Digestive problems (heartburn, bloating and constipation)
Heartburn, reflux, bloating and constipation are common complaints. Most improve with changes to daily habits, but some symptoms need to be checked early. This page explains the differences and the warning signs.
Not everything is from the stomach, but everything should be taken seriously
Digestive problems are very common, and most are not dangerous. Even so, some symptoms need to be checked early. This page explains the common complaints and sets out the warning signs separately.
Heartburn and reflux
Reflux means stomach contents coming back up into the oesophagus (food pipe). It happens to everyone sometimes. If it becomes frequent and troublesome and sometimes causes complications, it is called GERD. According to NIDDK the symptoms are:
- Heartburn: a burning feeling and pain behind the breastbone
- Regurgitation of food or liquid into the throat or mouth
- sometimes nausea, a persistent cough, a hoarse voice, or pain on swallowing. Some people have no heartburn but have these other symptoms.
Excess weight, pregnancy, smoking (and second-hand smoke) and some medicines raise the risk. If it is not treated, the oesophagus may become inflamed or narrowed, or the lining may change (Barrett’s oesophagus).
What helps? Based on the NIDDK and NHS sources: losing excess weight, avoiding the triggers that cause trouble for you, and not eating in the hours before bed (NIDDK says at least three hours and NHS says three to four hours). The NHS also lists raising the head and shoulders in bed and stopping smoking. A pharmacist can suggest an over-the-counter medicine; if medicine and changes in habits do not work, see the doctor.
Indigestion and stomach ulcer
Indigestion usually comes after a meal: burning, a feeling of fullness and bloating, nausea, belching. According to the NHS, see the doctor if it is frequent, the pain is severe, you have lost weight without reason, swallowing is hard, vomiting continues, you have iron-deficiency anaemia, or there is blood in your vomit or stools.
A stomach ulcer comes with burning pain in the upper abdomen (often worse at night), indigestion and nausea. The NHS gives the causes as infection with the bacterium Helicobacter pylori, regular use of anti-inflammatory painkillers such as ibuprofen, smoking and older age. Diagnosis and treatment are for the doctor.
Bloating and constipation
Constipation has common causes according to the NHS: too little fibre, too little fluid, inactivity, putting off going to the toilet, a change in diet, stress and side effects of some medicines. It is more common over the age of 65. These help:
- Eat more fibre, but build up gradually
- Drink enough water and other fluids and cut down on alcohol
- Be more active, for example a daily walk
- Have a regular time for the toilet and do not rush. Putting your feet on a low stool raises the legs and eases the position.
If that does not work, a pharmacist can suggest a laxative; according to the NHS, most laxatives are only suitable for a short time. See the doctor if constipation does not improve or keeps coming back, you have frequent bloating, there is blood in your stools, you have lost weight without reason, you are always tired, your bowel habit has suddenly changed, or you have stomach pain. The NHS stresses: talk to the doctor before stopping any prescribed medicine.
Irritable bowel syndrome (IBS). According to the NHS it comes with abdominal cramps, bloating and diarrhoea or constipation. Diagnosis is for the doctor; because the symptoms overlap with other conditions, do not diagnose yourself.
Warning signs
Do not wait on these; have them checked early (or immediately):
- Difficulty or pain when swallowing
- Unexplained weight loss
- Repeated vomiting
- Blood in vomit (bright red or like coffee grounds)
- Black, tarry stools or stools with blood
- Anaemia or ongoing tiredness together with these symptoms
According to MedlinePlus, gastrointestinal bleeding is not a disease in itself but a sign of another condition such as an ulcer or haemorrhoids, and the cause has to be found.
When should you call?
Call 115 (the emergency number in Iran) at once if you vomit blood or something like coffee grounds, your stools are black or bloody, or along with these you feel confused, weak, dizzy, or pale and sweaty, you are breathing fast and shallowly, or you have severe stomach pain. Sudden chest pain and severe stomach pain are also emergencies. Do not drive yourself.
Make an appointment if the symptoms continue, come back, or do not improve with medicine and changes in habits.
Every patient’s treatment plan is different; ask the doctor about your own situation.
Frequently asked questions
Is heartburn always reflux?
No. Burning and pressure in the chest can come from the heart too. If the pain comes with shortness of breath, cold sweat, nausea, or pain spreading to the arm, neck and jaw, think of a heart attack and call 115 (the emergency number in Iran). Do not try to tell the difference yourself.
Which foods should I cut out?
The NIDDK source says triggers differ from person to person. Fatty and spicy food, chocolate, coffee, alcohol and acidic foods such as citrus fruit and tomatoes are among the common ones. Rather than cutting out everything, see which ones cause trouble for you and talk to the doctor or a dietitian.
Can I take stomach tablets for a long time?
The doctor or pharmacist has to answer that. The NHS source says a pharmacist can suggest an over-the-counter medicine for indigestion, but symptoms such as repeated indigestion should be seen by a doctor. Do not increase the duration or dose on your own without advice.
Do painkillers such as ibuprofen harm the stomach?
According to the NHS source, ibuprofen and aspirin can make indigestion worse, and regular use of anti-inflammatory painkillers is one cause of stomach ulcers. If you take these medicines for another condition, do not stop them yourself; talk to the doctor.
How should long-term constipation be treated?
Habits first: more fibre, enough fluids, activity and a regular time for the toilet. If that does not help, the doctor looks for the cause; some medicines also cause constipation and should not be stopped without talking to the doctor.