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When are Bellyaches More than Just Bellyaches: A Conversation with a Gastroenterologist
Dr. John Dowd, gastroenterologist with Concord Gastroenterology Associates, discusses bellyaches, what they are, and when you should seek help from a doctor.
Featured Speaker:
John Dowd, DO
John Dowd, DO CLINICAL INTERESTS include Esophageal disorder, inflammatory bowel disease, colorectal cancer screening and prevention, biliary and pancreatic disorders and clinical nutrition. Transcription:
Scott Webb: Sometimes a bellyache is just a bellyache caused by what we eat or maybe gas and sometimes the bellyache is cause for concern. And joining me today to help us tell the difference is Dr. John Dowd. He's a gastroenterologist with Concord Gastroenterology Associates.
This is the Health Works Here podcast from Emerson Hospital. I'm Scott Webb. Doctor, thanks so much for your time today. We all get bellyaches from time to time, but it's not always clear what causes them. So what is a bellyache? And generally what causes them?
Dr. John Dowd: First of all, when we talk about abdominal pain, we have to differentiate if this is an acute abdominal pain or if this is chronic abdominal pain. And we generally use three months as a cut-up between acute and chronic. Acute abdominal pain is oftentimes a surgical emergency and is something that we may see, but refer immediately to a surgeon. Acute abdominal pain is usually something like a sick gallbladder or a sick appendix or intestinal obstruction. And those go to the surgeons and those get taken care of surgically.
There are a lot of other things that can cause acute abdominal pain that are not related to gastrointestinal organs, such as kidney stones or gynecologic pain in women, like endometriosis or ruptured ovarian cyst or something like that. But when we're talking about gastrointestinal abdominal pain, that's where we come in. And again, we want to differentiate acute from chronic, acute abdominal pain that we would deal with would be related to most often ulcers in the stomach or small intestine. It could be heartburn or reflux. It could be pancreatitis. It could be gallstones or kidney stones. Again, that would go to our Urology colleagues.
Other things that could cause abdominal pain that we would see would be somebody who we know has inflammatory bowel disease or somebody who doesn't have a diagnosis of inflammatory bowel disease yet, but that can cause abdominal pain such as Crohn's disease or ulcerative colitis. Diverticulitis is another cause of acute abdominal pain that we might see, and hernias. We can see patients with hernias, who can have acute abdominal pain, but often those will also go to our surgical colleagues.
Scott Webb: We don't want people diagnosing themselves, of course. But how do we know when a bellyache is just a bellyache maybe caused by something we ate? So if we have an immediate reaction to something we ate and our stomach starts hurting, well, maybe it was the thing. Maybe it was the salsa, whatever it might've been, right? What's that breaking point when we need to go to the emergency department or acute care or reach out?
Dr. John Dowd: The best marker would be how it responds over time. You're absolutely right. We can all have gas pains, and those can be very uncomfortable and can be mistaken even for surgical issues at some point in time. But if the pain is severe, and it's progressing and it's getting worse, or if it's associated with vomiting or bleeding. like for instance, if somebody's having vomiting that's bloody or having diarrhea that's bloody, then that is not something they should be managing at home.
But a little gas pain, "Oh. I had some cauliflower. I had some brussels sprouts. And now, I have some discomfort and I'm going to have a bowel movement and it's going to go away," then, we don't worry about that obviously. Or if you take an anti-gas medication and it settles it down. But again, pain that's progressive, getting worse and starts severe or pain that's associated with any of those other symptoms would be something that you should seek medical attention for immediately.
Scott Webb: Are the things that we can do along the way, whether it's diet, exercise, heating pads, besides over- the-counter medications for those occasional flare ups and those occasional bellyaches? Are those things that we can do, diet, exercise, heating pad?
Dr. John Dowd: If your abdominal pain is comes every time you eat yogurt or every time you have a dairy food or a food containing bread or pasta, then, if it's triggered by the same thing every time, then there's something to that. You have to listen to your body and avoid those foods. If it is a significant part of your diet, that you're not tolerant of, there may be a treatable medical condition. If you have abdominal pain because you eat too quickly, then we would say slow down, take smaller bites. You may be swallowing air in addition to your food. Slow down, be mindful of how you're eating and what you're eating.
Scott Webb: I want to ask you about this COVID-19 time and whether or not you're doing all face-to-face or a hybrid, a combination of virtual and face-to-face. And when it comes to bellyaches, how are you diagnosing these? Do you really need to see people in person?
