Bowls of lentils and rolled oats beside two fresh pears on a wooden kitchen counter

Diverticular Disease: Diverticulosis vs Diverticulitis Explained

On July 19, 2014September 11, 2026 By Dr. Scott RennieIn GastrointestinalLeave a comment

When a patient came in with abdominal pain or blood in their stool, one of the conditions we considered was diverticulitis. You may not have heard much about diverticulitis, so this post will try to answer some common questions about diverticular disease.

A diverticulum is a small pouch-like structure that sometimes forms in the muscular wall of the colon. These little pouches often cause no pain, and we usually become aware of them only after a procedure such as a colonoscopy, flexible sigmoidoscopy, a barium enema or a CT scan.

What is diverticulosis? Diverticulosis simply means that diverticula are present. Most people have no symptoms and will remain free of symptoms throughout their lives. (Roughly 15 to 25 percent go on to develop diverticulitis, which is more severe.) I usually think of a diverticulum as a small area where the colon balloons out. These are potentially weak spots that might become inflamed or may rupture under pressure.

What is diverticulitis? Diverticulitis is inflammation of a diverticulum, which occurs when there is thinning or breakdown of the wall of the colon. It is more severe than diverticulosis because the pouches have become irritated, inflamed or stretched, either from pressure within the colon or from hard particles of stool lodged inside them. The diverticulum becomes painful and may rupture, meaning the wall of the colon breaks down and allows stool and bacteria to enter the abdomen. Diverticulitis may also cause bleeding within the colon, because blood vessels often run through the area where diverticula form and they can bleed when the area gets inflamed.

Symptoms of diverticulitis: The symptoms depend on how severe the inflammation inside the colon is. The most common symptom is pain in the left lower abdomen. Patients may also have blood in the stool, nausea, vomiting, constipation, or diarrhea.

Classification of diverticulitis: Simple diverticulitis is more common and usually responds well to medical treatment without surgery. Complicated diverticulitis, about 25 percent of cases, usually requires surgery to remove the section of colon that has become inflamed or ruptured.

Treatment: Diverticulosis itself usually needs no treatment, since diverticula that are not inflamed are generally painless and cause no problems. Many providers do recommend increasing dietary fiber to reduce the chance of constipation, since constipation raises pressure within the colon, which can in turn lead to diverticulitis. Increasing fruits, vegetables, hydration and fiber has not been proven to prevent diverticulitis, however. We used to tell patients with diverticulosis to avoid seeds and nuts, on the theory that they increased the risk of diverticulitis. Research has since shown that advice to be wrong.

Diverticulitis does require treatment, and what you receive depends on the severity of your symptoms. Mild abdominal pain from diverticulitis can usually be managed at home with a clear liquid diet and oral antibiotics. If a patient develops a fever greater than 100.4 degrees F, worsening or severe abdominal pain, or an inability to keep fluids down, hospital treatment is usually recommended.

Hospitalization: If you need to be in the hospital for diverticulitis, you usually will not be allowed to eat or drink until you start feeling better, and antibiotics and IV fluids are given. If an abscess forms, a surgeon may need to drain it by placing a tube through the abdominal wall.

Complications: Peritonitis is a generalized infection within the abdomen that occurs if the colon ruptures. An emergency operation is often required in these cases to remove the diseased section of colon and reconnect the unaffected ends. Sometimes those two steps are done at separate times, with the removal first, so the colon is allowed to heal before the pieces are reattached.

Surgical treatment: Patients who don’t respond well to medical treatment, or who have repeated attacks of diverticulitis, may benefit from surgery to remove the diseased section of colon.

Bleeding from diverticulitis: Most of the time the bleeding stops on its own, but sometimes a colonoscopy or another procedure is necessary to get it under control.

Rectal Bleeding: What Are the Possible Causes of It?

