Fortunately, this is not something we have to live with, medical experts say. "While some systems in the body slow down, an increase in GI problems is not necessarily a normal part of aging," says David L. Carr-Locke, chief of digestive diseases at Beth Israel Medical Center in New York. It's just that many diseases that do affect the gastrointestinal tract develop or become more common as we age, including diabetes, arthritis, high blood pressure, thyroid disease and neurological problems such as Parkinson's disease.
"The medications we need to treat them also take a toll," says gastroenterologist Brijen J. Shah, assistant professor of gastroenterology, geriatrics and palliative medicine at the Mount Sinai Hospital. Antidepressants, pain relievers, drugs for insomnia, high blood pressure, incontinence, asthma and allergies, and even calcium and iron supplements can trigger or aggravate digestive problems. We also tend to be less active as we age, and exercise is essential for keeping the gut — and the rest of us — healthy.
Thanks to new treatments and smart lifestyle choices, there's a lot you can do to keep everything moving. Here's what you need to know:
What it feels like: Heartburn, a burning, stinging sensation rising from your stomach and chest to your throat; a sour taste in your mouth or constant need to clear your throat; episodes of coughing. If these symptoms happen frequently, you may have gastro-esophageal reflux disease (GERD).
What causes it: The valve between the esophagus and the stomach doesn't work properly, allowing stomach acid to leak upward. Severe cases can damage the lining of the esophagus, putting you at risk for esophageal cancer.
The fix: Change what you eat and when you eat. Although "everyone is different" in what triggers reflux, says Carr-Locke, it's been well established that coffee, tea, chocolate, carbonated drinks, spicy foods, alcohol, dairy products and tomatoes provoke or worsen reflux, and it makes sense to avoid the worst offenders. Keep a food diary so you know what you ate before a flare-up, delete those foods from your diet for two weeks, then gradually add them back to see how your react. Meanwhile, if you smoke, stop. Eat smaller meals, and never eat within two hours of lying down. Prop the head of your bed up by 6 to 10 inches (use blocks or books under the mattress, or buy a wedge-shaped foam pillow).
For short-term relief, try antacids or histamine-2 blockers such as Zantac or Pepcid AC that block stomach acid. More severe cases may require proton pump inhibitors (PPIs) such as Nexium, Prilosec and Prevacid — some of which can be found over the counter, others only by prescription. "Current PPI therapy — which reduces stomach acid — is the best we've ever had," says Carr-Locke. "Many patients find they can tolerate foods they never could before." Note, however, that these medications can have serious side effects and that some experts think they are overused. If symptoms persist after two weeks, or if you vomit blood or have trouble or pain when swallowing, see your doctor.
What it feels like: If you have a mild case you may not feel anything at all. More serious cases? Fever, chills, gassiness, bloating, alternating bouts of constipation and diarrhea, intense abdominal pain in the lower left abdomen.
What causes it: The walls of the colon may weaken and buckle, forming pockets or bulges called diverticula. Trouble sets in if they become inflamed or infected or burst, releasing fecal bacteria into the abdomen.
The fix: No symptoms? No problem. If an infection sets in, antibiotics, a liquid diet and rest may knock it out; a high-fiber diet may help keep it at bay, although recent studies suggest otherwise. More severe cases, including abscesses, bleeding and perforations of the intestinal wall, can cause severe pain and may require surgery. In the past, doctors told patients to avoid corn, popcorn and nuts, but new studies report that eating those foods doesn't cause or aggravate the condition.
What it feels like: Gnawing pain or dull ache in your upper abdomen. It may develop gradually or come on suddenly. You feel like throwing up, or may have already. You deeply regret eating that pepperoni pizza late last night.
What causes it? Indigestion, called gastritis or dyspepsia by doctors, is an inflammation of the stomach lining. Acute gastritis can be triggered by medications, especially aspirin or other pain relievers, as well as alcohol and food. Chronic gastritis may be caused by Helicobacter pylori (H. pylori), a bacterium that causes ulcers; if not treated early, it can lead to peptic ulcer disease and cancer.
