Dear Wellness Pharmacist:  I tend to get this annoying pain in my stomach area and I can’t pinpoint it and say that it occurs after anything specific.  For instance, like after I eat a specific food or after I complete a certain type of activity.  As an ostomate, I find that I am very in tune with my body, especially my abdominal area so I don’t feel like I have to go to the doctor for this type of niggling pain.  Do you have any suggestions on what I should do?

abdominalpain

Answer:  It is not the first time that I have heard from an ostomate that they are very in tune with their bodies and you know what, having had an ileostomy myself and currently having a J-pouch, I completely agree with you, we do know our bodies a heck of a lot better than most doctors will!  However, having said that, abdominal pain is nothing to take lightly.

Did you know that abdominal pain, ostomate or not, is one of the most common reasons for a physician visit here in Canada?

Abdominal pain can be a non specific symptom coming from a variety of sites.  Think about the gastrointestinal or “GI” tract…it encompasses everything from the mouth to the anus.  The abdomen itself is the house to many diverse organs and tissues so just basic causes of abdominal pain already include quite a hefty list including:

  • Inflammatory bowel disease (IBD) – as ostomates we know this one the best and it encompasses the two common culprits: ulcerative colitis (UC) and Crohn’s disease (CD)
  • Gallstones
  • Chronic pancreatitis
  • Gastroesophageal reflux disease, aka GERD
  • Irritable bowel syndrome IBS
  • Myofascial pain
  • Non ulcer (functional) dyspepsia (NUD),  – simply put, dyspepsia is pain or discomfort in your upper abdomen and “NUD” is where no known cause can be found for the symptom of dyspepsia
  • Peptic ulcer disease (PUD)

Before reading any further, if you or anyone you know has the following “RED FLAGS” in addition to abdominal pain and/or discomfort, it is essential to see a physician because it could be a sign of a serious GI pathology: having a difficult time swallowing in general (dysphagia), weight loss or gain of more than 3 kg over six months, persistent vomiting, bleeding, vomiting blood, bleeding in the stool, anemia, fever and/or chills.

So how can we help to alleviate or prevent abdominal pain?  Let’s look at a couple of different options:

  •  DIET: It plays a role in everything and abdominal pain is no different; however, it is highlighted when we look at prevention.  Often wheat, dairy, spicy foods, citrus fruits and foods with a high fat content tend to be common culprits that give rise to abdominal pain.  The best advice would be to stay away from these foods in order to steer clear of abdominal pain or discomfort.
  • YOGA: If in very simple terms we say for example that abdominal pain can often be linked to indigestion, constipation, stress or some sort of combination of abdominal organ problems then it may be helpful to look into some simple lifestyle measures such as performing some yoga postures to see if that will help to relieve our abdominal pain/discomfort before trying any drastic medication.  All of the following poses can be “googled” on the internet for proper technique and form.  Provided here are the names of the ones that you should try for abdominal pain & why:
    • The Cobra pose helps to strengthen the abdomen and relieve stress and it gives the needed pressure to the adrenal glands in order to provide a rich blood supply to the entire body.
    • The Locust pose is beneficial in treating constipation and poor digestion and is a posture where the whole body is in the prone position.
    • The Seated Forward Bend massages the internal organs, provides relief for constipation and helps with general stress relief which is great for abdominal discomfort in general.
  • HERBS: Certain ones have been used for generations to help alleviate abdominal pain.  Herbs fall into categories such as demulcents which help to coat the lining of the GI tract.  Specific demulcents are marshmallow root (not the fluffy marshmallows you put into hot chocolate!), and slippery elm.  Other herbal categories are anti inflammatory like white willow bark (FYI – the original source of Aspirin!), carminatives like ginger, fennel, peppermint and an excellent carminative and nervine (soothes the nervous system) called lemonbalm.  Lemonbalm is perfect for those suffering with IBS and require a soothing tea after meals to calm abdominal pain/discomfort or the feeling of gas and/or bloating.  If you go to any herbal store or pharmacy that carry natural products you should be able to find any of the above mentioned herbs.  It would be particularly helpful to speak to an herbalist or pharmacist with a background in natural health to ensure that you are using the herbs in their appropriate dosages and forms.
    • SUPPLEMENTS – There are alternative solutions that can be just as effective as prescription and OTCs in controlling abdominal pain.