On January 23, 2014September 11, 2026 By Dr. Scott RennieIn Gastrointestinal3 Comments

Editor’s note, August 2026. This post says colorectal screening begins at 50. The USPSTF lowered that to 45 in 2021, and several stool-based and visual options now sit alongside colonoscopy. Everything else here about the causes of rectal bleeding is unchanged.

Labelled diagram of the large intestine showing the cecum, ascending, transverse, descending and sigmoid colon, and the rectum — Anatomy of the large intestine. Image: OpenStax College, Anatomy and Physiology, CC BY 3.0.

One of the more common problems that brought patients in to see me, believe it or not, was seeing blood in the toilet, on the stool, or on the toilet paper after a bowel movement. Since I had seen several patients about this, I thought I would write about some of the possible causes.

Healthcare providers take this seriously, because blood noticed after a bowel movement can sometimes be a sign of colon or rectal cancer. Fortunately, most causes of rectal bleeding are not cancer.

Causes of rectal bleeding:

Hemorrhoids: Swollen blood vessels in the rectum or anus can cause itching, pain, and bleeding. Patients usually describe hemorrhoidal blood as bright red. It may coat the surface of the stool, drip into the toilet and turn the water red, or show up on the toilet paper. Hemorrhoids do not have to hurt. Painless rectal bleeding during a bowel movement is a common presentation.
Anal fissure: A tear in the lining of the anus can bleed, and there may be pain with a bowel movement.
Other causes include infection, colitis (which may be due to an autoimmune disease such as ulcerative colitis or Crohn’s disease), colon polyps, and colon cancer. If the bleeding comes from higher in the digestive tract, such as in or above the stomach, the blood may look dark black or tarry.

Diagnosis and testing: To find the cause of bloody stools, your provider may perform tests or refer you to a specialist. They will take into account the information you give them, your history, your symptoms, and your age.

1) Rectal exam: Your provider will usually examine the rectum and look for a source of bleeding such as a hemorrhoid or fissure. This may include a digital rectal exam, where the doctor inserts a gloved and lubricated finger into the rectum to feel for possible rectal cancers.

2) Anoscopy: Your doctor may use a small plastic device with an attached light to get a better look at the source of bleeding. Most of the time this is not painful, though it can be a bit uncomfortable, and it can be done in the office.

3) Sigmoidoscopy: This is usually done in an outpatient center, and the patient is usually not sedated. Sigmoidoscopes come in rigid and flexible forms, and the flexible one is used most often. A flexible tube, roughly 70 cm long and 1 cm wide, carrying a tiny video camera and a light, is inserted through the anus and gently into the colon while air is introduced to open the area and improve the view. A biopsy is often taken with a small tool. Sigmoidoscopy allows visualization of the anus, rectum, sigmoid colon and the top of the descending colon. It does not reach the entire colon, so it can miss cancers, polyps or bleeding sources in other areas.

4) Colonoscopy: Similar to sigmoidoscopy, but it allows the doctor to examine the entire colon with a longer flexible tube. The colonoscope, about 140 cm long, reaches everything the sigmoidoscope can and also allows visualization of the transverse colon, ascending colon and cecum. The patient is usually sedated.

When to seek help: It is impossible to know the cause of rectal bleeding without an examination. Everyone with rectal bleeding should talk to their healthcare provider about what evaluation they need. Even though there are common causes that are not cancerous, bleeding can be caused by cancer or by precancerous conditions.

Precancerous polyps may sit in the colon for years before turning cancerous, and they can be removed safely, which prevents them from ever becoming cancer. These polyps can produce symptoms very similar to an innocent hemorrhoid.

I’ve met patients who have ignored rectal bleeding for years because they thought it was because they had a hemorrhoid and it turned out to be cancer. With increasing age comes increasing risk of polyps and colon cancer.

