June 16, 2020
Thanks to COVID-19, our stress–and comfort food consumption–may be off the charts. That’s why tummy troubles could be a regular but unwelcome guest in your home.
But be alert to other possible problems in your gut—and perhaps other organs, says Dr. Shinil Shah, a general surgeon affiliated with Memorial Hermann-Texas Medical Center and Memorial Hermann Sugar Land Hospital.
You might even need to seek medical attention if you or a family member feels sudden and severe pain, has a high fever or chills, seems confused and/or has a noticeably distended abdomen. Also, be concerned about persistent nausea, vomiting or diarrhea or the inability to pass gas or have a bowel movement.
“Don’t wait until pain becomes unbearable to seek care,” Dr. Shah says.
The following symptoms may signal that something serious, yet correctable, may be amiss.
Culprit: Heartburn or Acid Reflux
Signs: Burning or discomfort under the breast bone, a sour taste in the mouth or difficulty swallowing may signal heartburn. Known as acid reflux or gastro esophageal reflux disease (GERD), it can be due to weakness of the valve between the esophagus and stomach, which could be from a hiatal hernia. Suffering tends to be worse when people lie down and also is worsened by caffeine, alcohol, chocolate or spicy foods. Other signs linked to GERD include chronic hoarseness, coughs, sore throat, asthma-like symptoms, difficulty swallowing or a feeling of food getting stuck in your chest when you swallow.
Who: While reflux can occur at any age, it is linked to being overweight and certain diet and lifestyle choices.
Take Action: If pain persists, follow up with your primary care doctor or gastroenterologist. Weight loss, smoking cessation, avoiding anti-inflammatory medications, diet changes, avoiding eating late at night, sleeping with the head of the bed elevated and a short course of anti-acids may help. If not, you may be referred to a specialist for an upper endoscopy to look for other causes.
Culprit: Hernia
Signs: Hernias, or tears, cause sudden onset of agony or swelling in the abdomen, classically near the bellybutton, in the groin or near a previous surgical incision.
Who: Anyone can have a hernia. Groin (inguinal) hernias tend to occur more often in men, but they can be seen at all ages and genders.
Take Action: See a general surgeon. Hernias that become enlarged or painful usually require surgery. Depending on your condition, your surgeon may perform either a laparoscopic hernia repair or an open hernia repair. If you suffer unrelenting agony, vomiting, nausea or inability to eat, drink, pass gas or have bowel movements, seek immediate medical attention.
Culprit: Kidney Stones
Signs: These cause intense bouts of pain in the flank, side or back that radiates to the groin. You also may be unable to urinate or may note visible blood in urine or stools.
Who: Adults tend to get kidney stones. Risk factors include gender (more common in men), family history, dehydration, diet, excess weight, certain prior operations, underlying kidney issues, genetic conditions and certain medications.
Take Action: Notify your primary care doctor or urologist. You may need to be evaluated at an urgent care facility or the emergency room if your pain won’t let up, worsens or causes fever. Some stones can pass through your urinary system on their own. Others may require surgery.
Culprit: Constipation or Diverticulitis
Signs: Chronic constipation causes hard stools and strained bowel movements. Over time, it can lead to diverticulosis, which can be thought of as pockets or balloons that tend to develop in the lower part of the large intestine. These can sometimes become inflamed (diverticulitis).
Who: Diverticulosis usually occurs after age 50 and in patients with a history of chronic constipation and straining. We are seeing it in younger and younger patients with low-fiber, highly refined diets as well as rising rates of obesity. Low- fiber diets, medications and sedentary lifestyles may all contribute to constipation.
Take Action: Your primary care doctor or pharmacist can suggest diet/lifestyle modifications. Weight loss, exercise, drinking more fluids and eating a diet higher in fiber and lower in fat also help. Over-the-counter laxatives can be used for mild symptoms.
Head to the emergency room (ER) if pain and vomiting become relentless, fevers exceed 100.4 degrees or you’re unable to drink water or have bowel movements. Fevers with left lower quadrant abdominal pain, especially in a patient with known constipation, may indicate diverticulitis. Extreme discomfort in the left quadrant that spreads to the entire belly is worrisome and requires immediate care.
Patients over 45–50 years of age who present with new-onset, unexplained constipation should talk to their primary care physician about getting a colonoscopy to screen for colorectal cancer.
Culprit: Food Poisoning
Signs: Vomiting and severe cramps, diarrhea and nausea that generally last up to 24–48 hours.
Who: This can happen to anyone, especially those who have experienced recent travel or new/unusual foods or who have friends or family members with similar symptoms. Undercooked food (meats) and raw foods also can provoke food poisoning.
Take Action: Wash hands frequently, wash produce thoroughly and keep raw meats separate from other food. If symptoms persist, contact your primary care physician.
