Published on Women’s Weekly
Find out what’s troubling your tummy – it could change your life!
Let’s face it – bowel habits do not make the most palatable topic for conversation. But how many of us have a worrying abdominal pain, rectal bleeding or changes in our bowel habits that we have chosen to ignore?
With colorectal cancer being the third most common cancer in women and the highest in Asia, we can no longer ignore these signs. Ageing, increasing affluence and risk factors – such as the western diet, obesity and smoking – do not help the case either.
Then there is gastric or stomach cancer. Although gastric cancer in Asia is decreasing due to the eradication of the H Pylori bacteria (this bacteria is linked to gastric cancer), Asia still has amongst the highest rates in the world.
“An increased risk of stomach cancer is associated with diets containing large amounts of smoked foods, salted fish and meat, and pickled foods. On the other hand, eating fruits and vegetables that are high in vitamins A and C can lower the risk of stomach cancer,” says Dr Prabhjot Singh Sidhu, consultant gastroenterologist and hepatologist at Ara Damansara Medical Centre.
Less scary but equally problematic are common gastrointestinal problems that occur more often among women compared to their male counterparts.
“This is because women have a longer gut transit time, which basically means everything moves slower from the start to the end of the digestive system,” explains Dr Prabhjot.
The slow transit means that women are more likely to suffer from chronic constipation than men, he adds. It also means they are more likely to experience nausea, bloating and gastritis than men. The situation tends to worsen with age.
“The slow gut transit also fluctuates with the menstrual cycle (which is worse in perimenstrual and perimenopausal phases), especially during pregnancy, due to hormonal changes. The delayed process also affects gallbladder function, leading to the increased likelihood of gallstones, although this is not the only reason for gallstones,” says Dr Prabhjot.
Not Just Wind
Interestingly, says Dr Prabhjot, studies show that women seek medical attention for Irritable Bowel Syndrome (IBS) three to five times more often than men. IBS makes the GI tract sensitive to irritants, such as bowel gas and other elements that otherwise do not bother anyone.
There are many facets to IBS itself, but the fact that women already have a GI tract that is much more sensitive to pressure changes compared to men only makes it worse.
What about Gastroesophageal Reflux Disease (GERD) or reflux? Women produce less stomach acid than men. “In addition, the ‘valve’ at the end of the oesophagus tends to also close more tightly in women, which offers more protection from damage caused by any refluxate. However, when reflux happens, women tend to suffer more unpleasant symptoms due to their increased sensitivity to corrosive elements,” explains Dr Prabhjot.
To top it off, women’s colons are 10cm longer than men’s, which just means there is “more to go wrong”.
“There are many theories out there, but the general view is that the woman’s body needs to make more space for her reproductive organs. This means that the colon has to compromise or get out of the way. Just wait until the baby comes and demands more space! This complicates gastrointestinal conditions because the path leading to the exit is now more congested,” says Dr Prabhjot.
“It is not all doom and gloom though,” he adds. “Understanding how women differ from men allows doctors to manage their conditions more effectively.”
Not Just Food
What we eat plays an important role in intestinal health. For instance, consuming cabbage can cause bloating while spicy foods and an irregular diet can cause gastritis. Those with celiac disease get loose stools if they eat white bread.
However, it would be overly simplistic to think that a change of diet can reverse cancer or underlying medical conditions such as a polyp or stomach ulcers.
“Left untreated, gastrointestinal conditions not only cause distress and affect your quality of life, but can even be life-threatening, such as in the case of cancer,” cautions Dr Prabhjot. He advises seeking medical attention when something seems out of the norm.
“Let your doctor take your history and conduct a physical examination, and perhaps do internal investigations such as gastroscopy or colonoscopy,” he says. “Only when all forms of the disease are ruled out, then diet and other factors will be considered.”
Naturally, stress also plays a part in gastrointestinal health. The brain and the gut are connected through a very complex system. Having good gut flora affects mood and overall health, which is why it is important to have a balanced diet and regular meals.
“Studies also show that the microbiota of men and women are affected differently, even when fed the same diet. Hormonal changes in women are one of the main factors,” says Dr Prabhjot.
Nutritional requirements also change with age. For instance, a 30-year-old woman would need to be aware of potential deficiencies in iron, folate, vitamin D, calcium and iodine, whereas an older woman should be careful about deficiencies in B12, calcium, vitamin D, fibre, omega-3 and zinc.
Tests for Gut Health
| Gastroscopy (upper GI endoscopy): • Takes about four minutes • Minimal or no discomfort • No sedation is needed most of the time but is available if requested |
| Conventional Gastroscopy: • Done via the mouth • Done lying down with mouth open and mouth guard in place |
| Transnasal Gastroscopy: • Done via the nose, with an ultra-thin endoscope inserted into the nose • You will sit up looking at the same screen as your doctor in real-time • More comfortable than a conventional gastroscopy |
| Colonoscopy (lower GI endoscopy) • Takes about 10 to 20 minutes • Sedation is not necessary but is available upon request • The bowel preparation prior to the procedure requires you to drink 2 litres of water mixed with bowel prep the night before • Slight discomfort is felt from the air insufflations that is needed to visualise the bowel wall but is easily relieved by passing wind |
Warning signs
The intestinal tract may be somewhat of a mystery, but Dr Prabhjot’s advice is simple – trust your gut! This means recognising changes in your body and getting it checked out by a specialist if you sense that something is wrong or you have a family history of risk factors.
Do not ignore these signs:
- Unintentional weight loss
- Change in bowel habits such as
- Constipation or loose stools
- Frequent abdominal or stomach pains • Anaemia
- Loss of appetite
- Feeling full quickly
- Bleeding during bowel movements
- Easily tired or breathless
- Pale skin and lethargy
