An irritable or sensitive bowel is a good example of a pain you can’t see. It looks normal at a laparoscopy or ultrasound but certainly doesn’t feel normal.
Women feel bowel pain low in their abdomen, in the same place that they feel period pain, pelvic muscle pain, ovary pain, bladder pain and endometriosis pain, so it’s easy for all these pains to get confused. The most typical feature of bowel pain is that the pain gets better after wind or a bowel action has been passed, and there are usually other bowel symptoms too, such as diarrhea, constipation or bloating.
Doctors often think of bloating as an inconvenience rather than a major problem. This is because bloating rarely means a serious illness. The trouble is that bloating makes women feel unattractive and uncomfortable. It also makes any other pelvic pain worse. Luckily, there is lots you can do to feel better.
Before you do anything about bloating, you should see your doctor. Sometimes women feel bloated because they have an ovarian cyst. Your doctor can check this for you. If this check is normal, then think about what type of bloating you have.
The first type of bloating is where the abdomen swells up and your stomach looks big. Women often feel like this near period time, but it is also aggravated by certain foods. These foods are described further below. Cutting down on these foods often makes a big difference to pain.
The second type of bloating is a feeling of being bloated, when you look normal. This is often due to a change in the way nerves work causing abnormal sensations such as bloating, and sensitivity to touch. You may find your clothes uncomfortable or dislike anyone touching your abdomen.
Many women with pelvic pain have a mix of both types of bloating.
What can I do?
Some of the foods most likely to cause problems are a special group of carbohydrates, sometimes called FODMAP foods. Common FODMAP foods include lactose, wheat products (bread, pasta, pizza etc.), onions, corn syrup, apples, and artificial sweeteners, but there are many others.
Most people absorb these foods quite quickly in their ‘small bowel’ (small intestine). This means that very little of those foods reaches the ‘large bowel’ further down.
Some people absorb these foods slowly, which means that more of these foods reaches the large bowel undigested. In the large bowel, the food is fermented by bacteria to form gas and other substances that irritate the bowel and cause pain, diarrhea and bloating. A small amount of these foods may be no problem at all, but a larger amount can cause lots of pain. If they also have a sensitive bowel, which many women with pelvic pain do, then they will really suffer.
This means that while your friends may be able to eat any food and feel fine, your bowel will be painful unless you are careful.
Should I just go ‘gluten-free’?
A gluten free diet is a special diet for people with Coeliac Disease. Women with coeliac disease need to be on a strict ‘gluten free’ diet for the rest of their life. Women with an irritable bowel often feel much better on a ‘gluten free’ diet, because by cutting out gluten they are also cutting out wheat, a major FODMAP food. They do not have a problem with gluten and may be able to tolerate small amounts of wheat. Before you change your diet, ask your doctor for a blood test that checks for coeliac disease. This test isn’t reliable if you have already cut out wheat from your diet, so it’s much easier to get it done first.
Are there any other problem foods?
Yes, definitely, but everyone is different. You might have a problem with rich or fatty foods (cream, takeaway, animal fats), alcohol, coffee, fizzy drinks, and spicy food. A low fat, low salt, high fiber diet is good for everyone, but even more important if you have bowel problems. If you find it all too hard to work out, a dietitian may be able to help.
We have been brought up to think that it’s important to have a bowel action every day. Actually, it’s OK to have a bowel action every couple of days or so, as long as it is soft and easy to pass when it happens. It is easiest to open your bowels when the bowel motion is soft and your bowel is contracting strongly enough to pass it easily.
You can make the bowel action softer by
Drinking enough water
Increasing the fiber in your diet
Taking a fiber supplement such as Sterculia (normafibe ®). This supplement is useful as it causes less wind than most other supplements
You can increase bowel contractions by:
Regular exercise, brisk walk every day
Allowing unhurried time to go to the toilet after breakfast in the morning
Avoiding medications such as codeine
A herbal treatment such as slippery elm
Other useful treatments include:
Peppermint oil capsules taken 3-4 times daily or peppermint tea
Iberogast liquid 20 drops from a chemist, drunk in warm water as tea 2-3 times daily
Some women have severe constipation, even when they do everything right. It is very unfair. They feel bloated and uncomfortable most of the time. If so, it is time to talk to your doctor, or maybe a gastroenterologist (bowel physician).
Content provided by Dr Susan Evans, Gynecologist, Laparoscopic Surgeon, & Specialist Pain Medicine Physician (https://www.drsusanevans.com.au/). Permission has been granted to publish this content on www.theendolifestyle.com.