Colon cancer screening: For patients at average risk, screening was started by checking the stool for small amounts of blood, which may be hidden, each year beginning at age 50. A first colonoscopy at age 50 was also recommended, unless other risk factors were present, and every 10 years thereafter unless a person was at increased risk based on family history or a previous diagnosis or biopsy result.

Update, 2026: The starting age has changed since this post was written. The American Cancer Society lowered it to 45 for people at average risk in 2018, the U.S. Preventive Services Task Force adopted 45 in 2021, and the ACS reaffirmed age 45 in its 2026 guideline update, with screening continuing through age 75 for those with a life expectancy over 10 years. If you are 45 or older and have not been screened, talk to your provider. See https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html

People at increased or high risk:

If you are at increased or high risk of colorectal cancer, you should begin screening before the standard starting age, be screened more often, or both. The following raise your risk above average:

A personal history of colorectal cancer or adenomatous polyps
A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s)
A strong family history of colorectal cancer or polyps
A known family history of a hereditary colorectal cancer syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colon cancer (HNPCC)

Celiac Disease and Gluten Sensitivity: Why Go Gluten Free?

On March 28, 2013August 30, 2026 By Dr. Scott RennieIn GastrointestinalLeave a comment

One of the most common questions I hear from patients lately is about the gluten free diet. Many want to know if going gluten free can help with weight loss, low energy, bloating, constipation, or heartburn. The conversation around gluten is everywhere. Some of the information is accurate, but a lot of it is based on rumor or advertising.

So what exactly are Celiac disease, gluten intolerance, and gluten sensitivity?

Celiac disease is an autoimmune condition that affects about 1% of the population. When patients with Celiac disease eat gluten, their immune system reacts by damaging the small intestine. Gluten is a protein found in wheat, rye, and barley. For people with this condition, avoiding these foods is essential. Even small amounts can cause illness.

Gluten intolerance, sometimes called non-Celiac gluten sensitivity, is different. It may affect as many as 10% of people. Symptoms can be milder than Celiac disease and may involve more than just the gastrointestinal tract. Definitions of gluten intolerance have shifted over time as we learn more, but the general idea is that some people feel unwell after eating gluten even without the intestinal damage seen in Celiac disease.

The small intestine’s main job is absorbing nutrients from food. In Celiac disease, that lining gets damaged, which makes it harder for the body to take in vitamins and minerals. Symptoms can include diarrhea, abdominal pain, gas, weight loss, and deficiencies in iron or vitamins. Some patients develop related conditions, such as osteoporosis or thyroid disease. Celiac disease is also linked to dermatitis herpetiformis, a very itchy rash that can form on the elbows, knees, or back.

There’s even an increased risk of intestinal lymphoma in patients with untreated Celiac disease. While this cancer is rare, the risk decreases when gluten is eliminated from the diet.

So how do we test for Celiac disease?

The most definitive test is a biopsy of the small intestine, usually done during an endoscopy. Blood tests can also help, such as tissue transglutaminase antibody (TTG) or endomysial antibody (EMA). These are often used in a Celiac panel. Your doctor can help decide which test makes sense based on your symptoms.

There isn’t a test for gluten intolerance. If blood work and biopsy are normal but symptoms improve on a gluten free diet, that’s sometimes how the diagnosis is made.

Celiac disease appears to have a genetic component. It’s more common in patients with European ancestry, as well as in parts of the Middle East, North Africa, and South Asia. It is rare in populations from northern Asia and southern Africa.

Treatment is simple in theory but difficult in practice. The only effective treatment is to completely avoid gluten. About 70% of patients feel better within two weeks of eliminating gluten. Antibody levels in the blood often return to normal as well. But gluten is in many foods, and avoiding it requires major lifestyle changes. It’s not just bread and pasta. Gluten can hide in supplements, sauces, and processed foods.

A dietician who specializes in Celiac disease is often the best partner for patients making these changes. They can help identify hidden sources of gluten and ensure nutritional needs are still being met. That’s important because gluten free foods often contain less iron, vitamin D, and B vitamins. Some processed gluten free products add extra sugar or fat to make up for texture.

