Definition & Facts

What is appendicitis?

Appendicitis is inflammation of your appendix.

How common is appendicitis?

In the United States, appendicitis is the most common cause of acute abdominal pain requiring surgery. Over 5% of the population develops appendicitis at some point.¹

Who is more likely to develop appendicitis?

Appendicitis most commonly occurs in the teens and twenties but may occur at any age.¹

What are the complications of appendicitis?

If appendicitis is not treated, it may lead to complications. The complications of a ruptured appendix are

• peritonitis, which can be a dangerous condition. Peritonitis happens if your appendix bursts and infection spreads in your abdomen. If you have peritonitis, you may be very ill and have
  • fever
  • nausea
  • severe tenderness in your abdomen
  • vomiting
• an abscess of the appendix called an appendiceal abscess.

References

Symptoms & Causes

What are the symptoms of appendicitis?

The most common symptom of appendicitis is pain in your abdomen.

If you have appendicitis, you’ll most often have pain in your abdomen that

• begins near your belly button and then moves lower and to your right
• gets worse in a matter of hours
• gets worse when you move around, take deep breaths, cough, or sneeze
• is severe and often described as different from any pain you’ve felt before
• occurs suddenly and may even wake you up if you’re sleeping
• occurs before other symptoms

Other symptoms of appendicitis may include

• loss of appetite
• nausea
• vomiting
• constipation or diarrhea
• an inability to pass gas
• a low-grade fever
• swelling in your abdomen
• the feeling that having a bowel movement will relieve discomfort

Symptoms can be different for each person and can seem like the following conditions that also cause pain in the abdomen:

• abdominal adhesions
• constipation
• inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis, long-lasting disorders that cause irritation and ulcers in the GI tract
• intestinal obstruction
• pelvic inflammatory disease

What causes appendicitis?

Appendicitis can have more than one cause, and in many cases the cause is not clear. Possible causes include:

• Blockage of the opening inside the appendix
• enlarged tissue in the wall of your appendix, caused by infection in the gastrointestinal (GI) tract or elsewhere in your body
• inflammatory bowel disease
• stool, parasites, or growths that can clog your appendiceal lumen
• trauma to your abdomen

When should I seek a doctor's help?

Appendicitis is a medical emergency that requires immediate care. See a health care professional or go to the emergency room right away if you think you or a child has appendicitis. A doctor can help treat the appendicitis and reduce symptoms and the chance of complications.

Diagnosis

How do doctors diagnose appendicitis?

Most often, health care professionals suspect the diagnosis of appendicitis based on your symptoms, your medical history, and a physical exam. A doctor can confirm the diagnosis with an ultrasound, x-ray, or MRI exam.

Medical history

A health care professional will ask specific questions about your symptoms and health history to help rule out other health problems. The health care professional will want to know

• when your abdominal pain began
• the exact location and severity of your pain
• when your other symptoms appeared
• your other medical conditions, previous illnesses, and surgical procedures
• whether you use medicines, alcohol, or illegal drugs

Physical exam

Health care professionals need specific details about the pain in your abdomen to diagnose appendicitis correctly. A health care professional will assess your pain by touching or applying pressure to specific areas of your abdomen.

The following responses to touch or pressure may indicate that you have appendicitis:

• Rovsing's sign
• Psoas sign
• Obturator sign
• Guarding
• Rebound tenderness
• Digital rectal exam
• Pelvic exam

Lab tests

Doctors use lab tests to help confirm the diagnosis of appendicitis or find other causes of abdominal pain.

Blood tests. A health care professional draws your blood for a blood test at a doctor’s office or a commercial facility. The health care professional sends the blood sample to a lab for testing. Blood tests can show a high white blood cell count, a sign of infection. Blood tests also may show dehydration or fluid and electrolyte imbalances.

Urinalysis. Urinalysis is testing of a urine sample. You will provide a urine sample in a special container in a doctor’s office, a commercial facility, or a hospital. Health care professionals can test the urine in the same location or send it to a lab for testing. Doctors use urinalysis to rule out a urinary tract infection or a kidney stone.

Pregnancy test. For women, health care professionals also may order blood or urine samples to check for pregnancy.

Imaging tests

Doctors use imaging tests to confirm the diagnosis of appendicitis or find other causes of pain in the abdomen.

Abdominal ultrasound. In an ultrasound, a health care professional uses a device, called a transducer, to bounce safe, painless sound waves off of your organs to create an image of their structure. He or she can move the transducer to different angles to examine different organs.

In an abdominal ultrasound, a health care professional applies a gel to your abdomen and moves a hand-held transducer over your skin. A health care professional performs this procedure in a doctor’s office, an outpatient center, or a hospital, and you don’t need anesthesia.

A radiologist reviews the images, which can show signs of

• a blockage in your appendiceal lumen
• a burst appendix
• inflammation
• other sources of abdominal pain

Health care professionals use an ultrasound as the first imaging test for possible appendicitis in infants, children, young adults, and pregnant women.

Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed pictures of your body’s internal organs and soft tissues without using x-rays.

A health care professional performs the procedure in an outpatient center or a hospital. A radiologist reviews the images. Patients don’t need anesthesia, although a health care professional may give light sedation, taken by mouth, to children and people with a fear of small spaces. A health care professional may inject a special dye, called contrast medium, into your body.

In most cases, you’ll lie on a table that slides into a tunnel-shaped device. The tunnel may be open ended or closed at one end.

An MRI can show signs of

• a blockage in your appendiceal lumen
• a burst appendix
• inflammation
• other sources of abdominal pain

When diagnosing appendicitis and other sources of abdominal pain, doctors can use an MRI as a safe, reliable alternative to a computerized tomography (CT) scan.²

CT scan. CT scans use x-rays and computer technology to create images.

A health care professional may give you a solution to drink and an injection of contrast medium. You’ll lie on a table that slides into a tunnel-shaped device that takes the x-rays. X-ray technicians perform CT scans in an outpatient center or a hospital. Radiologists review the images.

Patients don’t need anesthesia, although health care professionals may give children a sedative to help them fall asleep for the test.

A CT scan of the abdomen can show signs of inflammation, such as

• an enlarged or a burst appendix
• an appendiceal abscess
• a blockage in your appendiceal lumen

Women of childbearing age should have a pregnancy test before having a CT scan. The radiation from CT scans can be harmful to a developing fetus.

References

Treatment

How do doctors treat appendicitis?

Doctors typically treat appendicitis with surgery to remove the appendix. Surgeons perform the surgery in a hospital with general anesthesia. Your doctor will recommend surgery if you have continuous abdominal pain and fever, or signs of a burst appendix and infection. Prompt surgery decreases the chance that your appendix will burst.

Health care professionals call the surgery to remove the appendix an appendectomy. A surgeon performs the surgery using one of the following methods:

• Laparoscopic surgery. During laparoscopic surgery, surgeons use several smaller incisions and special surgical tools that they feed through the incisions to remove your appendix. Laparoscopic surgery leads to fewer complications, such as hospital-related infections, and has a shorter recovery time.
• Laparotomy. Surgeons use laparotomy to remove the appendix through a single incision in the lower right area of your abdomen.

After surgery, most patients completely recover from appendicitis and don’t need to make changes to their diet, exercise, or lifestyle. Surgeons recommend that you limit physical activity for the first 10 to 14 days after a laparotomy and for the first 3 to 5 days after laparoscopic surgery.

What if the surgeon finds a normal appendix?

In some cases, a surgeon finds a normal appendix during surgery. In this case, many surgeons will remove it to eliminate the future possibility of appendicitis. Sometimes surgeons find a different problem, which they may correct during surgery.

Can doctors treat appendicitis without surgery?

Some cases of mild appendicitis may be cured with antibiotics alone. All patients suspected of having appendicitis are treated with antibiotics before surgery, and some patients may improve completely before surgery is performed.

How do doctors treat complications of a burst appendix?

Treating the complications of a burst appendix will depend on the type of complication. In most cases of peritonitis, a surgeon will remove your appendix immediately with surgery. The surgeon will use laparotomy to clean the inside of your abdomen to prevent infection and then remove your appendix. Without prompt treatment, peritonitis can cause death.

A surgeon may drain the pus from an appendiceal abscess during surgery or, more commonly, before surgery. To drain an abscess, the surgeon places a tube in the abscess through the abdominal wall. You leave the drainage tube in place for about 2 weeks while you take antibiotics to treat infection. When the infection and inflammation are under control, about 6 to 8 weeks later, surgeons operate to remove what remains of the burst appendix.

Eating, Diet, & Nutrition

How can your diet help prevent or relieve appendicitis?

Researchers have not found that eating, diet, and nutrition cause or prevent appendicitis.?

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many digestive disorders.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.?

Definition & Facts

What is Barrett's Esophagus?

Barrett’s esophagus is a condition in which tissue that is similar to the lining of your intestine replaces the tissue lining your esophagus. Doctors call this process intestinal metaplasia.

Are people with Barrett’s esophagus more likely to develop cancer?

People with Barrett’s esophagus are more likely to develop a rare type of cancer called esophageal adenocarcinoma.

The risk of esophageal adenocarcinoma in people with Barrett’s esophagus is about 0.5 percent per year.¹ Typically, before this cancer develops, precancerous cells appear in the Barrett’s tissue. Doctors call this condition dysplasia and classify the dysplasia as low grade or high grade.

You may have Barrett’s esophagus for many years before cancer develops. Visit the National Cancer Institute to learn more about esophageal adenocarcinoma.

How common is Barrett’s esophagus?

Experts are not sure how common Barrett’s esophagus is. Researchers estimate that it affects 1.6 to 6.8 percent of people.²

Who is more likely to develop Barrett’s esophagus?

Men develop Barrett’s esophagus twice as often as women, and Caucasian men develop this condition more often than men of other races.¹ The average age at diagnosis is 55.³ Barrett’s esophagus is uncommon in children.³

References

Symptoms & Causes

What are the symptoms of Barrett’s esophagus?

While Barrett’s esophagus itself doesn’t cause symptoms, many people with Barrett’s esophagus have gastroesophageal reflux disease (GERD), which does cause symptoms.

What causes Barrett’s esophagus?

Experts don’t know the exact cause of Barrett’s esophagus. However, some factors can increase or decrease your chance of developing Barrett’s esophagus.

What factors increase a person’s chances of developing Barrett’s esophagus?

Having GERD increases your chances of developing Barrett’s esophagus. GERD is a more serious, chronic form of gastroesophageal reflux, a condition in which stomach contents flow back up into your esophagus. Refluxed stomach acid that touches the lining of your esophagus can cause heartburn and damage the cells in your esophagus.

Between 10 and 15 percent of people with GERD develop Barrett’s esophagus.⁴

Obesity—specifically high levels of belly fat—and smoking also increase your chances of developing Barrett’s esophagus. Some studies suggest that your genetics, or inherited genes, may play a role in whether or not you develop Barrett’s esophagus.

What factors decrease a person’s chances of developing Barrett’s esophagus?

Having a Helicobacter pylori (H. pylori) infection may decrease your chances of developing Barrett’s esophagus. Doctors are not sure how H. pylori protects against Barrett’s esophagus. While the bacteria damage your stomach and the tissue in your duodenum, some researchers believe the bacteria make your stomach contents less damaging to your esophagus if you have GERD.

Researchers have found that other factors may decrease the chance of developing Barrett’s esophagus, including

• frequent use of aspirin or other nonsteroidal anti-inflammatory drugs
• a diet high in fruits, vegetables, and certain vitamins

References

Diagnosis

How do doctors diagnose Barrett’s esophagus?

Doctors diagnose Barrett’s esophagus with an upper gastrointestinal (GI) endoscopy and a biopsy. Doctors may diagnose Barrett’s esophagus while performing tests to find the cause of a patient’s gastroesophageal reflux disease (GERD) symptoms.

Medical history

Your doctor will ask you to provide your medical history. Your doctor may recommend testing if you have multiple factors that increase your chances of developing Barrett’s esophagus.

Upper GI endoscopy and biopsy

In an upper GI endoscopy, a gastroenterologist, surgeon, or other trained health care provider uses an endoscope to see inside your upper GI tract, most often while you receive light sedation. The doctor carefully feeds the endoscope down your esophagus and into your stomach and duodenum. The procedure may show changes in the lining of your esophagus.

The doctor performs a biopsy with the endoscope by taking a small piece of tissue from the lining of your esophagus. You won’t feel the biopsy. A pathologist examines the tissue in a lab to determine whether Barrett’s esophagus cells are present. A pathologist who has expertise in diagnosing Barrett’s esophagus may need to confirm the results.

Barrett’s esophagus can be difficult to diagnose because this condition does not affect all the tissue in your esophagus. The doctor takes biopsy samples from at least eight different areas of the lining of your esophagus.

Who should be screened for Barrett’s esophagus?

Your doctor may recommend screening for Barrett’s esophagus if you are a man with chronic—lasting more than 5 years—and/or frequent—happening weekly or more—symptoms of GERD and two or more risk factors for Barrett’s esophagus. These risk factors include

• being age 50 and older
• being Caucasian
• having high levels of belly fat
• being a smoker or having smoked in the past
• having a family history of Barrett’s esophagus or esophageal adenocarcinoma

Treatment

How do doctors treat Barrett’s esophagus?

Your doctor will talk about the best treatment options for you based on your overall health, whether you have dysplasia, and its severity. Treatment options include medicines for GERD, endoscopic ablative therapies, endoscopic mucosal resection, and surgery.

Periodic surveillance endoscopy

Your doctor may use upper gastrointestinal endoscopy with a biopsy periodically to watch for signs of cancer development. Doctors call this approach surveillance.

Experts aren’t sure how often doctors should perform surveillance endoscopies. Talk with your doctor about what level of surveillance is best for you. Your doctor may recommend endoscopies more frequently if you have high-grade dysplasia rather than low-grade or no dysplasia. Read whether people with Barrett’s esophagus are more likely to develop cancer.

Medicines

If you have Barrett’s esophagus and gastroesophageal reflux disease (GERD), your doctor will treat you with acid-suppressing medicines called proton pump inhibitors (PPIs). These medicines can prevent further damage to your esophagus and, in some cases, heal existing damage.

PPIs include

• omeprazole (Prilosec, Zegerid)
• lansoprazole (Prevacid)
• pantoprazole (Protonix)
• rabeprazole (AcipHex)
• esomeprazole (Nexium)
• dexlansoprazole (Dexilant)

All of these medicines are available by prescription. Omeprazole and lansoprazole are also available in over-the-counter strength.

Your doctor may consider anti-reflux surgery if you have GERD symptoms and don’t respond to medicines. However, research has not shown that medicines or surgery for GERD and Barrett’s esophagus lower your chances of developing dysplasia or esophageal adenocarcinoma.

Endoscopic ablative therapies

Endoscopic ablative therapies use different techniques to destroy the dysplasia in your esophagus. After the therapies, your body should begin making normal esophageal cells.

A doctor, usually a gastroenterologist or surgeon, performs these procedures at certain hospitals and outpatient centers. You will receive local anesthesia and a sedative. The most common procedures are the following:

• Photodynamic therapy. Photodynamic therapy uses a light-activated chemical called porfimer (Photofrin), an endoscope, and a laser to kill precancerous cells in your esophagus. A doctor injects porfimer into a vein in your arm, and you return 24 to 72 hours later to complete the procedure.

• Radiofrequency ablation. Radiofrequency ablation uses radio waves to kill precancerous and cancerous cells in the Barrett’s tissue. An electrode mounted on a balloon or an endoscope creates heat to destroy the Barrett’s tissue and precancerous and cancerous cells.

Endoscopic mucosal resection

In endoscopic mucosal resection, your doctor lifts the Barrett’s tissue, injects a solution underneath or applies suction to the tissue, and then cuts the tissue off. The doctor then removes the tissue with an endoscope. Gastroenterologists perform this procedure at certain hospitals and outpatient centers. You will receive local anesthesia to numb your throat and a sedative to help you relax and stay comfortable.

Before performing an endoscopic mucosal resection for cancer, your doctor will do an endoscopic ultrasound.

Complications can include bleeding or tearing of your esophagus. Doctors sometimes combine endoscopic mucosal resection with photodynamic therapy.

Surgery

Surgery called esophagectomy is an alternative to endoscopic therapies. Many doctors prefer endoscopic therapies because these procedures have fewer complications.

Esophagectomy is the surgical removal of the affected sections of your esophagus. After removing sections of your esophagus, a surgeon rebuilds your esophagus from part of your stomach or large intestine. The surgery is performed at a hospital. You’ll receive general anesthesia, and you’ll stay in the hospital for 7 to 14 days after the surgery to recover.

Surgery may not be an option if you have other medical problems. Your doctor may consider the less-invasive endoscopic treatments or continued frequent surveillance instead.

Eating, Diet, & Nutrition

How can your diet help prevent Barrett’s esophagus?

Researchers have not found that diet and nutrition play an important role in causing or preventing Barrett’s esophagus.?

If you have gastroesophageal reflux (GER) or gastroesophageal reflux disease (GERD), you can prevent or relieve your symptoms by changing your diet. Dietary changes that can help reduce your symptoms include

• decreasing fatty foods
• eating small, frequent meals instead of three large meals

Avoid eating or drinking the fol?lowing items that may make GER or GERD worse:

• ?chocolate
• coffee
• peppermint
• greasy or spicy foods?
• tomatoes and tomato products
• alcoholic drinks

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many digestive disorders.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.?

Definition & Facts

What is fecal incontinence?

Fecal incontinence, also called accidental bowel leakage, is the accidental passing of bowel movements—including solid stools, liquid stools, or mucus—from your anus.

The most common type of fecal incontinence is called urge incontinence. When you have urge incontinence, you feel a strong urge to have a bowel movement but cannot stop it before reaching a toilet. If you have urge incontinence, your pelvic floor muscles may be too weak to hold back a bowel movement due to muscle injury or nerve damage.

Another type of fecal incontinence is called passive incontinence. When you have passive incontinence, leakage occurs without you knowing it. If you have passive incontinence, your body may not be able to sense when your rectum is full.

Fecal incontinence can be upsetting and embarrassing. Some people may feel ashamed and try to hide the problem. You may be afraid or embarrassed to talk about fecal incontinence with your doctor. However, talking openly and honestly with your doctor is important in diagnosing and treating your fecal incontinence.

Does fecal incontinence have other names?

Fecal incontinence is also called

• accidental bowel leakage
• bowel incontinence
• encopresis—a term used mostly for fecal incontinence in children

How common is fecal incontinence?

Medical experts consider fecal incontinence a common problem, affecting about 1 in 3 people who see a primary health care provider.¹

• Fecal incontinence is more common in older adults.²
• Among adults who are not in hospitals or nursing homes, between 7 and 15 out of 100 have fecal incontinence.¹
• Among adults who are in hospitals, between 18 and 33 out of 100 have fecal incontinence.³
• Among adults who are in nursing homes, between 50 and 70 out of 100 have fecal incontinence.²

Fecal incontinence occurs in about 2 out of 100 children.⁴

Who is more likely to have fecal incontinence?

You may be more likely to have fecal incontinence if you

• are older than age 65
• are not physically active
• have certain chronic diseases, medical conditions, or health problems
• have had your gallbladder removed
• are a current smoker

Children who were born with certain birth defects of the spinal cord, anus, or rectum are more likely to have fecal incontinence. Children who are constipated are also more likely to have fecal incontinence.

What other health problems do people with fecal incontinence have?

If you have fecal incontinence, you may also have other health problems, including

• diarrhea
• poor overall health
• chronic diseases and disorders such as
  • irritable bowel syndrome
  • type 2 diabetes
  • diseases that affect the nerves of your anus, pelvic floor, or rectum
  • inflammatory bowel disease
• damage to or weakness of the muscles of your anus, pelvic floor, or rectum
• damage to the nerves in your anus, pelvic floor, or rectum
• urinary incontinence
• proctitis

What problems may fecal incontinence cause?

The problems that fecal incontinence may cause include

• discomfort or irritation of the skin around the anus
• emotional and social distress, such as fear, embarrassment, social isolation, loss of self-esteem, anger, or depression
• quality-of-life issues, such as not being able to exercise, work, attend school, or go to social gatherings

References

Symptoms & Causes

What are the symptoms of fecal incontinence?

The symptoms of fecal incontinence depend on the type.

• If you have urge fecal incontinence, you will know when you need to pass stool but not be able to control passing stool before reaching a toilet.
• If you have passive fecal incontinence, you will pass stool or mucus from your anus without knowing it.

Some medical experts include streaks or stains of stool or mucus on your underwear—called soiling—as a symptom of fecal incontinence.

When should I see a doctor for fecal incontinence?

You should see a doctor if your fecal incontinence is frequent or severe. Although some people are able to manage mild or infrequent fecal incontinence on their own, you should see a doctor if your fecal incontinence is affecting your quality of life or causing emotional or social distress.

What causes fecal incontinence in adults?

Fecal incontinence has many causes, including digestive tract disorders and chronic diseases. Some causes of fecal incontinence, such as childbirth by vaginal delivery, happen only in women.

Diarrhea

Loose, watery stools from diarrhea fill your rectum quickly and are harder to hold in than solid stools. Diarrhea is the most common risk factor for fecal incontinence for people not staying in hospitals, nursing homes, or other similar institutions. Diarrhea may be caused by digestive tract problems such as

• inflammatory bowel disease
• irritable bowel syndrome
• proctitis

Constipation

Constipation can lead to large, hard stools that are difficult to pass. The hard stools stretch and, over time, weaken the muscles in your rectum. The weakened muscles let watery stools that build up behind the hard stool leak out.

Muscle injury or weakness

If the muscles in your anus, pelvic floor, or rectum are injured or weakened, they may not be able to keep your anus closed, letting stool leak out. These muscles can be injured or weakened by

• surgery to
  • remove cancer in the anus or rectum
  • remove hemorrhoids
  • treat anal abscesses and fistulas
• trauma

Nerve damage

If the nerves that control your anus, pelvic floor, and rectum are damaged, the muscles can’t work the way they should. Damage to the nerves that tell you when there is stool in your rectum makes it hard to know when you need to look for a toilet. Nerves can be damaged by

• a long-term habit of straining to pass stool
• brain injury
• spinal cord injury

Neurologic diseases

Neurologic diseases that affect the nerves of the anus, pelvic floor, or rectum can cause fecal incontinence. These diseases include

• dementia
• multiple sclerosis
• Parkinson’s disease
• stroke
• type 2 diabetes

Loss of stretch in the rectum

If your rectum is scarred or inflamed, it becomes stiff and can’t stretch as much to hold stool. Your rectum can get full quickly, and stool can leak out. Rectal surgery, radiation therapy in the pelvic area, and inflammatory bowel disease can cause scarring and inflammation in your rectum.

Hemorrhoids

Hemorrhoids can keep the muscles around your anus from closing completely, which lets small amounts of stool or mucus to leak out.

Rectal prolapse

Rectal prolapse—a condition that causes your rectum to drop down through your anus—can also keep the muscles around your anus from closing completely, which lets small amounts of stool or mucus leak out.

Physical inactivity

If you are not physically active, especially if you spend many hours a day sitting or lying down, you may be holding a lot of stool in your rectum. Liquid stool can then leak around the more solid stool. Frail, older adults are most likely to develop constipation-related fecal incontinence for this reason.

Childbirth by vaginal delivery

Childbirth sometimes causes injuries to the anal sphincters, which can cause fecal incontinence. The chances are greater if

• your baby was large
• forceps were used to help deliver your baby
• you had a vacuum-assisted delivery
• the doctor made a cut, called an episiotomy, in your vaginal area to prevent the baby’s head from tearing your vagina during birth

Rectocele

Rectocele is a condition that causes your rectum to bulge out through your vagina. Rectocele can happen when the thin layer of muscles separating your rectum from your vagina becomes weak. Stool may stay in your rectum because the rectocele makes it harder to push stool out.

What causes fecal incontinence in children?

For children older than age 4, the most common cause of fecal incontinence is constipation with a large amount of stool in the rectum. When this happens, a child may not be able to sense when a new stool is coming into the rectum. The child may not know that he or she needs to have a bowel movement. A large amount of stool in the rectum can cause the internal anal sphincters to become chronically relaxed, which lets soft stool seep around hard stool in the rectum and leak out.

Birth defects of the anus, rectum, or colon, such as Hirschsprung disease, can cause fecal incontinence in children. These birth defects may weaken pelvic floor muscles or damage nerves in the anus or rectum. Injuries to the nerves in the anus and rectum can also cause fecal incontinence, as can spinal cord injuries and birth defects of the spinal cord.

Diagnosis

How do doctors diagnose fecal incontinence?

Doctors use your medical history, a physical exam, and medical tests to diagnose fecal incontinence and its causes.

Medical history

In addition to reviewing your general medical history, your doctor may ask the following questions:

• When did your fecal incontinence start?
• Did your fecal incontinence start after
  • the birth of your child?
  • a motor vehicle accident?
  • a fall?
  • the start of another illness?
• How often does your fecal incontinence happen?
• How much stool passes?
• Do you pass liquid or solid stool?
• Do you have a strong urge to have a bowel movement before your fecal incontinence happens?
• Do you know when you need to have a bowel movement before it happens?
• Does your fecal incontinence happen without you knowing?
• Do you leak liquid stool or mucus?
• Do you have fecal incontinence when you have diarrhea or constipation?
• Is your fecal incontinence worse after eating?
• Do certain foods seem to make your fecal incontinence worse?
• How does fecal incontinence affect your daily life?

Your doctor may ask you to keep a stool diary to help answer these questions. A stool diary is a chart for recording details of your daily bowel movements. Your doctor may give you a stool diary form that he or she has created. Or, you can create your own stool diary form or record your bowel movement details in a notebook.

You may feel embarrassed or shy about answering your doctor’s questions. However, your doctor will not be shocked or surprised. The more details and examples you can give about your problem, the better your doctor will be able to help you. You can play an active role in your diagnosis by talking openly and honestly with your doctor.

Physical exam

Your doctor will perform a physical exam, including a

• digital rectal exam
• pelvic exam—an exam to check if internal female reproductive organs are normal by feeling their shape and size

What medical tests do doctors use to diagnose fecal incontinence?

Lab tests

Your doctor may use one or more of the following lab tests to look for signs of certain diseases and conditions that may be causing your fecal incontinence.

• Blood tests can show signs of anemia, inflammation, and infection.
• Stool tests can show the presence of blood and signs of infection and inflammation.
• Urine tests can show signs of diseases such as type 2 diabetes.

Bowel function tests

Your doctor may perform one or more of the following tests to see how well the muscles and nerves in your anus, pelvic floor, and rectum are working:

• anorectal manometry—a test that checks how sensitive your rectum is, how well it works, and how well the anal sphincters work
• defecography—an x-ray of the area around the anus and rectum to see how well you can hold and release stool
• electromyography—a test that checks how well the muscles and nerves of your anus and pelvic floor are working

Endoscopy

Your doctor may perform an endoscopy to look inside your anus, rectum, and colon for signs of inflammation and digestive tract problems that may be causing your fecal incontinence. Endoscopies for fecal incontinence include

• anoscopy
• colonoscopy
• flexible sigmoidoscopy
• rectoscopy—a procedure similar to an anoscopy to look inside your rectum

Imaging tests

To look for problems in the anus, pelvic floor, or rectum that may be causing your fecal incontinence, your doctor may perform an imaging test such as

• lower GI series
• magnetic resonance imaging
• ultrasound

Treatment

The first step in treating your fecal incontinence is to see a doctor. Your doctor will talk to you about the causes of fecal incontinence and how they can be treated. Simple treatments—such as diet changes, medicines, bowel training, and exercises to strengthen your pelvic floor muscles—can improve symptoms by about 60 percent.⁵ These treatments can stop fecal incontinence in 1 out of 5 people.⁵

Your doctor can recommend ways you can help manage and treat your fecal incontinence. Your doctor can also recommend ways to relieve anal discomfort and cope with your fecal incontinence.

