious matters for women that need frank and honest answers. "Many women think that you just don't talk about excretory functions because they're taboo symptoms," says Jacqueline L. Wolf, MD, a gastroenterologist in the Division of Gastroenterology at Beth Israel Deaconess Medical Center in Boston and author of the book: "A Women's Guide to a Healthy Stomach." "We're told to be lady-like." But, talking about digestive health is important and beneficial. Dr. Wolf runs down the top conditions women should be talking about.


"Once a woman gets pregnant during reproductive years, issues of gastrointestinal health are very important," says Dr. Wolf. Nausea and vomiting as well as constipation, reflux and heartburn, are common symptoms with pregnancy and there appears to be no harm to the baby as long as the mother can maintain good nutrition. However, they can be very distressing for the mother-to-be. There are many over-the-counter treatments that exist that are not harmful to the baby but may be very beneficial for mom.

(Credit: iStockphoto)

A more uncommon and serious gastrointestinal condition in pregnancy could be liver disease. If there are new abnormal liver function tests during pregnancy, a woman should consult with a specialist in liver disease.

Some gastrointestinal symptoms may exist before pregnancy. If they do, a woman needs to think about how to manage the symptoms and talk with her doctor about how a medication might affect the fetus and her ability to nurse after the baby is born.


Endometriosis is a painful condition in which tissue that lines the inside of a woman's uterus grows outside of the uterus. This disorder occurs in five percent of women in their reproductive years. Its symptoms include pain during or in between a woman's menstrual cycle, diarrhea or constipation. Dr. Wolf says in a more serious situation, endometriosis can cause scar tissue that, in some women, can result in infertility. In rare cases, she says it can cause bleeding in the bowel.

"It's important to diagnose it," says Dr. Wolf. "But, there is no way to prevent it, as far as we know." There are, however, ways to control the pain. A physician might prescribe hormones, a hormone secreting IUD or birth control. If those methods aren't successful, laparoscopy might be performed to remove mild to moderate endometriosis.

Colorectal Cancer

Dr. Wolf calls colorectal cancer an important issue for anyone over the age of 50. The cancer develops when some of the cells that line the rectum or colon become abnormal and grow. According to the American Cancer Society, this cancer is the third most common for both men and women in the U.S. Polyps usually occur before the cancer. By removing the pre-cancerous polyps, the risk of cancer is significantly decreased.

Women and men are different with the timing of polyp growth. Dr. Wolf says women don't tend to develop polyps – growths on the surface of the large intestine – as early as men. That may be due to hormones.

In many cases, colorectal cancer is also preventable. "The incidence of colorectal cancer appears to be decreasing," says Dr. Wolf. "And part of that is probably due to greater attention being paid to screening." So, when should you get a colonoscopy?

  • Age 50: this is the current recommendation for anyone with an average risk.
  • Age 40 or 10 years prior: if you have a family member that has or has had colorectal cancer or pre-cancerous polyps.
  • Consult a physician: if multiple family members have or have had colorectal cancer or other types of cancers.

Aspirin and exercise also appear to decrease the risk. There are many studies looking at diet as a way to prevent colorectal cancer as well. "I would recommend that people eat a low fat diet and that they eat a diet – if tolerated – high in vegetables and lean meats and fish."

Irritable Bowel Syndrome (IBS)

This condition includes abdominal pain, diarrhea or constipation, gas and bloating. While irritable bowel syndrome is not life threatening, Dr. Wolf says it is serious. "It causes a lot of discomfort and decreases quality of life." People suffering from IBS may seek medical attention more often and might have to frequently stay home.

Dr. Wolf points out that nutrition for a person with irritable bowel syndrome plays a major role and that there are several studies looking at the link to diet. A diet low in fermentable, oligosaccharide (wheat, garlic, onion), disaccharide (dairy), monosaccharide (certain fruits, high fructose corn syrup) and polyols (sweeteners like sorbitol or fruits with pits like avocado, cherry, plums) – low FODMAP – has been shown to greatly reduce or eradicate the symptoms in people with IBS. You can read more about a low FODMAP diet and its benefits by clicking here.


Constipation is a condition in which a person experiences difficulty emptying the bowels and can cause severe discomfort. It is defined as a decreased number of stools from the normal number, stools that are hard to eliminate, stools that are hard, or fewer stools than three per week. "Constant constipation is more chronic and common in women." Dr. Wolf calls it a major problem.

Several reasons can contribute to this issue, including a poor diet, poor fluid intake, or slow moving/poorly functioning bowels. While a change in food and drink might solve the condition, some cases may require physical therapy to improve the elimination of the stool from the rectum.


"Ten to twenty percent of people in the Western world suffer from reflux," says Dr. Wolf. Reflux occurs when the contents of the stomach – food, bile, liquid or acid -- travel back up the esophagus (the tube leading down the chest). Reflux may be very painful or asymptomatic, but can also cause such damage as laryngitis, esophagitis, chronic inflammation, or narrowing of the esophagus.

Certain medications and foods can contribute to reflux, and if your stomach doesn't empty well, it can add to the condition. Dr. Wolf points out that obesity makes reflux more likely and fatty foods cause the stomach to empty more slowly.

"Diet is important," points out Dr. Wolf. To avoid or lessen reflux, she recommends not eating three to four hours before lying down or going to bed. "I also tell patients to stay away from mint because it relaxes the high-pressure zone between the esophagus and stomach and to avoid caffeine – which includes chocolate -- because it can increase acid secretion." Other foods and drink to keep out of your diet include alcohol, garlic and onions.

Lactose Intolerance

A person who is lactose intolerant doesn't possess the enzyme or compound to break down the lactose – or, milk sugar – found in milk and other dairy products. It's a common condition and the symptoms include diarrhea, abdominal pain, bloating or constipation. "The condition won't damage your health, but it can be painful and impact your quality of life," she says. "And, as a woman ages, the tendency to lose the enzyme increases." Also, an infection – such as a norovirus – might cause a person to lose part or most of the enzyme temporarily or permanently.

Lactose intolerance is no more common in women than men. Preventing the condition can be as simple as avoiding products with lactose. "If someone is complaining about bloating or abdominal pain, one of the first things I do is change diet." But, Dr. Wolf cautions that alternatives with soy might also cause bloating.

Getting Information

Dr. Wolf credits the Internet and social media for helping in the discussion about women's digestive health. "There's a lot of information out there. The new trick is how to figure out if it is accurate." She points to trusted sources like hospitals and universities. And, of course, there is no substitute for your physician. "My feeling is if you want to try something and it doesn't have a downside or side effect, there is no harm."

Dr. Wolf also points out that, in most cases, diet and exercise are key to good health. "Eating can be very enjoyable. Good food is wonderful and makes life fuller. But, one needs to eat food that is healthy for your body."

Dr. Wolf is also part of a non-profit called Foodicine Health, Inc. It provides, in part, diet recommendations for people with medical conditions in which a new regime would be beneficial.

Get more information on these common women's digestive health issues as well as the Division of Gastroenterology at

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor. Posted May 2015

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