GUT FEELING

Disclaimer: This is the personal opinion of the author. This is not medical advice.

This article is about abdominal pain.

I was born a colicky baby (a baby who cried a lot). Therefore it may come as no surprise to you that my familiarity with abdominal pain is intimate. Doctors, parents and aunts did everything they could to treat me, get me to eat and stop complaining about stomach pain to no avail. It was only twenty or so years later that I figured out that I was likely lactose intolerant, and asked my doctor for a test. The test proved my theory and finally explained my childhood colic pains.

Our bodies often give us signs that something is wrong well before something bad happens or we can put a name to the issue. For example, I had pain in the appendix area years before a large cyst was found in my abdomen. I knew I had water filling up in my belly months before the cyst was found. I knew I had an ovarian torsion well before any doctor admitted the case (maybe because they were avoiding liability on account of failure to treat?) and I knew I had an adverse reaction to radio-imaging iodine before they told me it was nothing and administered a second dose, causing me to go into anaphylactic shock. (You can see after my experiences why I thought it important to share this article).

These seem like extreme examples, but they prove a point. As the old saying goes: You know your body best.

Now doctors and tests can do a lot for you. But they can only help when you can describe the symptoms in a way doctors clearly understand. The case has to be eloquent, descriptive, informed, important yet moderate enough for a doctor to take you seriously. The case can be especially bad for women and "female issues", where pain, even severe pain, is considered "normal" by doctors, and when abdominal discomfort and pain can mean anything from flatulence to ovarian cancer.

Worse yet if you have a ring on your finger. Well then, pregnancy tests galore! Before evaluating any other possibility, whether or not a child is possible or not at this point, you’ll find doctors deferring to the possibility of pregnancy at the earliest possible convenience. While it can be important to rule pregnancy out, doing the pregnancy runaround can sometimes prevent identification of the real issue, especially in systems where there is no single point of care, and instead, care is provided by a team of doctors and nurses (the last thing a doctor sees is the pregnancy test, not the complaint that led you do the test).

There are a few topics we aim to address in this article:

1. How to listen to your body and catch issues early

2. Breaking down the term "bloating" and using words to explain the difference between flatulence, IBS, menstrual cramps and other abdominal issues

3. A word of advice to doctors

A few words of caution: This article does not constitute official medical advice. It only contains advice and behaviors learned from my own personal experiences and that of the writers of this magazine.

Listen to your body

In the humdrum of life, it is easy to get swept up in one task and goal after the other. We don't often devote time to take a break, listen to our body, and check up on our physical health.

But just like adult women are encouraged to regularly perform a self breast palpation exam to help detect breast cancer early, we should regularly examine all parts of our body to ensure our bodies are running in good condition.

A few tips:

1. Pick a quiet time. Maybe early in the morning after Fajr when everyone is sleeping, there are no commitments, and stress levels are low.

2. Lay down and breathe deeply. As you breathe, feel every part of your body.

3. Does any part feel tense? Why is that? Can you relax it? Why not?

4. Does any part feel tender or ache? Palpate (feel) it with your hands. Press slightly. What do you feel now? Where is this pain or ache? Have you been feeling it for a while, but are accustomed to ignoring it in the wind of life, so much so that you don't feel it anymore?

5. Do you feel pain anywhere as you breathe in and out? Discomfort? Where? What kind of pain is it?

6. Perform a gentle massage over areas of your body that feel tired, ache, or feel pressure.

7. How does it feel after the massage

Get in the habit of doing these self check-ups regularly and practice noting down issues you notice to bring up with your doctor on your next visit. If you use a menstrual tracking app, many of them provide space to allow note taking of health symptoms. This is a great place to journal your health since it allows your doctor a quick and easy way to see your symptoms and relate them to your menstrual cycle, helping them determine if the issue is gynecological or otherwise.

Your doctor has some advice or knows something that will help you with what you are feeling.

Breaking down Bloating

Learning the right words to use in front of your doctor to explain what you are feeling is an important step to getting the right care and treatment that you need.

Bloating is an example of a loaded term that has many meanings and using it will likely not help you get the care you need. When you say bloating, the first thing people, and your doctor, think of is flatulence - a build up of gas in your abdomen. If you say bloating to your doctor, you'll likely hear something along the lines of: "avoid swallowing air when eating, avoid foods such as beans, lentils, and broccoli" and so on - great advice, if you are actually suffering from flatulence.

But often bloating - a feeling of pressure or abdominal discomfort in your abdomen, sometimes accompanied with abdominal distention, can mean a lot of things of which only one is flatulence.