Patients sometimes ask if they should just “try going gluten free.” I usually recommend testing first if symptoms suggest Celiac disease. That way, you don’t lose the chance to confirm the diagnosis. If the tests are negative, you can still try eliminating gluten to see if you feel better, but do it with support from a healthcare provider or dietician.

Practical considerations matter. Many people with Celiac disease also need extra calcium and vitamin D, and sometimes blood tests for iron, folic acid, or B12. Osteoporosis can be a risk, so bone density testing may be appropriate. Dairy intolerance is also common until the intestine heals.

Some naturally gluten free foods include rice, corn, potatoes, beans, nuts, seeds, and soy. Foods to avoid are wheat, rye, barley, malt, brewer’s yeast, and most oats unless specifically labeled gluten free. Most wines are safe, but most beers are not.

Gluten intolerance and Celiac disease are real conditions, but gluten isn’t harmful for most people. It’s important to understand why a gluten free diet might be necessary and not assume it’s a guaranteed path to better health.

For more information:

This is for educational purposes only. If you think you may have Celiac disease or gluten intolerance, talk with your healthcare provider.

Hemorrhoids Explained: Why They’re a Real Pain in the Rear

On March 20, 2012August 30, 2026 By Dr. Scott RennieIn Gastrointestinal4 Comments

Hemorrhoids are a common problem in both men and women who come to see their primary care or urgent care doctor. Hemorrhoids are enlarged or swollen veins in the lower rectum. They can cause pain, itching and rectal bleeding. Sometimes you can feel or see hemorrhoids around the outside of the anus. Other times they may be hidden from view inside the rectum (internal hemorrhoids). They are more common in older individuals and patients during and after pregnancy, those with diarrhea or constipation or in people who sit for prolonger periods of time. Symptoms: 1) Anal pain or itching 2) Tissue bulging around anus 3) Painless rectal bleeding 4) Difficulty cleaning or leakage of feces after bowel movement Diagnosis: Your healthcare provider will examine the rectum and anus to inspect for hemorrhoids. This exam may include inserting a gloved finger into the rectum. The reason for the digital exam is to inspect for possible rectal cancers and also to collect any stool that’s present and test for blood. If there is blood present, your healthcare provider may use a special tube called an anoscope, that is clear and allows visualization of the rectum/anus. Treatment: If hemorrhoids are diagnosed, one of the most important steps is avoiding constipation because they can lead to rectal bleeding or tearing the anus (called a fissure). Also, it is important to avoid pushing or straining during bowel movements because that can worsen existing hemorrhoids and risk causing development of additional hemorrhoids. Reducing constipation can be done by: 1) Increasing fiber – increasing fruits and vegetables contain fiber. In addition fiber supplements such as Metamucil may be helpful. 2) Laxatives – These are not “addictive” or increase your risk of constipation in the future. 3) Warm sitz baths – soaking the rectal area in warm water for 10 minutes 3x/day improve blood flow by relaxing the internal anal sphincter. 4) Topical treatments – Suppositories are creams with hydrocortisone may be helpful to relieve pain, itching and irritation. More invasive procedures: 1) Rubber band ligation – a rubber band or ring is place around the base of the internal hemorrhoid which restricts the blood supply to that area. This shrinks the hemorrhoid and reduces it. 2) Laser surgery – uses a laser or infrared light to destroy internal hemorrhoids 3) Sclerotherpay – a chemical solution is injected into the hemorrhoidal tissue causing it to break down and form a scar 4) Surgery – hemorrhoidectomy is the treatment of choice for patients with large internal hemorrhoids. A gastroenterologist is a doctor who specializes in the gastrointestinal tract. If you are looking for a gastroenterologist in your area, the American Gastroenterological Association has a locator: https://secure.gastro.org/GILocator/locator.asp I hope that you have found this information useful. Wishing you the best of health,