You can play an active role in your treatment by talking openly and honestly with your doctor about your symptoms and how well your treatments are working.

How can I manage and treat my fecal incontinence?

You can help manage and treat your fecal incontinence in the following ways.

Wearing absorbent pads

Wearing absorbent pads inside your underwear is the most frequently used treatment for fecal incontinence. For milder forms of fecal incontinence—few bowel leakage accidents, small volumes of stool, or staining of underwear—wearing absorbent pads may make a big difference in your quality of life. Wearing absorbent pads can be combined with other treatments.

Diet changes

Changing what you eat can help prevent or relieve your fecal incontinence. If diarrhea is the problem, your doctor will recommend avoiding foods and drinks that make your diarrhea worse. To find out which foods and drinks make your fecal incontinence better or worse, your doctor may recommend keeping a food diary to track

• what you eat each day
• how much of certain foods you eat
• when you eat
• what symptoms you have
• what types of bowel movements you have, such as diarrhea or constipation
• when your fecal incontinence happens
• which foods or drinks make your fecal incontinence better or worse

Take your food diary to your doctor to talk about the foods and drinks that affect your fecal incontinence.

If constipation or hemorrhoids are causing your fecal incontinence, your doctor may recommend eating more fiber and drinking more liquids. Talk with your doctor or a dietitian about how much fiber and liquids are right for you.

Over-the-counter medicines

Depending on the cause, over-the-counter medicines can help reduce or relieve your fecal incontinence. If diarrhea is causing your fecal incontinence, your doctor may recommend medicines such as loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol, Kaopectate). If constipation is causing your fecal incontinence, your doctor may recommend laxatives, stool softeners, or fiber supplements such as psyllium (Metamucil) or methylcellulose (Citrucel).

Bowel training

Your doctor may recommend that you train yourself to have bowel movements at certain times of the day, such as after meals. Developing regular bowel movements may take weeks to months to improve fecal incontinence.

Pelvic floor muscle exercises

Pelvic floor muscle exercises, also called Kegel exercises, can improve fecal incontinence symptoms. Tightening and relaxing your pelvic floor muscles many times a day can strengthen the muscles in your anus, pelvic floor, and rectum. Your doctor can help make sure you’re doing the exercises the right way.

How do doctors treat fecal incontinence?

How doctors treat fecal incontinence depends on the cause. Your doctor may recommend one or more of the following treatments:

Biofeedback therapy

Biofeedback therapy uses devices to help you learn how to do exercises to strengthen your pelvic floor muscles. This therapy can also help you learn how to

• sense when stool is filling your rectum if you have passive incontinence
• control strong sensations of urgency if you have urge incontinence

Biofeedback therapy can be more effective than learning pelvic floor exercises on your own. Ask your doctor about getting a biofeedback machine or device.

Sacral nerve stimulation

The sacral nerves control the anal sphincters, colon, and rectum. Doctors use sacral nerve stimulation—a type of electrical stimulation—when the nerves are not working properly. For this treatment, your doctor places thin wires under your skin near the sacral nerves, just above the tailbone. A battery-operated device sends mild electrical pulses through the wires to the sacral nerves.

Electrical stimulation of the sacral nerves helps them work properly. The electrical pulses do not hurt. You can turn the electrical stimulation on or off at any time.

Prescription medicines

If over-the-counter medicines to treat your fecal incontinence aren’t helping your symptoms, your doctor may prescribe prescription medicines that are stronger. These medicines may treat the causes of fecal incontinence, such as irritable bowel syndrome, Crohn’s disease, and ulcerative colitis.

Vaginal balloons

For women with fecal incontinence, your doctor may prescribe a device that inflates a balloon inside your vagina. The balloon puts pressure on the wall of your rectum through the vaginal wall. Pressure on the wall of your rectum keeps stool from passing. After your doctor makes sure the device fits right, you can add or remove air from the device as needed to control the passing of stool.

Nonabsorbable bulking agents

Nonabsorbable bulking agents are substances injected into the wall of your anus to bulk up the tissue around the anus. The bulkier tissues make the opening of your anus narrower so the sphincters are able to close better.

Surgery

Surgery may be an option for fecal incontinence that fails to improve with other treatments, or for fecal incontinence caused by injuries to the pelvic floor muscles or anal sphincters.

Sphincteroplasty. Sphincteroplasty—the most common fecal incontinence surgery—reconnects the separated ends of an anal sphincter torn by childbirth or another injury.

Artificial anal sphincter. This surgery involves placing a cuff around your anus and implanting a small pump under the skin so that you can inflate or deflate the cuff. Inflating the cuff controls the passage of stool. This surgery is not a common treatment because it may cause side effects.

Colostomy. Colostomy is a surgery in which the colon is brought through an opening in the abdominal wall, and stools are collected in a bag on the outside of the abdomen. Doctors may recommend this surgery as a last resort for the treatment of fecal incontinence. However, this surgery is rarely used to treat fecal incontinence because of the colostomy’s effect on quality of life.

Other surgeries. Doctors may perform other surgeries to treat the causes of fecal incontinence, such as

• hemorrhoids
• rectal prolapse
• rectocele

What should I do about anal discomfort?

Fecal incontinence can cause anal discomfort such as irritation, pain, or itching. You can help relieve anal discomfort by

• washing the anal area after a bowel movement
• changing soiled underwear as soon as possible
• keeping the anal area dry
• using a moisture-barrier cream in the area around your anus
• using nonmedicated powders
• using wicking pads or disposable underwear
• wearing clothes and underwear that let air pass through easily

Talk with your doctor or a health care professional about which moisture-barrier creams and nonmedicated powders are right for you.

How do I cope with my fecal incontinence?

Doing the following can help you cope with your fecal incontinence:

• using the toilet before leaving home
• carrying a bag with cleanup supplies and a change of clothes when leaving the house
• finding public restrooms before one is needed
• wearing absorbent pads inside your underwear
• wearing disposable underwear
• using fecal deodorants—over-the-counter pills that reduce the smell of stool and gas
• taking over-the-counter medicines to help prevent diarrhea before eating in restaurants or at social gatherings

As part of coping with your fecal incontinence, remember that fecal incontinence

• isn't something to be ashamed of—it's simply a medical problem
• can often be treated—a wide range of successful treatments are available
• isn't always a normal part of aging
• won't usually go away on its own—most people need treatment

What should I do if my child has fecal incontinence?

If your child has fecal incontinence and is older than age 4 and toilet trained, you should see a doctor to find out the cause. How the doctor treats your child’s incontinence depends on the cause.

References

Eating, Diet, & Nutrition

How can my diet help prevent or relieve fecal incontinence?

Depending on the cause, changing what you eat and drink can help prevent or relieve your fecal incontinence.

What should I eat if I have fecal incontinence?

You should eat a healthy, well-balanced diet. Your doctor or a dietitian can recommend a healthy eating plan that is right for you.

If your fecal incontinence is caused by constipation or hemorrhoids, eating more fiber and drinking more liquids can improve your symptoms. Talk with your doctor or a dietitian about how much fiber and liquids are right for you.

What should I avoid eating if I have fecal incontinence?

If your fecal incontinence is caused by diarrhea, you should avoid foods that make your symptoms worse, such as

• alcoholic beverages
• drinks and foods containing caffeine
• dairy products such as milk, cheese, and ice cream
• fatty and greasy foods
• drinks and foods containing fructose
• fruits such as apples, peaches, and pears
• spicy foods
• products, including candy and gum, with sweeteners ending in “–ol,” such as sorbitol, mannitol, xylitol, and maltitol

Keeping a food diary

Your doctor or dietitian may recommend keeping a food diary, which can help you find out which foods and drinks make your symptoms better or worse. After a few days, the diary may show a link between certain foods and drinks and your fecal incontinence. Changing the foods and drinks linked to your fecal incontinence may improve your symptoms.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

Definition & Facts

What is celiac disease?

Celiac disease is a digestive disorder that damages the small intestine. The disease is triggered by eating foods containing gluten. Gluten is a protein found naturally in wheat, barley, and rye, and is common in foods such as bread, pasta, cookies, and cakes. Many pre-packaged foods, lip balms and lipsticks, hair and skin products, toothpastes, vitamin and nutrient supplements, and, rarely, medicines, contain gluten.

Celiac disease can be very serious. The disease can cause long-lasting digestive problems and keep your body from getting all the nutrients it needs. Celiac disease can also affect the body outside the intestine.

Celiac disease is different from gluten sensitivity or wheat intolerance. If you have gluten sensitivity, you may have symptoms similar to those of celiac disease, such as abdominal pain and tiredness. Unlike celiac disease, gluten sensitivity does not damage the small intestine.

Celiac disease is also different from a wheat allergy. In both cases, your body’s immune system reacts to wheat. However, some symptoms in wheat allergies, such as having itchy eyes or a hard time breathing, are different from celiac disease. Wheat allergies also do not cause long-term damage to the small intestine.¹

How common is celiac disease?

As many as one in 141 Americans has celiac disease, although most don’t know it.²

Who is more likely to develop celiac disease?

Although celiac disease affects children and adults in all parts of the world, the disease is more common in Caucasians and more often diagnosed in females. You are more likely to develop celiac disease if someone in your family has the disease. Celiac disease also is more common among people with certain other diseases, such as Down syndrome, Turner syndrome, and type 1 diabetes.

What other health problems do people with celiac disease have?

If you have celiac disease, you also may be at risk for

• Addison’s disease
• Hashimoto’s disease
• primary biliary cirrhosis
• type 1 diabetes

What are the complications of celiac disease?

Long-term complications of celiac disease include

• malnutrition, a condition in which you don’t get enough vitamins, minerals, and other nutrients you need to be healthy
• accelerated osteoporosis or bone softening, known as osteomalacia
• nervous system problems
• problems related to reproduction

Rare complications can include

• intestinal cancer
• liver diseases
• lymphoma, a cancer of part of the immune system called the lymph system that includes the gut

In rare cases, you may continue to have trouble absorbing nutrients even though you have been following a strict gluten-free diet. If you have this condition, called refractory celiac disease, your intestines are severely damaged and can’t heal. You may need to receive nutrients through an IV.

References

Symptoms & Causes

What are the symptoms of celiac disease?

Most people with celiac disease have one or more symptoms. However, some people with the disease may not have symptoms or feel sick. Sometimes health issues such as surgery, a pregnancy, childbirth, bacterial gastroenteritis, a viral infection, or severe mental stress can trigger celiac disease symptoms.

If you have celiac disease, you may have digestive problems or other symptoms. Digestive symptoms are more common in children and can include

• bloating, or a feeling of fullness or swelling in the abdomen
• chronic diarrhea
• constipation
• gas
• nausea
• pale, foul-smelling, or fatty stools that float
• stomach pain
• vomiting

For children with celiac disease, being unable to absorb nutrients when they are so important to normal growth and development can lead to

• damage to the permanent teeth’s enamel
• delayed puberty
• failure to thrive in infants
• mood changes or feeling annoyed or impatient
• slowed growth and short height
• weight loss

Adults are less likely to have digestive symptoms and, instead, may have one or more of the following:

• anemia
• a red, smooth, shiny tongue
• bone or joint pain
• depression or anxiety
• dermatitis herpetiformis
• headaches
• infertility or repeated miscarriage
• missed menstrual periods
• mouth problems such a canker sores or dry mouth
• seizures
• tingling numbness in the hands and feet
• tiredness
• weak and brittle bones

Adults who have digestive symptoms with celiac disease may have

• abdominal pain and bloating
• intestinal blockages
• tiredness that lasts for long periods of time
• ulcers, or sores on the stomach or lining of the intestine

Celiac disease also can produce a reaction in which your immune system, or your body’s natural defense system, attacks healthy cells in your body. This reaction can spread outside your digestive tract to other areas of your body, including your

• bones
• joints
• nervous system
• skin
• spleen

Depending on how old you are when a doctor diagnoses your celiac disease, some symptoms, such as short height and tooth defects, will not improve.

Dermatitis herpetiformis

Dermatitis herpetiformis is an itchy, blistering skin rash that usually appears on the elbows, knees, buttocks, back, or scalp. The rash affects about 10 percent of people with celiac disease. The rash can affect people of all ages but is most likely to appear for the first time between the ages of 30 and 40. Men who have the rash also may have oral or, rarely, genital sores. Some people with celiac disease may have the rash and no other symptoms.

Why are celiac disease symptoms so varied?

Symptoms of celiac disease vary from person to person. Your symptoms may depend on

• how long you were breastfed as an infant; some studies have shown that the longer you were breastfed, the later celiac disease symptoms appear
• how much gluten you eat
• how old you were when you started eating gluten
• the amount of damage to your small intestine
• your age—symptoms can vary between young children and adults

People with celiac disease who have no symptoms can still develop complications from the disease over time if they do not get treatment.

What causes celiac disease?

Research suggests that celiac disease only happens to individuals who have particular genes. These genes are common and are carried by about one-third of the population. Individuals also have to be eating food that contains gluten to get celiac disease. Researchers do not know exactly what triggers celiac disease in people at risk who eat gluten over a long period of time. Sometimes the disease runs in families. About 10 to 20 percent of close relatives of people with celiac disease also are affected.³

Your chances of developing celiac disease increase when you have changes in your genes, or variants. Certain gene variants and other factors, such as things in your environment, can lead to celiac disease.

References

Diagnosis

How do doctors diagnose celiac disease?

Celiac disease can be hard to diagnose because some of the symptoms are like symptoms of other diseases, such as irritable bowel syndrome (IBS) and lactose intolerance. Your doctor may diagnose celiac disease with a medical and family history, physical exam, and tests. Tests may include blood tests, genetic tests, and biopsy.

Medical and family history

Your doctor will ask you for information about your family’s health—specifically, if anyone in your family has a history of celiac disease.

Physical exam

During a physical exam, a doctor most often

• checks your body for a rash or malnutrition, a condition that arises when you don’t get enough vitamins, minerals, and other nutrients you need to be healthy
• listens to sounds in your abdomen using a stethoscope
• taps on your abdomen to check for pain and fullness or swelling

Dental exam

For some people, a dental visit can be the first step toward discovering celiac disease. Dental enamel defects, such as white, yellow, or brown spots on the teeth, are a pretty common problem in people with celiac disease, especially children. These defects can help dentists and other health care professionals identify celiac disease.

What tests do doctors use to diagnose celiac disease?

Blood tests

A health care professional may take a blood sample from you and send the sample to a lab to test for antibodies common in celiac disease. If blood test results are negative and your doctor still suspects celiac disease, he or she may order more blood tests.

Genetic tests

If a biopsy and other blood tests do not clearly confirm celiac disease, your doctor may order genetic blood tests to check for certain gene changes, or variants.⁴ You are very unlikely to have celiac disease if these gene variants are not present. Having these variants alone is not enough to diagnose celiac disease because they also are common in people without the disease. In fact, most people with these genes will never get celiac disease.

Intestinal biopsy

If blood tests suggest you have celiac disease, your doctor will perform a biopsy to be sure. During a biopsy, the doctor takes a small piece of tissue from your small intestine during a procedure called an upper GI endoscopy.

Skin biopsy

If a doctor suspects you have dermatitis herpetiformis, he or she will perform a skin biopsy. For a skin biopsy, the doctor removes tiny pieces of skin tissue to examine with a microscope.

A doctor examines the skin tissue and checks the tissue for antibodies common in celiac disease. If the skin tissue has the antibodies, a doctor will perform blood tests to confirm celiac disease. If the skin biopsy and blood tests both suggest celiac disease, you may not need an intestinal biopsy.

Do doctors screen for celiac disease?

Screening is testing for diseases when you have no symptoms. Doctors in the United States do not routinely screen people for celiac disease. However, blood relatives of people with celiac disease and those with type 1 diabetes should talk with their doctor about their chances of getting the disease.

Many researchers recommend routine screening of all family members, such as parents and siblings, for celiac disease.⁵ However, routine genetic screening for celiac disease is not usually helpful when diagnosing the disease.

References

Treatment

How do doctors treat celiac disease?

A gluten-free diet

Doctors treat celiac disease with a gluten-free diet. Gluten is a protein found naturally in wheat, barley, and rye that triggers a reaction if you have celiac disease. Symptoms greatly improve for most people with celiac disease who stick to a gluten-free diet. In recent years, grocery stores and restaurants have added many more gluten-free foods and products, making it easier to stay gluten free.

Your doctor may refer you to a dietitian who specializes in treating people with celiac disease. The dietitian will teach you how to avoid gluten while following a healthy diet. He or she will help you

• check food and product labels for gluten
• design everyday meal plans
• make healthy choices about the types of foods to eat

For most people, following a gluten-free diet will heal damage in the small intestine and prevent more damage. You may see symptoms improve within days to weeks of starting the diet. The small intestine usually heals in 3 to 6 months in children. Complete healing can take several years in adults. Once the intestine heals, the villi, which were damaged by the disease, regrow and will absorb nutrients from food into the bloodstream normally.

Gluten-free diet and dermatitis herpetiformis

If you have dermatitis herpetiformis—an itchy, blistering skin rash—skin symptoms generally respond to a gluten-free diet. However, skin symptoms may return if you add gluten back into your diet. Medicines such as dapsone, taken by mouth, can control the skin symptoms. People who take dapsone need to have regular blood tests to check for side effects from the medicine.

Dapsone does not treat intestinal symptoms or damage, which is why you should stay on a gluten-free diet if you have the rash. Even when you follow a gluten-free diet, the rash may take months or even years to fully heal—and often comes back over the years.

Avoiding medicines and nonfood products that may contain gluten

In addition to prescribing a gluten-free diet, your doctor will want you to avoid all hidden sources of gluten.  If you have celiac disease, ask a pharmacist about ingredients in

• herbal and nutritional supplements
• prescription and over-the-counter medicines
• vitamin and mineral supplements

You also could take in or transfer from your hands to your mouth other products that contain gluten without knowing it. Products that may contain gluten include

• children’s modeling dough, such as Play-Doh
• cosmetics
• lipstick, lip gloss, and lip balm
• skin and hair products
• toothpaste and mouthwash
• communion wafers

Medications are rare sources of gluten. Even if gluten is present in a medicine, it is likely to be in such small quantities that it would not cause any symptoms.

Reading product labels can sometimes help you avoid gluten. Some product makers label their products as being gluten-free. If a product label doesn’t list the product’s ingredients, ask the maker of the product for an ingredients list.

What if changing to a gluten-free diet isn't working?

If you don’t improve after starting a gluten-free diet, you may still be eating or using small amounts of gluten. You probably will start responding to the gluten-free diet once you find and cut out all hidden sources of gluten. Hidden sources of gluten include additives made with wheat, such as

• modified food starch
• malt flavoring
• preservatives
• stabilizers

If you still have symptoms even after changing your diet, you may have other conditions or disorders that are more common with celiac disease, such as irritable bowel syndrome (IBS), lactose intolerance, microscopic colitis, dysfunction of the pancreas, and small intestinal bacterial overgrowth.

Eating, Diet, & Nutrition

What should I avoid eating if I have celiac disease?

Avoiding foods with gluten, a protein found naturally in wheat, rye, and barley, is critical in treating celiac disease. Removing gluten from your diet will improve symptoms, heal damage to your small intestine, and prevent further damage over time. While you may need to avoid certain foods, the good news is that many healthy, gluten-free foods and products are available.

You should avoid all products that contain gluten, such as most cereal, grains, and pasta, and many processed foods. Be sure to always read food ingredient lists carefully to make sure the food you want to eat doesn’t have gluten. In addition, discuss gluten-free food choices with a dietitian or health care professional who specializes in celiac disease.

What should I eat if I have celiac disease?

Foods such as meat, fish, fruits, vegetables, rice, and potatoes without additives or seasonings do not contain gluten and are part of a well-balanced diet. You can eat gluten-free types of bread, pasta, and other foods that are now easier to find in stores, restaurants, and at special food companies. You also can eat potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour instead of wheat flour.

In the past, doctors and dietitians advised against eating oats if you have celiac disease. Evidence suggests that most people with the disease can safely eat moderate amounts of oats, as long as they did not come in contact with wheat gluten during processing. You should talk with your health care team about whether to include oats in your diet.

When shopping and eating out, remember to

• read food labels—especially on canned, frozen, and processed foods—for ingredients that contain gluten
• identify foods labelled “gluten-free;” by law, these foods must contain less than 20 parts per million, well below the threshold to cause problems in the great majority of patients with celiac disease
• ask restaurant servers and chefs about how they prepare the food and what is in it
• find out whether a gluten-free menu is available
• ask a dinner or party host about gluten-free options before attending a social gathering

Foods labeled gluten-free tend to cost more than the same foods that have gluten. You may find that naturally gluten-free foods are less expensive. With practice, looking for gluten can become second nature.

If you have just been diagnosed with celiac disease, you and your family members may find support groups helpful as you adjust to a new approach to eating.

Is a gluten-free diet safe if I don't have celiac disease?

In recent years, more people without celiac disease have adopted a gluten-free diet, believing that avoiding gluten is healthier or could help them lose weight. No current data suggests that the general public should maintain a gluten-free diet for weight loss or better health. ^{6, 7}

A gluten-free diet isn’t always a healthy diet. For instance, a gluten-free diet may not provide enough of the nutrients, vitamins, and minerals the body needs, such as fiber, iron, and calcium. Some gluten-free products can be high in calories and sugar.

If you think you might have celiac disease, don’t start avoiding gluten without first speaking with your doctor. If your doctor diagnoses you with celiac disease, he or she will put you on a gluten-free diet.

Gluten-free food labeling requirements

The U.S. Food and Drug Administration (FDA) published a rule defining what “gluten-free” means on food labels. The "gluten-free" for food labeling rule requires that any food with the terms “gluten-free,” “no gluten,” "free of gluten,” and “without gluten” on the label must meet all of the definition’s requirements.

While the FDA rule does not apply to foods regulated by the U.S. Department of Agriculture, including meat and egg products, it is often still observed.

References

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many digestive disorders.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.?

Definition & Facts

What is chronic diarrhea in children?

Chronic diarrhea is passing loose, watery stools three or more times a day for at least 4 weeks. Children with chronic diarrhea may have loose, watery stools continually, or their diarrhea may come and go. Chronic diarrhea can affect children of any age.

Diarrhea that lasts only a short time is called acute diarrhea. Acute diarrhea, a common problem in children, usually lasts a few days and goes away on its own.

What are the complications of chronic diarrhea in children?

Malabsorption

Certain diseases and conditions that cause chronic diarrhea may cause malabsorption—a condition in which a child’s body can’t absorb nutrients from foods, resulting in shortages of protein, calories, and vitamins. See a list of malabsorption symptoms.

A child who does not absorb enough nutrients from the food he or she eats may become malnourished. Malnourishment during the years when nutrition is important to a child’s normal growth and development can result in health problems.

Dehydration

Chronic diarrhea may lead to dehydration. With diarrhea, especially acute diarrhea, a child’s body loses more fluid and electrolytes in loose stools than solid stools. See a list of dehydration symptoms.

Symptoms & Causes

What are the symptoms of chronic diarrhea in children?

The main symptom of chronic diarrhea in children is passing loose, watery stools three or more times a day for at least 4 weeks.

Depending on the cause, children with chronic diarrhea may also have one or more of the following symptoms:

• bloody stools
• chills
• fever
• loss of control of bowel movements
• nausea or vomiting
• pain or cramping in the abdomen

Chronic diarrhea may cause malabsorption and may lead to dehydration.

What are the symptoms of malabsorption and dehydration in children?

Malabsorption

Symptoms of malabsorption may include

• bloating
• changes in appetite
• gas
• loose, greasy, foul-smelling bowel movements
• weight loss or poor weight gain

Dehydration

Symptoms of dehydration may include

• thirst
• urinating less than usual, or no wet diapers for 3 hours or more
• lack of energy
• dry mouth
• no tears when crying
• decreased skin turgor, meaning that when your child’s skin is pinched and released, the skin does not flatten back to normal right away
• sunken eyes, cheeks, or soft spot in the skull

What causes chronic diarrhea in children?

Common diseases and disorders that cause chronic diarrhea in children include

• infections of the digestive tract
• celiac disease
• functional gastrointestinal (GI) disorders
• food allergies and intolerances
• inflammatory bowel disease
• small intestinal bacterial overgrowth

Infections of the digestive tract

Infections from harmful viruses, bacteria, or parasites sometimes lead to chronic diarrhea. Children may become infected through contaminated water, beverages, or food; or through person-to-person contact. After an infection, some children have problems digesting carbohydrates such as lactose or proteins in foods such as milk, milk products, or soy. These problems can cause prolonged diarrhea—often for up to 6 weeks—after an infection. Also, some bacterial and parasitic infections that cause diarrhea do not go away quickly without treatment.

Read more about infections that cause diarrhea, such as foodborne illnesses and viral gastroenteritis.

Celiac disease

Celiac disease is a digestive disorder that damages the small intestine. The disease is triggered by eating foods containing gluten. Gluten is a protein found naturally in wheat, barley, and rye. Gluten is common in foods such as bread, pasta, cookies, and cakes. Celiac disease can cause chronic diarrhea in children of any age.

Functional GI disorders

In functional GI disorders, symptoms are caused by changes in how the digestive tract works. Children with a functional GI disorder have frequent symptoms, yet the digestive tract does not become damaged. Functional GI disorders are not diseases; they are groups of symptoms that occur together.

Two functional GI disorders that cause chronic diarrhea in children are toddler’s diarrhea and irritable bowel syndrome (IBS).

Toddler’s diarrhea
Toddler’s diarrhea—also called functional diarrhea, or chronic nonspecific diarrhea of childhood—is a common cause of chronic diarrhea in toddlers (ages 1 to 3), and preschool-age children (ages 3 to 5). Children with toddler’s diarrhea pass four or more watery or loose stools a day and do not have any other symptoms. They typically are growing well, gaining weight, and are healthy.

Toddler’s diarrhea develops between the ages of 6 months and 3 years, and it usually goes away on its own by the time children begin grade school. Researchers think that drinking too many sugar-sweetened beverages, especially those high in high-fructose corn syrup and sorbitol, may cause toddler’s diarrhea.

IBS
The most common symptoms of IBS are abdominal pain, discomfort, or cramping; along with diarrhea, constipation, or both. The pain or discomfort of IBS typically gets better with the passage of stool or gas. IBS does not cause symptoms such as weight loss, vomiting, or blood in the stool.

IBS is a common cause of chronic diarrhea in grade school-age children and adolescents. Doctors rarely diagnose IBS in younger children because younger children are not able to report symptoms of IBS such as abdominal pain or discomfort.

Food allergies and intolerances

Food allergies, lactose intolerance, fructose intolerance, and sucrose intolerance are common causes of chronic diarrhea.

Food allergies
Milk, milk products, and soy allergies are the most common food allergies that affect the digestive tract in children. Food allergies usually appear in the first year of life. Many children outgrow allergies to milk, milk-products, and soy by age 3. Allergies to other foods such as cereal grains, eggs, and seafood may also affect the digestive tract in children.

Lactose intolerance
Lactose intolerance is a common condition that may cause diarrhea after eating foods or drinking beverages that contain milk or milk products. Low levels of lactase—the enzyme that helps digest lactose—or lactase deficiency, and malabsorption of lactose cause lactose intolerance.

The most common type of lactase deficiency in children develops over time, beginning after about age 2, when a child’s body begins to produce less lactase. Children who have lactase deficiency may not experience symptoms of lactose intolerance until they become older teenagers or adults.

