Digestive complaints are very common, with 69 per cent of people having experienced some sort of persistent gut complaint, according to Love your Gut’s recent The State of the Nation’s Gut report. Yet there’s often a reluctance to seek help when a problem arises: a quarter of people do not see a GP about chronic symptoms. Embarrassment remains a major contributory factor – almost half of people who delay seeking help state this as a reason. Women are more embarrassed about discussing gut health than men, but older people over 65 are the most comfortable with it. And interestingly, one in three people surveyed said they would feel more comfortable talking about gut health if professionals used less medical jargon. So what answers do the experts suggest should be given to people when they do seek advice?
“Bread gets a bad press as being unhealthy and a common food that should be avoided. This really isn’t true and the bloating you’re experiencing could be related to a number of things. Whatever you do, don’t cut out large food groups from your diet unnecessarily,” says Emer Delaney, registered dietitian and British Dietetic Association (BDA) spokesperson.
Emer also suggests customers could see a GP to have tests such as a coeliac screen, faecal calprotectin and H. pylori. If there is no underlying medical cause for bloating, it might be diet related, with dairy, gluten and fructose being the most common culprits. Customers should be advised to keep a food diary for two weeks and record symptoms before seeing a GP or dietitian.
Exercise is helpful for improving gas-related bloating and simeticone can be recommended as it helps break up gas bubbles. Avoiding fizzy drinks may also be beneficial.
“Bloating is a symptom of numerous gut problems, and while it might be irritable bowel syndrome (IBS), tests should be done to rule out other possible causes. It may be due to an overgrowth of bacteria in the gut, which can happen after surgery. It could be caused by lactose intolerance, which can be diagnosed with a breath test. Another cause of bloating without other symptoms is a diet high in refined sugars,” says Dr Phil Smith, medical director of Guts UK and gastroenterologist at the Royal Liverpool Hospital.
IBS affects one in five people in the UK at some point and may recur throughout life. It is thought to be linked with over-activity in parts of the bowel and may also be linked with stress and anxiety, a bout of gastroenteritis, or bacteria in the gut. The main symptoms of IBS are stomach pain, bloating, diarrhoea and constipation.
Treatment includes antispasmodics to treat stomach cramps, such as mebeverine or hyoscine. Laxatives are used to treat constipation and loperamide may be recommended for diarrhoea. Peppermint oil may also help ease bloating and wind.
“Lactose intolerance is often associated with lots of wind, bloating, stomach rumbling and loose stools, and is more common in those of Asian or African-Caribbean descent. There is a breath test available to assess your tolerance, but it’s not always conclusive,” says Emer. She advises that customers can try avoiding animal milks for a couple of weeks while monitoring symptoms, then drinking a large glass of milk. If symptoms return then lactose intolerance is likely. “If you are [lactose intolerant], there are many lactose-free milks, cheeses and yoghurts available, but check they are enriched with calcium,” Emer adds.
“It will take your bowel a little time to get used to this transition. If it persists, try to identify which foods may cause it and reduce these. A dietitian could help if you’re not sure,” says Emer.
A high fibre diet is very good for general health, protecting against colon cancer, reducing weight and improving constipation. If wind is a problem then cutting down on the worst food culprits, including beans, cabbage, sprouts, leeks, cauliflower, lentils and garlic, can help. Charcoal tablets available over the counter can help reduce wind by absorbing excess gas.
“Whenever a customer visits the pharmacy for symptom-specific medication, this is an opportunity to offer a listening ear, discuss symptoms and raise awareness of red flag symptoms,” says Ewa Gabzdyl, pharmacist and medical expert at the IBS Network. “The whole team should be aware of these symptoms and offer customers the chance to talk to the pharmacist.”
If customers notice any of the following symptoms persisting for more than a few days, they should be referred to the pharmacist:
“Constipation is common during pregnancy and iron tablets won’t help this. You need to try and include lots of soluble fibre such as porridge, pulses and lentils. Eating plenty of fruit and vegetables is also important, as they’re a great source of fibre. Include some golden linseeds in your daily diet as these are excellent for constipation. Start with one teaspoon a day and add to salads, yoghurts or fruit juice. You can increase it slowly up to a maximum of two tablespoons daily. Fluid is important too, so try and drink at least two litres a day. And keep as active as possible,” says Emer.
If symptoms persist, refer to a pharmacist who may suggest a bulk-forming laxative, such as lactulose or macrogols, which is safe in pregnancy. Senna isn’t suitable during the third trimester.
