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Ask the Gastroenterologist: Explaining the Mystery of Women’s Gut Health

By Dr. Asma Khapra

As a female gastroenterologist who specializes in women’s digestive health, many women ask me similar questions, especially as they age. In this article, I address FAQs that commonly arise, and I hope they will help you on your health journey!

  • Why do I need a screening colonoscopy?
  • Do I have SIBO?
  • Which is the best probiotic, and do I need one?
  • Can I do anything to help my chronic constipation?
  • What is gastroparesis?
  • How do I know if I have IBS?
  • How do hormones affect the gut?

Why do I need a screening colonoscopy?

My first response is always that, as we age, it’s important to prevent as many health problems as possible. Prevention is key- whether it is a mammogram, cholesterol screen, or pap smear. The colonoscopy is the only screening test in which not only can you diagnose cancer but also PREVENT colon cancer, as the goal is also to remove any precancerous lesions (polyps). Once you hit age 45, screening for colon cancer should begin for the average population. However, if you do have an immediate family member with colon cancer, then screening should start at age 40 or 10 years before the age of the family member’s diagnosis, whichever one is earlier. Now, as I mentioned, a colonoscopy IS the gold standard for screening for colon cancer.  Alternatives do exist for those who may not be able to undergo a colonoscopy due to other reasons or just won’t do it! These include stool tests such as a FIT (detects blood) annually or a Cologuard (detects blood/genetic material) every three years. A virtual colonoscopy is a special type of CT scan that can also be used but is not as good for smaller polyps, less than 1 cm. Anything you choose is better than nothing. So if you remember one thing…… GET SCREENED!

Do I have SIBO (small intestinal bacterial overgrowth)?

This is a hot topic everyone seems to want to know about! So what is SIBO? SIBO is an abnormally high growth of bacteria in the small intestine, causing bloating, cramping, and particularly diarrhea. Some risk factors include prior surgeries (i.e., gastric bypass) or adhesions, underlying disease of the small bowel, diverticulosis of small bowel, diabetes, and slow motility (less common type- methane overgrowth). If SIBO is suspected, testing with a breath test is reasonable. Unfortunately, the breath tests are not always 100% accurate, and thus some people choose to be treated without testing if the suspicion is high. Usually, antibiotics are the mainstay of treatment. However, diet can also be helpful, specifically the FODMAP or the SCD (Specific Carbohydrate Diet). Great resources to learn more about SIBO and treatment, as well as diet, are available on www.Gastrogirl.com and the book “Breaking the Vicious Cycle.”

Which is the “best” probiotic, and do I need one?

The microbiome has become a hotbed of discovery, but there is so much still unknown. Often people come into my office and ask me for recommendations for the “best” probiotic. There are no FDA-approved probiotics, and large, rigorous studies comparing probiotics are not available. The AGA (American Gastroenterology Association) reviewed the available data and came up with only two situations in which probiotics have been deemed officially helpful in adults. Their recommendations include prevention of a gut infection called C difficile when using antibiotics, and probiotic use in the condition of pouchitis (seen in inflammatory bowel disease). However, this does not mean that probiotics cannot be useful. I have seen many patients who find that probiotics help general gut symptoms- most commonly diarrhea and bloating. It may be worth trying probiotics if symptoms like these exist.  I often caution patients against the use of probiotics if they have a weakened immune system, such as with the use of immunosuppressant medication. In these situations, it is best to discuss using probiotics with your doctor. As time goes on, more recommendations will come forth, so stay tuned.

Can I do anything to help my chronic constipation?

Many women suffer from constipation and often ask why? For most, it is a combination of factors, including hormonal changes, slow gut motility, pelvic floor problems, or irritable bowel syndrome (IBS). But the good news is there are many options currently for improving symptoms! I am listing my top favorite “over the counter” recommendations below:

  • Increasing fiber intake to 25-35 grams of fiber per day
  • Magnesium supplements (if ok with your doctor)
  • Increasing exercise
  • MiraLAX (an osmotic laxative and safe long term), avoid stimulant laxatives

If these over-the-counter methods fail, there are many safe prescription alternatives, so visit your doctor or a gastroenterologist to help you decide on the next steps. For those who are struggling with pelvic floor problems, I would encourage you to have a conversation with your physician about trying physical therapy with biofeedback. These strategies and others have had strong positive statistical outcomes and have helped patients improve their quality of life. Remember, your health is important so just be sure you don’t ignore any warning signs such as rectal bleeding since this will require additional testing. The bottom line is…. don’t suffer in silence, reach out to your doctor for advice!