What’s Causing My Abdominal Pain? Common Causes Explained

On February 28, 2012August 30, 2026 By Dr. Scott RennieIn GastrointestinalLeave a comment

Patients who present to the clinic or urgent care with abdominal pain can be some of the most challenging, because of the many different causes. The job of your primary care or urgent care provider is to determine whether the pain is requiring immediate surgical evaluation. Medical providers must try to determine which patients can safely be observed and their symptoms treated and which patients require further investigation by a specialist such as a surgeon. This is difficult because abdominal pain is often non-specific and presents with other symptoms very commonly. Triage: We must urgently investigate abdominal pain in many patients. Some patients require assessment of their airway, breathing and circulation followed by appropriate resuscitation. Patients who may need surgery must be transferred to a facility where they can receive that care where appropriate nursing care, laboratory, surgical consultation, and radiology facilities are available. Patients who are having less severe pain or signs on exam may require consultation or referral for further management. Helpful information from patients: 1) Time course of pain 2) Location of pain 3) Radiation of pain 4) Factors that make the pain worse or better (such as foods or antacids) 5) Associated symptoms including fever, chills, weight loss, nausea, vomiting, diarrhea, constipation, blood in the stools, jaundice, change in stool or urine color or diameter of the stools. 6) Past medical history, including history of abdominal surgeries 7) Family history of bowel disorders 8) Alcohol intake 9) Medications – including Tylenol, aspirin, and ibuprofen/aleve 10) Menstrual and contraceptive history in women Surgical abdomen: Usually defined as a condition with rapidly worsening course without surgical intervention. Obstructions of the intestines and peritonitis (inflammation/irritation of the inner wall of the abdomen that covers most abdominal organs) are reasons for referral to a surgeon. Sometimes tests will be ordered such as an abdominal radiograph, CBC, comprehensive metabolic panel with liver enzymes, lipase, a urine analysis and pregnancy test (in women of childbearing potential). Other things we consider in determining the cause of the abdominal pain are the location of the pain and changes in where the pain radiates as well as how rapidly the pain gets worse. Some possible causes of abdominal pain are many – gallstones or gallbladder dysfunction, peptic ulcer, hiatal hernia, pneumonia, heart attack, pancreatitis, heartburn, lactose intolerance, celiac sprue, pregnancy (including ectopic), endometriosis, sickle cell disease, appendicitis, ovarian cyst or torsion, UTI, kidney stones, constipation, colitis, diverticulitis, pelvic inflammatory disease, gastroenteritis, intestinal ischemia (decreased blood flow to the intestines), diabetic ketoacidosis, kidney infection, abdominal aortic aneurism, or even trauma. Treatment: Is tailored to address the cause of the pain. If no cause can be found at your doctor’s office, the goal is to determine whether it is safe for you to go home with medications to help with the pain, and testing done as an outpatient or whether you need to be transferred to the hospital where further workup can be done immediately. I hope that you have found this information useful. Wishing you the best of health,

Gastroenteritis: Nausea, Vomiting, Diarrhea and Dehydration

On February 27, 2012August 30, 2026 By Dr. Scott RennieIn Gastrointestinal1 Comment

Editor’s note, August 2026. This post recommends advancing to a BRAT or BRATTY diet. That advice has been dropped. Returning to a normal diet as soon as it is tolerated is preferred now, because the restricted version is low in protein and energy and does not shorten the illness. The rehydration advice below still stands, and it is the part that matters.