“Antibiotics can cause side effects such as nausea, vomiting and diarrhoea. By altering the microbial balance with the gastrointestinal tract, further pathogenic bacteria can selectively overgrow, increasing risk of a further intestinal infection, the main symptom being diarrhoea,” says nutritional therapist at Bio-Kult, Natalie Lamb. “Rates of antibiotic associated diarrhoea vary from five to 39 per cent. Studies have indicated that probiotics may prevent antibiotic-associated diarrhoea (AAD) via restoration of the gut microflora and by enhancing general immunity.”
Probiotics may help treat and prevent AAD and can be taken as capsules or as a drink.
In children, diarrhoea is most commonly caused by a gastroenteritis virus, such as rotavirus. “An incidence of diarrhoea, especially lasting over three days and accompanied by a fever, should be discussed with your GP. A course of antibiotics may be prescribed if the diarrhoea is infectious,” says Natalie.
The main risk in children is dehydration, so drinking plenty of fluids is vital. Rehydration sachets will help replace lost fluids and salts quickly. If a child is not dehydrated (or once this has been treated), encourage them to eat normally. The old advice about withholding food during diarrhoea is no longer recommended.
“Whenever you experience changes in bowel habit, a good first step is to start making a note of what you’re experiencing and when. Then when you visit your GP you can give an accurate description of what’s happening,” says Ewa Gabzdyl, pharmacist and medical expert at the IBS Network. “NICE guidelines suggest if you’ve experienced abdominal pain or discomfort, bloating, and a change in bowel habit for at least six months, it might be IBS. However, as lots of bowel conditions have similar symptoms, it’s important to visit your GP to get an accurate diagnosis before beginning any kind of treatment.”
Dr Smith says: “The cause will depend on your age, health and any medication you’re taking. If this is a new change and you’re in your 50s or 60s and have a family history of bowel cancer, this is something that should be investigated as a possible cause of your symptoms, especially if there are other signs such as weight loss or passing blood. In a younger person with no risk factors, it’s more likely that IBS is the cause.”
Dyspepsia, or heartburn, is more common as people get older, but also if people are overweight, have a hiatus hernia, drink [alcohol] or smoke. It can be caused by the sphincter muscle not contracting properly, which allows acid to pass back up,” says Dr Smith.
Lifestyle changes are the first things to try to help prevent it. This can involve losing weight, if needed, giving up smoking, reducing alcohol intake, cutting down on caffeine and avoiding spicy foods. Refraining from eating large meals before bedtime and raising the head of the bed can help to prevent heartburn
Antacids can help by neutralising stomach acid. If symptoms don’t improve, customers could try an acid suppressing medication such as a proton pump inhibitor (PPI) or an H2 antagonist.
“Another possible cause is H. pylori, a common cause of gastric ulcers, which also gives burning pain. A test can diagnose this, and it can be treated with antibiotics,” says Dr Smith.
Limiting alcohol intake and not drinking on an empty stomach can help reduce the risk of indigestion, as can avoiding high fat snacks such as nuts, crisps and cheese.
Natalie suggests: “There are some simple adjustments that may help. Try to eat slowly, chewing each mouthful up to 30 times. Sitting down while you eat can help too. Liquid dilutes the digestive enzymes, so try reducing intake during a meal. Pathogenic bacteria and fungi produce more gas than beneficial strains and love fermenting sugars and refined carbohydrates, which may be in abundance at a Christmas buffet. Taking probiotics daily may help rebalance gut flora and aid good digestion.”
If customers do succumb to a bout of indigestion, remedies such as antacids can help.
Nearly half of sufferers with digestive health complaints delay seeking help due to embarrassment, so it’s important for pharmacy staff to help customers overcome this and feel comfortable about seeking help sooner. Using simple, clear language and avoiding medical jargon can help them feel at ease and break down taboos.
“Many people can feel embarrassed when talking about their bowel habits. A good way to put patients at ease is to suggest discussing their symptoms in a more private area of the pharmacy. Showing people the Bristol Stool Form Scale may also help patients find the right words to describe what they’re experiencing in a medically accurate way,” says Ewa Gabzdyl, pharmacist and medical expert at the IBS Network. “Use open questions such as ‘Tell me how your symptoms affect your daily life’ to get a rounded picture of the patient’s health.”
Laura Jones, clinical lead at Assured Pharmacy, says: “Many patients who are embarrassed will find it difficult to approach you to ask for advice even if they want it, especially in a busy pharmacy. So, you can help by approaching them and asking if they need any assistance. Don’t forget to offer them the consultation room as research shows that most patients are not aware of them, even the regulars. If you have display materials or leaflets, these can also help to start a conversation.”
Limiting alcohol intake and not drinking on an empty stomach can help reduce the risk of indigestion