What is Gastroparesis?

August is Gastroparesis Awareness Month! So what is it? Gastroparesis literally means “partial paralysis of the stomach” and is a condition in which there is a delay in food moving through the stomach. Causes are broad, and it can be seen in conditions such as diabetes, autoimmune disease, and post-viral infections. It can also occur spontaneously. While it is not a very common disorder, it is becoming increasingly recognized, often associated with constipation and more often seen in women. Symptoms typically include nausea/vomiting, feeling full fast, reflux, and bloating. As you can see, these symptoms are nonspecific and can overlap with many other conditions, so the diagnosis can often occur late. Fortunately, it is not a dangerous condition for most people but can cause unpleasant symptoms. Testing is available and dietary modifications are the first step in improving the condition — this includes eating small meals and lower residue or less fibrous foods that empty out of the stomach faster. Limited medication options are available for gastroparesis currently, but luckily this is an active area of study.

How do I know if I have IBS (irritable bowel syndrome)?

IBS is common in women. Very often, patients come in with a variety of complaints for years but didn’t realize these were all related to IBS. It is a functional problem, which means that your gut is sensitive but structurally normal.  The definition is based on clinical symptoms of 3-6 months of abdominal discomfort associated with bowel changes, which can be either diarrhea or constipation, or both. The good news is there are medications and other options available now! I have included a few of these below:

  • Medications/supplements:  Antispasmodics, gut-specific antibiotic (Xifaxan), medications targeted at constipation/diarrhea, peppermint oil supplements, antianxiety meds
  • Dietary advances such as FODMAP diet
  • Hypnosis and Cognitive Behavioral Therapy

Patients have time and time again told me that they knew they had IBS but figured there was nothing they could do to improve the complaints. This is a common misconception, so talk to your doctor and get started on a path to a happier gut.

How do hormones affect the gut?

Women are fierce as they deal with the struggles of childbirth, raising kids, and then menopause. We often hear about how hormonal shifts in women affect mood as well as the reproductive system, but we don’t often talk about the impact on the gut. Estrogen and progesterone will fluctuate during this time. For instance, in perimenopause, estrogen levels rise and fall initially before dropping off precipitously at menopause. These fluctuations in hormones around menopause can do the following:

  • Worsen underlying gut symptoms—including gas, bloating, belching, nausea, and abdominal discomfort
  • Affect how fast food moves through the GI tract, and cause symptoms of constipation 
  • In perimenopause, bloating occurs when women retain more water
  • During and after menopause, bloating can be related to the slowing of digestion and constipation.

Don’t be alarmed if you notice these changes or even others that are unexpected. Manage symptoms as best as you can, get lots of sleep, exercise, and eat well. These steps will help you on your journey through this phase of life!

Hopefully, the information above gives you a roadmap of options and advice for managing your gut health. If you would like to read and hear more about these topics, feel free to watch my videos on doctorpedia.com, a leading source of information for patients provided directly by doctors. https://www.doctorpedia.com/doctor-profile/asma-khapra/

____________________

Dr. Asma Khapra is a board-certified gastroenterologist and Clinical Assistant Professor at George Washington University Hospital. She practices at Gastro Health-Virginia, is skilled in all aspects of gastroenterology, and specializes in Women’s Digestive Health. As voted by her peers, Dr. Khapra has been routinely recognized as a ‘Top Doctor’ in the Mid-Atlantic region by Washingtonian Magazine and Northern Virginia Magazine.

Dr. West recently hosted a video discussion with Dr. Khapra on these topics and more, which you can watch HERE . And don’t hesitate to reach out to Dr. West if you have any questions about your gut health.

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