    • 5-HTP, also known as 5-hydroxytryptophan is basically converted in the body to serotonin.  You can find 5-HTP in most pharmacies in the natural health section in a supplement form.  What 5-HTP does is boost the level of serotonin in the system.  By increasing serotonin you may be able to reduce or even eliminate pain because when you are low in serotonin you have a lower threshold of pain.
    • Vitamin B6 is another serotonin booster and helps the body in the production of serotonin.
      o MSM (methylsulfonylmethane) is a supplement that helps to decrease inflammation.  It is readily found in most pharmacies often in combination with products like glucosamine or chondroitin in the treatment of osteoarthritis because it is such a powerful anti inflammatory.
    • Boswellia is actually an herb too but is widely available.  It blocks the production of inflammatory substances called leukotrienes so it is similar to NSAIDs but lacks the risk of causing GI upset!
    • Turmeric is one of my favourite things to recommend to patients with abdominal pain/discomfort because it is such a powerful anti inflammatory but it is particularly great for the intestinal region.  Turmeric is not that well absorbed so when a patient takes it, imagine this yellow powder settling all through the GI tract and exerting it’s anti inflammatory effects…pretty amazing because it relieves pain and blocks inflammatory processes right on the spot it is localized on.
    • Bromelain is a substance that digests proteins and because of this it is very popular as a digestive aid so it’s great for patients that tend to have gas/bloating after meals and have abdominal pain/discomfort for that reason.  On the other hand, if there is abdominal pain, bromelain supplements also have evidence for reducing swelling, inflammation and pain as well as to help improve blood flow to painful areas in the body.  This is the supplement that is found in high amounts in pineapples.
  • OTCs – Over the counter medications are those that are found at pharmacies and health foods stores that you do not need a prescription for.  Your pharmacist will help you choose from the list of things below that the abdominal pain you are experiencing could be caused by:
    • For heartburn we recommend antacids such as ranitidine.  All medications have a brand name and a generic name.  Ranitidine’s brand name is Zantac so you may be more familiar with that name and have seen commercials for Zantac and its powerful acid reducing properties after a really spicy meal!  These medications help to neutralize the stomach acid which is what is causing the pain in the first place.  Other OTC products recommended are Maalox (aluminium hydroxide, magnesium hydroxide) or Gaviscon (alginic acid, sodium bicarbonate) which help to provide a coating along the esophagus and stomach lining to help “cool” the area and again, neutralize the acidity of the stomach.
    • For constipation we recommend a mild stool softener such as Docusate sodium.  Another type of laxative is called a saline laxative and its effect is also to soften the stool.  An example is milk of magnesia.  Senokot or Ex-Lax are examples of stimulant laxatives and these cause the muscles of the intestine to propel their contents more rapidly and also to increase the amount of water in the stool.  Prunes fall into the category of stimulant laxative.  Finally, glycerin suppositories are the worst case scenario and rarely have to be used in an OTC situation.  It is believed that they exert their effect by irritating the rectum.
    • For diarrhea we recommend an anti motility agent like Imodium ONLY if there is no risk that the diarrhea is a result of something toxic like food poisoning because in that case you want the body to be able to flush out all of the toxins and not to hold onto anything.  Another OTC product recommended would be absorbents such as Kaopectate.  These bind water in the intestine and make the stool less watery.  Pepto Bismol although recommended for diarrhea and well tolerated isn’t that effective and therefore not a first or second choice for OTC products used in the selection of anti diarrhea medications.