Living with digestive disorders
Anyone feeling a little bunged up should take some comfort. In this day of high-tech medicine, gene therapy and magnetic resonance imaging, good old constipation remains the most common digestive disorder.
There are more than 50 digestive disorders, ranging from the trivial to the deadly serious. But “constipation is one of the most common problems” for people over 50, says gastroenterologist Dr. Khurhseed Jeejeebhoy of Toronto’s St. Michael’s Hospital. He’s one of Canada’s leading experts on digestive disorders.
Dietician Bev Bacon agrees. She works with the Providence Continuing Care Centre in Kingston, Ontario. “Generally, constipation is the number one problem — and it’s a serious quality of life issue.”
It may be tempting to dismiss a bout of constipation as nothing to worry about, but Jeejeebhoy begs to differ. If the back up is prolonged or recurrent, he says, it could be an outward sign of something more serious, such as colon cancer.
“It deserves a look-see, a colonoscopy,” he says. “If it turns out to be nothing, that’s great.”
The good news, Jeejeebhoy says, is that most constipation can be alleviated. The bad news is that you may he to change your habits. “Much of the treatment for this sort of thing is a lifestyle issue,” he says. “It’s not just taking some Metamucil.”
Change eating habits
That’s the advice physicians and nutritionists give about the three or four most common digestive disorders affecting those over 50:
• Don’t look for quick fixes through drugs — change your eating habits instead.
The digestive tract starts at the teeth and ends at the anus, with a lot of complicated apparatus in between, so it’s not surprising many things can go wrong. Even poorly fitting dentures can be classed as a digestive disorder, because they inhibit proper chewing.
Aside from constipation, the disorders likely to plague older people are:
• Reflux (what the TV commercials call heartburn)
• Diverticular disease, a painful illness of the large intestine
• Irritable bowel syndrome, an abnormal and painful contraction of the intestine.
Constipation has not had a great deal of scientific study, says gastroenterologist Dr. Alvin Newman of Toronto’s Mt. Sinai Hospital. “It’s not one of the glamour diseases,” he says. That said, it can be very serious — not only because it may be a symptom of something else — but because the discomfort (and sometimes outright pain) can be devastating to a person’s quality of life.
But even without extensive testing, both Newman and Jeejeebhoy agree there are often simple fixes for digestive disorders:
• Reducing dietary fat
• Eating plenty of fruits and vegetables
• Drinking more fluids.
“I recommend wheat bran added to a cereal,” says Jeejeebhoy.
On the other hand, Newman is a bit of a rebel when it comes to dietary fibre. He doesn’t hesitate to suggest standard laxatives, such as milk of magnesia or even the old standby, mineral oil. He has even prescribed a remedy right out of Shakespeare — the dried fruit senna, which was given to Lady MacBeth. It’s also the main ingredient in many health-food laxatives.
Part of the problem with just prescribing fibre, Newman says, is that it doesn’t take into account what’s causing the problem. In some cases, people have what he calls a “floppy colon” — the intestinal muscle tone is poor. “If you haven’t got any ‘oomph’ in the muscles, fibre isn’t going to help you,” he says.
In other cases, people have a “very messy, twisty, gnarled-up, functionally obstructed piece of bowel.” More fibre isn’t going to help. The answer is more likely to be more fluids to keep the fecal matter soft enough to move through the intestinal maze.
Dietician Bev Bacon tries to get patients to drink more fluids, especially those without caffeine, which has a slight dehydrating effect. The main job of the colon (where most constipation happens) is to re-absorb water from the fecal matter. If there’s not much water there to begin with, the colon doesn’t care — it just keeps on absorbing. The result can be hard, immovable feces, Bacon says.
Another factor, especially as we age, can be medication, she says. Drugs such as codeine, for example, have side effects that increase constipation. But the bottom line is that unless the constipation is a symptom of something else it can usually be remedied.
Harder to deal with is the problem of gastric reflux, something we all experience from time to time. Eat too much, smoke too much, bend over suddenly with a full stomach — and you can suddenly feel the burning sensation of stomach acid unleashed on the unprotected tissues of the esophagus.
Unlike the stomach, the esophagus, Newman says, “isn’t really designed to handle acid.” But most of the time, reflux goes away quickly — the acid returns to the stomach and stays there.
Problems arise, according to Dr. Joseph Mamazza, a surgeon at St. Michael’s, when the acid hits the esophagus often and isn’t cleared away quickly. Then — aside from discomfort — it can lead to inflammation, ulceration, scarring, bleeding and even cancer.
The good news is that — again — lifestyle changes can prevent a great deal of reflux. There are also medications that inhibit stomach acid, so that even if the stomach contents hit the esophagus, no damage is done.
And in some of the last-ditch cases that Mamazza treats, there may even be a surgical answer:
•Increasing the valve’s efficiency by wrapping a pressure cuff of stomach tissue around it. But he adds that only about 15 per cent of the patients he sees ever require surgery.
Causes of Reflux
The main causes of reflux are:
• Eating the wrong foods
• Eating late at night
• Drinking too much coffee
• Similar lifestyle problems.
The solution? You guessed it — avoid the problem areas. “If you have heartburn,” says Jeejeebhoy, “the first thing to do is eliminate factors that cause heartburn.”
A cousin of reflux is something called a hiatus hernia. In this condition, the esophagus becomes enlarged at the point where it enters the abdomen. Simply put, this reduces the pressure on the valve between the esophagus and the stomach and may allow some of the stomach to transport up into the chest.
Again, the hiatus hernia may not be a problem in itself. In fact, Mamazza says that most people with a hiatus hernia don’t have reflux disease. On the other hand, most people with reflux disease do have a hiatus hernia.
Because constant irritation caused by reflux can lead to cancers, it’s important to take look at the throat using an endoscope. If there’s no sign of malignancy, and the reflux continues, there’s a new class of drugs called proton pump inhibitors that can help.
Constant reflux can also cause ulcers. But there are other factors, including the bacterium helicobacter pylori, which has been proven to cause ulcers, particularly in older patients. But treating the condition with antibiotics can fix the problem.
Certain drugs and ulcers
Anti-inflammatory drugs – for example, taken to treat arthritis – can make a patient susceptible to ulcers. That’s because most anti-inflammatories not only inhibit the enzyme causing inflammation and pain, but in the process they also inhibit a closely related enzyme protecting tissue against acid.
“Instead of using heat and exercise and physical resources, (patients) want instant pain relief,” Jeejeebhoy says. “As a result 25 per cent will develop ulcers.”
There’s hope on the horizon, though. A new class of drugs, called COX-2 inhibitors, promises to deliver pain relief to arthritis sufferers without destroying acid protection, thereby reducing the risk of ulcers.
The third major category of digestive disorders affecting older people is diverticular disease — an illness of the colon not to be confused with diverticulitis. This problem occurs as the wall of the colon is not uniformly strong. Under pressure, some of it may bulge outward, forming small pouches. If fecal matter gets trapped in those pouches, the result is often pain in the lower left side of the belly, as well as some disturbance in bowel habits.
The pain is caused by muscle spasms, not by inflammation or infection. While uncomfortable at times, diverticulitis disease is usually not life threatening. Therapy is again simple:
• Keep the bowels moving
• Avoid foods that are likely to get trapped (Newman cites peanuts in particular)
• Drinks lots of fluids to keep the feces soft.