Ask an expert about….stomach ache 

This one hour web chat took place at:
10.30 - 11.30am on Monday 15 December 2014

Tummy troubles, digestive and bowel problems are no fun in the festive season.  To answer your questions on anything from unexplained rumbling tums and constipation to ulcerative colitis, crohn’s disease and colo-rectal cancer, we had Mr Richard Cohen hosting our web chat.  Mr Cohen is a consultant colo-rectal surgeon with an impressive CV – having trained at Cambridge University and undertaken research at Yale University in the USA, he is currently clinical director for gastro-intestinal services at UCLH.  

Please see the transcript below

10:27 Mr Richard Cohen: 
Welcome to our web chat on the subject of stomache ache. My name is Richard Cohen – consultant colorectal surgeon and I am ready and waiting to take your questions.
10:28 [Comment From TimTim: ] 
"Good morning Mr Cohen. I am male, 56, and have experienced symptoms of belching, acid reflux and discomfort for about 6 months. I was referred pretty smartish for gastroscopy which revealed mild oesophagitis and gastritis, but nothing more sinister. Omeprazole helps, but I don't really want drugs long-term. Is this just "one of those things", and I'll now just have to put up with it? I don't feel anyone has really explained it!"
10:29 Mr Richard Cohen: 
Tim, what you describe is a feature of modern living. There are lots of folk who take anti acids such as Omeprazole medium to long term.If the medication helps I would consider taking it. Sometimes less medicinal antacids such as Gaviscon or even milk will do the trick and you may wish to discuss that with your GP
10:30 [Comment From DeborahDeborah: ] 
My digestive system/tummy has been playing up over the last year. If I eat a meal I have to go to the toilet 5 minutes later to relieve my bowels. I have stopped eating lunch at work due to this problem. I also have trapped wind, a throbbing pain in my digestive system for most of the day, every day. When I go to the loo most times the stools are very loose but if they are slightly more solid they is mucous. I hope you can help.
10:31 Mr Richard Cohen: 
Hi Deborah. With your symptoms I am sure you need to ask your GP to refer you to a gastroenterologist to be checked out. They can often help with advice or medications, but need to do tests first to identify the cause. Often it is just a functional problem (the way your bowels work)
10:32 [Comment From BernadetteBernadette: ] 
Low carb diets are very popular at the moment. However, I am not convinced they are as healthy as we are led to believe. What is your opinion on this? Should we be cutting out bread, potatoes, pasta, rice etc. Can vegetables and fruit alone provide the fibre we need to keep our bowels healthy?
10:32 Mr Richard Cohen:
Bernadette, my view is that we need to enjoy life and I only recommend restrictive diets to patients who have a real need, such as coeliac disease or a need for weight loss. There are some patients who find excluding certain foods from their diet makes them feel a lot better, but often the only way to work out which food is causing the mischief is trial and error.
10:33 [Comment From SusannaSusanna: ] 
Dear Richard I have been having mild stomach pains, many times I don’t feel like eating and if I do I feel like I want to throw up. Can you help? Many thanks
10:34 Mr Richard Cohen: 
Hi Susanna. These sound like very general symptoms,I advise you go and see your GP. He or she may want to send you up for special tests
10:34 [Comment From SueSue: ]
Dear Mr Cohen, I had 3 major scoliosis correction operations 2 years ago and I was on huge amounts of pain relief and medication. The second operation was abandoned due to spinal cord complications and then resumed a week later. Since then I have had problems with my bowels and 2 years ago it was so bad I lost weight and had to go to A&E twice. I have had bad flare ups since March and then it calmed down. Now it seems to be returning. I have devised a diet for myself which avoids well known foods that trigger IBS and IBD. I have had an endoscopy and a scan but nothing has been revealed. Are there any ideas from yourself why this has going on since my surgeries. Kind regards,
10:35 Mr Richard Cohen:
Hi Sue. Sorry to read about your troubles. Most spinal units have access to specialist doctors who have an interest in spine related bowel difficulty and I recommend you ask them for a referral
10:35 [Comment From JohnJohn: ] 
Re: this morning's chat, is it true that ulcerarive colitis can be put in abeyance by smoking cigarettes? I know theyr'e bad for you, but I never had this illness till after I gave up smoking, and the medications- immunosuppressants AND anti- inflammatories- just aren't working.
10:36 Mr Richard Cohen: 
John, thank you. It is true that in studies it has been shown that people who smoke have some protection from ulcerative colitis and that smoking is really bad for patients with Crohns disease. They have not yet worked out what substance in cigarette smoke helps the colitis. I am afraid that smoking is still extremely hazardous for health and we do not recommend people take up smoking. If the medications are not working I would go back to your doctors and ask them to try other meds. In ulcerative colitis in highly selected patients surgery can be effective, but we reserve it for the very worst cases
10:37[Comment From SallySally: ] 
Does smoking and coffee irritate stomach probs? I do both and suffer from cramps and IBS attacks from time to time....

10:38 Mr Richard Cohen: 
Hi Sally
There is no doubt that smoking irritates stomach problems. The situation with coffee is less clear cut and if you are worried you should try cutting it out for a month and see how you get on

10:41 [Comment From JaniceJanice: ] 
Hello - i am a 66 year old with lots of stomach problems - I've been diagnosed with collitis and a narrower than usual back passage - I get very bad cramps, and cannot leave the house without wearing a pad. These come on in fits and starts and I take colofac to help. Is there anything I can do to pre-epmt them? They are very life-limiting...