Let's start with the most basic form of abdominal discomfort:

Menstrual Cramps

Menstrual cramps in their most pure form feel like your uterus is squeezing (because that is what it is actually doing). Sometimes that may be accompanied with a kind of pain that feels like sweaty exhaustion - often as your lining is shedding. Sometimes the pain is sharp and pointed. And sometimes it is a dull ache in the pelvis. These symptoms depend on your body, may be similar to your mother's menstrual symptoms at your age, or may be a sign of other issues.

In your early years, pain can feel very severe as your body isn't used to dealing with the pain of menstruation. Over time, menstrual pain can feel like it has disappeared. Though if you listen closely, the pain is still there.

Take note of what your usual pain symptoms are, and be sure to describe your pain and talk to your doctor about what your pain feels like and if it is normal. Very severe and debilitating pain (inability to play sports or function) may point to issues such as endometriosis.

To some people, menstrual cramps only exhibit themselves in a feeling of mild pressure throughout the abdomen (avoid the use of the word bloating).

Flatulence

Flatulence can be most easily described as the overproduction of gas. When that gas isn't allowed safe passages, this can lead to bloating, or pressure in the abdomen from pent up gas. There are a few easy ways to know if the pressure in your abdomen is because of gas.

1. Try Belly breathing. When breathing through your belly, expand your belly when you breathe in, contract your belly when you breathe out. Doing stomach breathing gives gas a bit of room to move, and the expand/contract pushes the gas around a bit. If you feel the centers of pressure changing or moving as you do belly breathing, it is a sure sign your bloating is actually flatulence

2. Walking. Walking, similar to belly breathing, gently exercises your abdomen enough to allow gas to move and pass.

3. Fennel seeds. If eating fennel seeds allows your gas to pass, you were likely suffering from flatulence.

4. If you don't have much fat on your belly, pressing on your abdomen, you should be able to palpate (feel) pockets of gas in your abdomen.

Irritable bowel syndrome

I've experienced two forms of IBS: acute and chronic.

Acute is easy to identify. It feels like your stomach is cramping - similar to menstrual cramps except in the upper or mid abdomen, or that your stomach is turning very tightly, like someone is wringing your intestines. Acute IBS can feel very disturbing and debilitating. While there isn't really a treatment for acute IBS, pain killers are often prescribed (painkillers often don't work as well, if at all for gut pain) one thing that has helped me through bouts is a herbal remedy called Karmeena, often available at South Asian grocery stores, albeit I would recommend discussing strategies and treatments with your doctor before trying anything.

Chronic IBS feels very different from acute IBS. It feels similar to flatulence in that your belly feels very full and pressurized. It is different in that the tests provided above for flatulence fail. Belly breathing may initially move some gas, but further belly breathing provides no relief. Your intestines may also feel tight. Some ways to know if what you are feeling might be related to intestinal swelling/IBS: if your bowel movements change during IBS bouts, and either reduce in volume, or become thin, this is almost a sure sign of some sort of bowel obstruction - either intestinal swelling or some other form of obstruction. If this is coupled with rectal bleeding, this is a sure sign you should get help from a medical professional urgently.

Chronic inflammation of your intestines can lead to tissue death and may cause enough damage to end up requiring you to get a bowel resection - surgery which involves cutting out a part of your intestine and stitching the rest back together. It is better to work with a dietitian to find the foods that trigger your IBS, learn to avoid them, and prevent IBS episodes all together.

But as you'll find when you talk to the doctors, most of the work in finding what triggers you falls on you as the patient - by systematically trying different foods and listening to your body and it's reaction. I myself have found the main irritants for my gut to be Canola Oil, and high-lactose milk products (ice-cream, cream, milk). (Little known fact, many dairy products are naturally lactose-free or low lactose, such as yogurt, and some cheeses).

A Note for Doctors

Patients often know what they are feeling, but just don’t have the words to describe it. If they are coming to you with a complaint, it means the issue bothers them enough for them to bring it up. They have probably tried solving the problem in different ways before coming to you. Instead of trying to label the problem immediately, explore the problem space and provide the patient the tools they need to help you with a differential diagnosis.

One of the best things a doctor offered me during an illness was a means by which I could help her identify my illness. Armed with the symptoms to look out for, and the potential diagnoses, I was able to point my doctor to the correct diagnosis, and receive proper treatment before the illness got worse.

Now that’s good medicine.

Photo by Jamie Street on Unsplash