It’s normal to get a stomachache now and then, like after a super-spicy meal or before a big job interview. But gut woes that stick around for more than a few days could signal bigger problems—anything from lactose intolerance to ulcerative colitis. And, unfortunately, gastrointestinal conditions can be tricky to diagnose. “There’s a lot of overlap, the symptoms aren’t always specific—for example, pretty much every GI condition can cause bloating or pain—and it’s possible to have more than one issue at once,” says gastroenterologist Robynne Chutkan, MD, founder of the GutBiome Institute in Chevy Chase, Md., and author of The Microbiome Solution. Here’s how to start sussing out your symptoms—and smart strategies for relieving them.
Your symptoms: Diarrhea and blood in your poop.
You could have an inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease. Ulcerative colitis is a chronic inflammatory bowel disease (IBD) that causes ulceration (wearing away) and inflammation of the large intestine. You might have diarrhea, abdominal cramps, and pain, but the classic symptom is blood in the stool. “If it’s been going on for months and there’s a lot of bleeding—you’ll see blood mixed with the stool, rather than streaks—it’s most likely colitis,” says gastroenterologist Lisa Ganjhu, DO, clinical associate professor of medicine at NYU Langone Medical Center. An abnormal immune system response may be involved; heredity can also play a role. Mild cases may benefit from lifestyle changes, such as avoiding foods that seem to cause flare-ups and reducing stress. Research suggests that a low FODMAP diet may help some IBD patients. (FODMAPs—fermentable oligo-, di- and monosaccharides and polyols—are poorly absorbed carbs found in wheat, dairy, legumes, certain fruits and vegetables, and artificial sweeteners; consult a dietitian if you’re thinking of going low FODMAP.) Most cases require prescription drugs, such as anti-inflammatories, steroids or immune suppressors. In some cases, surgery may be needed. (See below for more info on Crohn’s.)
Your symptoms: Diarrhea (but no blood in your poop), along with abdominal pain.
It could be irritable bowel syndrome with diarrhea (IBS-D), which is marked by episodes of diarrhea and lower-abdominal pain that improves after you go number two. Your gut may be releasing excess fluid into the GI tract during digestion, or food may be moving too fast through your system. There’s no surefire cure for IBS, so the goal is to avoid your personal triggers—which could include particular foods, extreme stress, and/or travel. If you have IBS-D, you could take a fiber tablet during flare-ups to sop up extra water in the colon. Or consider a low FODMAP diet; a 2016 study from the University of Michigan Health System showed that this eating style led to major improvement in abdominal pain for people with IBS. Exercise can relieve stress as well as help keep your gut moving normally. Some research suggests that consuming probiotics may ease IBS symptoms, too. There are also a handful of prescription drugs that may help manage IBS symptoms, but they don’t work for everyone and can have serious side effects.
Your symptoms: Diarrhea (but no blood in your poop and no abdominal pain), and occasional bloat. Symptoms are worse after you eat dairy.
You likely have lactose intolerance, an inability to digest the milk sugars in cow’s milk. Besides diarrhea, you may experience bloating or notice gurgling or other stomach noises after having pizza, a latte or other dairy. You’ll need to cut out dairy or take lactase enzyme pills to ease its digestion.
Your symptoms: Diarrhea (but no blood in your poop and no abdominal pain), and occasional bloat. Symptoms are worse after you eat bread or pasta.
Signs point to celiac disease or non-celiac gluten sensitivity. Celiac disease is an autoimmune disorder in which eating gluten, a protein in wheat, rye, and barley, causes the immune system to attack the lining of the small intestine, producing symptoms such as abdominal pain, bloating, and diarrhea; sometimes it can also lead to brain fog, rashes, and joint pain. Longer-term, the intestinal damage can compromise your ability to absorb nutrients. A blood test and biopsy can confirm the diagnosis, and only going 100 percent gluten-free can heal the gut and stop your symptoms. With non-celiac gluten sensitivity, gluten won’t inflict the type of damage to the small intestine seen in celiac disease, but you can still experience stomachaches, headaches, fatigue, depression and other symptoms in response to it. Most people with gluten sensitivity feel better after cutting out gluten.
Your symptoms: Diarrhea (but no blood in your poop and no abdominal pain). Your diarrhea isn’t affected by eating bread, pasta, or dairy.
If it started within the past few days, it could be food poisoning or a stomach virus. Sip electrolyte-rich fluids (broth, coconut water, Gatorade); call your doc if you have a fever over 102 degrees or your diarrhea lasts more than a few days.
Your symptoms: You’re totally bloated, but you started the day with a flat belly
You may be swallowing air (the technical term is aerophagia) when doing things like drinking soda, chewing gum, or talking while eating.
Your symptoms: Long-lasting bloat. You recently took a lot of antibiotics of acid-suppressing drugs.
You could have small intestinal bacterial overgrowth (SIBO), in which bacteria in the small intestine have gotten out of whack. Although SIBO can be caused by taking antibiotics, one of the treatments is, ironically, more antibiotics (particularly rifaximin, which stays in the gut) to slay the bad bugs, and then probiotics to repopulate your gut with healthy bacteria. Altering your diet can also help, notes Dr. Chutkan. “Most people treated with rifaximin alone improve for a couple of weeks, then get worse unless they change their diet,” she says. Many doctors recommend limiting certain hard-to-digest carbohydrates, including lactose, fructose, and resistant starch.
Your symptoms: Constipation and severe abdominal pain after you eat.
You might have Crohn’s disease. Another type of IBD, Crohn’s disease can cause abdominal pain (especially in the right lower quadrant), diarrhea, sometimes bloody stool, fatigue, weight loss and, over time, bowel obstruction (leading to constipation) and even malnutrition. As with ulcerative colitis, an abnormal immune response may be a factor: “Your body’s antibodies are essentially chewing up the colon,” explains Dr. Ganjhu. While ulcerative colitis affects only the inner lining of the colon and rectum, Crohn’s can affect all the layers of the bowel, as well as the entire GI tract, anywhere from your mouth to your butt. Treatment often involves lifelong immune-suppressing drugs, plus steroids for flare-ups. Ask your doctor whether a modified diet could improve your symptoms. Some cases may require surgery.
Your symptoms: Constipation along with weight gain, fatigue, and/or feeling extra sensitive to cold.
It could be an underactive thyroid (aka hypothyroid), which slows many of the body’s systems, including digestion. After your diagnosis is confirmed with blood tests, treatment is daily thyroid medication.
Your symptoms: Constipation that feels better after you poop. You don’t have severe abdominal pain after you eat, and you’re not gaining weight, extra tired, and/or extra sensitive to cold.
It might be irritable bowel syndrome with constipation (IBS-C). Hallmarks: episodes of constipation and abdominal pain that’s relieved with a bowel movement. The culprit could be certain foods, gut bacteria problems, and/or stress.
Your symptoms: Constipation and bloat that’s worse around your period or ovulation. You don’t have severe abdominal pain after you eat, and you’re not gaining weight, extra tired, and/or extra sensitive to cold. You haven’t recently taken antibiotics.
See your ob-gyn to get checked for a possible gynecological condition such as endometriosis, ovarian cysts, polycystic ovary syndrome, or fibroids, any of which may also cause GI symptoms such as bloating, constipation, or abdominal pain.
Your symptoms: Constipation. You don’t have severe abdominal pain after you eat, and you’re not gaining weight, extra tired, and/or extra sensitive to cold. Your symptoms aren’t worse around your period or ovulation.