Infants—newborns to age 1—rarely have lactose intolerance at birth. However, premature infants may experience lactose intolerance for a short time after birth. People sometimes mistake milk allergy, which can cause diarrhea in infants, for lactose intolerance.

Fructose intolerance
Fructose intolerance is a condition that may cause diarrhea after eating foods or drinking beverages that contain fructose, a sugar found in fruits, fruit juices, and honey. Fructose is added to many foods and soft drinks as a sweetener called high-fructose corn syrup. Fructose malabsorption causes fructose intolerance. The amount of fructose that a child’s body can absorb varies. A child’s ability to absorb fructose increases with age. Some children may be able to tolerate more fructose as they get older.

Sucrose intolerance
Sucrose intolerance is a condition that may cause diarrhea after eating foods or drinking beverages that contain sucrose, also known as table sugar or white sugar. Sucrose malabsorption causes sucrose intolerance. Children who are sucrose intolerant lack the enzyme that helps digest sucrose. Most children with sucrose intolerance are better able to tolerate sucrose as they get older.

Inflammatory bowel disease (IBD)

The two main types of IBD are Crohn’s disease and ulcerative colitis. These disorders can affect children at any age. However, they commonly begin in the grade school years or in adolescence.

Small intestinal bacterial overgrowth (SIBO)

SIBO is an increase in the number of bacteria or a change in the type of bacteria in your small intestine. SIBO is often related to diseases that damage the digestive system such as Crohn’s disease.

Diagnosis

How do doctors find the cause of chronic diarrhea in children?

To find the cause of a child’s chronic diarrhea, doctors may use information from the child’s medical and family history, a physical exam, or tests.

Medical and family history

Your child’s doctor will ask you for information about your child’s symptoms, such as

• how long your child has had diarrhea
• how much stool your child passes
• how often your child has diarrhea
• how your child’s stool looks, such as color and consistency
• whether your child has other symptoms along with diarrhea

The doctor will ask about the foods your child eats and beverages he or she drinks. The doctor may recommend keeping a diary of what your child eats and drinks and his or her bowel habits.

Your child’s doctor may also ask about family medical history. Some of the conditions that cause chronic diarrhea, such as Crohn’s disease and ulcerative colitis, run in families.

Physical exam

During a physical exam, a doctor typically

• checks blood pressure and pulse
• checks for symptoms of dehydration and malabsorption
• listens to sounds in your child’s abdomen using a stethoscope
• taps on your child’s abdomen to check for pain or tenderness

What tests do doctors use to find the cause of chronic diarrhea in children?

Doctors may use the following tests to help find the cause of a child’s chronic diarrhea:

Stool test

Stool tests can show the presence of blood and signs of infection, food allergies, and digestive tract problems, such as malabsorption of certain sugars, proteins, or nutrients. A health care professional will give you a container for catching and storing a sample of your child’s stool, along with instructions on where to send or take the sample for testing. A doctor may also do a digital rectal exam to check for blood in your child’s stool.

Blood tests

A health care professional may take a sample of your child’s blood to test for signs of certain diseases or disorders that can cause chronic diarrhea, such as infections or celiac disease.

Hydrogen breath tests

This test measures the amount of hydrogen in a child’s breath. Normally, little hydrogen is found in your child’s breath. However, bacteria break down sugars—such as lactose, fructose, and sucrose—that are not digested by the small intestine and produce high levels of hydrogen. By measuring the amount of hydrogen in your child’s breath, a doctor can diagnose

• lactose intolerance
• fructose intolerance
• sucrose intolerance
• small intestinal bacterial overgrowth (SIBO)

For a lactose intolerance test, your child will drink a beverage that contains a known amount of lactose. For a fructose intolerance test, your child will drink a beverage that contains a known amount of fructose For a sucrose intolerance test, your child will drink a beverage that contains a known amount of sucrose. For a SIBO test, your child will drink a beverage that contains a known amount of sugar. Your child will then breathe into a balloon-type container that measures hydrogen. If the hydrogen level is high, your doctor will diagnose one of these disorders.

Fasting tests

To find out if a food allergy or intolerance is causing your child’s chronic diarrhea, the doctor may recommend that your child avoid foods with lactose, carbohydrates, wheat, or other ingredients to see if a change in diet reduces or stops the diarrhea.

Endoscopy

Your doctor may use endoscopy to look inside your child’s body to help find the cause of his or her chronic diarrhea. Endoscopic procedures include

• colonoscopy
• flexible sigmoidoscopy
• upper gastrointestinal (GI) endoscopy

Treatment

How do doctors treat chronic diarrhea in children?

How doctors treat chronic diarrhea in children depends on the cause. Doctors may be able to reduce or stop chronic diarrhea by treating the cause.

Infections of the digestive tract

Your child’s doctor may prescribe antibiotics to treat bacterial infections and medicines that target parasites to treat parasitic infections. If your child has long-lasting problems digesting certain carbohydrates or proteins after an infection, a doctor may recommend changes in the foods your child eats.

Your child’s doctor may prescribe antibiotics to treat your child’s small intestinal bacterial overgrowth (SIBO) and may recommend changes in what your child eats.

Functional GI disorders

Toddler’s diarrhea
For toddler’s diarrhea, treatment is usually not needed. Most children outgrow toddler’s diarrhea by the time they start school (around age 5). In many children, reducing sugar-sweetened beverages and increasing the amount of fiber and fat in the diet may improve symptoms of toddler’s diarrhea.

Irritable bowel syndrome
A doctor may treat your child’s irritable bowel syndrome with changes in what your child eats and medicines.

Food allergies and intolerances

Food allergies
If your child has a food allergy, his or her doctor will recommend avoiding foods that trigger the allergy. Keeping a diary of what your child eats and drinks and his or her bowel habits will help your child’s doctor find out what foods trigger the allergy.

Celiac disease
If your child has celiac disease, his or her doctor will recommend avoiding all foods and products that contain gluten.

Lactose intolerance
If your child is lactose intolerant, his or her doctor will recommend reducing or avoiding foods and beverages that contain milk or milk products. Most children with lactose intolerance can tolerate some amount of lactose in what they eat or drink. The amount of change needed in what a child eats or drinks depends on how much lactose a child can consume without symptoms. Your child’s doctor may recommend dietary supplements that contain lactase, the enzyme that helps digest lactose. Your child’s doctor may also recommend calcium supplements.

Fructose intolerance
If your child is fructose intolerant, his or her doctor will recommend reducing or avoiding foods and beverages that contain fructose.

Sucrose intolerance
If your child is sucrose intolerant, his or her doctor will recommend reducing or avoiding foods and beverages that contain sucrose.

Inflammatory bowel disease

A doctor may use medicines, surgery, and changes in what your child eats to treat inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis.

Eating, Diet, & Nutrition

How can what a child eats help prevent or treat chronic diarrhea?

Eating, diet, and nutrition play a major role in treating chronic diarrhea in children. Depending on the cause, changing what your child eats can reduce or stop chronic diarrhea. Changing what your child eats may also help manage symptoms of some of the causes of chronic diarrhea. Talk with your child’s doctor before changing what he or she eats. Your child’s doctor or a dietitian can recommend a healthy eating plan that is right for your child.

What should a child with chronic diarrhea eat?

A child with chronic diarrhea should eat foods that may improve symptoms and ensure good nutrition for normal growth and development.

Children whose chronic diarrhea was caused by an infection of the digestive tract should eat the foods they normally eat. If your child has long-lasting problems digesting certain carbohydrates or proteins after an infection, talk with your child’s doctor about what foods your child should eat.

Increasing the amount of fat and fiber your child eats may improve symptoms of toddler’s diarrhea.

What should a child with chronic diarrhea avoid eating?

What foods your child should avoid eating depends on the cause of chronic diarrhea. In general, your child should avoid foods that make symptoms worse.

To find out if certain foods trigger your child’s symptoms, keep a diary and track

• what your child eats each day
• what symptoms your child has
• when the symptoms occur
• what foods make the symptoms worse

Take your notes to your child’s doctor and talk about which foods seem to make your child’s symptoms worse. Your child may need to avoid these foods or eat less of them.

More information on what your child should eat or avoid eating if he or she has chronic diarrhea caused by certain digestive tract problems is available in these NIDDK health topics:

• Celiac Disease
• Crohn’s Disease
• Irritable Bowel Syndrome (IBS) in Children
• Lactose Intolerance
• Ulcerative Colitis

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many diseases and conditions.

What are clinical trials and what role do children play in research?

Clinical trials are research studies involving people of all ages. Clinical trials look at safe and effective new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving quality of life. Research involving children helps scientists

• identify care that is best for a child
• find the best dose of medicines
• find treatments for conditions that only affect children
• treat conditions that behave differently in children
• understand how treatment affects a growing child’s body

Find out more about clinical trials and children.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.??

Definition & Facts

What are colon polyps?

Colon polyps are growths on the lining of your colon and rectum. You can have more than one colon polyp.

Are colon polyps cancerous?

Colon and rectal cancer—also called colorectal cancer—most often begins as polyps. Most polyps are not cancerous, but some may turn into cancer over time. Removing polyps can help prevent colorectal cancer. Colorectal cancer is the second leading cause of cancer death in the United States.¹

How common are colon polyps?

Colon polyps are common in American adults. Anywhere between 15 and 40 percent of adults may have colon polyps. Colon polyps are more common in men and older adults.²

Who is more likely to develop colon polyps?

Although anyone can develop colon polyps, you may have a greater chance of developing them if you

• are over age 50
• have someone in your family who has had polyps or colorectal cancer
• have inflammatory bowel disease such as ulcerative colitis or Crohn’s disease
• have obesity³
• smoke cigarettes³

When should I start colon polyp screening?

Screening is testing for diseases when you have no symptoms. Finding and removing polyps can help prevent colorectal cancer. Your doctor will recommend screening for colorectal cancer starting at age 50 if you don’t have health problems or other factors that make you more likely to develop colorectal cancer.⁴

If you are at higher risk for colorectal cancer, your doctor may recommend screening at a younger age. You also may need to be tested more often.

If you are older than age 75, talk with your doctor about whether you should be screened. For more information, read the current colorectal cancer screening guidelines from the U.S. Preventive Services Task Force.

References

Symptoms & Causes

What are the symptoms of colon polyps?

Most people with colon polyps don’t have symptoms. You can’t tell that you have polyps because you feel well. When colon polyps do cause symptoms, you may

• have bleeding from your rectum. You might notice blood on your underwear or on toilet paper after you’ve had a bowel movement.
• have blood in your stool. Blood can make stool look black or can show up as red streaks in your stool.
• feel tired because you have anemia and not enough iron in your body. Bleeding from colon polyps can lead to anemia and a lack of iron.

Many other health problems can also cause these symptoms. However, if you have bleeding from your rectum or blood in your stool, contact your doctor right away.

What causes colon polyps?

Experts aren’t sure what causes colon polyps. However, research suggests that certain factors, such as age and family history, can raise your chances of developing colon polyps. Learn who is more likely to develop colon polyps.

Diagnosis

How do doctors diagnose colon polyps?

Doctors can find colon polyps only by using certain tests or procedures, such as a colonoscopy or imaging study. Your doctor may first take a medical and family history and perform a physical exam to help decide which test or procedure is best for you.

For example, your doctor may ask if you have any symptoms. He or she may also ask if you have a family history of colon polyps or colorectal cancer. After taking a medical and family history, your doctor may perform a physical exam.

Tests and procedures

• Flexible sigmoidoscopy. For a flexible sigmoidoscopy, a trained medical professional uses a sigmoidoscope—a flexible, narrow tube with a light and tiny camera on one end—to look inside your rectum and lower colon. Flexible sigmoidoscopy can show irritated or swollen tissue, ulcers, polyps, and cancer.
• Colonoscopy. During a colonoscopy, a trained medical professional uses a long, flexible, narrow tube with a light and tiny camera on one end, called a colonoscope, to look inside your rectum and colon. Colonoscopy can show irritated and swollen tissue, ulcers, polyps, and cancer.
• Virtual colonoscopy. Virtual colonoscopy uses x-rays and a computer to create images of your rectum and colon from outside the body. Virtual colonoscopy can show ulcers, polyps, and cancer. Doctors can’t remove polyps during virtual colonoscopy.
• Lower gastrointestinal series. For a lower gastrointestinal (GI) series, a doctor uses x-rays and a chalky liquid called barium to view your large intestine. The barium will make your large intestine easier to see on an x-ray. A lower GI series is also called a barium enema.

Treatment

How do doctors treat colon polyps?

Doctors treat colon polyps by removing them.

In most cases, doctors use special tools during a colonoscopy or flexible sigmoidoscopy to remove colon polyps. After doctors remove the polyp, they send it for testing to check for cancer. A pathologist will review the test results and send a report to your doctor. Doctors can remove almost all polyps without surgery.

If you have colon polyps, your doctor will ask you to get tested regularly in the future because you have a higher chance of developing more polyps.

Seek Care Right Away

Call your doctor right away if you have any of the following symptoms after he or she removes a colon polyp:

• severe pain in your abdomen
• fever
• bloody bowel movements that do not get better
• bleeding from your anus that does not stop
• dizziness
• weakness

How can I prevent colon polyps?

Researchers don’t know a sure way to prevent colon polyps. However, you can take steps to lower your chances of developing colon polyps.

Eating, diet, and nutrition

Eating, diet, and nutrition changes—such as eating less red meat and more fruits and vegetables—may lower your chances of developing colon polyps.

Healthy lifestyle choices

You can make the following healthy lifestyle choices to help lower your chances of developing colon polyps:

• get regular physical activity (PDF, 1.07 MB)
• don’t smoke cigarettes, and if you do smoke, quit
• avoid drinking alcohol
• lose weight if you’re overweight

Aspirin

Taking a low dose of aspirin every day for a long period of time may help prevent polyps from developing into colorectal cancer in some people.⁵ However, taking aspirin daily may cause side effects such as bleeding in your stomach or intestines. Talk with your doctor before you start taking aspirin daily.

References

Eating, Diet, & Nutrition

What type of eating plan is best to prevent colon polyps?

Research suggests that making the following changes may have health benefits and may lower your chances of developing colon polyps:

• eating more fruits, vegetables, and other foods with fiber, such as beans and bran cereal.
• losing weight if you’re overweight and not gaining weight if you’re already at a healthy weight

Foods to limit

Research suggests that eating less of the following foods may have health benefits and may lower your chances of developing polyps:

• fatty foods, such as fried foods
• red meat, such as beef and pork
• processed meat, such as bacon, sausage, hot dogs, and lunch meats

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many digestive disorders.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

Definition & Facts

What is Constipation?

Constipation is a condition in which you typically have:

• fewer than three bowel movements a week
• bowel movements with stools that are hard, dry, and small, making them painful or difficult to pass

Some people think they are constipated if they don’t have a bowel movement every day. However, people can have different bowel movement patterns. Some people may have three bowel movements a day. Other people may only have three bowel movements a week.

Constipation most often lasts for only a short time and is not dangerous. You can take steps to prevent or relieve constipation.

How common is constipation?

Constipation is one of the most common gastrointestinal (GI) problems, affecting about 42 million people in the United States.¹

Who is more likely to become constipated?

Constipation is common among all ages and populations in the United States, yet certain people are more likely to become constipated, including

• women, especially during pregnancy or after giving birth
• older adults
• non-Caucasians
• people with lower incomes
• people who just had surgery
• people taking medicines to treat depression or to relieve pain from things such as a broken bone, a pulled tooth, or back pain

What are the complications of constipation?

Chronic, or long-lasting, constipation can lead to health problems such as hemorrhoids, anal fissures, rectal prolapse, or fecal impaction.

Hemorrhoids

Hemorrhoids are swollen and inflamed veins around your anus or in your lower rectum. You can develop hemorrhoids if you strain to have a bowel movement. If you have hemorrhoids, you may have bleeding in your rectum. You have bleeding in the rectum when you see bright red blood in your stool, on toilet paper, or in the toilet after a bowel movement.

Anal fissures

Anal fissures are small tears in your anus that may cause itching, pain, or bleeding.

Rectal prolapse

Rectal prolapse happens when your rectum slips so that it sticks out of your anus. Rectal prolapse can happen if you strain during bowel movements, among other reasons. Rectal prolapse may cause mucus to leak from your anus. Rectal prolapse is most common in older adults with a history of constipation, and is also more common in women than men, especially postmenopausal women.²

Fecal impaction

Fecal impaction happens when hard stool packs your intestine and rectum so tightly that the normal pushing action of your colon is not enough to push the stool out. Fecal impaction occurs most often in children and older adults.

References

Symptoms & Causes

What are the symptoms of constipation?

The most common symptoms of constipation are

• fewer-than-normal bowel movements
• stool that is difficult or painful to pass
• pain or bloating in your abdomen

What causes constipation?

Constipation can happen for many reasons, and constipation may have more than one cause at a time. Among the most common causes of constipation are

• slow movement of stool through the colon
• delayed emptying of the colon from pelvic disorders, especially in women
• a form of irritable bowel syndrome (IBS) that has symptoms of both IBS and constipation, also called IBS with constipation, or IBS-C.

Constipation may become worse because of the following factors:

Diets low in fiber

Fiber helps stool stay soft. Drink liquids to help fiber keep stool soft.

Older adults commonly have constipation because of limited dietary fiber, lack of physical activity, and medications.

Lack of physical activity

If you don’t exercise or move around regularly you may get constipated. For example, people may be less active because they

• have other health problems
• sit all day and don’t exercise regularly
• have to stay in bed most of the time because of an illness or accident

Medicines

Some medicines that doctors prescribe to treat other health problems can cause constipation. Medicines that can cause constipation include

• antacids—used to neutralize stomach acid—that contain aluminum and calcium
• anticholinergics—used to treat muscle spasms in the intestines
• anticonvulsants—used to decrease abnormal electrical activity in the brain to prevent seizures
• antispasmodics—used to reduce muscle spasms in the intestines
• calcium channel blockers—used to treat high blood pressure and heart disease
• diuretics—used to help the kidneys remove fluid from the blood
• iron supplements—used to build up higher iron levels in the blood
• medicines used to treat Parkinson’s disease
• narcotics—used to treat severe pain
• some medicines used to treat depression

Life changes or daily routine changes

Constipation can happen when your life or daily routine changes. For example, your bowel movements can change

• when you travel
• if you become pregnant
• as you get older

Ignoring the urge to have a bowel movement

If you ignore the urge to have a bowel movement, over time, you may stop feeling the need to have one. You may delay having a bowel movement because you do not want to use toilets outside of your home, do not have access to a toilet, or may feel you are too busy. This habit can lead to constipation.

Certain health problems

Some health problems can make stool move more slowly through your colon, rectum, or anus, causing constipation. These health problems include

• disorders that affect your brain and spine, such as Parkinson’s disease
• spinal cord or brain injuries
• diabetes
• hypothyroidism

Gastrointestinal (GI) tract problems

Problems in your GI tract that compress or narrow your colon and rectum can cause constipation. These problems include

• tumors
• inflammation, or swelling, such as diverticulitis or inflammatory bowel disease

Functional GI disorders

Functional GI disorders happen when your GI tract behaves in an abnormal way, yet without evidence of damage due to a disease. For example, IBS is a common functional GI disorder, and many people with IBS can have IBS with constipation.

Diagnosis

How do doctors diagnose constipation?

Doctors diagnose constipation by

• taking a medical history
• performing a physical exam
• performing diagnostic tests, such as a blood test

Medical history

The medical history will include questions about your constipation, such as

• how often you have a bowel movement
• how long you’ve had symptoms
• what your stools look like and whether you have blood in your stool
• your eating habits
• your level of physical activity
• the medicines you take

Physical exam

The physical exam may include a digital rectal exam. During a digital rectal exam, your doctor will have you bend over a table or lie on your side while holding your knees close to your chest. After putting on a glove, the doctor slides a lubricated finger into your anus to check for tenderness, blockage, or blood, and will ask you to squeeze your anal muscles.

Diagnostic tests

The tests your doctor may order for constipation depend on

• how long you’ve been constipated
• how severe your constipation is
• your age
• whether you’ve had blood in your stool, recent changes in your bowel movement pattern, or weight loss

What tests do doctors use to diagnose constipation?

A doctor may use one or more of the following tests to diagnose constipation.

Blood test

A health care professional may take a blood sample from you to test for certain conditions that can cause constipation, such as anemia or hypothyroidism.

Flexible sigmoidoscopy or colonoscopy

Although the tests are similar, doctors use a colonoscopy to view your rectum and entire colon, while they use a flexible sigmoidoscopy to view just your rectum and lower colon. For either procedure, you’ll lie on a table while your doctor inserts a flexible tube into your anus. A small camera on the tube sends a video image of your bowel lining to a monitor. The procedures can show signs of problems in your lower gastrointestinal (GI) tract.

During these two tests, your doctor may also perform a biopsy. The doctor may take several small pieces of tissue from different areas of your bowel lining. A pathologist will look at the tissue using a microscope. You won’t feel the biopsy.

Colorectal transit studies

Colorectal transit studies are tests that show how well stool moves through your colon.

• Radiopaque markers. For this test, you swallow capsules with small radioactive markers that doctors can see on an x-ray. Three to 7 days after you swallow the capsules, a health care professional will take several x-rays of your abdomen that track the movement of the markers through your colon. You eat a high-fiber diet to help stool and the markers move through your GI tract. The markers pass when you have a bowel movement.
• Scintigraphy. For this test, you eat a meal that contains radioactive substances. The dose of radioactive substances is small, so scintigraphy isn’t likely to damage your cells. A health care professional will use computers and special cameras placed outside your body over your abdomen to create pictures of the radioactive substances as they move through your intestines.

Anorectal function tests

Anorectal function tests can show problems in your anus or rectum.

• Anal manometry uses pressure sensors and a balloon that a health care professional inflates inside your rectum to check how sensitive your rectum is and how well it works. Anal manometry also checks the tightness of the muscles around your anus and how well they respond to nerve signals. For this test, a health care professional puts a thin tube that has pressure sensors and a balloon on its tip into your anus. Once the balloon reaches your rectum and the pressure sensors are in your anus, the health care professional slowly pulls the tube out to measure muscle tone and contractions. The test takes about 30 minutes.

• Balloon expulsion tests consist of a health care professional filling a balloon with different amounts of water after he or she places it into your rectum. The health care professional will give you a stopwatch and instructions to go to the restroom and measure the amount of time it takes you to push the balloon out. If you can’t push out a balloon filled with less than 150 milliliters of water, or it takes longer than 1 minute to push the balloon out, you may have a problem pushing out stool.

Lower GI series

A lower GI series is an x-ray exam that doctors use to look at your large intestine. A health care professional will perform the procedure at a hospital or an outpatient center. A health care professional may give you written instructions about what to do at home before the procedure, called a bowel prep.

The health care professional may ask you to follow a clear liquid diet for 1 to 3 days before the procedure. You may also need to use a laxative or an enema before the procedure. Laxatives and enemas cause diarrhea, so you should stay close to a bathroom during the bowel prep.

For the procedure, you’ll lie on a table while your doctor inserts a flexible tube into your anus. Your doctor then fills your large intestine with barium, which makes signs of problems that may be causing constipation show up more clearly on x-rays.

Traces of barium in your large intestine can cause white or light-colored stools for several days. Enemas and repeated bowel movements may cause anal soreness. A health care professional will give you specific instructions about eating and drinking after the procedure.

Defecography

Defecography is a video x-ray of the area around your anus and rectum. The procedure may show problems with how you have a bowel movement.

During the test, a health care professional fills your rectum with a soft paste that shows up on x-rays and feels like stool. You sit on a toilet next to an x-ray machine. The health care professional will ask you to first pull in and squeeze muscles to keep stool in. Then, he or she will tell you to strain to have a bowel movement. The health care professional looks for problems as you push the paste out.

Magnetic resonance imaging (MRI)

MRI machines use radio waves and magnets to produce detailed pictures of your body’s internal organs and soft tissues without using x-rays.

Patients don’t need anesthesia, although a health care professional may give light sedation, taken by mouth, to children and people with a fear of small spaces. A health care professional may inject a special dye, called contrast medium, into your body. In most cases, you’ll lie on a table that slides into a tunnel-shaped device. The tunnel may be open ended or closed at one end. A radiologist reviews the images. A doctor can use the MRI images to diagnose health problems that may be causing your constipation.

Computerized tomography (CT) scan

CT scans use x-rays and computer technology to create images. A health care professional may give you a solution to drink and an injection of contrast medium. You’ll lie on a table that slides into a tunnel-shaped device that takes the x-rays. Radiologists review the images. A doctor can use the MRI images to diagnose health problems that may be causing your constipation.

Patients don’t need anesthesia, although health care professionals may give children a sedative to help them fall asleep for the test.

Women of childbearing age should have a pregnancy test before having a CT scan. The radiation from CT scans can be harmful to a developing fetus.

Treatment

How do doctors treat constipation?

Treatment for constipation depends on

• what’s causing your constipation
• how bad your constipation is
• how long you’ve been constipated

Treatment for constipation may include the following:

Changes in eating, diet, and nutrition

Changes in your eating, diet, and nutrition can treat constipation. These changes include

• drinking liquids throughout the day. A health care professional can recommend how much and what kind of liquids you should drink.
• eating more fruits and vegetables.
• eating more fiber.

Read about what you should eat to help prevent and relieve constipation and foods to avoid if you are constipated.

Exercise and lifestyle changes

Exercising every day may help prevent and relieve constipation.

You can also try to have a bowel movement at the same time each day. Picking a specific time of day may help you have a bowel movement regularly. For example, some people find that trying to have a bowel movement 15 to 45 minutes after breakfast helps them have a bowel movement. Eating helps your colon move stool. Make sure you give yourself enough time to have a bowel movement. You should also use the bathroom as soon as you feel the urge to have a bowel movement.

Over-the-counter medicines

Your doctor may suggest using a laxative for a short time if you’re doing all the right things and are still constipated. Your doctor will tell you what type of laxative is best for you. Over-the-counter laxatives come in many forms, including liquid, tablet, capsule, powder, and granules.

If you’re taking an over-the-counter or prescription medicine or supplement that can cause constipation, your doctor may suggest you stop taking it or switch to a different one.

Bulk-forming agents. Bulk-forming agents absorb fluid in your intestines, making your stool bulkier. Bulkier stool helps trigger the bowel to contract and push stool out. Be sure to take bulk-forming agents with water or they can cause an obstruction or a blockage in your bowel. They can also cause bloating and pain in your abdomen. Brand names include

• Citrucel
• FiberCon
• Konsyl
• Metamucil
• Serutan

Osmotic agents. Osmotic agents help stool retain fluid. Stools with more fluid increase your number of bowel movements and soften stool. Older adults and people with heart or kidney failure should be careful when taking osmotic agents. They can cause dehydration or a mineral imbalance. Brand names include

• Cephulac
• Fleet Phospho-Soda
• Milk of Magnesia
• Miralax
• Sorbitol

Stool softeners. Stool softeners help mix fluid into stools to soften them. Doctors recommend stool softeners for people who should avoid straining while having a bowel movement. Doctors often recommend stool softeners after surgery or for women after childbirth. Brand names include

• Colace
• Docusate
• Surfak

Lubricants. Lubricants work by coating the surface of stool, which helps the stool hold in fluid and pass more easily. Lubricants are simple, inexpensive laxatives. Doctors may recommend lubricants for people with anorectal blockage. Brand names include

• Fleet
• Zymenol

If these laxatives don’t work for you, your doctor may recommend other types of laxatives, including

Stimulants. Stimulant laxatives cause the intestines to contract, which moves stool. You should only use stimulants if your constipation is severe or other treatments have not worked. Brand names include

• Correctol
• Dulcolax
• Purge
• Senokot

People should not use stimulant laxatives containing phenolphthalein. Phenolphthalein may increase your chances of cancer. Most laxatives sold in the United States do not contain phenolphthalein. Make sure to check the ingredients on the medicine’s package or bottle.