Dr. John Dowd: So COVID and the sort of popularization of telemedicine has, I think, been really great for patients and for us, but not for abdominal pain. I am personally not comfortable diagnosing or managing abdominal pain without a physical examination. There are a lot of things that we can do in GI that don't require us laying hands on patients' belies, but abdominal pain is not one of them.
We talked before about reflux and reflux is one of those things that, it's really symptom driven. The symptoms don't necessarily correlate with the disease severity, for better, for worse. In other words, patients who describe very severe symptoms may not have severe disease and patients who describe relatively mild symptoms may have severe disease.
But for abdominal pain, you really need to do a physical exam. You need to evaluate for where the pain is, if the pain is associated with a rebound, which is pain when you push in and you want to see if the pain is worse when you push in or when you let go suddenly. And those are signs of inflammation of the inside of the abdomen and that's a serious symptom that needs additional testing and/or evaluation by a surgeon. So again, abdominal pain that's acute or abdominal pain that's severe really needs to not be managed by telemedicine.
Scott Webb: So doctor, as we get close to wrapping up here, when should we reach out to our primary or a gastroenterologist about bellyaches? You've talked today about acute versus chronic and all the bad stuff that could come from a chronic bellyache. So when do you recommend that we reach out and maybe stop self-medicating so much?
Dr. John Dowd: So if your abdominal pain is associated with distension or swelling in your abdomen or vomiting that may be a sign of intestinal obstruction, and you should get medical attention. If your abdominal pain is associated with fever, then you should be seen by a physician. If you have a significant alteration in your appetite or in your bowel habits, then you should be seen by a physician.
Additionally, more urgent evaluation would be if you had a trauma and you had pain after a trauma or the pain was very severe or you had blood in either the stool or if you were vomiting and you had blood in your vomiting, that would be a reason to see a doctor immediately.
Scott Webb: Yeah. Well, great advice today and you have a really effective way of going through all of this stuff. So doctor, thanks so much for your time today and you stay well.
Dr. John Dowd: Thanks so much for having me on.
Scott Webb: Go to EmersonGI.org or reach Concord Gastroenterology Associates at (978) 287-3835 for more information or to make an appointment. And thanks for listening to Emerson's Health Works Here, podcast. I'm Scott Webb and make sure to catch the next episode by subscribing to the Health Works Here podcast on Apple podcasts, Google podcasts, Spotify, or wherever podcasts can be heard.
Scott Webb: Sometimes a bellyache is just a bellyache caused by what we eat or maybe gas and sometimes the bellyache is cause for concern. And joining me today to help us tell the difference is Dr. John Dowd. He's a gastroenterologist with Concord Gastroenterology Associates.
This is the Health Works Here podcast from Emerson Hospital. I'm Scott Webb. Doctor, thanks so much for your time today. We all get bellyaches from time to time, but it's not always clear what causes them. So what is a bellyache? And generally what causes them?
Dr. John Dowd: First of all, when we talk about abdominal pain, we have to differentiate if this is an acute abdominal pain or if this is chronic abdominal pain. And we generally use three months as a cut-up between acute and chronic. Acute abdominal pain is oftentimes a surgical emergency and is something that we may see, but refer immediately to a surgeon. Acute abdominal pain is usually something like a sick gallbladder or a sick appendix or intestinal obstruction. And those go to the surgeons and those get taken care of surgically.
There are a lot of other things that can cause acute abdominal pain that are not related to gastrointestinal organs, such as kidney stones or gynecologic pain in women, like endometriosis or ruptured ovarian cyst or something like that. But when we're talking about gastrointestinal abdominal pain, that's where we come in. And again, we want to differentiate acute from chronic, acute abdominal pain that we would deal with would be related to most often ulcers in the stomach or small intestine. It could be heartburn or reflux. It could be pancreatitis. It could be gallstones or kidney stones. Again, that would go to our Urology colleagues.
Other things that could cause abdominal pain that we would see would be somebody who we know has inflammatory bowel disease or somebody who doesn't have a diagnosis of inflammatory bowel disease yet, but that can cause abdominal pain such as Crohn's disease or ulcerative colitis. Diverticulitis is another cause of acute abdominal pain that we might see, and hernias. We can see patients with hernias, who can have acute abdominal pain, but often those will also go to our surgical colleagues.
