The Digestive System

How does the digestive system work?

It may seem like digestion only happens in your stomach, but it’s a long process that involves many organs. Together they form the digestive tract.

Digestion begins in your mouth, where saliva starts to break down food when you chew. When you swallow, your chewed food moves to your esophagus, a tube that connects your throat to your stomach. Muscles in the esophagus push the food down to a valve at the bottom of your esophagus, which opens to let food into the stomach.

Your stomach breaks food down using stomach acids. Then the food moves into the small intestine. There, digestive juices from several organs, like your pancreas and gallbladder, break down the food more, and nutrients are absorbed. What’s left goes through your large intestine. The large intestine absorbs water. The waste then moves out of your body through the rectum and anus.

Digestive problems can happen anywhere along the way.

Gas and Bloating

Bloating and passing gas can be uncomfortable and embarrassing. Here’s what you need to know.

What is gas?

Gas is a normal part of healthy digestion. Air that is in your digestive tract is either released through your mouth as a burp or through your anus as gas. You typically pass gas 13 to 21 times a day.

What causes gas?

Gas is created when you swallow air, such as when you eat and drink. But it’s also a byproduct of the breakdown of food. Some foods cause more gas than others. You may also be more sensitive to particular foods and may have more gas when you eat them.

Taking some medications can also cause gas.

Which foods cause gas?

You’ve probably noticed you feel gassy after eating certain foods. Cut back on the common culprits:

• Apples
• Asparagus
• Beans
• Broccoli
• Brussels sprouts
• Cabbage
• Cauliflower
• Milk and dairy products
• Mushrooms
• Onions
• Peaches
• Pears
• Prunes
• Wheat

When gas builds up in your stomach and intestines, you may have bloating – swelling in your belly and a feeling of fullness. It may happen to you more often if you have:

• A stomach infection
• Irritable bowel syndrome (IBS). This digestive condition causes stomach pain, cramping, and diarrhea or constipation.
• Celiac disease. When people with this condition eat gluten, their bodies produce antibodies that attack the intestinal lining.
• Hormonal changes that happen around women’s periods
• Constipation

While bloating is usually just uncomfortable, it can sometimes cause pain in your belly or sides.

How can I reduce gas and bloating?

Diet and lifestyle changes can make a big difference:

• Cut back on fatty foods.
• Avoid fizzy drinks.
• Eat and drink slowly.
• Quit smoking.
• Don’t chew gum.
• Exercise more.
• Avoid foods that cause gas.
• Avoid sweeteners that cause gas such as fructose and sorbitol. They are often found in candies, chewing gum, energy bars, and low-carb foods.

What OTC medicines treat excess gas?

If you have a lot of gas or are very uncomfortable, an over-the-counter medicine may help.

• Lactase supplements. If dairy is causing your problems, taking these tablets or drops just before you eat will help you digest lactose (the main sugar in dairy foods) and reduce gas.
• Alpha-galactosidase. This digestive aid comes as liquid or tablets. You take it before you eat to help your body break down the complex carbs or sugars that cause gas, such as those found in beans, broccoli, and cabbage. Caution: People with the genetic condition galactosemia should avoid it. It may also interfere with some diabetes drugs like acarbose (Precose) or miglitol (Glyset). If you take medication for diabetes, talk to your doctor or pharmacist before taking this aid.
• Simethicone (Mylicon). Taking these liquids or tablets can relieve the uncomfortable bloating and pain from gas.
• Probiotics. These supplements contain “friendly” bacteria that can help digestion. In addition to tablets and powders you sprinkle on your food, foods like yogurt, kefir, and sauerkraut contain probiotics.

Heartburn/GERD

What is heartburn?

What causes heartburn?

There’s a muscle at the entrance of your stomach, called the lower esophageal sphincter (LES), that acts like a gate: It opens to let food move from your esophagus to your stomach, and it shuts to stop food and acid from coming back out.

When the LES opens too often or isn’t tight enough, stomach acid can rise up into the esophagus and cause the burning feeling.

What triggers heartburn?

Triggers vary from person to person, but you may be more likely to get heartburn when you:

• Overeat
• Eat spicy, fatty, acidic, or greasy foods
• Consume caffeine or alcohol
• Smoke
• Lie down shortly after you eat
• Are under stress

Some people have a higher risk of heartburn, including those who are:

• Smokers
• Overweight
• Pregnant
• Have a hiatal hernia, where the stomach bulges up into the chest through an opening in the diaphragm

How should I change my diet to avoid heartburn?