If you’ve been taking laxatives for a long time and can’t have a bowel movement without taking a laxative, talk with your doctor about how you can slowly stop using them. If you stop taking laxatives, over time, your colon should start moving stool normally.

Prescription medicines

If over-the-counter medicines do not relieve your symptoms, your doctor may prescribe one of the following medicines:

Chloride channel activator. If you have irritable bowel syndrome (IBS) with long-lasting or idiopathic—meaning the cause is not known—constipation, your doctor may prescribe lubiprostone (Amitiza). Lubiprostone is a chloride channel activator available with a prescription. Research has shown lubiprostone to be safe when used for 6 to 12 months. This type of medicine increases fluid in your GI tract, which helps to

• reduce pain or discomfort in your abdomen
• make your stool softer
• reduce your need to strain when having a bowel movement
• increase how often you have bowel movements

Guanylate cyclase-C agonist. If you have IBS with long-lasting or idiopathic constipation, your doctor may prescribe linaclotide (Linzess) to help make your bowel movements regular. Linaclotide is a guanylate cyclase-C agonist that eases pain in your abdomen and speeds up how often you have bowel movements.

Biofeedback

If you have problems with the muscles that control bowel movements, your doctor may recommend biofeedback to retrain your muscles. Biofeedback uses special sensors to measure bodily functions. A video monitor shows the measurements as line graphs, and sounds from the equipment tell you when you’re using the correct muscles. By watching the monitor and listening to the sounds, you learn how to change the muscle function. Practicing at home can improve muscle function. You may have to practice for 3 months before you get all the benefit from the training.

Surgery

You may need surgery to treat an anorectal blockage caused by rectal prolapse if other treatments don’t work. You may need surgery to remove your colon if your colon muscles don’t work correctly. Your doctor can tell you about the benefits and risks of surgery.

How do doctors treat complications of constipation?

Doctors can treat or tell you how to treat complications of constipation. Hemorrhoids, anal fissures, rectal prolapse, and fecal impaction all have different treatments.

Hemorrhoids

You can treat hemorrhoids at home by

• making dietary changes to prevent constipation
• taking warm tub baths
• applying over-the-counter hemorrhoid cream to the area or using suppositories—a medicine you insert into your rectum—before bedtime

Talk with your doctor about hemorrhoids that do not respond to at-home treatments.

Anal fissures

You can treat anal fissures at home by

• making changes in your diet to prevent constipation
• applying over-the-counter hemorrhoid cream to numb the area or relax your muscles
• using stool softeners
• taking warm tub baths

Your doctor may recommend surgery to treat anal fissures that don’t heal with at-home treatments.

Rectal prolapse

Your doctor may be able to treat your rectal prolapse in his or her office by manually pushing the rectum back through your anus. If you have a severe or chronic—long-lasting—rectal prolapse, you may need surgery. The surgery will strengthen and tighten your anal sphincter muscle and repair the prolapsed lining. You can help prevent rectal prolapse caused by constipation by not straining during a bowel movement.

Fecal impaction

You can soften a fecal impaction with mineral oil that you take by mouth or through an enema. After softening the impaction, a health care professional may break up and remove part of the hardened stool by inserting one or two gloved, lubricated fingers into your anus.

Eating, Diet, & Nutrition

How can my diet help prevent and relieve constipation?

You can drink water and other fluids, such as fruit and vegetable juices and clear soups, to help the fiber in your diet work better. This change should make your stools more normal and regular. Ask your doctor about how much you should drink each day based on your health and activity level and where you live.

Depending on their age and sex, adults should get 22 to 34 grams of fiber a day.³ Older adults sometimes don’t get enough fiber in their diets, because they may lose interest in food. If you are older and have lost interest in food, talk with your doctor if

• food doesn’t taste the same as it once did
• you don’t feel hungry as often
• you don’t want to cook
• you have problems chewing or swallowing

Talk with your doctor to plan a diet with the right amount of fiber for you. Be sure to add fiber to your diet a little at a time so that your body gets used to the change.

Use this table as a tool to help replace less healthy foods with foods that have fiber.

What should I avoid eating if I'm constipated?

If you’re constipated, try not to eat too many foods with little or no fiber, such as

• cheese
• chips
• fast food
• ice cream
• meat
• prepared foods, such as some frozen meals and snack foods
• processed foods, such as hot dogs or some microwavable dinners

References

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many digestive disorders.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.?

Definition & Facts

What is constipation in children?

Constipation in children is a condition in which a child may have

• fewer than two bowel movements a week
• bowel movements with stools that are hard, dry, and small, making them painful or difficult to pass

In most cases, constipation in children lasts a short time and is not dangerous.

How common is constipation in children?

Almost 5 percent of visits to pediatricians are for constipation. About 25 percent of the children who visit gastroenterologists are constipated.¹

What are the complications of constipation in children?

Constipation can lead to health problems such as fecal impaction, anal fissures, or rectal prolapse.

Fecal impaction

Fecal impaction happens when hard stool packs a child’s intestine and rectum so tightly that the normal pushing action of the colon is not enough to push the stool out.

Anal fissures

Anal fissures are small tears in the anus that may cause itching, pain, or bleeding.

Rectal prolapse

Rectal prolapse happens when a child’s rectum slips so that it sticks out from his or her anus. Rectal prolapse in children is not common in developed countries.² Rectal prolapse can happen if a child strains during bowel movements, among other reasons. Rectal prolapse may cause mucus to leak from the child’s anus.

References

Symptoms & Causes

What are the symptoms of constipation in children?

If a child is constipated, he or she may have the following symptoms:

Posturing or changing positions

Posturing or changing positions can show that a child is trying to hold in stool or is constipated. When a child postures or changes position, he or she may

• stand on tiptoes and then rock back on his or her heels
• clench his or her buttocks muscles
• do unusual, dancelike movements

Parents or caretakers often mistake these postures as ways to try and have a bowel movement.

Abdominal pain and bloating

A child may feel pain or bloating in his or her abdomen.

Stool in a child’s underwear

If a child delays having a bowel movement, he or she may develop a large amount of stool in the rectum—something health care professionals call a fecal impaction. Some of this stool may leak and soil a child’s underwear. Parents or caretakers often mistake this soiling as a sign of diarrhea.

Urinary incontinence

Stool in a child’s colon can press against his or her bladder. This pressure may cause daytime or nighttime wetting called urinary incontinence.

When should a child with constipation see a doctor?

A child should see a doctor if his or her symptoms of constipation last for more than 2 weeks. You should take a child to see a doctor right away if he or she has one or more of the following symptoms:

• fever
• vomiting
• blood in his or her stool
• a swollen abdomen
• weight loss

What causes constipation in children?

Constipation happens when stool stays too long in a child’s colon. Causes of constipation in children may include the following:

Ignoring the urge to have a bowel movement

Children most often get constipated from holding in stool. When a child holds in stool, the colon absorbs too much fluid and his or her stool becomes hard, dry, and difficult to pass.

Children may hold in stool because they

• are feeling stressed about potty training
• are embarrassed to use a public bathroom
• do not want to interrupt playtime
• are worried about having a painful or an unpleasant bowel movement

Diets low in fiber

Another common cause of constipation in children is a diet with too little fiber. Fiber helps stool stay soft so that it moves smoothly through a child’s colon. Liquids such as water and juice help fiber work better.

Medicines

Some medicines that doctors prescribe to treat other health problems can cause constipation in children. Medicines that can cause constipation in children include

• antacids—used to neutralize stomach acid—that contain aluminum and calcium
• anticholinergics—used to treat muscle spasms in the intestines
• narcotics—used to treat severe pain
• some medicines used to treat depression

Certain health problems

Certain health problems can make stool move more slowly through a child’s colon, rectum, or anus, causing constipation:

• Hirschsprung disease—a birth defect in which the large intestine lacks some nerve cells. The signals that tell your muscles to push stool along are missing, so stool stays in the large intestine and causes blockage.
• obstructions that block part of the lower gastrointestinal (GI) tract
• tumors or narrowing of the GI tract

Functional GI disorders

Functional GI disorders happen when something changes the way a child’s GI tract works, yet doesn’t cause damage. Functional constipation happens when the muscles in a child’s colon or anus move stool more slowly, and it often happens during one of three times:

• when infants transition from breast milk to formula or when they start eating solid foods
• when parents or caretakers are potty training toddlers, and toddlers are learning how to control bowel movements
• when children start school and avoid using the bathroom at school for bowel movements

Irritable bowel syndrome (IBS) is also a functional GI disorder. Children with IBS can be constipated.

Diagnosis

How do doctors diagnose constipation in children?

To find out why a child is constipated, the child’s doctor will take a medical history and perform a physical exam, and may order tests.

Medical history

The medical history will include questions about the child’s constipation, such as

• what are the child’s bowel movement patterns, including how often the child has bowel movements
• when the first bowel movement after birth happened
• what are the child’s eating habits, including when and what the child most often eats and drinks
• what are the child’s social situations like, including
  • his or her day care attendance
  • his or her potty training
• whether the child has any health problems
• whether the child is taking medicine that can cause constipation
• what is the family’s history of constipation

Doctors primarily use a child’s medical history to diagnose functional constipation. The child’s history and symptoms may be different depending on his or her age.

Physical exam

During a physical exam, a doctor will listen for bowel sounds and feel the child’s abdomen for

• swelling
• tenderness
• masses, or lumps

The physical exam may include a rectal exam. After putting on a glove, a doctor will slide a lubricated finger into a child’s anus to check for tenderness, blockage, or blood.

Diagnostic tests

Since functional constipation is so common in children, doctors do not normally use diagnostic tests for children with constipation unless they do not respond to treatment or the doctor suspects a specific cause.

What tests do doctors use to diagnose constipation in children?

A doctor may use one or more of the following tests to diagnose constipation:

Blood test

A blood test might show an abnormality, such as anemia, indicating that a disease might be the cause of a child’s constipation.

X-ray

A doctor may order an x-ray of the child’s abdomen to look for problems causing the constipation. The child will lie on a table or stand during the x-ray. A health care professional positions the x-ray machine over the child’s abdomen. The child will hold his or her breath while the health care professional takes the x-ray so that the picture will not be blurry. The health care professional may ask the child to change position for more x-rays.

Treatment

How do doctors treat constipation in children?

Parents or caretakers can most often treat a child at home. However, if a child does not respond to treatment, call the child’s doctor. Treatment for constipation in children may include changes in eating, diet, and nutrition; behavioral changes; and enemas and laxatives:

Changes in eating, diet, and nutrition

Changes in a child’s eating, diet, and nutrition can treat constipation. These changes include

• drinking liquids throughout the day. A health care professional can recommend how much and what kind of liquids a child should drink.
• eating more fruits and vegetables.
• eating more fiber.

Read what a child should eat to help prevent and relieve constipation and foods to avoid if a child is constipated.

Behavioral changes

Changing a child’s patterns and behaviors about having bowel movements can help treat constipation. You can help the child by

• encouraging older children to use the toilet shortly after meals to build a routine
• using a reward system when children use the bathroom regularly
• taking a break from potty training until the constipation stops

Enemas and laxatives

Some children need to have an enema or take medicines to treat constipation. Most often, a doctor will first recommend using an enema. Cleansing a child’s bowel with an enema flushes water or a laxative into his or her anus using a special squirt bottle, which helps the child pass stool.

A doctor may prescribe a laxative for a child to take by mouth until his or her bowel movements are normal. Laxatives clean out the bowel and help a child have a bowel movement. Once a child has better eating and bowel habits, the doctor will recommend stopping the laxative. If you stop giving a child the laxative too soon then the child could become constipated again. You should not give a child laxatives unless told to do so by a doctor.

How do doctors treat complications of constipation in children?

Doctors can treat or recommend how to treat complications of constipation in children. Fecal impaction, anal fissures, and rectal prolapse all have different treatments.

Fecal impaction

Talk with the child’s doctor for how to treat fecal impaction in a child under 2 years old.

For a child who is 2 years old or older, you can soften his or her fecal impaction with mineral oil that he or she takes by mouth or through an enema. A health care professional may then recommend that you bring the child in to the doctor’s office. The health care professional can break up and remove part of the hardened stool by inserting one or two gloved, lubricated fingers into the child’s anus.

Anal fissures

You can treat a child’s anal fissures by

• making changes in his or her diet to prevent constipation
• applying over-the-counter anesthetic cream to numb the area or relax his or her muscles
• using stool softeners
• having him or her take warm tub baths to soothe the area

Rectal prolapse

A child’s doctor may be able to treat rectal prolapse during an office visit by manually pushing the rectum back through the child’s anus. Helping a child prevent constipation is the best way to prevent rectal prolapse.

Eating, Diet, & Nutrition

How can a child's diet help prevent or relieve constipation?

A child should drink water and other fluids, such as fruit and vegetable juices and clear soups, to help the fiber in his or her diet work better. This change should make the child’s stools more normal and regular. A doctor can help you plan a diet with the appropriate amount of fiber to help treat a child with constipation. A list of high-fiber foods appears below. Use this table as a tool to help replace less healthy foods with foods that have fiber.

Children ages 1 to 18, depending on their age and sex, should get 14 to 31 grams of fiber a day.³ Fiber guidelines are not available for infants less than 1 year old, who normally eat little to no solid food yet. Talk with the infant’s doctor about possibly breastfeeding the infant or what kind of foods he or she should eat.

What should my child avoid eating if he or she is constipated?

If a child is constipated, try not to give him or her too many foods with little or no fiber, such as

• ?cheese
• chips
• fast food
• ice cream
• meat
• prepared foods, such as some frozen meals and snack foods, such as saltine or animal crackers, angel food cake, and vanilla wafers
• processed foods, such as hot dogs or some microwavable dinners, such as pizza, Salisbury steak, and pot pie?

References

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many diseases and conditions.

What are clinical trials and what role do children play in research?

Clinical trials are research studies involving people of all ages. Clinical trials look at safe and effective new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving quality of life. Research involving children helps scientists

• identify care that is best for a child
• find the best dose of medicines
• find treatments for conditions that only affect children
• treat conditions that behave differently in children
• understand how treatment affects a growing child’s body

Find out more about clinical trials and children.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.??

Definition & Facts

What is Crohn’s disease?

Crohn’s disease is a chronic disease that causes inflammation and irritation in your digestive tract. Most commonly, Crohn’s affects your small intestine and the beginning of your large intestine. However, the disease can affect any part of your digestive tract, from your mouth to your anus. Learn more about your digestive system and how it works.

Crohn’s disease is an inflammatory bowel disease (IBD). Ulcerative colitis and microscopic colitis are other common types of IBD.

Crohn’s disease most often begins gradually and can become worse over time. You may have periods of remission that can last for weeks or years.

How common is Crohn’s disease?

Researchers estimate that more than half a million people in the United States have Crohn’s disease.¹ Studies show that, over time, Crohn’s disease has become more common in the United States and other parts of the world.^1,2 Experts do not know the reason for this increase.

Who is more likely to develop Crohn’s disease?

Crohn’s disease can develop in people of any age and is more likely to develop in people

• between the ages of 20 and 29²
• who have a family member, most often a sibling or parent, with IBD
• who smoke cigarettes

What are the complications of Crohn’s disease?

Complications of Crohn’s disease can include the following:

• Intestinal obstruction. Crohn’s disease can thicken the wall of your intestines. Over time, the thickened areas of your intestines can narrow, which can block your intestines. A partial or complete intestinal obstruction, also called a bowel blockage, can block the movement of food or stool through your intestines.
• Fistulas. In Crohn’s disease, inflammation can go through the wall of your intestines and create tunnels, or fistulas. Fistulas are abnormal passages between two organs, or between an organ and the outside of your body. Fistulas may become infected.
• Abscesses. Inflammation that goes through the wall of your intestines can also lead to abscesses. Abscesses are painful, swollen, pus-filled pockets of infection.
• Anal fissures. Anal fissures are small tears in your anus that may cause itching, pain, or bleeding.
• Ulcers. Inflammation anywhere along your digestive tract can lead to ulcers or open sores in your mouth, intestines, anus, or perineum.
• Malnutrition. Malnutrition develops when your body does not get the right amount of vitamins, minerals, and nutrients it needs to maintain healthy tissues and organ function.
• Inflammation in other areas of your body. You may have inflammation in your joints, eyes, and skin.

What other health problems do people with Crohn’s disease have?

If you have Crohn’s disease in your large intestine, you may be more likely to develop colon cancer. If you receive ongoing treatment for Crohn’s disease and stay in remission, you may reduce your chances of developing colon cancer.³

Talk with your doctor about how often you should get screened for colon cancer. Screening is testing for diseases when you have no symptoms. Screening for colon cancer can include colonoscopy with biopsies. Although screening does not reduce your chances of developing colon cancer, it may help to find cancer at an early stage and improve the chance of curing the cancer.

References

Symptoms & Causes

What are the symptoms of Crohn’s Disease?

The most common symptoms of Crohn’s disease are

• diarrhea
• cramping and pain in your abdomen
• weight loss

Other symptoms include

• anemia
• eye redness or pain
• feeling tired
• fever
• joint pain or soreness
• nausea or loss of appetite
• skin changes that involve red, tender bumps under the skin

Your symptoms may vary depending on the location and severity of your inflammation.

Some research suggests that stress, including the stress of living with Crohn’s disease, can make symptoms worse. Also, some people may find that certain foods can trigger or worsen their symptoms.

What causes Crohn’s disease?

Doctors aren’t sure what causes Crohn’s disease. Experts think the following factors may play a role in causing Crohn’s disease.

Autoimmune reaction

One cause of Crohn’s disease may be an autoimmune reaction—when your immune system attacks healthy cells in your body. Experts think bacteria in your digestive tract can mistakenly trigger your immune system. This immune system response causes inflammation, leading to symptoms of Crohn’s disease.

Genes

Crohn’s disease sometimes runs in families. Research has shown that if you have a parent or sibling with Crohn’s disease, you may be more likely to develop the disease. Experts continue to study the link between genes and Crohn’s disease.

Other factors

Some studies suggest that other factors may increase your chance of developing Crohn’s disease:

• Smoking may double your chance of developing Crohn’s disease.⁴
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen,⁵ antibiotics,⁶ and birth-control pills⁶ may slightly increase the chance of developing Crohn’s disease.
• A high-fat diet may also slightly increase your chance of getting Crohn’s disease.⁷

Stress and eating certain foods do not cause Crohn’s disease.

References

Diagnosis

How do doctors diagnose Crohn’s disease?

Doctors typically use a combination of tests to diagnose Crohn’s disease. Your doctor will also ask you about your medical history—including medicines you are taking—and your family history and will perform a physical exam.

Physical exam

During a physical exam, a doctor most often

• checks for bloating in your abdomen
• listens to sounds within your abdomen using a stethoscope
• taps on your abdomen to check for tenderness and pain and to see if your liver or spleen is abnormal or enlarged

Diagnostic tests

Your doctor may use the following tests to help diagnose Crohn’s disease:

• lab tests
• intestinal endoscopy
• upper gastrointestinal (GI) series
• computed tomography (CT) scan

Your doctor may also perform tests to rule out other diseases, such as ulcerative colitis, diverticular disease, or cancer, that cause symptoms similar to those of Crohn’s disease.

What tests do doctors use to diagnose Crohn’s disease?

Your doctor may perform the following tests to help diagnose Crohn’s disease.

Lab tests

Lab tests to help diagnose Crohn’s disease include:

Blood tests. A health care professional may take a blood sample from you and send the sample to a lab to test for changes in

• red blood cells. If your red blood cells are fewer or smaller than normal, you may have anemia.
• white blood cells. When your white blood cell count is higher than normal, you may have inflammation or infection somewhere in your body.

Stool tests. A stool test is the analysis of a sample of stool. Your doctor will give you a container for catching and storing the stool. You will receive instructions on where to send or take the kit for analysis. Doctors use stool tests to rule out other causes of digestive diseases.

Intestinal endoscopy

Intestinal endoscopies are the most accurate methods for diagnosing Crohn’s disease and ruling out other possible conditions, such as ulcerative colitis, diverticular disease, or cancer. Intestinal endoscopies include the following:

Colonoscopy. Colonoscopy is a procedure in which a doctor uses a long, flexible, narrow tube with a light and tiny camera on one end, called a colonoscope or endoscope, to look inside your rectum and colon. The doctor may also examine your ileum to look for signs of Crohn’s disease.

A trained specialist performs a colonoscopy in a hospital or an outpatient center. A health care professional will give you written bowel prep instructions to follow at home before the procedure. You will receive sedatives, anesthesia, or pain medicine during the procedure.

During a colonoscopy, you’ll be asked to lie on a table while the doctor inserts a colonoscope into your anus and slowly guides it through your rectum and colon and into the lower part of your ileum. If your doctor suspects that you have Crohn’s disease, the colonoscopy will include biopsies of your ileum, colon, and rectum. You won’t feel the biopsies.

Upper GI endoscopy and enteroscopy. In an upper GI endoscopy, your doctor uses an endoscope to see inside your upper digestive tract, also called your upper GI tract.

A trained specialist performs the procedure at a hospital or an outpatient center. You should not eat or drink before the procedure. A health care professional will tell you how to prepare for an upper GI endoscopy. You most often receive a liquid anesthetic to numb your throat and a light sedative to help you stay relaxed and comfortable during the procedure.

During the procedure, the doctor carefully feeds the endoscope down your esophagus and into your stomach and duodenum.

During an enteroscopy, a doctor examines your small intestine with a special, longer endoscope using one of the following procedures:

• push enteroscopy, which uses a long endoscope to examine the upper portion of your small intestine
• single- or double-balloon enteroscopy, which uses small balloons to help move the endoscope into your small intestine
• spiral enteroscopy, which uses a tube attached to an endoscope that acts as a corkscrew to move the instrument into your small intestine

Capsule endoscopy. In capsule endoscopy, you swallow a capsule containing a tiny camera that allows your doctor to see inside your digestive tract. You should not eat or drink before the procedure. A health care professional will tell you how to prepare for a capsule endoscopy. You don’t need anesthesia for this procedure.

The test begins in a doctor’s office, where you swallow the capsule. You can leave the doctor’s office during the test. As the capsule passes through your digestive tract, the camera will record and transmit images to a small receiver device that you wear. When the recording is done, your doctor downloads and reviews the images. The camera capsule leaves your body during a bowel movement, and you can safely flush it down the toilet.

Upper GI series

An upper GI series is a procedure in which a doctor uses x-rays, fluoroscopy, and a chalky liquid called barium to view your upper GI tract.

An x-ray technician and a radiologist perform this test at a hospital or an outpatient center. You should not eat or drink before the procedure. A health care professional will tell you how to prepare for an upper GI series. You don’t need anesthesia for this procedure.

For the procedure, you’ll be asked to stand or sit in front of an x-ray machine and drink barium. The barium will make your upper GI tract more visible on an x-ray. You will then lie on the x-ray table, and the radiologist will watch the barium move through your upper GI tract on the x-ray and fluoroscopy.

CT scan

A CT scan uses a combination of x-rays and computer technology to create images of your digestive tract.

For a CT scan, a health care professional may give you a solution to drink and an injection of a special dye, called contrast medium. Contrast medium makes the structures inside your body easier to see during the procedure. You’ll lie on a table that slides into a tunnel-shaped device that takes the x-rays. CT scans can diagnose both Crohn’s disease and the complications of the disease.

Treatment

How do doctors treat Crohn’s disease?

Doctors treat Crohn’s disease with medicines, bowel rest, and surgery.

No single treatment works for everyone with Crohn’s disease. The goals of treatment are to decrease the inflammation in your intestines, to prevent flare-ups of your symptoms, and to keep you in remission.

Medicines

Many people with Crohn’s disease need medicines. Which medicines your doctor prescribes will depend on your symptoms.

Although no medicine cures Crohn’s disease, many can reduce symptoms.

Aminosalicylates. These medicines contain 5-aminosalicylic acid (5-ASA), which helps control inflammation. Doctors use aminosalicylates to treat people newly diagnosed with Crohn’s disease who have mild symptoms. Aminosalicylates include

• balsalazide
• mesalamine
• olsalazine
• sulfasalazine

Some of the common side effects of aminosalicylates include

• diarrhea
• headaches
• heartburn
• nausea and vomiting
• pain in your abdomen

Corticosteroids. Corticosteroids, also known as steroids, help reduce the activity of your immune system and decrease inflammation. Doctors prescribe corticosteroids for people with moderate to severe symptoms. Corticosteroids include

• budesonide
• hydrocortisone
• methylprednisolone
• prednisone

Side effects of corticosteroids include

• acne
• bone mass loss
• high blood glucose
• high blood pressure
• a higher chance of developing infections
• mood swings
• weight gain

In most cases, doctors do not prescribe corticosteroids for long-term use.

Immunomodulators. These medicines reduce immune system activity, resulting in less inflammation in your digestive tract. Immunomodulators can take several weeks to 3 months to start working. Immunomodulators include

• 6-mercaptopurine, or 6-MP
• azathioprine
• cyclosporine
• methotrexate

Doctors prescribe these medicines to help you go into remission or help you if you do not respond to other treatments. You may have the following side effects:

• a low white blood cell count, which can lead to a higher chance of infection
• feeling tired
• nausea and vomiting
• pancreatitis

Doctors most often prescribe cyclosporine only if you have severe Crohn’s disease because of the medicine’s serious side effects. Talk with your doctor about the risks and benefits of cyclosporine.

Biologic therapies. These medicines target proteins made by the immune system. Neutralizing these proteins decreases inflammation in the intestines. Biologic therapies work to help you go into remission, especially if you do not respond to other medicines. Biologic therapies include

• anti-tumor necrosis factor-alpha therapies, such as adalimumab, certolizumab, and infliximab
• anti-integrin therapies, such as natalizumab and vedolizumab
• anti-interleukin-12 and interleukin-23 therapy, such as ustekinumab

Doctors most often give patients infliximab every 6 to 8 weeks at a hospital or an outpatient center. Side effects may include a toxic reaction to the medicine and a higher chance of developing infections, particularly tuberculosis.

Other medicines. Other medicines doctors prescribe for symptoms or complications may include

• acetaminophen for mild pain. You should avoid using ibuprofen, naproxen, and aspirin because these medicines can make your symptoms worse.
• antibiotics to prevent or treat complications that involve infection, such as abscesses and fistulas.
• loperamide to help slow or stop severe diarrhea. In most cases, people only take this medicine for short periods of time because it can increase the chance of developing megacolon.

Bowel rest

If your Crohn’s disease symptoms are severe, you may need to rest your bowel for a few days to several weeks. Bowel rest involves drinking only certain liquids or not eating or drinking anything. During bowel rest, your doctor may

• ask you to drink a liquid that contains nutrients
• give you a liquid that contains nutrients through a feeding tube inserted into your stomach or small intestine
• give you intravenous (IV) nutrition through a special tube inserted into a vein in your arm

You may stay in the hospital, or you may be able to receive the treatment at home. In most cases, your intestines will heal during bowel rest.

Surgery

Even with medicines, many people will need surgery to treat their Crohn’s disease. One study found that nearly 60 percent of people had surgery within 20 years of having Crohn’s disease.⁸ Although surgery will not cure Crohn’s disease, it can treat complications and improve symptoms. Doctors most often recommend surgery to treat

• fistulas
• bleeding that is life threatening
• intestinal obstructions
• side effects from medicines when they threaten your health
• symptoms when medicines do not improve your condition

A surgeon can perform different types of operations to treat Crohn’s disease.

For any surgery, you will receive general anesthesia. You will most likely stay in the hospital for 3 to 7 days following the surgery. Full recovery may take 4 to 6 weeks.

