April 23, 2009

Wondering about your stomach pains? SHAPE shares the most common causes of stomach pain and offers practical advice on what to do next.

Want to avoid stomach aches forever? Don't eat. Don't stress. Don't drink. Oh, and hope like heck that no one in your family has a history of tummy troubles either. Not exactly realistic, right? Fortunately, you don't have to go to such extremes to feel better.

The first step: Make an appointment with your doctor. Sounds obvious, but some women don't bring up their stomach pains during office visits because, frankly, they find them quite embarrassing," says Dayna Early, M.D., a gastroenterologist at the Washington University School of Medicine in St. Louis. Next, examine your lifestyle: Often you can cure yourself of your distress simply by eliminating certain habits that you may not even realize are causing your stomach pain symptoms.

Finally, don't worry -- even if your problem is a medical one, there are plenty of treatment options. When lifestyle changes don't help, medication often does. "There's no need for women to suffer," Early says. Here, the country's leading gastroenterologists list the most common causes of digestive woes in women -- and give simple solutions for feeling better fast.

Common causes of stomach pain # 1

You're overweight. Carrying extra pounds can leave you more susceptible to developing gallstones, solid deposits of cholesterol or calcium salts that can cause severe upper stomach pains in your right abdomen, Raymond says.

Gallstones occur in up to 20 percent of American women by age 60, and women between the ages of 20 and 60 are three times more likely to develop them than men.

Excess weight also raises risk of GERD: One study published last August at the Baylor College of Medicine found that overweight people were 50 percent more likely to have GERD symptoms than those at a healthy weight. "Extra weight puts pressure on your stomach, which in turn puts pressure on the valve between the stomach and your esophagus, thus making it easier for acid to back up," Early explains. Losing just 10 to 15 pounds may be enough to eliminate these stomach pains.

Got GERD symptoms, including stomach pains? The first step of GERD treatment involves making lifestyle and dietary changes.

Common Causes of Stomach Pain, # 2:

You're popping over-the-counter remedies, instead of watching what you eat. Everyone takes the occasional Tums, but if you're downing over-the-counter acid blockers morning, noon and night, you may have GERD, gastroesophageal reflux disease, a chronic condition caused by stomach acid that moves from your belly into your esophagus, usually a result of a weakness in the muscular valve that separates the stomach and the esophagus.

A 2005 review published in the medical journal Gut concluded that up to 20 percent of all Westerners suffer from GERD symptoms -- and the first step toward getting healthy involves making lifestyle changes, such as watching what you eat.

Specific foods -- namely citrus fruits, tomatoes and tomato sauces, chocolate, wine and caffeinated beverages -- can trigger GERD symptoms. To help with GERD treatment, your doctor may also have you keep a food diary for two weeks so you can pinpoint which foods are particular problems for you, adds Roshini Rajapaksa, M.D., a gastroenterologist at the New York University School of Medicine.

One tip to reduce stomach pains: Fill up on fiber-rich foods like fruits, veggies and whole grains and limit saturated fat. A Baylor College of Medicine study found that people who ate high-fiber diets (at least 20 grams a day) were 20 percent less likely to suffer from GERD symptoms, and those who ate a diet low in saturated fat also cut their odds.

Common Causes of Stomach Pain, # 3:

You're simply stressed beyond belief. Ever wonder why you end up having to run to the bathroom every time you're up against a tight work deadline or anxious about a fight with your husband? When you're frazzled, elevated levels of stress hormones activate the normal contractions of both your stomach and colon, causing them to go into spasms, says Patricia Raymond, M.D., a GI doctor at Eastern Virginia Medical School in Norfolk, Va. (Stress hormones also can contribute to the overproduction of stomach acid, making you more susceptible to GERD symptoms.)

On top of that, stress often begets poor eating (think fatty, processed chips and cookies with very little fiber), which can cause constipation, and even more bloating. When you know you're going to have a tough day, plan to eat regular small meals so you're not too hungry or too full and avoid overindulging in caffeine -- all of which can trigger stomach pains.

Then get moving: An aerobic workout (aim for at least 30 minutes) won't just help get rid of stress, it will also help counter any constipation by speeding up the movement of food through your digestive tract, Raymond says. Continue reading for info about irritable bowel syndrome and its stomach pain.

If you've had intestinal symptoms for more than three months, then your stomach pains may be irritable bowel syndrome symptoms.

Find out more on

Common Causes of Stomach Pain, # 4:

You've got a bowel that's easily irritated. If you've had intestinal pain for more than three months, you may have what doctors call irritable bowel syndrome (IBS), a problem that affects about one in every five women. This condition is characterized by bloating, gas and alternating bouts of diarrhea and constipation brought on by anything from dietary changes to stress, Raymond says.

Ask your doctor about the IgG antibody test, a blood test that helps pinpoint particular food sensitivities, suggests Mark Hyman, M.D., a former medical director of Canyon Ranch in Lenox, Mass., and author of Ultrametabolism (Scribner, 2006). A British study found that eliminating foods from your diet based on test results improved irritable bowel syndrome symptoms by 26 percent.

"Other studies show peppermint-oil capsules, available at health-food stores, help relieve IBS symptoms by relaxing the colon," adds Michael Cox, M.D., a gastroenterologist at Mercy Medical Center in Baltimore. (Look for "enteric coated" pills; these break down in the colon, not the stomach where they can cause irritation.)