Viral gastroenteritis is an illness that we often see in the urgent care and medical clinic in both adults and children. It causes diarrhea and vomiting. How do I get infected? If you touch an infected person or an object that has been touched by someone who is infected (that has the virus on it), you could become contaminated. If you eat foods or drink liquids with the virus you may also become infected. It is important for people with the virus to wash their hands. Symptoms: Possible symptoms include nausea, vomiting, diarrhea, fever, headache or muscle aches, belly pain or cramping and loss of appetite. If your body loses too much water, you can become dehydrated. Symptoms of dehydration include dark yellow urine, feeling thirsty, tired, dizzy or confused. Dehydration that is severe can be life threatening. Babies, infants, young children and the elderly are more likely to become dehydrated. When should I call a doctor or nurse? If you or your family member has symptoms of dehydration (mentioned above), diarrhea or vomiting that lasts longer than 24 hours, vomiting blood or have bloody diarrhea, they haven’t had anything to drink in a few hours or been able to urinate in the past 6-8 hours during the day, if a baby or young child hasn’t had a wet diaper in 4-6 hrs. Diagnosis: Most of the time the diagnosis can be made after obtaining a history and performing a physical exam, but sometimes your healthcare provider may obtain blood tests, urine tests or tests on a stool sample. Treatment of viral gastroenteritis: For severe gastroenteritis with dehydration patients are sometimes treated with IV fluids (a thin tube that goes into the vein). We do not give antibiotics for viral gastroenteritis because they don’t help cure a viral infection. We can give medicine in the IV to help reduce the nausea as well. Sometimes suppositories or oral medications for nausea can be helpful. Small sips of clear fluids at home every 15 minutes can help prevent dehydration. We generally try to avoid red colored fluids so that if it passes right through, we don’t confuse the red color for blood in the stool. Once vomiting has stopped for 24 hours, starting small bites of crackers can be tried. The diet usually advances to a “BRATTY” diet at this point – ie. “Bannanas, Rice, Apples, Tea, Toast and Yogurt” are all bland foods that are easy on the stomach. Prevention of viral gastroenteritis: Wash your hands with soap after using the bathroom or change your child’s diaper and before you eat. Avoid changing diapers near where you prepare food and make sure your baby gets the rotavirus vaccine. Rotavirus is a common infection that causes severe nausea, vomiting and diarrhea in children. Dehydration: This is a term that medical providers use to describe when the body loses too much water. It can be mild or severe. Usually mild dehydration doesn’t cause problems, however severe hydration is a medical emergency and can be life threatening. You children and babies are more at risk for dehydration because they have a small body mass and less to lose to begin with. Causes of dehydration: Vomiting, diarrhea, sweating/high fever, medicines called diuretics or water pills. Also some people who have nausea or sore throat might not drink enough fluids. Symptoms of dehydration: With mild dehydration, patients might not notice any symptoms, however as dehydration gets worse it can cause: 1) Feeling thirsty 2) Urinating less often, or having dark yellow or brown urine 3) Dry mouth or cracked lips 4) No tears when a child cries 5) Feeling tired or confused 6) Feeling light headed or dizzy 7) Eyes look sunken in the face 8) Babies can have a sunken gap between the bones in the babies skull. This soft spot can feel/look caved in. When to seek help: Call your medical provider if your child has any symptoms of dehydration. You should also call if the patient has diarrhea that lasts more than a few days, vomits blood or has bloody diarrhea, vomiting lasts more than 24 hours, urinating much more than usual, haven’t had anything to drink in many hours, hasn’t needed to urinate in the past 6-8 hours (in adults/older children) or hasn’t had a wet diaper in 4-6 hrs. I hope that you have found this information useful. Wishing you the best of health,

I think I may be constipated – How do I know?

On February 26, 2012August 30, 2026 By Dr. Scott RennieIn GastrointestinalLeave a comment

I am Scott Rennie, DO, board certified in Family Medicine and Obesity Medicine. I practice entirely by telemedicine, licensed in all 50 states. Most of my work now is weight loss, metabolic health and menopause care. If this was useful, Start here lists what I write about now.