Small bowel resection. Small bowel resection is surgery to remove part of your small intestine. When you have an intestinal obstruction or severe Crohn’s disease in your small intestine, a surgeon may need to remove that section of your intestine. The two types of small bowel resection are

• laparoscopic—when a surgeon makes several small, half-inch incisions in your abdomen. The surgeon inserts a laparoscope—a thin tube with a tiny light and video camera on the end—through the small incisions. The camera sends a magnified image from inside your body to a video monitor, giving the surgeon a close-up view of your small intestine. While watching the monitor, the surgeon inserts tools through the small incisions and removes the diseased or blocked section of small intestine. The surgeon will reconnect the ends of your intestine.
• open surgery—when a surgeon makes one incision about 6 inches long in your abdomen. The surgeon will locate the diseased or blocked section of small intestine and remove or repair that section. The surgeon will reconnect the ends of your intestine.

Subtotal colectomy. A subtotal colectomy, also called a large bowel resection, is surgery to remove part of your large intestine. When you have an intestinal obstruction, a fistula, or severe Crohn’s disease in your large intestine, a surgeon may need to remove that section of intestine. A surgeon can perform a subtotal colectomy by

• laparoscopic colectomy—when a surgeon makes several small, half-inch incisions in your abdomen. While watching the monitor, the surgeon removes the diseased or blocked section of your large intestine. The surgeon will reconnect the ends of your intestine.
• open surgery—when a surgeon makes one incision about 6 to 8 inches long in your abdomen. The surgeon will locate the diseased or blocked section of large intestine and remove that section. The surgeon will reconnect the ends of your intestine.

Proctocolectomy and ileostomy. A proctocolectomy is surgery to remove your entire colon and rectum. An ileostomy is a stoma, or opening in your abdomen, that a surgeon creates from a part of your ileum. The surgeon brings the end of your ileum through an opening in your abdomen and attaches it to your skin, creating an opening outside your body. The stoma is about three-quarters of an inch to a little less than 2 inches wide and is most often located in the lower part of your abdomen, just below the beltline.

A removable external collection pouch, called an ostomy pouch or ostomy appliance, connects to the stoma and collects stool outside your body. Stool passes through the stoma instead of passing through your anus. The stoma has no muscle, so it cannot control the flow of stool, and the flow occurs whenever occurs.

If you have this type of surgery, you will have the ileostomy for the rest of your life.

How do doctors treat the complications of Crohn’s disease?

Your doctor may recommend treatments for the following complications of Crohn’s disease:

• Intestinal obstruction. A complete intestinal obstruction is life threatening. If you have a complete obstruction, you will need medical attention right away. Doctors often treat complete intestinal obstruction with surgery.
• Fistulas. How your doctor treats fistulas will depend on what type of fistulas you have and how severe they are. For some people, fistulas heal with medicine and diet changes, whereas other people will need to have surgery.
• Abscesses. Doctors prescribe antibiotics and drain abscesses. A doctor may drain an abscess with a needle inserted through your skin or with surgery.
• Anal fissures. Most anal fissures heal with medical treatment, including ointments, warm baths, and diet changes.
• Ulcers. In most cases, the treatment for Crohn’s disease will also treat your ulcers.
• Malnutrition. You may need IV fluids or feeding tubes to replace lost nutrients and fluids.
• Inflammation in other areas of your body. Your doctor can treat inflammation by changing your medicines or prescribing new medicines.

References

Eating, Diet, & Nutrition

How can my diet help the symptoms of Crohn’s disease?

Changing your diet can help reduce symptoms. Your doctor may recommend that you make changes to your diet such as

• avoiding carbonated, or “fizzy,” drinks
• avoiding popcorn, vegetable skins, nuts, and other high-fiber foods
• drinking more liquids
• eating smaller meals more often
• keeping a food diary to help identify foods that cause problems

Depending on your symptoms or medicines, your doctor may recommend a specific diet, such as a diet that is

• high calorie
• lactose free
• low fat
• low fiber
• low salt

Talk with your doctor about specific dietary recommendations and changes.

Your doctor may recommend nutritional supplements and vitamins if you do not absorb enough nutrients. For safety reasons, talk with your doctor before using dietary supplements, such as vitamins, or any complementary or alternative medicines or medical practices.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many digestive disorders.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.?

Definition & Facts

What is diarrhea?

Diarrhea is loose, watery stools three or more times a day. Diarrhea may be acute, persistent, or chronic:

• Acute diarrhea is a common problem that typically lasts 1 or 2 days and goes away on its own.

• Persistent diarrhea lasts longer than 2 weeks and less than 4 weeks.

• Chronic diarrhea lasts at least 4 weeks. Chronic diarrhea symptoms may be continual or may come and go.

How common is diarrhea?

Diarrhea is a common problem. Acute diarrhea is more common than persistent or chronic diarrhea. Researchers estimate that about 179 million cases of acute diarrhea occur in the United States each year.¹

What are the complications of diarrhea?

Dehydration

Diarrhea may cause dehydration, which means your body lacks enough fluid and electrolytes to work properly. Your body loses more fluid and electrolytes in loose stools than solid stools. See a list of the symptoms of dehydration.

Malabsorption

Diarrhea may cause malabsorption. If people do not absorb enough nutrients from the food they eat, they may become malnourished. Certain conditions that cause chronic diarrhea—such as infections, food allergies and intolerances, and certain digestive tract problems—may also cause malabsorption. See a list of the symptoms of malabsorption.

References

Symptoms & Causes

What are the symptoms of diarrhea?

The main symptom of diarrhea is passing loose, watery stools three or more times a day.

People with diarrhea may also have one or more of the following symptoms:

• an urgent need to use the bathroom
• cramping
• loss of control of bowel movements
• nausea
• pain in the abdomen

People with diarrhea caused by some infections may also have one or more of the following symptoms:

• bloody stools
• fever and chills
• light-headedness and dizziness
• vomiting

Diarrhea may cause dehydration and malabsorption.

What are the symptoms of dehydration and malabsorption?

Dehydration and malabsorption can be serious complications of diarrhea. Their symptoms in adults, infants, toddlers, and young children are as follows.

Dehydration

Symptoms of dehydration in adults may include:

• thirst
• urinating less than usual
• feeling tired
• dark-colored urine
• dry mouth
• decreased skin turgor, meaning that when your skin is pinched and released, the skin does not flatten back to normal right away
• sunken eyes or cheeks
• light-headedness or fainting

Signs of dehydration in infants, toddlers, and young children may include

• thirst
• urinating less than usual, or no wet diapers for 3 hours or more
• lack of energy
• dry mouth
• no tears when crying
• decreased skin turgor
• sunken eyes, cheeks, or soft spot in the skull

Malabsorption

Symptoms of malabsorption in adults may include

• bloating
• changes in appetite
• gas
• loose, greasy, foul-smelling bowel movements
• weight loss

Symptoms of malabsorption in infants, toddlers, and young children may include

• bloating
• changes in appetite
• gas
• loose, greasy, foul-smelling bowel movements
• weight loss or poor weight gain

What causes diarrhea?

Acute and persistent diarrhea may have causes that are different from those of chronic diarrhea. In many cases, doctors do not find the cause of diarrhea. Most diarrhea goes away on its own within 4 days, and finding the cause is not necessary.

Acute and persistent diarrhea

The most common causes of acute and persistent diarrhea are infections, travelers’ diarrhea, and side effects of medicines.

Infections

Three types of infections that cause diarrhea include

• Viral infections. Many viruses cause diarrhea, including norovirus and rotavirus. Viral gastroenteritis is a common cause of acute diarrhea.

• Bacterial infections. Several types of bacteria can enter your body through contaminated food or water and cause diarrhea. Common bacteria that cause diarrhea include Campylobacter, Escherichia coli (E. coli), Salmonella, and Shigella.

• Parasitic infections. Parasites can enter your body through food or water and settle in your digestive tract. Parasites that cause diarrhea include Cryptosporidium enteritis, Entamoeba histolytica, and Giardia lamblia.

Infections in the digestive tract that spread through foods or drinks are called foodborne illnesses.

Infections lasting more than 2 weeks and less than 4 weeks can cause persistent diarrhea.

Travelers’ diarrhea

Travelers’ diarrhea is caused by eating food or drinking water contaminated with bacteria, viruses, or parasites. Travelers’ diarrhea is most often acute. However, some parasites cause diarrhea that lasts longer. Travelers’ diarrhea can be a problem for people traveling to developing countries.

Side effects of medicines

Many medicines may cause diarrhea. Medicines that may cause diarrhea include antibiotics, antacids containing magnesium, and medicines used to treat cancer.

Chronic diarrhea

Some infections, food allergies and intolerances, digestive tract problems, abdominal surgery, and long-term use of medicines can cause chronic diarrhea.

Infections

Some infections from bacteria and parasites that cause diarrhea do not go away quickly without treatment. Also, after an infection, people may have problems digesting carbohydrates such as lactose or proteins in foods such as cow’s milk, milk products, or soy. Problems digesting carbohydrates or proteins can prolong diarrhea.

Food allergies and intolerances

Allergies to foods such as cow’s milk, soy, cereal grains, eggs, and seafood may cause chronic diarrhea.

Lactose intolerance is a common condition that may cause diarrhea after eating foods or drinking liquids that contain milk or milk products.

Fructose intolerance is a condition that may cause diarrhea after eating foods or drinking liquids that contain fructose, a sugar found in fruits, fruit juices, and honey. Fructose is added to many foods and soft drinks as a sweetener called high-fructose corn syrup.

Sugar alcohols such as sorbitol, mannitol, and xylitol may cause diarrhea in some people. Sugar-free candies and gum often include these sugar alcohols.

Digestive tract problems

Digestive tract problems that may cause chronic diarrhea include

• celiac disease
• Crohn’s disease
• irritable bowel syndrome and other functional gastrointestinal (GI) disorders
• small intestinal bacterial overgrowth
• ulcerative colitis

Abdominal surgery

You may develop chronic diarrhea after abdominal surgery. Abdominal surgery is an operation on the appendix, gallbladder, large intestine, liver, pancreas, small intestine, spleen, or stomach.

Long-term use of medicines

Medicines that must be taken for a long time may cause chronic diarrhea. Some medicines, such as antibiotics, can change the normal gut flora and increase your chances of infection with Clostridium difficile, a bacterium that can cause chronic diarrhea.

Diagnosis

How do doctors find the cause of diarrhea?

Doctors do not typically need to find a cause of acute diarrhea. If your diarrhea lasts longer than 4 days or you have symptoms such as fever or bloody stools, your doctor may need to find the cause. Your doctor may use information from your medical and family history, a physical exam, or tests to find the cause of your diarrhea.

Medical and family history

Your doctor will ask for information about your symptoms, such as

• how long you have had diarrhea
• how much stool you have passed
• how often you have diarrhea
• how your stool looks, such as color or consistency
• whether you have other symptoms along with diarrhea

Your doctor will ask about the foods you eat and the beverages you drink. If your doctor suspects you have a food allergy or intolerance, he or she may recommend that you change what you eat to see if your symptoms improve.

Your doctor will also ask about

• current and past medical conditions
• prescription and over-the-counter medicines
• recent contact with other people who are sick
• recent travel to developing countries

Your doctor may ask whether anyone in your family has a history of conditions that cause chronic diarrhea, such as celiac disease, Crohn’s disease, irritable bowel syndrome, lactose intolerance, and ulcerative colitis.

Physical exam

During a physical exam, your doctor may

• check your blood pressure and pulse for signs of dehydration
• examine your body for signs of fever or dehydration
• use a stethoscope to listen to sounds in your abdomen
• tap on your abdomen to check for tenderness or pain

Sometimes, doctors perform a digital rectal exam. Your doctor will have you bend over a table or lie on your side while holding your knees close to your chest. After putting on a glove, the doctor will slide a lubricated finger into your anus to check for blood in your stool.

What tests do doctors use to find the cause of diarrhea?

Your doctor may use the following tests to help find the cause of your diarrhea.

Stool test

Stool tests can show the presence of blood, bacteria, or parasites; or signs of diseases and disorders. A health care professional will give you a container for catching and storing the stool. You will receive instructions on where to send or take the container for analysis.

Blood tests

A health care professional may take a blood sample to test for certain diseases or disorders that can cause diarrhea.

Hydrogen breath test

This test is used to diagnose lactose intolerance by measuring the amount of hydrogen in your breath. Normally, little hydrogen is detectable in your breath. With lactose intolerance, undigested lactose produces high levels of hydrogen in your breath. For this test, you will drink a beverage that contains a known amount of lactose. You will then breathe into a balloon-type container that measures your breath hydrogen level. If the hydrogen level is high, your doctor will diagnose lactose intolerance.

Fasting tests

To find out if a food intolerance or allergy is causing your diarrhea, your doctor may ask you to avoid foods with lactose, carbohydrates, wheat, or other ingredients to see whether your diarrhea responds to a change in diet.

Endoscopy

Your doctor may use endoscopy to look inside your body to help find the cause of your diarrhea. Endoscopic procedures include

• colonoscopy
• flexible sigmoidoscopy
• upper gastrointestinal (GI) endoscopy

Treatment

How can I treat my acute diarrhea?

In most cases, you can treat your acute diarrhea with over-the-counter medicines such as loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol, Kaopectate). Doctors generally do not recommend using over-the-counter medicines for people who have bloody stools or fever—signs of infection with bacteria or parasites. If your diarrhea lasts more than 2 days, see a doctor right away.

When you have acute diarrhea, you may lose your appetite for a short time. When your appetite returns, you can go back to eating your normal diet. Learn more about eating when you have diarrhea.

How can I treat my child’s acute diarrhea?

Over-the-counter medicines to treat acute diarrhea in adults can be dangerous for infants, toddlers, and young children. Talk to a doctor before giving your child an over-the-counter medicine. If your child’s diarrhea lasts more than 24 hours, see a doctor right away.

You can give your child his or her usual age-appropriate diet. You can give your infant breast milk or formula as usual.

How do doctors treat persistent and chronic diarrhea?

How doctors treat persistent and chronic diarrhea depends on the cause. Doctors may prescribe antibiotics and medicines that target parasites to treat bacterial or parasitic infections. Doctors may also prescribe medicines to treat some of the conditions that cause chronic diarrhea, such as Crohn’s disease, irritable bowel syndrome, or ulcerative colitis. How doctors treat chronic diarrhea in children also depends on the cause.

Doctors may recommend probiotics. Probiotics are live microorganisms, most often bacteria, that are similar to microorganisms you normally have in your digestive tract. Researchers are still studying the use of probiotics to treat diarrhea.

For safety reasons, talk with your doctor before using probiotics or any other complementary or alternative medicines or practices. If your doctor recommends probiotics, talk with him or her about how much probiotics you should take and for how long.

How can I prevent diarrhea?

You can prevent certain types of diarrhea, such as those caused by infections—including rotavirus and traveler’s diarrhea—and foodborne illnesses.

Infections

You can reduce your chances of getting or spreading infections that can cause diarrhea by washing your hands thoroughly with soap and warm water for 15 to 30 seconds

• after using the bathroom
• after changing diapers
• before and after handling or preparing food

Rotavirus, which causes viral gastroenteritis, was the most common cause of diarrhea in infants before rotavirus vaccines became available. The vaccines have reduced the number of cases of rotavirus and hospitalizations due to rotavirus among children in the United States.¹

Two oral vaccines are approved to protect children from rotavirus infections:

• rotavirus vaccine, live, oral, pentavalent (RotaTeq). Doctors give infants this vaccine in three doses: at 2 months of age, 4 months of age, and 6 months of age.
• rotavirus vaccine, live, oral (Rotarix). Doctors give infants this vaccine in two doses: at 2 months of age and at 4 months of age.

For the rotavirus vaccine to be effective, infants should receive all doses by 8 months of age. Infants 15 weeks of age or older who have never received the rotavirus vaccine should not start the series.

Parents or caregivers of infants should discuss rotavirus vaccination with a doctor.

Travelers’ diarrhea

To reduce the chances of getting travelers’ diarrhea when traveling to developing countries, avoid

• drinking tap water
• using tap water to make ice, prepare foods or drinks, or brush your teeth
• drinking juice or milk or eating milk products that have not been pasteurized—heated to kill harmful microbes—viruses, bacteria, and parasites
• eating food from street vendors
• eating meat, fish, or shellfish that is raw, undercooked, or not served hot
• eating raw vegetables and most raw fruits

You can drink bottled water, soft drinks, and hot drinks such as coffee or tea made with boiling water.

If you are worried about travelers’ diarrhea, talk with your doctor before traveling. Doctors may recommend taking antibiotics before and during a trip to help prevent travelers’ diarrhea. Early treatment with antibiotics can shorten a case of travelers’ diarrhea.

Foodborne illnesses

You can prevent foodborne illnesses that cause diarrhea by properly storing, cooking, cleaning, and handling foods.

How can I treat or prevent dehydration caused by diarrhea?

To treat or prevent dehydration, you need to replace lost fluids and electrolytes—called rehydration therapy—especially if you have acute diarrhea. Although drinking plenty of water is important in treating and preventing dehydration, you should also drink liquids that contain electrolytes, such as the following:

• broths
• caffeine-free soft drinks
• fruit juices
• sports drinks

If you are an older adult or have a weak immune system, you should also drink oral rehydration solutions, such as Pedialyte, Naturalyte, Infalyte, or CeraLyte. Oral rehydration solutions are liquids that contain glucose and electrolytes. You can make oral rehydration solutions at home (PDF, 90KB) .

How can I treat or prevent my child’s dehydration caused by diarrhea?

To treat or prevent dehydration, give your child liquids that contain electrolytes. You can also give your child an oral rehydration solution, such as Pedialyte, Naturalyte, Infalyte, or CeraLyte, as directed. Talk to a doctor about giving these solutions to your infant.

References

Eating, Diet, & Nutrition

What should I eat if I have diarrhea?

If you have diarrhea, you may lose your appetite for a short time. In most cases, when your appetite returns, you can go back to eating your normal diet. Parents and caretakers should give children with diarrhea their usual age-appropriate diet and give infants breast milk or formula.

Your doctor may recommend changing your diet to treat some causes of chronic diarrhea, such as lactose intolerance or celiac disease.

What should I avoid eating if I have diarrhea?

You should avoid foods that may make your diarrhea worse, such as

• alcoholic beverages
• drinks and foods containing caffeine
• dairy products such as milk, cheese, and ice cream
• fatty and greasy foods
• drinks and foods containing fructose
• fruits such as apples, peaches, and pears
• spicy foods
• diet drinks and sugarless gum and candies containing sweeteners such as sorbitol, mannitol, and xylitol

Research shows that following a restricted diet does not help treat diarrhea in most cases. Most experts do not recommend fasting or following a restricted diet when you have diarrhea.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

Definition & Facts

What is gas?

Gas is air in your digestive tract. Gas leaves your body through your mouth when you burp or through your anus when you pass gas.

Flatulence is excess gas in your stomach or intestines that can cause bloating and flatus. Flatus, gas that leaves your body through your anus, can contain small amounts of sulfur. Flatus that contains more sulfur has more of an odor.

Learn more about your digestive tract and how it works.

How common is gas?

Everyone has gas. People may think that they burp or pass gas too often and that they have too much gas. Having too much gas is uncommon.

Who is more likely to get gas?

Certain conditions may cause you to have more gas or to have more symptoms when you have a normal amount of gas in your digestive tract. People who swallow more air or eat certain foods may be more likely to have more gas.

Symptoms & Causes

What are the symptoms of gas?

The most common gas symptoms include burping, passing gas, bloating, and pain or discomfort in your abdomen. Gas symptoms vary from person to person.

Burping

Burping, or belching, once in a while, especially during and after meals, is normal. If you burp a lot, you may be swallowing too much air and releasing it before the air enters your stomach.

Passing gas

Passing gas around 13 to 21 times a day is normal.¹

Bloating

Bloating is a feeling of fullness or swelling in your abdomen. Bloating most often occurs during or after a meal.

Pain or discomfort in your abdomen

You may feel pain or discomfort in your abdomen when gas does not move through your intestines normally.

When should I talk with a doctor about my gas symptoms?

You should talk with your doctor if

• gas symptoms bother you
• your symptoms change suddenly
• you have other symptoms with gas—such as constipation, diarrhea, or weight loss

What causes gas?

Gas normally enters your digestive tract when you swallow air and when bacteria in your large intestine break down certain undigested foods. You may have more gas in your digestive tract if you swallow more air or eat certain foods.

Swallowed air

Everyone swallows a small amount of air when eating and drinking. You swallow more air when you

• chew gum
• drink carbonated, or fizzy, drinks
• eat or drink too fast
• smoke
• suck on hard candy
• wear loose-fitting dentures

Swallowed air that doesn’t leave your stomach by burping moves into your intestines and passes through your anus.

Bacteria in your large intestine

Your stomach and small intestine don’t fully digest some of the carbohydrates—sugars, starches, and fiber—in the food you eat. Undigested carbohydrates will pass to your large intestine, which contains bacteria. These bacteria break down undigested carbohydrates and create gas in the process.

What foods, drinks, or products cause gas?

A variety of foods, drinks, and products can cause gas. See the following table for examples.

What conditions cause excess gas or increase gas symptoms?

Some conditions can cause you to have more gas than usual or have more symptoms when you have gas. These conditions include the following:

Small intestinal bacterial overgrowth

Small intestinal bacterial overgrowth is an increase in the number of bacteria or a change in the type of bacteria in your small intestine. These bacteria can produce extra gas and may also cause diarrhea and weight loss. Small intestinal bacterial overgrowth is most often a complication of other conditions.

IBS

Irritable bowel syndrome (IBS) is a group of symptoms—including pain or discomfort in your abdomen and changes in your bowel movement patterns—that occur together. IBS can affect how gas moves through your intestines. You may also feel bloated due to increased sensitivity to normal amounts of gas.

GERD

Gastroesophageal reflux disease (GERD) is a chronic condition that occurs when stomach contents flow back up into your esophagus. People with GERD may burp a lot to relieve discomfort.

Problems digesting carbohydrates

Problems digesting carbohydrates that can lead to gas and bloating include

• lactose intolerance, a condition in which you have digestive symptoms such as bloating, gas, or diarrhea after eating or drinking milk or milk products.
• dietary fructose intolerance, a condition in which you have digestive symptoms such as bloating, gas, or diarrhea after consuming foods that contain fructose.
• celiac disease, an immune disorder in which you cannot tolerate gluten, a protein found in wheat, rye, barley, and some products such as lip balm and cosmetics. If you have celiac disease, gluten damages the lining of your small intestine.

Conditions that affect how gas moves through your intestines

Conditions that affect how gas moves through your intestines can lead to problems with gas and bloating. These conditions include dumping syndrome, abdominal adhesions, abdominal hernias, and conditions that can cause an intestinal obstruction such as colon cancer or ovarian cancer.

References

Diagnosis

How do doctors diagnose the cause of gas?

Doctors may diagnose the causes of excess gas or increased gas symptoms with a medical history and physical exam.

If your doctor thinks you may have a condition that causes excess gas or increases gas symptoms, he or she may order more tests.

Medical history

For a medical history, your doctor will ask about

• your symptoms
• your eating habits
• prescription and over-the-counter medicines you take
• current and past medical conditions

Your doctor may ask you to keep a diary of the food you eat and when your gas symptoms occur. Your diary may show specific foods that are causing gas. Reviewing your diary may also help your doctor find out if you have more gas or are more sensitive to normal amounts of gas.

Physical exam

During a physical exam, a doctor typically

• checks for bloating or swelling in your abdomen
• listens to sounds within your abdomen using a stethoscope
• taps on your abdomen to check for tenderness or pain

Treatment

How can I reduce or prevent excess gas?

To reduce or prevent excess gas and gas symptoms, your doctor may suggest the following:

Swallow less air

Your doctor may suggest that you take steps to swallow less air. For example, eat more slowly, avoid gum and hard candies, and don’t use a straw. If you wear dentures, check with your dentist to make sure they fit correctly. Swallowing less air may help ease gas symptoms, especially if you burp a lot.

Quit smoking

If you smoke, quit smoking. Your doctor can help you find ways to quit smoking. Studies show that people who get help quitting have a better chance of succeeding.

Change your diet

To reduce gas, your doctor may suggest you eat smaller, more frequent meals and eat less of the foods that give you gas. Learn more about changing your diet to reduce gas.

Take medicines

Some over-the-counter medicines may reduce gas or gas symptoms:

• Alpha-galactosidase (Beano, Gas-Zyme 3x) contains the enzyme the body lacks to digest sugars in beans, grains, and many vegetables. You can take this enzyme just before eating to break down gas-producing sugars. Doctors recommend the enzyme for adults and for children ages 12 and older.
• Simethicone (Gas-X, Mylanta Gas) can relieve gas-related bloating and pain or discomfort in your abdomen by helping gas pass through your digestive tract. Doctors may recommend simethicone for infants and children.
• Lactase tablets and drops are available for people with lactose intolerance. The lactase enzyme digests the lactose in the food or drink and reduces the chances of developing symptoms such as bloating, gas, or diarrhea. Lactose-free and lactose-reduced milk and milk products are available at most supermarkets and are identical nutritionally to regular milk and milk products. Check with your doctor before using lactase products. Some people, such as children younger than age 3 and pregnant and breastfeeding women, may not be able to take these products.

For safety reasons, talk with your doctor before using supplements or any complementary or alternative medicines or medical practices.

Your doctor may prescribe medicines to help reduce gas or gas symptoms, especially if you have small intestinal bacterial overgrowth or irritable bowel syndrome.

Eating, Diet, & Nutrition

What should I avoid eating to reduce gas?

You may be able to reduce gas by avoiding or eating less of the foods that give you gas. You can keep a food diary to help figure out which foods give you gas and how much of the gas-producing foods you can handle.

You may try avoiding or limiting

• carbonated, or fizzy, drinks
• fried and high-fat foods
• high-fiber foods for a few weeks and then slowly increasing your daily fiber intake
• sugar

If your doctor diagnoses you with celiac disease, your doctor will recommend a gluten-free diet. Most people with celiac disease see a big improvement in their symptoms when they follow a gluten-free diet.

If your doctor diagnoses you with lactose intolerance, your doctor may recommend limiting how much lactose you eat or drink. Many people can manage the symptoms of lactose intolerance by changing their diet.

If your doctor diagnoses you with irritable bowel syndrome, your doctor may recommend trying a special diet—called Low FODMAP or FODMAP. If you follow this diet, you avoid or eat less of certain foods—called high FODMAP foods—that contain carbohydrates that are hard to digest. Examples of high FODMAP foods include certain fruits and vegetables, dairy products, wheat and rye products, and foods that contain certain types of sweeteners.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.?

Definition & Facts

What is GER?

Gastroesophageal reflux (GER) happens when your stomach contents come back up into your esophagus.

Stomach acid that touches the lining of your esophagus can cause heartburn, also called acid indigestion.

Does GER have another name?

Doctors also refer to GER as

• acid indigestion
• acid reflux
• acid regurgitation
• heartburn
• reflux

How common is GER?

Having GER once in a while is common.

What is GERD?

Gastroesophageal reflux disease (GERD) is a more serious and long-lasting form of GER.

What is the difference between GER and GERD?

GER that occurs more than twice a week for a few weeks could be GERD. GERD can lead to more serious health problems over time. If you think you have GERD, you should see your doctor.

How common is GERD?

GERD affects about 20 percent of the U.S. population.¹

Who is more likely to have GERD?

Anyone can develop GERD, some for unknown reasons. You are more likely to have GERD if you are

• overweight or obese
• a pregnant woman
• taking certain medicines
• a smoker or regularly exposed to secondhand smoke

What are the complications of GERD?