If your irritable bowel syndrome symptoms are moderate, they should improve with these two strategies. For more severe cases, your doctor may prescribe Zelnorm, a medication that regulates the movement of stools through your bowels, and may suggest dietary changes and relaxation techniques, such as yoga. Stomach pains can occur if you're lactose intolerant. For more information on being lactose intolerant, continue reading.

A significant percentage of women are lactose intolerant, struggling to digest milk, ice cream and some cheeses. Do your stomach pains sound like this type?

Common Causes of Stomach Pain, # 5:

You're lactose intolerant. About one in four women have trouble digesting lactose, a sugar found naturally in dairy products like milk, ice cream and soft cheese. If you suspect that your gas or stomach bloating are a result of lactose intolerance, you can cut out dairy products for a couple weeks to see if symptoms improve, suggests John Chobanian, M.D., a gastroenterologist at Mount Auburn Hospital in Cambridge, Mass.

Still not sure? Ask your doctor about the hydrogen breath test, where you blow into a bag after downing a lactose-laced drink. High levels of hydrogen indicate you're lactose intolerant. But even then, you don't have to give up dairy.

Yogurt and hard cheese are the easiest for your body to break down; yogurt contains enzymes that help you process the lactose and hard cheese doesn't contain very much lactose in the first place. You may also be able to retrain your digestive system to break down lactose by consuming smaller amounts of milk several times a day for three or four weeks, according to Purdue University researchers.

Some women also find that drinking milk with food also minimizes stomach pain symptoms. "I recommend starting with half a cup of milk with a meal, and if this is tolerated, after a few days, slowly increasing the amount so you're sipping 2-3 cups a day," says study author Dennis Savaiano, Ph.D., dean of Purdue University's School of Consumer and Family Sciences in West Lafayette, Ind. Or try drinking lactose-free milk and/or take Lactaid tablets before eating dairy; both contain lactase, the enzyme that breaks down lactose. Women may also suffer stomach pains if they are fructose intolerant.

Limiting fruit and avoiding certain ones can help control the stomach pains and stomach bloating associated with being fructose intolerant.

Common Causes of Stomach Pain, # 6:

You're eating too much fruit. A University of Kansas Medical Center study found that almost half of all patients complaining of unexplained gas and stomach bloating after having 25 grams of fructose (the simple sugar found in fruit) were actually caused by being fructose intolerant, meaning their bodies aren't able to digest fructose properly. Like lactose intolerance, this condition can be diagnosed with a breath test.

If you're suffering from being fructose intolerant, your first step should be to steer clear of products that contain fructose as the primary sugar, such as apple juice, says study author Peter Beyer, M.S., R.D., a professor of dietetics and nutrition at the University of Kansas.

While you won't need to swear off fruit entirely, you may have to avoid certain kinds: "You should limit consumption of fruits that are specifically high in fructose, such as apples and bananas," Beyer explains. One medium apple has about 8 grams of fructose, one medium banana has almost 6, a cup of cubed cantaloupe has 3 and apricots have less than a gram apiece.

Another strategy: Spread out your daily fruit servings so you don't eat them all in one sitting, to avoid stomach pain.

Common Causes of Stomach Pain, # 7:

You're chewing gum to keep from snacking. Believe it or not, chomping on gum is a big cause of stomach pains. "You often swallow lots of air, which can create gas and bloating," explains Christine Frissora, M.D., a gastroenterologist at NewYork-Presbyterian Hospital in New York City. In addition, some sugarless gums contain the sweetener sorbitol, just small amounts of which can contribute to swelling in your belly. "Sorbitol pulls water into your large intestine, which can cause bloating and, in high enough doses, diarrhea," Cox explains.

One study published in the journal Gastroenterology found that just 10 grams of sorbitol (the equivalent of a few sugar-free candies) produced stomach bloating symptoms, while 20 grams caused cramps and diarrhea. Other sugar substitutes to monitor: maltitol, mannitol and xylitol, also found in some sugarless gum as well as in low-carb products. (Sometimes these are listed just as "sugar alcohols" on labels.)

Yet another of the common causes of stomach pain is celiac disease, managed by a gluten free diet. Read on for details!

Common Causes of Stomach Pain, #8:

You're sensitive to wheat. About one in 133 people in the United States suffers from celiac disease, also known as gluten intolerance, according to a 2003 University of Maryland study. In people with celiac disease, gluten (found in wheat, rye, barley and many packaged products), sets off an autoimmune reaction that causes their bodies to produce antibodies that attack the villi, tiny hairlike projections in the small intestine that absorb vitamins, minerals and water, Cox explains.

Over time, these villi are damaged, causing abdominal cramping and stomach bloating, and preventing you from absorbing nutrients. This makes you more susceptible to vitamin and mineral deficiencies, as well as to conditions like anemia and osteoporosis. There's a strong genetic link too: The disease occurs in 5-15 percent of the children and siblings of people who have it.

Although the diagnosis can be made via a simple antibody blood test, celiac disease is easily missed because the symptoms so closely mimic those of other stomach pain conditions, such as lactose intolerance and irritable bowel syndrome. "I've diagnosed women with this condition who've suffered for years and have been misdiagnosed or told by doctors that their symptoms were all in their head or stress-related," Frissora says.

The treatment is a diet in which you eliminate grains such as wheat, rye and barley. "Following a gluten free diet is incredibly tricky: You may have to make a trip to the nutritionist to sort out what you can and can't eat," Early acknowledges. "But once you modify your diet, the stomach pain symptoms will disappear." Gluten free foods are available at natural-food markets and health-food stores.


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