Constipation is a common condition that I see in the clinic. It’s a topic that few people enjoy talking about but is very common. In fact, almost everyone gets constipated at some time during his or her life. Women and the elderly are more commonly affected. Though not usually serious, constipation can be a concern. Constipation: A bowel motility disorder that occurs when bowel movements become less frequent. The normal time between bowel movements varies widely from person to person – some people having a bowel movement 3 times a day, and others only 1 to 2 times per week. In general, going more than 3 days without a bowel movement can cause pain. After 3 days, the stool becomes harder and more difficult to pass. Some signs that you may be constipated (2 or more during 3 months at least): Straining during bowel movement more than 25% of the time, lumpy or hard stools more than 25% of the time, sensation of anorectal obstruction, sensation of incomplete evacuation more than 25% of the time, manual maneuvering required to defecate, three or fewer bowel movements in a week. Symptoms of constipation: Infrequent bowel movements and/or difficulty passing stool, swollen abdomen or abdominal pain, vomiting. Some causes of constipation: Medications (especially strong pain medications such as narcotics, antidepressants or iron pills), low fiber diet, dehydration, disruption of regular diet or routine (traveling), inadequate activity or exercise, eating large amounts of dairy products, stress, resisting the urge to have a bowel movement (sometimes the result of painful hemorrhoids), overuse of laxatives, hypothyroidisms, Parkinson’s disease or Multiple Sclerosis, antacid medications containing calcium or aluminum, depression, eating disorders, irritable bowel syndrome, pregnancy and colon cancer. Treatment options: Increase hydration – drink 1.5 – 2 quarts of water each day Add fruits and vegetables to your diet Eat prunes and/or bran cereal A mild stool softener or laxative may be used Medication choices: 1) Bulk forming laxative: Metamucil, Citrucel, Fibercon or Benefiber 2) Surfactants – Lower the surface tension of stool, thereby allowing water to more easily enter the stool. Docusate/Colace is an example 3) Osmotic agents: Cause intestinal water secretion and thereby increase stool frequency. Examples are Polyethylene glycol (PEG) which is also known as Miralax. Excessive use of these agents may result in electrolyte and volume overload in patients with renal or cardiac dysfunction. Lactulose is a synthetic disaccharide that is not metabolized in the intestine, thus water and electrolytes remain in the lumen of the intestine. Sorbitol is a less expensive alternative. Saline laxatives such as milk of magnesia and magnesium citrate are poorly absorbed and act as hyperosmolar solutions. 4) Stimulant laxatives: Dulcolax, senna and sodium picosulfate primarily exert their effects via alteration of electrolyte transport by the intestinal mucosa. 5) Suppositories: For treatment of functional defecation disorder – glycerin or bisacodyl suppositories may help liquefy stool and thereby overcome the obstruction. Other treatments for Constipation: Behavioral approaches (habit training has been especially successful for children), biofeedback – a behavioral approach that can be used to correct inappropriate contraction of the pelvic floor muscles and external anal sphincter during defecation in patients with functional defecation disorder. Warning about constipation: Since constipation can be a sign of possible bowel obstruction or even cancer – I recommend calling your doctor if this is a new problem for you, if you have blood in your stool, you are losing weight even if you’re not dieting, you have severely painful bowel movements, your constipation has lasted more than two weeks. I hope that you have found this information useful. Wishing you the best of health,

Heartburn and GERD: Answers to Your Common Questions

On February 24, 2012September 11, 2026 By Dr. Scott RennieIn Gastrointestinal1 Comment