Without treatment, GERD can sometimes cause serious complications over time, such as

Esophagitis

Esophagitis is inflammation in the esophagus. Adults who have chronic esophagitis over many years are more likely to develop precancerous changes in the esophagus.

Esophageal stricture

An esophageal stricture happens when your esophagus becomes too narrow. Esophageal strictures can lead to problems with swallowing.

Respiratory problems

With GERD you might breathe stomach acid into your lungs. The stomach acid can then irritate your throat and lungs, causing respiratory problems, such as

• asthma—a long-lasting disease in your lungs that makes you extra sensitive to things that you’re allergic to
• chest congestion, or extra fluid in your lungs
• a dry, long-lasting cough or a sore throat
• hoarseness—the partial loss of your voice
• laryngitis—the swelling of your voice box that can lead to a short-term loss of your voice
• pneumonia—an infection in one or both of your lungs—that keeps coming back
• wheezing—a high-pitched whistling sound when you breathe

Barrett’s esophagus

GERD can sometimes cause Barrett’s esophagus. A small number of people with Barrett’s esophagus develop a rare yet often deadly type of cancer of the esophagus.

If you have GERD, talk with your doctor about how to prevent or treat long-term problems.

References

Symptoms & Causes

What are the symptoms of GER and GERD?

If you have gastroesophageal reflux (GER), you may taste food or stomach acid in the back of your mouth.

The most common symptom of gastroesophageal reflux disease (GERD) is regular heartburn, a painful, burning feeling in the middle of your chest, behind your breastbone, and in the middle of your abdomen. Not all adults with GERD have heartburn.

Other common GERD symptoms include

• bad breath
• nausea
• pain in your chest or the upper part of your abdomen
• problems swallowing or painful swallowing
• respiratory problems
• vomiting
• the wearing away of your teeth

Some symptoms of GERD come from its complications, including those that affect your lungs.

What causes GER and GERD?

GER and GERD happen when your lower esophageal sphincter becomes weak or relaxes when it shouldn’t, causing stomach contents to rise up into the esophagus. The lower esophageal sphincter becomes weak or relaxes due to certain things, such as

• increased pressure on your abdomen from being overweight, obese, or pregnant
• certain medicines, including
  • those that doctors use to treat asthma—a long-lasting disease in your lungs that makes you extra sensitive to things that you’re allergic to
  • calcium channel blockers—medicines that treat high blood pressure
  • antihistamines—medicines that treat allergy symptoms
  • painkillers
  • sedatives—medicines that help put you to sleep
  • antidepressants—medicines that treat depression
• smoking, or inhaling secondhand smoke

A hiatal hernia can also cause GERD. Hiatal hernia is a condition in which the opening in your diaphragm lets the upper part of the stomach move up into your chest, which lowers the pressure in the esophageal sphincter.

When should I seek a doctor’s help?

You should see a doctor if you have persistent GER symptoms that do not get better with over-the-counter medications or change in your diet.

Call a doctor right away if you

• vomit large amounts
• have regular projectile, or forceful, vomiting
• vomit fluid that is
  • green or yellow
  • looks like coffee grounds
  • contains blood
• have problems breathing after vomiting
• have pain in the mouth or throat when you eat
• have problems swallowing or painful swallowing

Diagnosis

How do doctors diagnose GER?

In most cases, your doctor diagnoses gastroesophageal reflux (GER) by reviewing your symptoms and medical history. If your symptoms don’t improve with lifestyle changes and medications, you may need testing.

How do doctors diagnose GERD?

If your GER symptoms don’t improve, if they come back frequently, or if you have trouble swallowing, your doctor may recommend testing you for gastroesophageal reflux disease (GERD).

Your doctor may refer you to a gastroenterologist to diagnose and treat GERD.

What tests do doctors use to diagnose GERD?

Several tests can help a doctor diagnose GERD. Your doctor may order more than one test to make a diagnosis.

Upper gastrointestinal (GI) endoscopy and biopsy

In an upper GI endoscopy, a gastroenterologist, surgeon, or other trained health care professional uses an endoscope to see inside your upper GI tract. This procedure takes place at a hospital or an outpatient center.

An intravenous (IV) needle will be placed in your arm to provide a sedative. Sedatives help you stay relaxed and comfortable during the procedure. In some cases, the procedure can be performed without sedation. You will be given a liquid anesthetic to gargle or spray anesthetic on the back of your throat. The doctor carefully feeds the endoscope down your esophagus and into your stomach and duodenum. A small camera mounted on the endoscope sends a video image to a monitor, allowing close examination of the lining of your upper GI tract. The endoscope pumps air into your stomach and duodenum, making them easier to see.

The doctor may perform a biopsy with the endoscope by taking a small piece of tissue from the lining of your esophagus. You won’t feel the biopsy. A pathologist examines the tissue in a lab.

In most cases, the procedure only diagnoses GERD if you have moderate to severe symptoms.

Read more about upper GI endoscopy.

Upper GI series

An upper GI series looks at the shape of your upper GI tract.

An x-ray technician performs this procedure at a hospital or an outpatient center. A radiologist reads and reports on the x-ray images. You don’t need anesthesia. A health care professional will tell you how to prepare for the procedure, including when to stop eating and drinking.

During the procedure, you will stand or sit in front of an x-ray machine and drink barium to coat the inner lining of your upper GI tract. The x-ray technician takes several x-rays as the barium moves through your GI tract. The upper GI series can’t show GERD in your esophagus; rather, the barium shows up on the x-ray and can find problems related to GERD, such as

• hiatal hernias
• esophageal strictures
• ulcers

You may have bloating and nausea for a short time after the procedure. For several days afterward, you may have white or light-colored stools from the barium. A health care professional will give you instructions about eating, drinking, and taking your medicines after the procedure.

Esophageal pH and impedance monitoring

The most accurate procedure to detect acid reflux is esophageal pH and impedance monitoring. Esophageal pH and impedance monitoring measures the amount of acid in your esophagus while you do normal things, such as eating and sleeping.

A gastroenterologist performs this procedure at a hospital or an outpatient center as a part of an upper GI endoscopy. Most often, you can stay awake during the procedure.

A gastroenterologist will pass a thin tube through your nose or mouth into your stomach. The gastroenterologist will then pull the tube back into your esophagus and tape it to your cheek. The end of the tube in your esophagus measures when and how much acid comes up your esophagus. The other end of the tube attaches to a monitor outside your body that records the measurements.

You will wear a monitor for the next 24 hours. You will return to the hospital or outpatient center to have the tube removed.

This procedure is most useful to your doctor if you keep a diary of when, what, and how much food you eat and your GERD symptoms are after you eat. The gastroenterologist can see how your symptoms, certain foods, and certain times of day relate to one another. The procedure can also help show whether acid reflux triggers any respiratory symptoms.

Bravo wireless esophageal pH monitoring

Bravo wireless esophageal pH monitoring also measures and records the pH in your esophagus to determine if you have GERD. A doctor temporarily attaches a small capsule to the wall of your esophagus during an upper endoscopy. The capsule measures pH levels in the esophagus and transmits information to a receiver. The receiver is about the size of a pager, which you wear on your belt or waistband.

You will follow your usual daily routine during monitoring, which usually lasts 48 hours. The receiver has several buttons on it that you will press to record symptoms of GERD such as heartburn. The nurse will tell you what symptoms to record. You will be asked to maintain a diary to record certain events such as when you start and stop eating and drinking, when you lie down, and when you get back up.

To prepare for the test talk to your doctor about medicines you are taking. He or she will tell you whether you can eat or drink before the procedure. After about seven to ten days the capsule will fall off the esophageal lining and pass through your digestive tract.

Esophageal manometry

Esophageal manometry measures muscle contractions in your esophagus. A gastroenterologist may order this procedure if you’re thinking about anti-reflux surgery.

The gastroenterologist can perform this procedure during an office visit. A health care professional will spray a liquid anesthetic on the back of your throat or ask you to gargle a liquid anesthetic.

The gastroenterologist passes a soft, thin tube through your nose and into your stomach. You swallow as the gastroenterologist pulls the tube slowly back into your esophagus. A computer measures and records the pressure of muscle contractions in different parts of your esophagus.

The procedure can show if your symptoms are due to a weak sphincter muscle. A doctor can also use the procedure to diagnose other esophagus problems that might have symptoms similar to heartburn. A health care professional will give you instructions about eating, drinking, and taking your medicines after the procedure.

Treatment

How do you control GER and GERD?

You may be able to control gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) by

• not eating or drinking items that may cause GER, such as greasy or spicy foods and alcoholic drinks
• not overeating
• not eating 2 to 3 hours before bedtime
• losing weight if you’re overweight or obese
• quitting smoking and avoiding secondhand smoke
• taking over-the-counter medicines, such as Maalox, or Rolaids

How do doctors treat GERD?

Depending on the severity of your symptoms, your doctor may recommend lifestyle changes, medicines, surgery, or a combination.

Lifestyle changes

Making lifestyle changes can reduce your GER and GERD symptoms. You should

• lose weight, if needed.
• wear loose-fitting clothing around your abdomen. Tight clothing can squeeze your stomach area and push acid up into your esophagus.
• stay upright for 3 hours after meals. Avoid reclining and slouching when sitting.
• sleep on a slight angle. Raise the head of your bed 6 to 8 inches by safely putting blocks under the bedposts. Just using extra pillows will not help.
• quit smoking and avoid secondhand smoke.

Over-the-counter and prescription medicines

You can buy many GERD medicines without a prescription. However, if you have symptoms that will not go away, you should see your doctor.

All GERD medicines work in different ways. You may need a combination of GERD medicines to control your symptoms.

Antacids. Doctors often first recommend antacids to relieve heartburn and other mild GER and GERD symptoms. Antacids include over-the-counter medicines such as

• Maalox
• Mylanta
• Riopan
• Rolaids

Antacids can have side effects, including diarrhea and constipation.

H2 blockers. H2 blockers decrease acid production. They provide short-term or on-demand relief for many people with GER and GERD symptoms. They can also help heal the esophagus, although not as well as other medicines. You can buy H2 blockers over-the-counter or your doctor can prescribe one. Types of H2 blockers include

• cimetidine (Tagamet HB)
• famotidine (Pepcid AC)
• nizatidine (Axid AR)
• ranitidine (Zantac 75)

If you get heartburn after eating, your doctor may recommend that you take an antacid and an H2 blocker. The antacid neutralizes stomach acid, and the H2 blocker stops your stomach from creating acid. By the time the antacid stops working, the H2 blocker has stopped the acid.

Proton pump inhibitors (PPIs). PPIs lower the amount of acid your stomach makes. PPIs are better at treating GERD symptoms than H2 blockers.² They can heal the esophageal lining in most people with GERD. Doctors often prescribe PPIs for long-term GERD treatment.

However, studies show that people who take PPIs for a long time or in high doses are more likely to have hip, wrist, and spinal fractures. You need to take these medicines on an empty stomach so that your stomach acid can make them work.

Several types of PPIs are available by a doctor’s prescription, including

• esomeprazole (Nexium)
• lansoprazole (Prevacid)
• omeprazole (Prilosec, Zegerid)
• pantoprazole (Protonix)
• rabeprazole (AcipHex)

Talk with your doctor about taking lower-strength omeprazole or lansoprazole, sold over the counter.

Prokinetics. Prokinetics help your stomach empty faster. Prescription prokinetics include

• bethanechol (Urecholine)
• metoclopramide (Reglan)

Both of these medicines have side effects, including

• nausea
• diarrhea
• fatigue, or feeling tired
• depression
• anxiety
• delayed or abnormal physical movement

Prokinetics can cause problems if you mix them with other medicines, so tell your doctor about all the medicines you’re taking.

Antibiotics. Antibiotics, including erythromycin, can help your stomach empty faster. Erythromycin has fewer side effects than prokinetics; however, it can cause diarrhea.

Surgery

Your doctor may recommend surgery if your GERD symptoms don’t improve with lifestyle changes or medicines. You’re more likely to develop complications from surgery than from medicines.

Fundoplication is the most common surgery for GERD. In most cases, it leads to long-term reflux control.

A surgeon performs fundoplication using a laparoscope, a thin tube with a tiny video camera. During the operation, a surgeon sews the top of your stomach around your esophagus to add pressure to the lower end of your esophagus and reduce reflux. The surgeon performs the operation at a hospital. You receive general anesthesia and can leave the hospital in 1 to 3 days. Most people return to their usual daily activities in 2 to 3 weeks.

Endoscopic techniques, such as endoscopic sewing and radiofrequency, help control GERD in a small number of people. Endoscopic sewing uses small stitches to tighten your sphincter muscle. Radiofrequency creates heat lesions, or sores, that help tighten your sphincter muscle. A surgeon performs both operations using an endoscope at a hospital or an outpatient center, and you receive general anesthesia.

The results for endoscopic techniques may not be as good as those for fundoplication. Doctors don’t use endoscopic techniques often.

References

Eating, Diet, & Nutrition

How can your diet help prevent or relieve GER or GERD?

You can prevent or relieve your symptoms from gastroesophageal reflux (GER) or gastroesophageal reflux disease (GERD) by changing your diet. You may need to avoid certain foods and drinks that make your symptoms worse. Other dietary changes that can help reduce your symptoms include

• decreasing fatty foods
• eating small, frequent meals instead of three large meals

What should I avoid eating if I have GER or GERD?

Avoid eating or drinking the following items that may make GER or GERD worse:

• chocolate
• coffee
• peppermint
• greasy or spicy foods
• tomatoes and tomato products
• alcoholic drinks

What can I eat if I have GER or GERD?

Eating healthy and balanced amounts of different types of foods is good for your overall health. For more information about eating a balanced diet, visit Choose My Plate.

If you’re overweight or obese, talk with your doctor or a dietitian about dietary changes that can help you lose weight and decrease your GERD symptoms.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many digestive disorders.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.?

Definition & Facts

What is GER?

Gastroesophageal reflux (GER) happens when stomach contents come back up into the esophagus.

Stomach acid that touches the lining of the esophagus can cause heartburn, also called acid indigestion.

Does GER have another name?

Doctors also refer to GER as:

• acid indigestion
• acid reflux
• acid regurgitation
• heartburn
• reflux

How common is GER in children and teens?

Occasional GER is common in children and teens—ages 2 to 19—and doesn’t always mean that they have gastroesophageal reflux disease (GERD).¹

What is GERD?

GERD is a more serious and long-lasting form of GER in which acid reflux irritates the esophagus.

What is the difference between GER and GERD?

GER that occurs more than twice a week for a few weeks could be GERD. GERD can lead to more serious health problems over time. If you think your child or teen has GERD, you should take him or her to see a doctor or a pediatrician.

How common is GERD in children and teens?

Up to 25 percent of children and teens have symptoms of GERD, although GERD is more common in adults.¹

What are the complications of GERD in children and teens?

Without treatment, GERD can sometimes cause serious complications over time, such as:

Esophagitis

Esophagitis may lead to ulcerations, a sore in the lining of the esophagus.

Esophageal Stricture

An esophageal stricture happens when a person’s esophagus becomes too narrow. Esophageal strictures can lead to problems with swallowing.

Respiratory Problems

A child or teen with GERD might breathe stomach acid into his or her lungs. The stomach acid can then irritate his or her throat and lungs, causing respiratory problems or symptoms, such as

• asthma—a long-lasting lung disease that makes a child or teen extra sensitive to things that he or she is allergic to
• chest congestion, or extra fluid in the lungs
• a dry, long-lasting cough or a sore throat
• hoarseness—the partial loss of a child or teen’s voice
• laryngitis—the swelling of a child or teen’s voice box that can lead to a short-term loss of his or her voice
• pneumonia—an infection in one or both lungs—that keeps coming back
• wheezing—a high-pitched whistling sound that happens while breathing

A pediatrician should monitor children and teens with GERD to prevent or treat long-term problems.

References

Symptoms & Causes

What are the symptoms of GER and GERD in children and teens?

If a child or teen has gastroesophageal reflux (GER), he or she may taste food or stomach acid in the back of the mouth.

Symptoms of gastroesophageal reflux disease (GERD) in children and teens can vary depending on their age. The most common symptom of GERD in children 12 years and older is regular heartburn, a painful, burning feeling in the middle of the chest, behind the breastbone, and in the middle of the abdomen. In many cases, children with GERD who are younger than 12 don’t have heartburn.

Other common GERD symptoms include

• bad breath
• nausea
• pain in the chest or the upper part of the abdomen
• problems swallowing or painful swallowing
• respiratory problems
• vomiting
• the wearing away of teeth

What causes GER and GERD in children and teens?

GER and GERD happen when a child or teen’s lower esophageal sphincter becomes weak or relaxes when it shouldn’t, causing stomach contents to rise up into the esophagus. The lower esophageal sphincter becomes weak or relaxes due to certain things, such as

• increased pressure on the abdomen from being overweight, obese, or pregnant
• certain medicines, including
  • those used to treat asthma—a long-lasting disease in the lungs that makes a child or teen extra sensitive to things that he or she is allergic to
  • antihistamines—medicines that treat allergy symptoms
  • painkillers
  • sedatives—medicines that help put someone to sleep
  • antidepressants—medicines that treat depression
• smoking,which is more likely with teens than younger children, or inhaling secondhand smoke

Other reasons a child or teen develops GERD include

• previous esophageal surgery
• having a severe developmental delay or neurological condition, such as cerebral palsy

When should I seek a doctor's help?

Call a doctor right away if your child or teen

• vomits large amounts
• has regular projectile, or forceful, vomiting
• vomits fluid that is
  • green or yellow
  • looks like coffee grounds
  • contains blood
• has problems breathing after vomiting
• has mouth of throat pain when he or she eats
• has problems swallowing or pain when swallowing
• refuses food repeatedly, causing weight loss or poor growth
• shows signs of dehydration, such as no tears when he or shes cries

Diagnosis

How do doctors diagnose GER in children and teens?

In most cases, a doctor diagnoses gastroesophageal reflux (GER) by reviewing a child or teen’s symptoms and medical history. If symptoms of GER do not improve with lifestyle changes and anti-reflux medicines, he or she may need testing.

How do doctors diagnose GERD in children and teens?

If a child or teen’s GER symptoms do not improve, if they come back frequently, or he or she has trouble swallowing, the doctor may recommend testing for gastroesophageal reflux disease (GERD).

The doctor may refer the child or teen to a pediatric gastroenterologist to diagnose and treat GERD.

What tests do doctors use to diagnose GERD?

Several tests can help a doctor diagnose GERD. A doctor may order more than one test to make a diagnosis.

Upper GI Series

An upper GI series looks at the shape of the child or teen’s upper GI tract.

During the procedure, the child or teen will drink liquid contrast (barium or gastrograffin) to coat the lining of the upper GI tract. The x-ray technician takes several x-rays as the contrast moves through the GI tract. The technician or radiologist will often change the position of the child or teen to get the best view of the GI tract. They may press on the child’s abdomen during the x-ray procedure.

The upper GI series can’t show mild irritation in the esophagus. It can find problems related to GERD, such as esophageal strictures, or problems with the anatomy that may cause symptoms of GERD.

Children or teens may have bloating and nausea for a short time after the procedure. For several days afterward, they may have white or light-colored stools from the barium. A health care professional will give you specific instructions about the child or teen’s eating and drinking after the procedure.

Esophageal pH and impedance monitoring

The most accurate procedure to detect acid reflux is esophageal pH and impedance monitoring. Esophageal pH and impedance monitoring measures the amount of acid or liquid in a child or teen’s esophagus while he or she does normal things, such as eating and sleeping.

This procedure takes place at a hospital or outpatient center. A nurse or physician places a thin flexible tube through the child or teen’s nose into the stomach. The tube is then pulled back into the esophagus and taped to the child or teen’s cheek. The end of the tube in the esophagus measures when and how much acid comes up into the esophagus. The other end of the tube attaches to a monitor outside his or her body that records the measurements. The placement of the tube is sometimes done while a child is sedated after an upper endoscopy, but can be done while a child is fully awake.

The child or teen will wear a monitor for the next 24 hours. He or she will return to the hospital or outpatient center to have the tube removed. Children may need to stay in the hospital for the esophageal pH and impedancemonitoring.

This procedure is most useful to the doctor if you keep a diary of when, what, and how much food the child or teen eats and his or her GERD symptoms after eating. The gastroenterologist can see how the symptoms, certain foods, and certain times of day relate to one another. The procedure can also help show whether acid reflux triggers any respiratory symptoms the child or teen might have.

Upper Gastro Intestinal (GI) endoscopy and biopsy

In an upper GI endoscopy, a gastroenterologist, surgeon, or other trained health care professional uses an endoscope to see inside a child or teen’s upper GI tract. This procedure takes place at a hospital or an outpatient center.

An intravenous (IV) needle will be placed in the child or teen’s arm to give him or her medicines that keep him or her relaxed and comfortable during the procedure. They may be given a liquid anesthetic to gargle or spray anesthetic on the back of his or her throat. The doctor carefully feeds the endoscope down the child or teen’s esophagus then into the stomach and duodenum. A small camera mounted on the endoscope sends a video image to a monitor, allowing close examination of the lining of the upper GI tract. The endoscope pumps air into the child or teen’s stomach and duodenum, making them easier to see.

The doctor may perform a biopsy with the endoscope by taking small pieces of tissue from the lining of the child or teen’s esophagus, stomach, or duodenum. He or she won’t feel the biopsy. A pathologist examines the tissue in a lab.

In most cases, the procedure only diagnoses GERD if the child or teen has moderate to severe symptoms.

Treatment

How do doctors treat GER and GERD in children and teens?

You can help control a child or teen’s gastroesophageal reflux (GER) or gastroesophageal reflux disease (GERD) by having him or her

• not eat or drink items that may cause GER, such as greasy or spicy foods
• not overeat
• avoid smoking and secondhand smoke
• lose weight if he or she is overweight or obese
• avoid eating 2 to 3 hours before bedtime
• take over-the-counter medicines, such as Alka-Seltzer, Maalox, or Rolaids

How do doctors treat GERD in children and teens?

Depending on the severity of the child’s symptoms, a doctor may recommend lifestyle changes, medicines, or surgery.

Lifestyle changes

Helping a child or teen make lifestyle changes can reduce his or her GERD symptoms. A child or teen should

• lose weight, if needed.
• eat smaller meals
• avoid high-fat foods
• wear loose-fitting clothing around the abdomen. Tight clothing can squeeze the stomach area and push the acid up into the esophagus.
• stay upright for 3 hours after meals and avoid reclining and slouching when sitting.
• sleep at a slight angle. Raise the head of the child or teen’s bed 6 to 8 inches by safely putting blocks under the bedposts. Just using extra pillows will not help.
• If a teen smokes, help them quit smoking and avoid secondhand smoke.

Over-the-counter and prescription medicines

If a child or teen has symptoms that won’t go away, you should take him or her to see a doctor. The doctor can prescribe medicine to relieve his or her symptoms. Some medicines are available over the counter.

All GERD medicines work in different ways. A child or teen may need a combination of GERD medicines to control symptoms.

Antacids

Doctors often first recommend antacids to relieve GER and other mild GERD symptoms. A doctor will tell you which over-the-counter antacids to give a child or teen, such as

• Alka-Seltzer
• Maalox
• Mylanta
• Riopan
• Rolaids

Antacids can have side effects, including diarrhea and constipation. Don’t give your child or teen over-the-counter antacids without first checking with his or her doctor.

H2 blockers

H2 blockers decrease acid production. They provide short-term or on-demand relief for many people with GERD symptoms. They can also help heal the esophagus, although not as well as other medicines. If a doctor recommends an H2 blocker for the child or teen, you can buy them over the counter or a doctor can prescribe one. Types of H2 blockers include

• cimetidine (Tagamet HB)
• famotidine (Pepcid AC)
• nizatidine (Axid AR)
• ranitidine (Zantac 75)

If a child or teen develops heartburn after eating, his or her doctor may prescribe an antacid and an H2 blocker. The antacids neutralize stomach acid, and the H2 blockers stop the stomach from creating acid. By the time the antacids wear off, the H2 blockers are controlling the acid in the stomach.

Don’t give your child or teen over-the-counter H2 blockers without first checking with his or her doctor.

Proton pump inhibitors (PPIs)

PPIs lower the amount of acid the stomach makes. PPIs are better at treating GERD symptoms than H2 blockers.² They can heal the esophageal lining in most people with GERD. Doctors often prescribe PPIs for long-term GERD treatment.

However, studies show that people who take PPIs for a long time or in high doses are more likely to have hip, wrist, and spinal fractures. A child or teen should take these medicines on an empty stomach so that his or her stomach acid can make them work correctly.

Several types of PPIs are available by a doctor’s prescription, including

• esomeprazole (Nexium)
• lansoprazole (Prevacid)
• omeprazole (Prilosec, Zegerid)
• pantoprazole (Protonix)
• rabeprazole (AcipHex)

Talk with the child or teen’s doctor about taking lower-strength omeprazole or lansoprazole, sold over the counter. Don’t give a child or teen over-the-counter PPIs without first checking with his or her doctor.

Prokinetics

Prokinetics help the stomach empty faster. Prescription prokinetics include

• bethanechol (Urecholine)
• metoclopramide (Reglan)

Both these medicines have side effects, including

• nausea
• diarrhea
• fatigue, or feeling tired
• depression
• anxiety
• delayed or abnormal physical movement

Prokinetics can cause problems if a child or teen mixes them with other medicines, so tell the doctor about all the medicines he or she is taking.

Antibiotics

Antibiotics, including erythromycin, can help the stomach empty faster. Erythromycin has fewer side effects than prokinetics; however, it can cause diarrhea.

Surgery

A pediatric gastroenterologist may recommend surgery if a child or teen’s GERD symptoms don’t improve with lifestyle changes or medicines. A child or teen is more likely to develop complications from surgery than from medicines.

Fundoplication is the most common surgery for GERD. In most cases, it leads to long-term reflux control.

A surgeon performs fundoplication using a laparoscope, a thin tube with a tiny video camera. During the operation, a surgeon sews the top of the stomach around the esophagus to add pressure to the lower end of the esophagus and reduce reflux.

The surgeon performs the operation at a hospital. The child or teen receives general anesthesia and can leave the hospital in 1 to 3 days. Most children and teens return to their usual daily activities in 2 to 3 weeks.

Endoscopic techniques, such as endoscopic sewing and radiofrequency, help control GERD in a small number of people. Endoscopic sewing uses small stitches to tighten the sphincter muscle. Radiofrequency creates heat lesions, or sores, that help tighten the sphincter muscle. A surgeon performs both operations using an endoscope at a hospital or an outpatient center, and the child or teen receives general anesthesia.

The results for endoscopic techniques may not be as good as those for fundoplication. Doctors don’t use endoscopic techniques.

References

Eating, Diet, & Nutrition

How can diet help prevent or relieve GER or GERD in children and teens?

You can help a child or teen prevent or relieve their symptoms from gastroesophageal reflux (GER) or gastroesophageal reflux disease (GERD) by changing their diet. He or she may need to avoid certain foods and drinks that make his or her symptoms worse. Other dietary changes that can help reduce the child or teen’s symptoms include

• decreasing fatty foods
• eating small, frequent meals instead of three large meals

What should a child or teen with GERD avoid eating or drinking?

He or she should avoid eating or drinking the following items that may make GER or GERD worse

• chocolate
• coffee
• peppermint
• greasy or spicy foods
• tomatoes and tomato products

What can a child or teen eat if they have GERD?

Eating healthy and balanced amounts of different types of foods is good for your child or teen’s overall health. For more information about eating a balanced diet, visit Choose My Plate.

If your child or teen is overweight or obese, talk with a doctor or dietitian about dietary changes that can help with losing weight and decreasing the GERD symptoms.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many diseases and conditions.