The fix: Depends on what's causing the inflammation. If you've been taking aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), switch to another pain reliever. If you have an ulcer, a combo of antibiotics and antacids can help. Too many late nights or too much stress? Antacids, histamine-2 blockers and PPIs can curb stomach acid. Cut back on alcohol and fatty foods. Eat smaller meals, and eat them slowly. Try taking a short walk after meals. If you're a smoker, stop. If the pain is still there after a few days, or if you develop shortness of breath and worsening pain that shoots down your arm, see a doctor immediately.
What it feels like: For no obvious reason, there's been a change in your normal bowel pattern: You're going less frequently; you're straining; stools are hard and dry.
What causes it: It could be your diet — too much fat, too little fiber and fluids. It could be medications or supplements. Or perhaps your body rhythms are out of whack because you've been traveling or been sick. Less likely: underlying health issues such as irritable bowel syndrome (IBS), diabetes, colon cancer.
The fix: Gradually increase fluids and high-fiber foods, such as whole-grain breads and cereals, nuts, seeds, fresh fruits and vegetables. Get moving, even if it's just to walk around the block. Stool softeners, fiber laxatives or those containing polyethylene glycol may help, but stay away from stimulant products, such as those containing senna, which can be habit-forming and damage the nerves in your colon. If problems persist for more than a few days, or if constipation comes on quickly and is very painful, see your doctor.
5. Irritable Bowel Syndrome (IBS)
What it feels like: The list of symptoms is long and varied: chronic constipation often alternating with diarrhea; gas; bloating; cramping and a feeling that you haven't gotten everything out. Your life is ruled by proximity to a bathroom.
What causes it: Intestinal muscles go haywire, either contracting too quickly or not enough. Stress is often blamed — and there's no doubt that it ratchets up the misery — but family history plays a part, too. Recent research links the neurotransmitter serotonin to IBS, but so far there are no tests or scans to officially diagnose the condition. "Since symptoms for many GI problems overlap, we first rule out other conditions that might be causing the pain, especially if someone is over 50," Shah says. "If none can be found, you might get an IBS diagnosis."
The fix: There's no one-size-fits-all solution; find a doctor who won't dismiss your symptoms and will experiment. Track foods that seem to bring on an attack: carbonated drinks; gassy foods such as coleslaw, broccoli, cauliflower or beans; bran or high-gluten cereal; as well as foods that contain fructose — a sugar found in fruits, root vegetables, caffeine, chocolate and chewing gum. If constipation is your main problem, gradually eat more high-fiber foods. Over-the-counter meds for constipation or diarrhea may help. To reduce stress, consider cognitive therapy, meditation and acupuncture, which studies have found can provide significant relief. One centuries-old aid is peppermint oil, but check with your doctor to find out how much you should take, since it can cause reflux in high doses.
6. Crohn's Disease and Ulcerative Colitis
What it feels like: Both are inflammatory bowl diseases (IBD). Crohn's disease targets the intestines and bowel but can also affect any part of the digestive tract. Some people have mild intermittent flare-ups; others experience excruciating cramping, vomiting, bloating, bloody diarrhea, loss of appetite and weight loss and fatigue. Ulcerative colitis has similar, though less severe, symptoms and affects only the colon and rectum.
What causes it: These are autoimmune disorders in which the immune system — designed to guard against bacteria, viruses and other foreign invaders — turns on itself. The result: chronic inflammation, scarring and blockage. Since it can be hard to absorb key nutrients, such as vitamin B-12, you may be at risk for pernicious anemia.
The fix: Crohn's and ulcerative colitis cannot be cured, but you can tame symptoms with a combination of lifestyle changes and medications, including antibiotics, anti-inflammatory and immunosuppressant drugs, plus over-the-counter meds for diarrhea and constipation. Stop smoking, ramp up fluids, exercise and experiment to see which foods you can tolerate. Some find that dairy products worsen symptoms; others can't eat high-fiber grains and vegetables. Eating small meals gives the body time to digest.
Margery D. Rosen is a New York City-based writer specializing in health and psychology.
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