You might have noticed that your heartburn gets worse when you eat or drink certain things. Here are a few that can trigger heartburn:

• Alcohol
• Chocolate
• Coffee
• Fatty or fried foods
• Greasy foods
• Onions
• Oranges, lemons, and other citrus fruits and juices
• Vinegar, hot sauces, and salad dressings
• Peppermint
• Sodas and other bubbly drinks
• Spicy foods
• Tomatoes and tomato sauce

Big meals can also set off heartburn. Instead of eating three big meals a day, try to eat several small meals throughout the day.

What else can I do to prevent heartburn?

Here are a few steps to try:

• Lose weight if you’re overweight. Extra pounds put pressure on your stomach, forcing more acid up into your esophagus.
• Wear loose clothing. Tight clothes that press on your stomach can trigger heartburn.
• If you smoke, quit. Cigarette smoke relaxes the muscle that prevents acid from backing up into the esophagus. It also may increase how much acid your stomach makes.
• Check your medicines. Regular use of anti-inflammatory and pain medicines (other than acetaminophen) contributes to heartburn.
• Avoid high-impact exercise.

• Eat a light dinner and avoid foods that trigger your heartburn.
• Don’t lie down for at least 2 to 3 hours after you eat.
• Use blocks or books to raise the head of your bed by 4-6 inches. Or put a foam wedge under your mattress at the head of the bed. Sleeping at an angle will help stop acid from backing up into your esophagus.

Can exercise cause heartburn?

Exercise has more than a few health perks. Among them is weight loss, which can help you avoid getting heartburn in the first place if you are overweight. But some types of exercise can trigger the burning sensation. You’ll be less likely to reach for your heartburn medicine if you avoid crunches and inverted poses in yoga. You may need to find alternatives to high-impact workouts. For example, bicycle or swim instead of going for a run.

What is GERD?

Everyone has heartburn from time to time. But when you have it frequently (at least twice a week for a few weeks), or when it begins to interfere with your daily life or damage your esophagus, your doctor may tell you that you have a long-term condition called gastroesophageal reflux disease, or GERD. It’s also known as acid reflux disease. Heartburn is the most common symptom of GERD.

What are other symptoms of GERD?

Besides the frequent burning in your chest, you might also have symptoms like:

• Bad breath or a sour taste in your mouth or in the back of your throat
• Breathing problems
• Coughing
• Feeling like you have a lump in the back of your throat
• Hoarse or raspy voice
• Nausea
• Difficult or painful swallowing
• Sore throat
• Tooth decay
• Vomiting

Is it GERD or something else?

Frequent heartburn is a symptom of GERD. It’s important to get help if you have heartburn frequently so you can avoid complications from GERD and uncover any other problems. Call your doctor or make an appointment with a gastroenterologist, who specializes in digestive illnesses.

What are the complications of frequent heartburn and GERD?

Over time, heartburn that isn’t treated or controlled well by lifestyle changes or medicine may cause serious problems, including:

• Breathing problems like asthma, nighttime choking, and repeated pneumonia
• Changes in the cells that line the esophagus, called Barrett’s esophagus. This can possibly lead to cancer of the esophagus.
• Painful inflammation of the esophagus called esophagitis
• Narrowing of the esophagus, called an esophageal stricture. This can cause problems swallowing.

Several types of over-the-counter (OTC) and prescription medicines can help with heartburn. Your doctor or pharmacist can help you find the one that’s right for you.

Antacids

What type of antacid should I choose?

Soothe occasional, mild heartburn with an antacid that contains calcium carbonate or magnesium. They help neutralize stomach acid. Some prevent acid reflux. Those that contain magnesium may also help heal stomach ulcers. They come in liquids and pills and are fast-acting.

What are the side effects of antacids?

Antacids can cause constipation and diarrhea. Look for brands that contain calcium carbonate, magnesium hydroxide, and aluminum hydroxide to reduce these side effects. Don’t take antacids with magnesium if you have chronic kidney disease. Some antacids have a lot of salt, so you should take them only for occasional heartburn.