What are clinical trials and what role do children play in research?

Clinical trials are research studies involving people of all ages. Clinical trials look at safe and effective new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving quality of life. Research involving children helps scientists

• identify care that is best for a child
• find the best dose of medicines
• find treatments for conditions that only affect children
• treat conditions that behave differently in children
• understand how treatment affects a growing child’s body

Find out more about clinical trials and children.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.??

Definition & Facts

What is GER?

Gastroesophageal reflux (GER) happens when stomach contents come back up into the esophagus. Infants—babies younger than 2 years—with GER spit up liquid mostly made of saliva and stomach acid. Stomach acid that touches the lining of the infant’s esophagus can cause heartburn, also called acid indigestion.

Does GER have another name?

Doctors also refer to GER as

• acid indigestion
• acid reflux
• acid regurgitation
• heartburn
• reflux

How common is GER in infants?

GER is common in infants. About half of all infants spit up, or regurgitate, many times a day in the first 3 months of their lives. In most cases, infants stop spitting up between the ages of 12 and 14 months.¹

What is GERD?

GERD is a more serious and long-lasting form of GER in which acid reflux irritates the esophagus.

What is the difference between GER and GERD?

Infants with symptoms that prevent them from feeding or those with GER that lasts more than 12 to 14 months may actually have GERD. If you think your infant has GERD, you should take him or her to see a doctor or a pediatrician.

How common is GERD in infants?

GERD is common in infants. Two-thirds of 4-month-olds have symptoms of GERD. By 1 year old, up to 10 percent of infants have symptoms of GERD.¹

References

Symptoms & Causes

What are the symptoms of GERD in infants?

The main symptom of gastroesophageal reflux disease (GERD) in infants is spitting up more than they normally do. Infants with GERD can also have some or all of the following recurring symptoms:

• arching of the back, often during or right after feeding
• colic—crying that lasts for more than 3 hours a day with no medical cause
• coughing
• gagging or trouble swallowing
• irritability, particularly after feeding
• pneumonia—an infection in one or both of the lungs
• poor feeding or refusal to feed
• poor growth and malnutrition
• poor weight gain
• trouble breathing
• vomiting
• weight loss
• wheezing—a high-pitched whistling sound that happens while breathing

What causes GER & GERD in infants?

Gastroesophageal reflux (GER) happens when an infant’s lower esophageal sphincter is not fully developed, and the muscle lets the stomach contents back up the esophagus. Once the stomach contents move up into the esophagus, the infant will regurgitate, or spit up. Once an infant’s sphincter muscle fully develops, he or she should no longer spit up.

GERD happens when an infant’s lower esophageal sphincter muscle becomes weak or relaxes when it shouldn’t. This weakness or relaxation lets the stomach contents come back up into the esophagus.

When should I seek a doctor's help?

Call a doctor right away if an infant

• vomits large amounts
• has regular projectile, or forceful, vomiting, particularly in infants younger than 2 months
• vomits fluid that is
  • green or yellow
  • looks like coffee grounds
  • contains blood
• has problems breathing after vomiting or spitting up
• often refuses feedings, causing weight loss or poor growth
• cries 3 or more hours a day and is more irritable than usual
• shows signs of dehydration, such as having dry diapers or extreme fussiness

Diagnosis

How do doctors diagnose GER in infants?

In most cases, a doctor diagnoses gastroesophageal reflux (GER) by reviewing an infant’s symptoms and medical history. If symptoms of GER do not improve with feeding changes and anti-reflux medicines, he or she may need testing.

How do doctors diagnose GERD in infants?

The doctor may recommend testing for gastroesophageal reflux disease (GERD) if

• an infant’s symptoms don’t improve
• he or she is not gaining weight
• he or she is having lung problems

The doctor may refer the infant to a pediatric gastroenterologist to diagnose and treat GERD.

What tests do doctors use to diagnose GERD in infants?

Several tests can help a doctor diagnose GERD. A doctor may order more than one test to make a diagnosis.

Upper gastro intestinal (GI) endoscopy and biopsy

In an upper GI endoscopy, a gastroenterologist, surgeon, or other trained health care professional uses an endoscope to see inside an infant’s upper GI tract. This procedure takes place at a hospital or an outpatient center. A health care professional will use an upper GI endoscopy especially if an infant has growth or breathing problems.

An intravenous (IV) needle is placed into one of the veins in the infant’s arms, hands, or feet to give him or her medicines to keep him or her relaxed during the endoscopy procedure. The infant will receive extra oxygen throughout the procedure. The health care professional carefully feeds the endoscope down the infant’s esophagus and into the stomach and duodenum. A small camera mounted on the endoscope sends a video image to a monitor, allowing close examination of the lining of the upper GI tract. The endoscope pumps air into the infant’s GI tract, making them easier to see.

The doctor may perform a biopsy with the endoscope by taking a small piece of tissue from the lining of the infant’s esophagus. He or she won’t feel the biopsy. A pathologist examines the tissue in a lab.

In most cases, the procedure only diagnoses GERD if the infant has moderate to severe symptoms

Upper GI series

An upper GI series looks at the shape of an infant’s upper GI tract.

An x-ray technician performs this procedure at a hospital or an outpatient center. A radiologist reads and reports on the x-ray images. The infant doesn’t need anesthesia. If possible, you shouldn’t feed the infant before the procedure. Check with the doctor about what to do to prepare the infant for an upper GI series.

During the procedure, a health care professional will give the infant liquid contrast (barium) in a bottle or mixed with food to coat the inner lining of the upper GI tract. The x-ray technician takes several x-rays as the contrast moves through the GI tract. The technician or radiologist will often change the position of the infant to get the best view of the GI tract. The barium shows up on the x-ray and can help find problems related to GERD.

For several days afterward, the infant may have white or light-colored stools from the barium. A health care professional will give you specific instructions about the infant’s feeding and drinking after the procedure.

Esophageal pH and impedance monitoring

The most accurate procedure to detect acid reflux is esophageal pH and impedance monitoring. Esophageal pH and impedance monitoring measures the amount of acid or liquid in an infant’s esophagus while he or she does normal things, such as eating and sleeping.

This procedure takes place at a hospital or outpatient center. A nurse or physician places a thin flexible tube through the infant’s nose into the stomach. The tube is then pulled back into the esophagus and is secured in place with tape to the infant’s cheek. The end of the tube in the esophagus measures when and how much acid or liquid comes into the esophagus from the stomach. The other end of the tube attaches to a monitor outside his or her body that records the measurements. The placement of the tube is sometimes done while a child is sedated after an upper endoscopy, but can be done while an infant is fully awake.

Most infants will stay overnight in the hospital for 24 hours after the tube is placed.

This procedure is most useful to the doctor if you keep a diary of when, what, and how much food the infant eats and his or her GERD symptoms after feeding. The gastroenterologist can see how the symptoms, certain foods, and certain times of day relate to one another. The procedure can also show whether or not reflux triggers any breathing problems.

Treatment

How do doctors treat GER in infants?

In most cases, gastroesophageal reflux (GER) in infants goes away before it becomes gastroesophageal reflux disease (GERD), so doctors don’t treat GER in infants.

How do doctors treat GERD in infants?

Treatment for GERD depends on an infant’s symptoms and age and may involve feeding changes, medicines, or surgery.

Feeding changes

A doctor may first recommend treating an infant’s GERD by changing the way you feed him or her. The doctor may suggest that you

• add up to 1 tablespoon of rice cereal for every 2 ounces of formula in the infant’s bottles. If the mixture is too thick, you can change the nipple size or cut a little “x” in the nipple to make the opening larger. Do not change formulas unless the doctor tells you to.
• add rice cereal to breast milk stored in a bottle for breastfed babies.
• burp infants after they have 1 to 2 ounces of formula, or burp breastfed infants after nursing from each breast.
• avoid overfeeding infants. Follow the amount of formula or breast milk recommended.
• hold infants upright for 30 minutes after feedings.
• try putting infants on a hydrolyzed protein formula for 2 to 4 weeks if the doctor thinks he or she may be sensitive to milk protein. The protein content of this type of formula is already broken down or “predigested.”

Over-the-counter and prescription medicines

A doctor may recommend medicines that treat GERD by decreasing the amount of acid in the infant’s stomach. The doctor will only prescribe a medicine if the infant still has regular GERD symptoms and if

• you have tried making feeding changes
• the infant has problems sleeping or feeding
• the infant does not grow properly

The doctor will often prescribe a medicine on a trial basis and will explain any possible complications. You shouldn’t give an infant any medicines unless told to do so by a doctor.

H2 blockers. H2 blockers decrease acid production. They provide short-term or on-demand relief for infants with GERD symptoms. They can also help heal the esophagus.

A doctor may prescribe an H2 blocker, such as

• cimetidine (Tagamet HB)
• famotidine (Pepcid AC)
• nizatidine (Axid AR)
• ranitidine (Zantac 75)

Proton pump inhibitors (PPIs). PPIs lower the amount of acid the infant’s stomach makes. PPIs are better at treating GERD symptoms than H2 blockers.² They can heal the esophageal lining in infants. Doctors often prescribe PPIs for long-term GERD treatment.

An infant needs to be given these medicines on an empty stomach so that his or her stomach acid can make them work.

Several types of PPIs are available by a doctor’s prescription, including

• esomeprazole (Nexium)
• lansoprazole (Prevacid)
• omeprazole (Prilosec, Zegerid)
• pantoprazole (Protonix)
• rabeprazole (AcipHex)

Surgery

A pediatric gastroenterologist will only use surgery to treat GERD in infants in severe cases. Infants must have severe breathing problems or a physical problem that causes GERD symptoms for surgery to be an option.

References

Eating, Diet, & Nutrition

How can diet prevent or relieve GER and GERD in infants?

An infant’s doctor will first suggest feeding changes if the infant is not growing well or has malnutrition.

If feeding changes don’t help an infant’s GERD symptoms, the doctor may suggest a higher-calorie formula or tube feedings. For tube feedings, a doctor places a feeding tube through an infant’s nose or mouth and into the stomach. An infant feeds from food, liquids, and medicines through the tube.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many diseases and conditions.

What are clinical trials and what role do children play in research?

Clinical trials are research studies involving people of all ages. Clinical trials look at safe and effective new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving quality of life. Research involving children helps scientists

• identify care that is best for a child
• find the best dose of medicines
• find treatments for conditions that only affect children
• treat conditions that behave differently in children
• understand how treatment affects a growing child’s body

Find out more about clinical trials and children.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.??

Definition & Facts

What is GI bleeding?

Gastrointestinal (GI) bleeding is any type of bleeding that starts in your GI tract, also called your digestive tract. GI bleeding is a symptom of a disease or condition, rather than a disease or condition itself.

Acute GI bleeding is sudden and can sometimes be severe. Chronic GI bleeding is slight bleeding that can last a long time or may come and go.

Learn more about your digestive system and how it works.

Does GI bleeding have another name?

GI bleeding is also called bleeding in the digestive tract, upper GI bleeding, or lower GI bleeding. The upper GI tract and lower GI tract are different areas of your GI tract.

How common is GI bleeding?

Every year, about 100,000 people in the United States go to the hospital for upper GI bleeding.¹ About 20 to 33 percent of GI bleeding episodes in Western countries are in the lower GI tract.²

Who is more likely to have GI bleeding?

Men are twice as likely as women to have upper GI bleeding.³

References

Symptoms & Causes

What are the symptoms of GI bleeding?

Symptoms of gastrointestinal (GI) bleeding may include

• black or tarry stool
• bright red blood in vomit
• cramps in the abdomen
• dark or bright red blood mixed with stool
• dizziness or faintness
• feeling tired
• paleness
• shortness of breath
• vomit that looks like coffee grounds
• weakness

Acute bleeding symptoms

You may go into shock if you have acute bleeding. Acute bleeding is an emergency condition. Symptoms of shock include

• a drop in blood pressure
• little or no urination
• a rapid pulse
• unconsciousness

If you have any symptoms of shock, you or someone should call 911 right away.

Chronic bleeding symptoms

You may develop anemia if you have chronic bleeding. Symptoms of anemia may include feeling tired and shortness of breath, which can develop over time.

Some people may have occult bleeding. Occult bleeding may be a symptom of inflammation or a disease such as colorectal cancer. A simple lab test can detect occult blood in your stool.

What causes GI bleeding?

Many conditions can cause GI bleeding. A doctor can try to find the cause of your bleeding by finding its source. The following conditions, which are listed in alphabetical order, include possible causes of GI bleeding:

Angiodysplasia. Angiodysplasia is when you have abnormal or enlarged blood vessels in your GI tract. These blood vessels can become fragile and bleed.

Benign tumors and cancer. Benign tumors and cancer in the esophagus, stomach, colon, or rectum may cause bleeding when they weaken the lining of the GI tract. A benign tumor is an abnormal tissue growth that is not cancerous.

Colitis. Ulcers in the large intestine are a complication of colitis. Ulcerative colitis is an inflammatory bowel disease that can cause GI bleeding.

Colon polyps. Colon polyps can cause GI bleeding. You can have more than one colon polyp at a time. Some types of polyps may be cancerous or can become cancerous.

Diverticular disease. Diverticular disease can cause GI bleeding when small pouches, or sacs, form and push outward through weak spots in your colon wall.

Esophageal varices. Esophageal varices can cause GI bleeding. Esophageal varices are usually related to a chronic liver condition called cirrhosis.

Esophagitis. The most common cause of esophagitis is gastroesophageal reflux (GER). GER happens when your lower esophageal sphincter is weak or relaxes when it should not. Stomach acid can damage your esophagus and cause sores and bleeding.

Gastritis. Some common causes of gastritis include

• the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and other medicines
• infections
• Crohn’s disease
• serious illnesses
• severe injuries

If untreated, gastritis can lead to ulcers or worn-away areas of the stomach lining that can bleed in your GI tract.

Hemorrhoids or anal fissures. Hemorrhoids can cause GI bleeding. Constipation and straining during bowel movements cause hemorrhoids to swell. Hemorrhoids cause itching, pain, and sometimes bleeding in your anus or lower rectum. Anal fissures are small tears that also can cause itching, tearing, or bleeding in your anus.

Mallory-Weiss tears. Severe vomiting may cause Mallory-Weiss tears, which can cause GI bleeding. You can have more than one Mallory-Weiss tear at a time.

Peptic Ulcers. The bacteria Helicobacter pylori (H. pylori) and use of NSAIDs can cause peptic ulcers. Peptic ulcers can wear away your mucosa and cause GI bleeding.

Diagnosis

How do doctors diagnose GI bleeding?

To diagnose gastrointestinal (GI) bleeding, a doctor will first find the site of the bleeding based on your medical history—including what medicines you are taking—and family history, a physical exam, and diagnostic tests.

Physical exam

During a physical exam, a doctor most often

• examines your body
• listens to sounds in your abdomen using a stethoscope
• taps on specific areas of your body

Diagnostic tests

Depending on your symptoms, your doctor will order one or more diagnostic tests to confirm whether you have GI bleeding and, if so, to help find the source of the bleeding.

What tests do doctors use to diagnose GI bleeding?

Your doctor may perform the following tests to help diagnose the cause of your GI bleeding.

Lab tests

Lab tests to help diagnose the cause of your GI bleeding include:

Stool tests. A stool test is the analysis of a sample of stool. Your doctor will give you a container for catching and storing the stool. You will receive instructions on where to send or take the kit for analysis. Stool tests can show occult bleeding.

Blood tests. A health care professional may take a blood sample from you and send the sample to a lab to test. The blood test can help determine the extent of your bleeding and whether you have anemia.

Gastric lavage

A gastric lavage is a procedure in which a doctor passes a tube through your nose or mouth into your stomach to remove your stomach contents to determine the possible location of your GI bleeding. A doctor may also use gastric lavage to help prepare for another diagnostic test or, most often, for acute, severe bleeding. The doctor performs this procedure in an outpatient center or a hospital. You most often receive a liquid anesthetic to numb your throat.

Endoscopy

Endoscopy procedures involve a doctor examining a hollow passage in your body using a special instrument. An endoscopy procedure may help your doctor see if and where you have GI bleeding and the bleeding’s cause. Doctors most often use upper GI endoscopy and colonoscopy to test for acute GI bleeding in the upper and lower GI tracts.^4,5

Upper GI endoscopy. In an upper GI endoscopy, your doctor feeds an endoscope down your esophagus and into your stomach and duodenum. A trained specialist performs the procedure at a hospital or an outpatient center. You most often receive a liquid anesthetic to numb your throat and a light sedative to help you stay relaxed and comfortable during the procedure.

Enteroscopy. During an enteroscopy, a doctor examines your small intestine with a special, longer endoscope.

Capsule endoscopy. In capsule endoscopy, you swallow a capsule containing a tiny camera that allows your doctor to see inside your GI tract. You don’t need anesthesia for this procedure. The test begins in a doctor’s office, where you swallow the capsule. As the capsule passes through your GI tract, the camera will record images that your doctor later downloads and reviews. The camera capsule leaves your body during a bowel movement.

Colonoscopy. Colonoscopy is a procedure in which a doctor uses a long, flexible, narrow tube with a light and tiny camera on one end, called a colonoscope or scope, to look inside your rectum and colon. A trained specialist performs a colonoscopy in a hospital or an outpatient center. You will receive sedatives, anesthesia, or pain medicine during the procedure. The doctor can see and treat any GI bleeding during a colonoscopy.

Flexible sigmoidoscopy. Flexible sigmoidoscopy is a procedure in which a doctor uses a flexible, narrow tube with a light and tiny camera on one end, called a sigmoidoscope or scope, to look inside your rectum and sigmoid colon and treat any bleeding. A trained specialist performs a flexible sigmoidoscopy at a doctor’s office, a hospital, or an outpatient center. You do not need anesthesia for this procedure.

Imaging tests

To help find the cause of your GI bleeding, your doctor may order one or more of the following imaging tests. You do not need anesthesia for these tests.

Abdominal CT scan. An abdominal computerized tomography (CT) scan uses a combination of x-rays and computer technology to create images of your GI tract. An x-ray technician performs the procedure in an outpatient center or a hospital. A radiologist reads and reports on the images.

Lower GI series. A lower GI series is a procedure in which a doctor uses x-rays and a chalky liquid called barium to view your large intestine. An x-ray technician and a radiologist perform a lower GI series at a hospital or an outpatient center.

Upper GI series. An upper GI series is a procedure in which a doctor uses x-rays, fluoroscopy, and a chalky liquid called barium to view your upper GI tract. An x-ray technician and a radiologist perform an upper GI series at a hospital or an outpatient center.

Angiogram. An angiogram is a special kind of x-ray in which a radiologist threads a catheter through your large arteries. The radiologist performs the procedure and interprets the images in a hospital or an outpatient center. You may receive a light sedative to help you stay relaxed and comfortable during the procedure.

Radionuclide scan. A radionuclide scan can help your doctor find the cause of your GI bleeding. A specially trained technician performs this scan in an outpatient center or a hospital. The technician injects a mixture of your blood and radioactive material into your body to highlight the area in your body that is bleeding. The dose of radioactive chemicals is small, so the chance of it causing damage to your cells is low. A special camera takes pictures that highlight the radioactive material.

Procedures to examine the GI tract

If none of the other tests help your doctor diagnose the source of your GI bleeding, a surgeon may perform one of the following operations to examine your GI tract:

Laparotomy. During a laparotomy, a surgeon will make a single cut in your abdomen and explore the abdomen. During the operation, the surgeon can treat the problems that cause the bleeding. You will receive general anesthesia.

Laparoscopy. During a laparoscopy, a surgeon uses a laparoscope to make several small cuts in your abdomen. The surgeon inserts special tools and a camera to try to locate and treat the source of the bleeding. You will receive general anesthesia.

References

Treatment

How do doctors treat GI bleeding?

Treatment of gastrointestinal (GI) bleeding depends on the cause and location of your bleeding.

Treatment during a diagnostic procedure

During an upper GI endoscopy, a lower GI endoscopy, a colonoscopy, a flexible sigmoidoscopy, or a laparotomy, a doctor can stop the bleeding in your GI tract. He or she can stop the bleeding by inserting tools through an endoscope, colonoscope, or sigmoidoscope to

• inject medicines into the bleeding site
• treat the bleeding site and surrounding tissue with a heat probe, an electric current, or a laser
• close affected blood vessels with a band or clip

During an angiogram, a radiologist can inject medicines or other materials into blood vessels to stop some types of bleeding.

Learn more about the procedures doctors use to diagnose GI bleeding.

Medicines

When infections or ulcers cause bleeding in your GI tract, health care professionals prescribe medicines to treat the problem.

Surgery

When a person has severe acute bleeding or bleeding that does not stop, a surgeon may need to perform a laparoscopy or a laparotomy to stop the bleeding.

How can I prevent GI bleeding?

Doctors can prevent GI bleeding by treating the conditions that cause the bleeding. You can prevent some of the causes of bleeding in your GI tract by

• limiting the amount of nonsteroidal anti-inflammatory drugs (NSAIDs) you take or by talking with your health care professional about other medicine options
• following your doctor’s recommendations for treatment of gastroesophageal reflux (GER)

Eating, Diet, & Nutrition

What should I eat if I have GI bleeding?

If you have a history of gastrointestinal (GI) bleeding from diverticular disease, anal fissures, or hemorrhoids, you should follow the diet your health care professional recommends.

What should I avoid if I have GI bleeding?

If you have had bleeding from peptic ulcers or gastritis, you can help prevent GI bleeding by avoiding alcoholic drinks and smoking. Alcohol and smoking can increase stomach acids and lead to ulcers. Do not drink alcoholic beverages or smoke if you have GI bleeding.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.?

Definition & Facts

What are hemorrhoids?

Hemorrhoids, also called piles, are swollen and inflamed veins around your anus or in your lower rectum.

The two types of hemorrhoids are

• external hemorrhoids, which form under the skin around the anus
• internal hemorrhoids, which form in the lining of the anus and lower rectum

How common are hemorrhoids?

Hemorrhoids are common in both men and women¹ and affect about 1 in 20 Americans.² About half of adults older than age 50 have hemorrhoids.²

Who is more likely to get hemorrhoids?

You are more likely to get hemorrhoids if you

• strain during bowel movements
• sit on the toilet for long periods of time
• have chronic constipation or diarrhea
• eat foods that are low in fiber
• are older than age 50
• are pregnant
• often lift heavy objects

What are the complications of hemorrhoids?

Complications of hemorrhoids can include the following:

• blood clots in an external hemorrhoid
• skin tags—extra skin left behind when a blood clot in an external hemorrhoid dissolves
• infection of a sore on an external hemorrhoid
• strangulated hemorrhoid—when the muscles around your anus cut off the blood supply to an internal hemorrhoid that has fallen through your anal opening
• anemia

References

Symptoms & Causes

What are the symptoms of hemorrhoids?

The symptoms of hemorrhoids depend on the type you have.

If you have external hemorrhoids, you may have

• anal itching
• one or more hard, tender lumps near your anus
• anal ache or pain, especially when sitting

Too much straining, rubbing, or cleaning around your anus may make your symptoms worse. For many people, the symptoms of external hemorrhoids go away within a few days.

If you have internal hemorrhoids, you may have

• bleeding from your rectum––bright red blood on stool, on toilet paper, or in the toilet bowl after a bowel movement
• a hemorrhoid that has fallen through your anal opening, called prolapse

Internal hemorrhoids that are not prolapsed most often are not painful. Prolapsed internal hemorrhoids may cause pain and discomfort.

Although hemorrhoids are the most common cause of anal symptoms, not every anal symptom is caused by a hemorrhoid. Some hemorrhoid symptoms are similar to those of other digestive tract problems. For example, bleeding from your rectum may be a sign of bowel diseases such as Crohn’s disease, ulcerative colitis, or cancer of the colon or rectum.

When should I seek a doctor’s help?

You should seek a doctor’s help if you

• still have symptoms after 1 week of at-home treatment
• have bleeding from your rectum

What causes hemorrhoids?

The causes of hemorrhoids include

• straining during bowel movements
• sitting on the toilet for long periods of time
• chronic constipation or diarrhea
• a low-fiber diet
• weakening of the supporting tissues in your anus and rectum that happens with aging
• pregnancy
• often lifting heavy objects

Diagnosis

How are hemorrhoids diagnosed?

Your doctor can often diagnose hemorrhoids based on your medical history and a physical exam. He or she can diagnose external hemorrhoids by checking the area around your anus. To diagnose internal hemorrhoids, your doctor will perform a digital rectal exam and may perform procedures to look inside your anus and rectum.

Medical history

Your doctor will ask you to provide your medical history and describe your symptoms. He or she will ask you about your eating habits, toilet habits, enema and laxative use, and current medical conditions.

Physical exam

Your doctor will check the area around your anus for

• lumps or swelling
• internal hemorrhoids that have fallen through your anal opening, called prolapse
• external hemorrhoids with a blood clot in a vein
• leakage of stool or mucus
• skin irritation
• skin tags––extra skin that is left behind when a blood clot in an external hemorrhoid dissolves
• anal fissures—a small tear in the anus that may cause itching, pain, or bleeding

Your doctor will perform a digital rectal exam to

• check the tone of the muscles in your anus
• check for tenderness, blood, internal hemorrhoids, and lumps or masses

Procedures

Your doctor may use the following procedures to diagnose internal hemorrhoids:

• Anoscopy. For an anoscopy, your doctor uses an anoscope to view the lining of your anus and lower rectum. Your doctor will carefully examine the tissues lining your anus and lower rectum to look for signs of lower digestive tract problems and bowel disease. Your doctor performs an anoscopy during an office visit or at an outpatient center. Most patients do not need anesthesia.
• Rigid proctosigmoidoscopy. Rigid proctosigmoidoscopy is similar to anoscopy, except that your doctor uses an instrument called a proctoscope to view the lining of your rectum and lower colon. Your doctor will carefully examine the tissues lining your rectum and lower colon to look for signs of lower digestive tract problems and bowel disease. Your doctor performs this procedure during an office visit or at an outpatient center or a hospital. Most patients do not need anesthesia.

Your doctor may diagnose internal hemorrhoids while performing procedures for other digestive tract problems or during routine examination of your rectum and colon. These procedures include colonoscopy and flexible sigmoidoscopy.

Treatment

How can I treat my hemorrhoids?

You can most often treat your hemorrhoids at home by

• eating foods that are high in fiber
• taking a stool softener or a fiber supplement such as psyllium (Metamucil) or methylcellulose (Citrucel)
• drinking water or other nonalcoholic liquids each day as recommended by your health care professional
• not straining during bowel movements
• not sitting on the toilet for long periods of time
• taking over-the-counter pain relievers such as acetaminophen, ibuprofen, naproxen, or aspirin
• sitting in a tub of warm water, called a sitz bath, several times a day to help relieve pain

Applying over-the-counter hemorrhoid creams or ointments or using suppositories—a medicine you insert into your rectum—may relieve mild pain, swelling, and itching of external hemorrhoids. Most often, doctors recommend using over-the-counter products for 1 week. You should follow up with your doctor if the products

• do not relieve your symptoms after 1 week
• cause side effects such dry skin around your anus or a rash

Most prolapsed internal hemorrhoids go away without at-home treatment. However, severely prolapsed or bleeding internal hemorrhoids may need medical treatment.

How do doctors treat hemorrhoids?

Doctors treat hemorrhoids with procedures during an office visit or in an outpatient center or a hospital.