I often get questions from patients asking how to treat their heartburn also called gastroesophageal reflux disease or GERD. It is sometimes confusing to diagnose and can also cause dangerous complications if not treated. GERD is a common condition where acid contents from the stomach go backwards up the esophagus (food tube between your mouth and stomach). This can irritate and inflame the esophagus causing a burning sensation and other problems. There is a sphincter/valve at the top of the stomach that helps keep the stomach contents from going backwards, but if the spincter (called the lower esophageal sphincter or LES) doesn’t fully close, liquid contents of the stomach which contain acid can leak back into the esophagus. Risk factors: Obesity, pregnancy, smoking, hiatal hernia (a problem where part of the stomach moves above the diaphragm), alcohol and medications. The medication list is extensive and includes: 1) Non-steroidal anti-inflammatory medications such as ibuprofen, aspirin or aleve 2) Beta-blockers which are used for high blood pressure 3) Bronchodilators such as prednisone used for asthma 4) Calcium channel blockers used for high blood pressure 5) Dopamine-active medications used for Parkinson’s disease 6) Sedative medications which are used for insomnia/anxiety 7) Tri-cyclic anti depressant medications – used for pain/IBS Symptoms of GERD: Nausea after eating, hiccups, feeling that food is stuck behind breastbone, burning pain in the chest which is increased by bending, stooping, lying down or eating, usually worse at night and relieved by antacids. How do I find out if I have GERD/Heartburn? There are many different tests that can be used to help diagnose esophageal reflux such as: a trial of a medication for heartburn such as a GI cocktail (a mixture of Mylanta, viscous lidocaine and donnatol), esophagogastroduodenoscopy(EGD) – which is when a doctor inserts a camera that looks down the esophagus when you are under anesthesia, barium swallow, esophageal pH monitoring, and esophageal manometry. Sometimes a stool blood test is used to diagnose bleeding that might be coming from the esophagus, stomach or intestines. Helicobacter Pylori, also known as H. pylori is a bacterium that is commonly found in the stomach. About half of the world’s population has this bacteria and they have no symptoms and will never develop problems. However, H. pylori can cause stomach ulcers, and much less commonly, stomach cancer. We really don’t know why some people with H. pylori get these symptoms and others do not. Stomach ulcers can cause symptoms such as pain or discomfort in the upper abdomen, bloating, feel full after eating only a small amount of food, lack of appetite, nausea and vomiting, black or tar-colored stools, and even low blood count and fatigue. Treatment: Treatment is tailored toward the individual patient and might include some of the following options: 1) Treat H. pylori with antibiotics if it is present 2) Diet modification – avoid a core group of reflux-inducing foods (fatty foods, chocolate, peppermint, excessive alcohol) and spicy foods like citrus fruits, coffee, tomatoes/marinara sauce (found in spaghetti and pizza), garlic, onions, peppers, chili, carbonated beverages 3) Stop smoking or chewing tobacco 4) Reduce or stop medicines which can make GERD worse such as NSAIDs (aspirin, ibuprofen, Aleve, Excedrine etc. – see list above) 5) Refrain from laying in a supine (on your back) after meals and avoid meals right before bedtime 6) Lose weight – obesity is a risk factor for GERD, erosive esophagitis, and esophageal adenocarcinoma (cancer). 7) Promotion of salivation by chewing gun, or oral lozenges might be helpful for mild heartburn as saliva neutralizes refluxed acid. 8) Acid-suppressive medications:

Antacids such as tums
H2 blockers such as famotidine (Pepcid) twice a day for mild GERD. This post originally named Zantac. Ranitidine is no longer available: the FDA asked manufacturers to pull it from the US market in April 2020 after NDMA contamination was found in the product. The box sold as Zantac 360 today contains famotidine, which is a different drug
Prescription PPI (such as Prilosec) – for more severe GERD

9) Acid barrier medications: Sucralfate protects the stomach or ulcer from acid by acting as a barrier It is important to be monitored closely if you are taking medication for heartburn because some of the complications that come with heartburn/reflux and the possibly with the medications used to treat them might be: Pneumonia, hypergastrinemia, atrophic gastritis, intestinal infections, vitamin B12 malabsorption, iron malabsorbtion, hip fracture and calcium malabsorption, magnesium absorption and drug interactions. I hope that you have found this information useful. Wishing you the best of health,

Dr. Scott Rennie

Category: Gastrointestinal

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