H2 Blockers

What do H2 blockers do?

H2 blockers help relieve and prevent occasional heartburn by lowering the amount of acid your stomach makes. Though they don’t work as fast as antacids, their effects last longer. Your doctor may tell you to take an antacid and an H2 blocker together. H2 blockers are for short-term use – less than 2 weeks. You can take them before your meals to prevent heartburn, or at bedtime. They come in liquids and pills.

All H2 blockers work about the same. So if one doesn’t help with your heartburn, switching to a different one isn’t likely to help. Switching to a higher-dose prescription version of the drug might help, though. Talk to your doctor if over-the-counter H2 blockers aren’t working for you.

• Anti-seizure medicines
• Blood thinners
• Medicines for heart rhythm problems

Talk to your doctor if you take any of these medicines and you need to take an H2 blocker.

What are the side effects of H2 blockers?

The most common side effects are mild and include:

• Constipation
• Diarrhea
• Headache
• Nausea or vomiting

Proton-Pump Inhibitors (PPIs)

What are PPIs?

PPIs are used to prevent frequent heartburn that happens more than twice a week. They work by lowering the amount of acid your stomach makes. Often, they work better than H2 blockers. You also can take these drugs for a longer period of time than H2 blockers.

PPIs are available over the counter and by prescription. But if you have GERD, you may need prescription-strength medication.

How do you take PPIs?

You need to take PPIs once a day on an empty stomach so they’ll work best. Usually you’ll take the medicine every morning, about 30 to 60 minutes before you eat breakfast, to control stomach acid.

What are the side effects of PPIs?

The most common side effects are mild and include:

• Diarrhea
• Headache
• Nausea and vomiting
• Stomach pain

PPIs may also raise your chances of getting kidney disease, and fractures of the hip, wrist, and spin, and may lead to low magnesium levels. The risk is highest in people who take high dose PPIs for a year or more. 

Prokinetics

What are prokinetics?

Prokinetics help your stomach empty faster, so you have less acid left behind. Usually you take this medicine before meals and at bedtime.

Prokinetics are sold only by prescription.

What are the side effects of prokinetics?

Prokinetics can have more serious side effects than PPIs or H2 blockers. These include:

• Anxiety
• Depression
• Diarrhea
• Drowsiness
• Fatigue
• Crankiness
• Nausea

If Medicines Don’t Help

Should I call my doctor?

What will my doctor do?

Your doctor will ask about your symptoms and do an exam. It can be helpful to keep a journal to note what you eat and drink and when you have heartburn. This will help you and your doctor pinpoint your triggers.

If medicine and lifestyle changes don’t control your heartburn, you can take one of these tests to find out what’s causing the problem:

pH test. This measures the acidity of your esophagus. The doctor will either attach a small sensor to your esophagus or place a thin tube down your esophagus.

Endoscopy. A long, thin tube with a camera and light on the end is put down your esophagus so your doctor can look inside your esophagus and stomach. Endoscopy can look for problems such as an ulcer or narrowing inside your esophagus.

When is heartburn an emergency?

Heartburn is usually a minor problem that goes away over time. But if you also have other symptoms, it could be a sign that something more serious is wrong. Call your doctor or go to the emergency room if:

• It hurts to swallow.
• You feel like you’re choking.
• You have black, tarry-looking bowel movements.
• Your mouth or throat hurts when you eat.
• You have difficulty swallowing foods
• Your voice is hoarse.
• Your vomit contains blood or what looks like coffee grounds.
• You have trouble breathing.

Is it heartburn or a heart attack?

Heartburn doesn’t affect your heart, but it can feel a lot like the chest pain that happens during a heart attack. Call 911 if you have any of these symptoms along with chest pain, even if you’re not sure that you’re having a heart attack:

• Dizziness
• Nausea and vomiting
• Pain that travels to your neck and shoulder, jaw, or back
• Shortness of breath
• Sweating

Over-the-Counter Heartburn Relief

Constipation

How do I know if I’m constipated?

What’s considered a normal number of bowel movements varies from person to person. If you are straining when going to the bathroom, you are probably constipated. You may also have hard stools or a feeling that your bowel movement isn’t complete.

Occasional constipation is common, but if you have less than three bowel movements in a week, see your doctor.