Scott Webb: We don't want people diagnosing themselves, of course. But how do we know when a bellyache is just a bellyache maybe caused by something we ate? So if we have an immediate reaction to something we ate and our stomach starts hurting, well, maybe it was the thing. Maybe it was the salsa, whatever it might've been, right? What's that breaking point when we need to go to the emergency department or acute care or reach out?
Dr. John Dowd: The best marker would be how it responds over time. You're absolutely right. We can all have gas pains, and those can be very uncomfortable and can be mistaken even for surgical issues at some point in time. But if the pain is severe, and it's progressing and it's getting worse, or if it's associated with vomiting or bleeding. like for instance, if somebody's having vomiting that's bloody or having diarrhea that's bloody, then that is not something they should be managing at home.
But a little gas pain, "Oh. I had some cauliflower. I had some brussels sprouts. And now, I have some discomfort and I'm going to have a bowel movement and it's going to go away," then, we don't worry about that obviously. Or if you take an anti-gas medication and it settles it down. But again, pain that's progressive, getting worse and starts severe or pain that's associated with any of those other symptoms would be something that you should seek medical attention for immediately.
Scott Webb: Are the things that we can do along the way, whether it's diet, exercise, heating pads, besides over- the-counter medications for those occasional flare ups and those occasional bellyaches? Are those things that we can do, diet, exercise, heating pad?
Dr. John Dowd: If your abdominal pain is comes every time you eat yogurt or every time you have a dairy food or a food containing bread or pasta, then, if it's triggered by the same thing every time, then there's something to that. You have to listen to your body and avoid those foods. If it is a significant part of your diet, that you're not tolerant of, there may be a treatable medical condition. If you have abdominal pain because you eat too quickly, then we would say slow down, take smaller bites. You may be swallowing air in addition to your food. Slow down, be mindful of how you're eating and what you're eating.
Scott Webb: I want to ask you about this COVID-19 time and whether or not you're doing all face-to-face or a hybrid, a combination of virtual and face-to-face. And when it comes to bellyaches, how are you diagnosing these? Do you really need to see people in person?
Dr. John Dowd: So COVID and the sort of popularization of telemedicine has, I think, been really great for patients and for us, but not for abdominal pain. I am personally not comfortable diagnosing or managing abdominal pain without a physical examination. There are a lot of things that we can do in GI that don't require us laying hands on patients' belies, but abdominal pain is not one of them.
We talked before about reflux and reflux is one of those things that, it's really symptom driven. The symptoms don't necessarily correlate with the disease severity, for better, for worse. In other words, patients who describe very severe symptoms may not have severe disease and patients who describe relatively mild symptoms may have severe disease.
But for abdominal pain, you really need to do a physical exam. You need to evaluate for where the pain is, if the pain is associated with a rebound, which is pain when you push in and you want to see if the pain is worse when you push in or when you let go suddenly. And those are signs of inflammation of the inside of the abdomen and that's a serious symptom that needs additional testing and/or evaluation by a surgeon. So again, abdominal pain that's acute or abdominal pain that's severe really needs to not be managed by telemedicine.
Scott Webb: So doctor, as we get close to wrapping up here, when should we reach out to our primary or a gastroenterologist about bellyaches? You've talked today about acute versus chronic and all the bad stuff that could come from a chronic bellyache. So when do you recommend that we reach out and maybe stop self-medicating so much?
Dr. John Dowd: So if your abdominal pain is associated with distension or swelling in your abdomen or vomiting that may be a sign of intestinal obstruction, and you should get medical attention. If your abdominal pain is associated with fever, then you should be seen by a physician. If you have a significant alteration in your appetite or in your bowel habits, then you should be seen by a physician.
Additionally, more urgent evaluation would be if you had a trauma and you had pain after a trauma or the pain was very severe or you had blood in either the stool or if you were vomiting and you had blood in your vomiting, that would be a reason to see a doctor immediately.
Scott Webb: Yeah. Well, great advice today and you have a really effective way of going through all of this stuff. So doctor, thanks so much for your time today and you stay well.
Dr. John Dowd: Thanks so much for having me on.
Scott Webb: Go to EmersonGI.org or reach Concord Gastroenterology Associates at (978) 287-3835 for more information or to make an appointment. And thanks for listening to Emerson's Health Works Here, podcast. I'm Scott Webb and make sure to catch the next episode by subscribing to the Health Works Here podcast on Apple podcasts, Google podcasts, Spotify, or wherever podcasts can be heard.