Culprit: Pneumonia or Lung Infections
Signs: Similar to food poisoning, you may suffer nausea, vomiting and abdominal cramps. Often, with symptomatic gallstones, fatty meals may cause recurrent pain or cramping in the center or upper right of the abdomen, sometimes extending to the back or right shoulder. The discomfort tends to come and go.
Who: Children and adults with persistent flu-like symptoms may have pneumonia or a lung infection.
Take Action: Labs and a chest X-ray at an urgent care or ER may help diagnose pneumonia.
Culprit: Gallstones
Signs: Similar to food poisoning, you may suffer nausea, vomiting and abdominal cramps. Often, with symptomatic gallstones, fatty meals may cause recurrent pain or cramping in the center or upper right of the abdomen, sometimes extending to the back or right shoulder. The discomfort tends to come and go.
Who: One in five adults has gallstones, which classically occur in middle-age women who have been pregnant. Other risks include being overweight and having a high-fat diet. Your gallbladder is a small, pear-shaped organ that stores bile from the liver and ships it to your intestines.
Take Action: Alert your primary care physician or gastroenterologist, who may order blood tests and an abdominal ultrasound. You may need to seek prompt medical attention at an urgent care clinic or ER if symptoms last more than 24 hours, you have persistent nausea and vomiting and/or you’re unable to eat or drink. “That’s when we worry about dehydration,” Dr. Shah says. Other worrisome signals include high fevers, yellowing skin (jaundice), unrelenting itching, very dark urine, light clay-colored stools and unexpected weight loss.
Culprit: Appendicitis
Signs: Pain often is generalized at first, migrating and settling in the right lower abdomen. Often, it’s accompanied by nausea, vomiting and/or fever.
Who: Though most commonly teens and young or middle-aged adults have appendicitis, “it can happen to anyone,” Dr. Shah warns.
Take Action: Alert your primary care physician and head to urgent care or an ER.
Culprit: Bowel Blockage
Signs: Nausea, vomiting, cramps, a distended abdomen and pain that comes in waves, as well as the inability to pass gas or have a bowel movement, may signal an intestinal blockage.
Who: People of any age who’ve had abdominal/pelvic surgery may get fibrous adhesions that lead to partial or full blockages. There are a variety of other risk factors for bowel blockages, including Crohn’s disease, certain tumors and hernias.
Take Action: Alert your surgeon if you’ve had an operation recently. “Vomiting may not occur, depending on where the blockage is,” Dr. Shah says. “Severe pain in waves, nausea, inability to tolerate oral intake and an inability to pass gas are enough cause for concern to head to urgent care or the ER.”
Culprit: Ovarian Cysts or Ectopic Pregnancy / Pregnancy-Related Complications
Signs: Pregnant women or those of child-bearing age can have sharp and sudden-onset abdominal discomfort, which may be accompanied by vaginal bleeding.
Who: Women of childbearing age can have these conditions. Excess weight also boosts likelihood.
Take Action: Notify your obstetrician or gynecologist immediately if you experience symptoms and are pregnant or could be pregnant. Your doctor may recommend that you head to urgent care or the ER if pain is severe or unrelenting.
Culprit: Ulcers
Signs: Symptoms of ulcers may be variable; they may be vague or cause no symptoms. Or, ulcers can cause burning pain in the center of the abdomen, bloating, heartburn-like sensations or signs of bleeding (such as black stools). Stress and spicy foods may aggravate pain, as can an empty stomach. Thus, agony tends to be worse at night or between meals. In some cases, eating may actually help the pain.
Who: About 70% of stomach ulcers are due to bacterium Helicobacter pylori (H. pylori). Smokers, alcohol drinkers and those who take excessive aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen or naproxen sodium are at higher danger. Ulcers are rare in very young children.
Take Action: Speak to your primary care physician, who may refer you to a gastroenterologist to order laboratory tests for h. pylori (breath test). An endoscopy may be needed to help diagnose the problem. If an ulcer caused by H. pylori is found, treatment with antibiotics is usually necessary.
When you seek care, you don’t want to risk exposure to COVID-19. That’s why Memorial Hermann has adopted Safe Wait™ measures to protect patients and their families. All patients, employees and physicians are screened upon entering our facilities.
Doctors and staff wear surgical masks during appointments, and those treating patients also wear recommended personal protective equipment (PPE). Patients are screened by phone in advance of appointments for COVID-19 symptoms and given surgical masks to wear at their appointments.
Scheduled appointments are staggered and, when necessary, patients are asked to wait in their vehicles for their appointments. To minimize risk, visitors will not be allowed, with limited exceptions. Rooms and equipment are cleaned thoroughly between each patient. Offices are disinfected regularly as per U.S. Centers for Disease Control and Prevention guidelines.
The information in this article was accurate as of June 16, 2020.