Office treatments include the following:

• Rubber band ligation. Rubber band ligation is a procedure that doctors use to treat bleeding or prolapsing internal hemorrhoids. A doctor places a special rubber band around the base of the hemorrhoid. The band cuts off the blood supply. The banded part of the hemorrhoid shrivels and falls off, most often within a week. Scar tissue forms in the remaining part of the hemorrhoid, often shrinking the hemorrhoid. Only a doctor should perform this procedure—you should never try this treatment yourself.
• Sclerotherapy. A doctor injects a solution into an internal hemorrhoid, which causes scar tissue to form. The scar tissue cuts off the blood supply, often shrinking the hemorrhoid.
• Infrared photocoagulation. A doctor uses a tool that directs infrared light at an internal hemorrhoid. Heat created by the infrared light causes scar tissue to form, which cuts off the blood supply, often shrinking the hemorrhoid.
• Electrocoagulation. A doctor uses a tool that sends an electric current into an internal hemorrhoid. The electric current causes scar tissue to form, which cuts off the blood supply, often shrinking the hemorrhoid.

Outpatient center or hospital treatments include the following:

• Hemorrhoidectomy. A doctor, most often a surgeon, may perform a hemorrhoidectomy to remove large external hemorrhoids and prolapsing internal hemorrhoids that do not respond to other treatments. Your doctor will give you anesthesia for this treatment.
• Hemorrhoid stapling. A doctor, most often a surgeon, may use a special stapling tool to remove internal hemorrhoid tissue and pull a prolapsing internal hemorrhoid back into the anus. Your doctor will give you anesthesia for this treatment.

Sometimes complications of hemorrhoids also require treatment.

How can I prevent hemorrhoids?

You can help prevent hemorrhoids by

• eating foods that are high in fiber
• drinking water or other nonalcoholic liquids each day as recommended by your health care professional
• not straining during bowel movements
• not sitting on the toilet for long periods of time
• avoiding regular heavy lifting

Eating, Diet, & Nutrition

What should I eat if I have hemorrhoids?

Your doctor may recommend that you eat more foods that are high in fiber. Eating foods that are high in fiber can make stools softer and easier to pass and can help treat and prevent hemorrhoids. Drinking water and other liquids, such as fruit juices and clear soups, can help the fiber in your diet work better. Ask your doctor about how much you should drink each day based on your health and activity level and where you live.

The 2015-2020 Dietary Guidelines for Americans recommends a dietary fiber intake of 14 grams per 1,000 calories consumed. For example, for a 2,000-calorie diet, the fiber recommendation is 28 grams per day.

The amount of fiber in a food is listed on the food’s nutrition facts label. Some fiber-rich foods are listed in the table below.

A doctor or dietitian can help you learn how to add more high-fiber foods to your diet.

What should I avoid eating if I have hemorrhoids?

If your hemorrhoids are caused by chronic constipation, try not to eat too many foods with little or no fiber, such as

• cheese
• chips
• fast food
• ice cream
• meat
• prepared foods, such as some frozen and snack foods
• processed foods, such as hot dogs and some microwavable dinners

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.?

Definition & Facts

What is indigestion?

Indigestion, also called dyspepsia or upset stomach, is a general term that describes a group of gastrointestinal symptoms that occur together. These symptoms most often include

• pain, a burning feeling, or discomfort in your upper abdomen
• feeling full too soon while eating a meal
• feeling uncomfortably full after eating a meal

Indigestion may be

• occasional—happening once in a while
• chronic—happening regularly for a few weeks or months
• functional—having chronic symptoms without a specific cause

Indigestion is not a disease. However, indigestion may be a sign of certain digestive tract diseases or conditions. Indigestion is not always related to eating.

Sometimes digestive tract diseases such as peptic ulcer disease, gastritis, and stomach cancer cause chronic indigestion. However, most often doctors do not know what causes chronic indigestion. Chronic indigestion without a health problem or digestive tract disease that could explain symptoms is called functional dyspepsia.

How common is indigestion?

Indigestion is a common condition, affecting about 1 in 4 people in the United States each year.¹

Of those people with indigestion who see a doctor, almost 3 in 4 are diagnosed with functional dyspepsia.²

Who is more likely to get indigestion?

You are more likely to get indigestion if you

• drink
  • too many alcoholic beverages
  • too much coffee or too many drinks containing caffeine
• eat
  • too fast or too much during a meal
  • spicy, fatty, or greasy foods
  • foods that contain a lot of acid, such as tomatoes, tomato products, and oranges
• feel stressed
• have certain health problems or digestive tract diseases
• smoke
• take certain medicines

What are the complications of indigestion?

In most cases, indigestion does not have complications, although it may affect your quality of life.

References

Symptoms & Causes

What are the symptoms of indigestion?

When you have indigestion, you may have one or more of the following symptoms:

• pain, a burning feeling, or discomfort in your upper abdomen
• feeling full too soon while eating a meal
• feeling uncomfortably full after eating a meal
• bloating
• burping

Other symptoms may include

• burping up food or liquid
• loud growling or gurgling in your stomach
• nausea
• gas

Sometimes when you have indigestion, you may also have heartburn. However, heartburn and indigestion are two separate conditions.

Seek care right away

If you have indigestion and any of the following symptoms, you may have a more serious condition and should see a doctor right away:

• black, tarlike stools
• bloody vomit
• difficulty swallowing or painful swallowing
• frequent vomiting
• losing weight without trying
• pain in your chest, jaw, neck, or arm
• severe and constant pain in your abdomen
• shortness of breath
• sweating
• yellowing of your eyes or skin

You should also see a doctor if your indigestion lasts longer than 2 weeks.

What causes indigestion?

Some of the causes of indigestion include

• drinking
  • too many alcoholic beverages
  • too much coffee or too many drinks containing caffeine
  • too many carbonated, or fizzy, drinks
• eating
  • too fast or too much during a meal
  • spicy, fatty, or greasy foods
  • foods that contain a lot of acid, such as tomatoes, tomato products, and oranges
• feeling stressed
• smoking

Some medicines can cause indigestion, such as

• certain antibiotics—medicines that kill bacteria
• nonsteroidal anti-inflammatory drugs

Health problems and digestive tract diseases and conditions can cause indigestion, including

• acid reflux (GER and GERD)
• anxiety or depression
• gallbladder inflammation
• gastritis
• gastroparesis
• Helicobacter pylori (H. pylori) infection
• irritable bowel syndrome
• lactose intolerance
• peptic ulcer disease
• stomach cancer

Researchers do not know what causes functional dyspepsia. Some research³ suggests that the following factors may play a role in functional dyspepsia:

• eating
• gastroparesis
• problems in the first part of your small intestine, including inflammation and being overly sensitive to stomach acids
• infection by microorganisms such as H. pylori, Salmonella, Escherichia coli (E. coli), Campylobacter, giardia, or norovirus
• psychological problems, especially anxiety
• genes—a trait passed from parent to child

References

Diagnosis

How do doctors diagnose indigestion?

Your doctor diagnoses indigestion based on your medical history, a physical exam, upper gastrointestinal (GI) endoscopy, and other tests.

Medical history

Your doctor will review your symptoms and medical history. He or she will ask you about your eating and drinking habits, your use of over-the-counter and prescription medicines, and whether you smoke.

Physical exam

During a physical exam, your doctor may

• check for bloating
• listen to sounds in your abdomen using a stethoscope
• tap on your abdomen to check for tenderness, pain, and lumps
• look for yellowing of your eyes or skin

Upper GI endoscopy

Your doctor may perform an upper GI endoscopy to diagnose diseases and conditions that may be causing your indigestion, such as

• gastritis
• peptic ulcer disease
• stomach cancer

A doctor may recommend an upper GI endoscopy for people with indigestion who are older than 55 or for people with indigestion of any age who have

• a family history of cancer
• difficulty swallowing
• evidence of bleeding in the digestive tract
• frequent vomiting
• weight loss

During an upper GI endoscopy, your doctor can use tiny tools passed through the endoscope to take small pieces of tissue from the lining of your stomach and duodenum. This procedure is called an upper GI biopsy. A doctor will examine the tissue samples to look for digestive tract diseases and conditions, including Helicobacter pylori (H. pylori) infection.

Other tests

Imaging tests. Your doctor may use imaging tests such as x-rays, computed tomography (CT) scans, or ultrasound to look for diseases and conditions in your digestive tract that may be causing your indigestion.

H. pylori testing. Your doctor can detect an H. pylori infection by using blood, stool, or breath tests or by performing an upper GI biopsy.

Blood test. A health care professional may take a blood sample from you and send the sample to a lab to test for signs of H. pylori infection.

Stool test. Your doctor may use stool tests to look for signs of H. pylori infection. Your doctor may also use a stool test to see if treatment has worked to get rid of H. pylori.

Urea breath test. Your doctor may use a urea breath test to check for H. pylori infection. You will swallow a capsule, liquid, or pudding that contains urea—a waste product the body produces as it breaks down protein. The urea is “labeled” with a special carbon atom. If H. pylori are present, the bacteria will convert the urea into carbon dioxide. After a few minutes, you will breathe into a container, exhaling carbon dioxide. A health care professional will test your exhaled breath for labeled carbon dioxide. If the test detects the labeled carbon atoms, the health care professional will confirm an H. pylori infection in your digestive tract. A doctor can also use this test to see if treatment has worked to get rid of H. pylori.

Treatment

How do doctors treat indigestion?

Treatment for indigestion depends on the cause and may include

• over-the-counter and prescription medicines
• changing what you eat and drink
• psychological therapies

Over-the-counter and prescription medicines

You can buy many medicines to treat indigestion without a prescription, such as antacids, H2 blockers, or proton pump inhibitors. However, if your indigestion lasts longer than 2 weeks, you should see your doctor. Your doctor may prescribe acid-suppressing medicines that are stronger than the ones you can buy, antibiotics, prokinetics, or psychological medicines.

Antacids. Doctors often first recommend antacids—over-the-counter medicines that neutralize acids in your stomach. Antacids include

• calcium carbonate (Rolaids, Tums)
• loperamide (Imodium)
• simethicone (Maalox, Mylanta)
• sodium bicarbonate (Alka-Seltzer)

Antibiotics. To treat a Helicobacter pylori (H. pylori) infection, your doctor will prescribe antibiotics—medicines that kill bacteria. He or she will prescribe at least two of the following:

• amoxicillin (Amoxil)
• clarithromycin (Biaxin)
• metronidazole (Flagyl)
• tetracycline (Sumycin)
• tinidazole (Tindamax)

H2 blockers. H2 blockers are medicines that decrease the amount of acid your stomach produces. H2 blockers provide short-term or on-demand relief for many people with indigestion. You can buy an H2 blocker or your doctor can prescribe one. H2 blockers include

• cimetidine (Tagamet HB)
• famotidine (Pepcid AC)
• nizatidine (Axid AR)
• ranitidine (Zantac 75)

Proton pump inhibitors (PPIs). PPIs are most effective in treating indigestion if you also have heartburn. You can buy some PPIs or your doctor can prescribe one. PPIs include

• esomeprazole (Nexium)
• lansoprazole (Prevacid)
• omeprazole (Prilosec, Zegerid)
• pantoprazole (Protonix)
• rabeprazole (AcipHex)

Prokinetics. Prokinetics help your stomach empty faster. Prescription prokinetics include

• bethanechol (Urecholine)
• metoclopramide (Reglan)

Changes in what you eat and drink

Your doctor may recommend that you avoid certain foods and drinks that may cause indigestion or make your symptoms worse, such as

• alcoholic beverages
• carbonated, or fizzy, drinks
• foods or drinks that contain caffeine
• foods that contain a lot of acid, such as tomatoes, tomato products, and oranges
• spicy, fatty, or greasy foods

Psychological therapies

Your doctor may recommend a type of psychological therapy called “talk therapy” to help treat anxiety and depression that may be causing your indigestion. If stress is causing your indigestion, your doctor may recommend ways to help you reduce your stress, such as meditation, relaxation exercises, or counseling. Talk therapy can also help you learn how to reduce your stress.

What can I do to help prevent indigestion?

In addition to making changes in what you eat and drink, you can help prevent indigestion by making lifestyle changes such as

• avoiding exercise right after eating
• chewing food carefully and completely
• losing weight
• not eating late-night snacks
• not taking a lot of nonsteroidal anti-inflammatory drugs
• quitting smoking
• trying to reduce stress in your life
• waiting 2 to 3 hours after eating before you lie down

Eating, Diet, & Nutrition

How can my diet help prevent indigestion?

You can help prevent indigestion by changing what you eat and drink. You may need to avoid foods and drinks that cause indigestion.

What foods and drinks should I avoid if I have indigestion?

If you have indigestion, avoid foods and drinks that may make your symptoms worse, such as

• alcoholic beverages
• carbonated, or fizzy, drinks
• foods and drinks that contain caffeine
• foods that contain a lot of acid, such as tomatoes, tomato products, and oranges
• spicy, fatty, or greasy foods

What can I eat if I have indigestion?

You should eat a healthy, well-balanced diet. A healthy diet can improve your overall health, help manage certain diseases and conditions, and reduce the chance of disease.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

Definition & Facts

What is IBS?

Irritable bowel syndrome (IBS) is a group of symptoms—including pain or discomfort in your abdomen and changes in your bowel movement patterns—that occur together. Doctors call IBS a functional gastrointestinal (GI) disorder. Functional GI disorders happen when your GI tract behaves in an abnormal way without evidence of damage due to a disease.

Does IBS have another name?

In the past, doctors called IBS colitis, mucous colitis, spastic colon, nervous colon, and spastic bowel. Experts changed the name to reflect the understanding that the disorder has both physical and mental causes and isn’t a product of a person’s imagination.

What are the four types of IBS?

Doctors often classify IBS into one of four types based on your usual stool consistency. These types are important because they affect the types of treatment that are most likely to improve your symptoms.

The four types of IBS are

• IBS with constipation, or IBS-C
  • hard or lumpy stools at least 25 percent of the time
  • loose or watery stools less than 25 percent of the time
• IBS with diarrhea, or IBS-D
  • loose or watery stools at least 25 percent of the time
  • hard or lumpy stools less than 25 percent of the time
• Mixed IBS, or IBS-M
  • hard or lumpy stools at least 25 percent of the time
  • loose or watery stools at least 25 percent of the time
• Unsubtyped IBS, or IBS-U
  • hard or lumpy stools less than 25 percent of the time
  • loose or watery stools less than 25 percent of the time

How common is IBS?

Studies estimate that IBS affects 10 to 15 percent of U.S. adults.¹ However, only 5 to 7 percent of U.S. adults have received a diagnosis of IBS.²

Who is more likely to develop IBS?

IBS affects about twice as many women as men and most often occurs in people younger than age 45.¹

What other health problems do people with IBS have?

People with IBS often suffer from other GI and non-GI conditions. GI conditions such as gastroesophageal reflux disease and dyspepsia are more common in people with IBS than the general population.

Non-GI conditions that people with IBS often have include

• chronic fatigue syndrome
• chronic pelvic pain
• temporomandibular joint disorders
• depression
• anxiety
• somatoform disorders

References

Symptoms & Causes

What are the symptoms of IBS?

The most common symptoms of irritable bowel syndrome (IBS) include pain or discomfort in your abdomen and changes in how often you have bowel movements or how your stools look. The pain or discomfort of IBS may feel like cramping and have at least two of the following:

• Your pain or discomfort improves after a bowel movement.
• You notice a change in how often you have a bowel movement.
• You notice a change in the way your stools look.

IBS is a chronic disorder, meaning it lasts a long time, often years. However, the symptoms may come and go. You may have IBS if:

• You’ve had symptoms at least three times a month for the past 3 months.
• Your symptoms first started at least 6 months ago.

People with IBS may have diarrhea, constipation, or both. Some people with IBS have only diarrhea or only constipation. Some people have symptoms of both or have diarrhea sometimes and constipation other times. People often have symptoms soon after eating a meal.

Other symptoms of IBS are

• bloating
• the feeling that you haven’t finished a bowel movement
• whitish mucus in your stool

Women with IBS often have more symptoms during their menstrual periods.

While IBS can be painful, IBS doesn’t lead to other health problems or damage your gastrointestinal (GI) tract.

What causes IBS?

Doctors aren’t sure what causes IBS. Experts think that a combination of problems can lead to IBS.

Physical Problems

Brain-Gut Signal Problems

Signals between your brain and the nerves of your gut, or small and large intestines, control how your gut works. Problems with brain-gut signals may cause IBS symptoms.

GI Motility Problems

If you have IBS, you may not have normal motility in your colon. Slow motility can lead to constipation and fast motility can lead to diarrhea. Spasms can cause abdominal pain. If you have IBS, you may also experience hyperreactivity—a dramatic increase in bowel contractions when you feel stress or after you eat.

Pain Sensitivity

If you have IBS, the nerves in your gut may be extra sensitive, causing you to feel more pain or discomfort than normal when gas or stool is in your gut. Your brain may process pain signals from your bowel differently if you have IBS.

Infections

A bacterial infection in the GI tract may cause some people to develop IBS. Researchers don’t know why infections in the GI tract lead to IBS in some people and not others, although abnormalities of the GI tract lining and mental health problems may play a role.

Small Intestinal Bacterial Overgrowth

Normally, few bacteria live in your small intestine. Small intestinal bacterial overgrowth is an increase in the number or a change in the type of bacteria in your small intestine. These bacteria can produce extra gas and may also cause diarrhea and weight loss. Some experts think small intestinal bacterial overgrowth may lead to IBS. Research continues to explore a possible link between the two conditions.

Neurotransmitters (Body Chemicals)

People with IBS have altered levels of neurotransmitters—chemicals in the body that transmit nerve signals—and GI hormones. The role these chemicals play in IBS is unclear.

Younger women with IBS often have more symptoms during their menstrual periods. Post-menopausal women have fewer symptoms compared with women who are still menstruating. These findings suggest that reproductive hormones can worsen IBS problems.

Genetics

Whether IBS has a genetic cause, meaning it runs in families, is unclear. Studies have shown IBS is more common in people with family members who have a history of GI problems.

Food Sensitivity

Many people with IBS report that foods rich in carbohydrates, spicy or fatty foods, coffee, and alcohol trigger their symptoms. However, people with food sensitivity typically don’t have signs of a food allergy. Researchers think that poor absorption of sugars or bile acids may cause symptoms.

Mental Health Problems

Psychological, or mental health, problems such as panic disorder, anxiety, depression, and post-traumatic stress disorder are common in people with IBS. The link between mental health and IBS is unclear. GI disorders, including IBS, are sometimes present in people who have reported past physical or sexual abuse. Experts think people who have been abused tend to express psychological stress through physical symptoms.

If you have IBS, your colon may respond too much to even slight conflict or stress. Stress makes your mind more aware of the sensations in your colon. IBS symptoms can also increase your stress level.

Diagnosis

How do doctors diagnose IBS?

Your doctor may be able to diagnose irritable bowel syndrome (IBS) based on a review of your medical history, symptoms, and physical exam. Your doctor may also order tests.

To diagnose IBS, your doctor will take a complete medical history and perform a physical exam.

Medical History

The medical history will include questions about

• your symptoms
• family history of gastrointestinal (GI) tract disorders
• recent infections
• medicines
• stressful events related to the start of your symptoms

Your doctor will look for a certain pattern in your symptoms. Your doctor may diagnose IBS if

• your symptoms started at least 6 months ago
• you’ve had pain or discomfort in your abdomen at least three times a month for the past 3 months
• your abdominal pain or discomfort has two or three of the following features:
  • Your pain or discomfort improves after a bowel movement.
  • You notice a change in how often you have a bowel movement.
  • You notice a change in the way your stools look.

Physical Exam

During a physical exam, your doctor usually

• checks for abdominal bloating
• listens to sounds within your abdomen using a stethoscope
• taps on your abdomen checking for tenderness or pain

What tests do doctors use to diagnose IBS?

In most cases, doctors don’t need to perform tests to diagnose IBS. Your doctor may perform a blood test to check for other conditions or problems. Your doctor may perform more tests based on the results of the blood test and if you have

• a family history of celiac disease, colon cancer, or inflammatory bowel disease
• a fever
• anemia
• bleeding from your rectum
• weight loss

Blood test

Doctors use blood tests to check for conditions or problems other than IBS. A health care professional sends your blood sample to a lab.

Stool test

A stool test is the analysis of a sample of stool. Your doctor will give you a container for catching and holding a stool sample. You will receive instructions on where to send or take the kit for analysis, to check for blood or parasites. Your doctor may also check for blood in your stool by examining your rectum during your physical exam.

Flexible sigmoidoscopy

Flexible sigmoidoscopy is a procedure that uses a flexible, narrow tube with a light and tiny camera (called a sigmoidoscope) on one end to look inside your rectum and lower colon.

This procedure can show signs of conditions or problems in the lower GI tract. During the procedure, the doctor can take a biopsy. You won’t feel the biopsy.

Colonoscopy

Colonoscopy is a procedure that uses a long, flexible, narrow tube with a light and tiny camera (called a colonoscope) on one end to look inside your rectum and colon.

Colonoscopy can show irritated or swollen tissue, ulcers, polyps, and cancer. A trained specialist performs this procedure.

Lower GI series

A lower GI series, also called a Barium Enema, uses x-rays to look at your large intestine.

During a lower GI series, you’ll be asked to lie on a table while the doctor inserts a flexible tube into your anus. The doctor will fill your large intestine with barium. You may be asked to change positions several times during the test.

Treatment

How do doctors treat IBS?

Though irritable bowel syndrome (IBS) doesn’t have a cure, your doctor can manage the symptoms with a combination of diet, medicines, probiotics, and therapies for mental health problems. You may have to try a few treatments to see what works best for you. Your doctor can help you find the right treatment plan.

Changes in eating, diet, and nutrition

Changes in eating, diet, and nutrition, such as following a FODMAP diet, can help treat your symptoms.

Medicines

Your doctor may recommend medicine to relieve your symptoms.

• Fiber supplements to relieve constipation when increasing fiber in your diet doesn’t help.
• Laxatives to help with constipation. Laxatives work in different ways, and your doctor can recommend a laxative that’s right for you.
• Loperamide to reduce diarrhea by slowing the movement of stool through your colon. Loperamide is an antidiarrheal that reduces diarrhea in people with IBS, though it doesn’t reduce pain, bloating, or other symptoms.
• Antispasmodics, such as hyoscine, cimetropium, and pinaverium, help to control colon muscle spasms and reduce pain in your abdomen. 
• Antidepressants, such as low doses of tricyclic antidepressants and selective serotonin reuptake inhibitors, to relieve IBS symptoms, including abdominal pain. In theory, because of their effect on colon transit, tricyclic antidepressants should be better for people with IBS with diarrhea, or IBS-D, and selective serotonin reuptake inhibitors should be better for people with IBS with constipation, or IBS-C, although studies haven’t confirmed this theory. Tricyclic antidepressants work in people with IBS by reducing their sensitivity to pain in the gastrointestinal (GI) tract as well as normalizing their GI motility and secretion.
• Lubiprostone (Amitiza) for people who have IBS-C to improve abdominal pain or discomfort and constipation symptoms. 
• Linaclotide (Linzess) for people who have IBS-C to relieve abdominal pain and increase how often you have bowel movements.
• The antibiotic rifaximin to reduce bloating by treating small intestinal bacterial overgrowth. However, experts are still debating and researching the use of antibiotics to treat IBS.
• Coated peppermint oil capsules to reduce IBS symptoms.

Follow your doctor’s instructions when you use medicine to treat IBS. Talk with your doctor about possible side effects and what to do if you have them.

Some medicines can cause side effects. Ask your doctor and your pharmacist about side effects before taking any medicine. MedlinePlus maintains the latest information about side effects and drug warnings.

Probiotics

Your doctor may also recommend probiotics. Probiotics are live microorganisms—tiny organisms that can be seen only with a microscope. These microorganisms, most often bacteria, are like the microorganisms that are normally present in your GI tract. Studies have found that taking large enough amounts of probiotics, specifically Bifidobacteria and certain probiotic combinations, can improve symptoms of IBS. However, researchers are still studying the use of probiotics to treat IBS.

You can find probiotics in dietary supplements, such as capsules, tablets, and powders, and in some foods, such as yogurt.

Discuss your use of complementary and alternative medical practices, including probiotics and dietary supplements, with your doctor.

Therapies for mental health problems

Psychological therapies may improve your IBS symptoms.

Managing Stress

Learning to reduce stress can help improve IBS. With less stress, you may find you have less cramping and pain. You may also find it easier to manage your symptoms.

Some options for managing stress include

• taking part in stress reduction and relaxation therapies such as meditation
• getting counseling and support
• taking part in regular exercise such as walking or yoga
• reducing stressful life situations as much as possible
• getting enough sleep

Talk Therapy

Talk therapy may reduce stress and improve your IBS symptoms. Two types of talk therapy that health care professionals use to treat IBS are cognitive behavioral therapy and psychodynamic, or interpersonal, therapy. Cognitive behavioral therapy focuses on your thoughts and actions. Psychodynamic therapy focuses on how your emotions affect your IBS symptoms. This type of therapy often involves relaxation and stress management techniques.

Gut-Directed Hypnotherapy

In gut-directed hypnotherapy, a therapist uses hypnosis to help you relax the muscles in the colon.

Mindfulness Training

Mindfulness training can teach you to focus your attention on sensations occurring at the moment and to avoid catastrophizing, or worrying about the meaning of those sensations.

Eating, Diet, & Nutrition

How can my diet treat the symptoms of IBS?

Eating smaller meals more often, or eating smaller portions, may help your irritable bowel syndrome (IBS) symptoms. Large meals can cause cramping and diarrhea if you have IBS.

Eating foods that are low in fat and high in carbohydrates, such as pasta, rice, whole-grain breads and cereals, fruits, and vegetables, may help.

Fiber may improve constipation symptoms caused by IBS because it makes stool soft and easier to pass. Fiber is a part of foods such as whole-grain breads and cereals, beans, fruits, and vegetables. The U.S. Department of Agriculture and U.S. Department of Health and Human Services state in its Dietary Guidelines for Americans, 2010 (PDF, 2.963 MB) that adults should get 22 to 34 grams of fiber a day.³

While fiber may help constipation, it may not reduce the abdominal discomfort or pain of IBS. In fact, some people with IBS may feel a bit more abdominal discomfort after adding more fiber to their diet. Add foods with fiber to your diet a little at a time to let your body get used to them. Too much fiber at once can cause gas, which can trigger symptoms in people with IBS. Adding fiber to your diet slowly, by 2 to 3 grams a day, may help prevent gas and bloating.

What should I avoid eating to ease IBS symptoms?

Certain foods or drinks may make symptoms worse, such as

• foods high in fat
• some milk products
• drinks with alcohol or caffeine
• drinks with large amounts of artificial sweeteners
• beans, cabbage, and other foods that may cause gas

To find out if certain foods trigger your symptoms, keep a diary and track

• what you eat during the day
• what symptoms you have
• when symptoms occur

Take your notes to your doctor and talk about which foods seem to make your symptoms worse. You may need to avoid these foods or eat less of them.

Your doctor may recommend that you try a special diet—called low FODMAP or FODMAP—to reduce or avoid certain foods containing carbohydrates that are hard to digest. Examples of high FODMAP foods and products you may reduce or avoid include

• fruits such as apples, apricots, blackberries, cherries, mango, nectarines, pears, plums, and watermelon, or juice containing any of these fruits
• canned fruit in natural fruit juice, or large quantities of fruit juice or dried fruit
• vegetables such as artichokes, asparagus, beans, cabbage, cauliflower, garlic and garlic salts, lentils, mushrooms, onions, and sugar snap or snow peas
• dairy products such as milk, milk products, soft cheeses, yogurt, custard, and ice cream
• wheat and rye products
• honey and foods with high-fructose corn syrup
• products, including candy and gum, with sweeteners ending in “–ol,” such as
  • sorbitol
  • mannitol
  • xylitol
  • maltitol

References

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many digestive disorders.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.?