There are many causes of constipation, and sometimes you have more than one:

• Not drinking enough water
• Eating a diet low in fiber
• Traveling or changing your routine
• Getting too little exercise
• Taking certain medicines, such as antidepressants, antihistamines, iron, and some pain medications (particularly narcotic pain medications)
• Medical conditions including cancer, diabetes, IBS, and hypothyroidism
• Pregnancy
• Blockages in the large intestine
• Problems with the nerves or muscles around the large intestine or rectum
• Taking too many laxatives

When should I call my doctor?

If you are constipated for more than 2 weeks, are losing weight, have blood in your stool, or you are having severe pain, see your doctor. These may be signs of a serious problem.

How can I prevent and treat constipation without medication?

• Drink plenty of water (60-80 ounces per day). An extra two to four glasses a day may help.
• Eat prunes or bran cereal to get 20-35 grams of fiber per day.
• Eat more vegetables and fruit.
• Drink warm wateror herbal tea in the morning.
• Exercise often.

When lifestyle changes don’t solve your problems, there are several over-the-counter medications that can help. Talk to your pharmacist or doctor about which medicine is right for you. Be sure to read labels carefully before taking these medicines. Using some over-the-counter treatments for constipation for more than 2 weeks can make your symptoms worse and may be a sign of something more serious.

• Bulk-forming laxatives. You take these fiber supplements with water to bulk up your stool, which can trigger your bowels to push it out. Some common bulk laxatives are methylcellulose, polycarbophil, psyllium, and wheat dextrin.
• Lubricants, like mineral oil. They coat the surface of the intestine and block water from being absorbed from the stool, which helps it pass more easily.
• Osmotic agents. These help keep more water in the intestine, which can expand the intestine and stimulate a bowel movement. Osmotic agents are not for some older adults and people with heart or kidney failure. Talk to your doctor before taking this type of medicine.
• Stool softeners. By adding fluid to stools, softeners help you avoid straining and make them easier to pass.
• Stimulants. These laxatives make the intestines contract, which helps move the stool.
• Suppositories or enemas. Some laxatives come in a form that can be inserted into the rectum. These are helpful when you have to avoid straining, such as after surgery or childbirth.

Hemorrhoids

What are hemorrhoids?

Hemorrhoids are swollen blood vessels in the rectum and the anus, and they can be uncomfortable. They can be either inside the rectum (internal) or under the skin around the anus (external). Internal hemorrhoids usually don’t cause discomfort, though straining to have a bowel movement may cause them to bleed or lead to spasms in the muscles of the rectum, which can be painful. External hemorrhoids itch and may bleed.

What are the symptoms of hemorrhoids?

• Bleeding during a bowel movement. You might also notice blood on the toilet paper after you wipe.
• Itching around the anus
• Swelling or pain around the anus
• Painful or sensitive lumps around the anus

What causes hemorrhoids?

Constipation or straining during bowel movements causes most hemorrhoids. You may also have hemorrhoids if you don’t get enough fiber in your diet.

Being pregnant or overweight can cause hemorrhoids because of the extra pressure on your rectum. Hormonal changes that happen during pregnancy can also weaken the muscles of the rectum and anus.

When should I call my doctor?

If you think you have hemorrhoids, see your doctor. They can recommend treatment and make sure your symptoms are not caused by another condition.

You should also see your doctor if your hemorrhoids haven’t gotten better with treatment. You may need to see a doctor who specializes in hemorrhoids.

How can I treat hemorrhoids without medication?

• Add fiber to your diet to help relieve constipation and make your stools softer. This will make it easier to have bowel movements and reduce the pressure on hemorrhoids.
• Try a stool softener.
• Exercise to help relieve constipation.
• Don’t strain during bowel movements.
• Soak in a plain, warm bath or sitz bath (a few inches of water that covers your private parts and bottom) to help relieve the pain.
• Keep the area clean and dry.
• Use moist wipes instead of dry toilet paper so you don’t irritate the area any further.
• Apply an ice pack or cold compress to help with swelling.
• Avoid spicy foods to prevent itching.

Medications include creams, suppositories, pads, and ointments. Most products contain witch hazel or hydrocortisone, which can help stop the itching and swelling and may ease pain. Most over-the-counter medications should not be used for more than a week. Talk to your doctor or pharmacist about which is the best option for you.

Diarrhea

What is diarrhea?

Diarrhea is loose, watery stool that sends you to the bathroom more often than usual. When you have diarrhea, you may have stomach pain and cramps or bloating.

What causes it?

Many things cause diarrhea, including viruses, bacteria, parasites, medications, and medical conditions that affect the stomach, intestines, or colon. What you eat can also be a culprit.

When should I call my doctor?

If you have occasional, mild diarrhea, there is probably no reason for concern. But if it lasts for more than 2 days and hasn’t improved, you should call your doctor. If your infant or child has diarrhea, call your pediatrician.

• Severe belly or rectal pain
• Bloody or black stools
• Fever above 102 F

Dehydration. Signs of dehydration include feeling very thirsty, having a dry mouth or skin, having little or no urine, having dark yellow urine, and feeling weak.

How can I treat my diarrhea?

Drink plenty of fluids (water, sports drinks, fruit juice) to keep from getting dehydrated. Avoid alcohol, caffeine, and dairy. If you aren’t nauseated, you can eat plain, bland, low-fiber foods including bananas, plain white rice, toast, and crackers.

As long as you don’t have other symptoms that worry you, you may also try some over-the-counter treatments:

• Loperamide (Imodium): This comes in liquid and capsules. It works by slowing movement in your intestines and colon so you can absorb more water, making the stool less watery. Talk to your doctor about taking this medicine. Do not give it to children under 2.
• Bismuth subsalicylate (Pepto-Bismol, Pink Bismuth): This medicine reduces mild diarrhea and comes in liquids, capsules, and chewable tablets. You shouldn’t take it if you’re allergic to aspirin or have a fever. Don’t give it to children under 2. If you’re taking a blood thinner, don’t take this medicine before talking to your doctor.
• Probiotics: The same supplements that can help with bloating from gas may also help relieve some types of diarrhea by adding “good” bacteria to your digestive system.

How to Fix Digestive Issues

Fiber

Fiber is a natural part of plants. There are two types. Both are important and work in different ways.

Soluble fiber dissolves in water, turning into a gel. Think of it as a sponge, soaking up fluid. Soluble fiber can help with diarrhea, which happens when there is too much water in your colon. It also slows the emptying of your stomach so you feel fuller longer, which can help you lose weight.

Sources include:

• Apples
• Citrus fruits
• Lentils
• Nuts
• Oatmeal
• Psyllium

Insoluble fiber doesn’t dissolve in water. Think of it as a broom: It helps keep food and waste moving through your body. Because insoluble fiber attracts water in your gut, it makes stools softer and easier to pass. Eating a diet rich in insoluble fiber can help with constipation.

Sources include:

• Carrots
• Cauliflower
• Legumes
• Potatoes
• Whole grains

Women should get about 25 grams of fiber per day. Men should get 38 grams.

If you have trouble getting enough fiber from foods, your doctor may suggest you take fiber supplements.

Water is essential to good health and normal bowel function. Water also helps keep stools soft but solid and well-formed. Avoid drinking beverages such as coffee or soda if you think they trigger your digestive problems.

Probiotics

Your digestive tract is full of different kinds of bacteria. You may think that is a bad thing, but most of the bacteria in your gut are healthy. They break down toxins, help your body make some vitamins, and play a role in keeping you healthy. But when you have too much of some kinds of bacteria, you may get an illness or have unpleasant symptoms.

Probiotics are like the healthy bacteria in your body. Eating foods that contain them, or taking probiotic supplements, can help keep a balance of good and bad bacteria in your body.

Experts aren’t sure exactly how they work, but probiotics may help:

• Relieve bloating from gas
• Keep you regular
• Relieve some types of diarrhea
• Boost your immunity
• Fight infections
• Prevent harmful bacteria from growing in your stomach
• Destroy the bacteria that make you sick
• Make B vitamins your body needs

• Buttermilk
• Fermented and unfermented milk
• Kefir
• Kimchi
• Miso
• Sauerkraut
• Some pickles
• Some soft cheeses
• Soy drinks
• Tempeh
• Yogurt with live, active cultures

Should I take a probiotic supplement?

People with certain conditions shouldn’t take them, and some probiotics may affect how well your other medications work. Talk to your doctor or pharmacist about whether probioticsupplements are right for you.