10:42 Mr Richard Cohen: 
Hi Janice
Really sorry to read about your problems. These are clearly very complex and beyond the scope of this web chat. I am sure that you are under the care of experts for your medical problems and you need to discuss with them whether they can improve your situation. Good luck and I wish you better

10:44 [Comment From Clare Michelle LinleyClare Michelle Linley: ] 
I sent an e mail with regards to my swollen abdomen. did you receive it?
10:46 Mr Richard Cohen: 
Hi Clare
I received your email. I am afraid that your situation is too complex to deal with in a simple web chat. I can say that your current specialist is well known to me and is exactly the right person to help you

10:46 [Comment From MartinMartin: ] 
ive had loose bowels for the lastg month - I have a low back problem which has flared up recently - i take naproxen when bad - could this be the issue

10:48 Mr Richard Cohen: 
Hi Martin
It could be the medication and it will be interesting to see what happens when you stop taking it.
If the loose stools persist you need to see your GP to decide whether you warrant more in depth investigation

10:48 [Comment From BernadetteBernadette: ] 
Thanks for your response. I did follow a low carb diet successfully for a few years, but then tried to reintroduce bread/rice and now I get severe constipation with all the unpleasant side effects that brings (which I never had before) I am in my early 50s so that could also be a factor? I am now taking Benefibre, but not sure this is a good idea either. I eat lots of green vegetable/salads, but find fruit too bloating.

10:50 Mr Richard Cohen: 
Hi again
If your low carb diet worked for you and reintroducing carbs made you bad again it sounds like you need to think about adopting the diet that worked for you in the long term

10:51 [Comment From beverleybeverley: ] 
Good day doc, i was recently diagnosed with mild chrons . Why does my stomach rumble so much with excesssive gas even with meds.

10:53 Mr Richard Cohen: 
Good day Beverley
Rumbly tummy is a common symptom.
In patients with Crohn's disease it can be because the bowel has to work harder to move food through the Crohn's affected section.

10:54 [Comment From RoisinRoisin: ] 
Do you believe in wheat free for losing weight? I am thinking of a life change in Jan as I'm overweight and a lot of the diets cut out carbs/wheat...

10:56 Mr Richard Cohen: 
Hi Roisin
I am sure we need a dedicated web chat on losing weight.
I am not an expert but I believe it is all about diet and excercise. I do not believe that going wheat free is a major part of wt loss diet, unless it works well for you.

10:56 [Comment From khadijakhadija: ] 
Hello I am 18 years old and get really bad stomach aches in the morning and at night and take omeprazole every morning and every day diarrhea and I had blood tests done which indicated that I have an inflamed bowel and take buscopan for the tummy aches and I have an appointment to see a gastro doctor in febuary and that appoiinment cant come eailer can you please help me on what I can do next

10:58 Mr Richard Cohen: 
Hi Khadija
I am sure you need to attend your gastro appointment as arranged.
It is worth making a written list of the things which you think might be important so you dont forget anything at the appointment

10:58 [Comment From JonelleJonelle: ] 
I get v bad stomach cramps after eating chocolate..but I lvoe it and can't stop! What's causing this?

10:59 Mr Richard Cohen: 
Hi Jonelle.
You know what to do.....cut down on the chocolate I am afraid. Try an apple instead!

11:00 [Comment From chrischris: ] 
Please can you comment on my question of oxalaplatin/avastin/capecitabine versus RFA for colorectal cancer.Thanks

11:00 Mr Richard Cohen: 
Thank you Chris
You need to discuss this one with your oncologist. A lot depends on the scans and results for each individual patient
I wish you better

11:00 [Comment From JaniceJanice: ] 
Thank you Mr Cohen

11:01 Mr Richard Cohen: 
You are very welcome.
Happy to try and help

11:01 [Comment From TimTim: ] 
I understand that regular aspirin can help with some conditions, eg heart. How significant is the risk of gastric inflammation, ulcers etc from taking an aspirin each day?

11:04 Mr Richard Cohen: 
Hi Tim
Interesting area for us medics.
Aspirin in low doses has been shown to protect against cardiovascular disease and indeed some cancers (such as bowel cancer) but as you suggest has the potential down side of causing irritation to the GI tract.
I am sure the debate will continue as to whether we should all take an junior aspirin a day. For now i think it is an individual patient choice and you need to discuss it with your GP

11:05 [Comment From BernadetteBernadette: ] 
Okay thank you : )

11:06 Mr Richard Cohen: 
Thank you
Good luck with the low carb diet

11:06 [Comment From SueSue: ] 
Every morning for the last 11 days, when I've woken and stood up, I've had the most horrendous pain across my middle back. And wind. It lasts for approx 30 mins to an hour, with some considerable burping going on! I'm assuming the two are related. I dont' know what's causing this as I've not changed my diet, exercise routine or anything else. Stress levels haven't changed either, as far as I'm aware. Can you advise at all?
11:07 Mr Richard Cohen: 
Thank you for joining us Sue
I am afraid I cannot advise on this but if it continues I am sure you should go and see your GP.
I hope it stops soon

11:08 [Comment From LucyLucy: ] 
What do you think to yakult, bio drinks etc? I am on a very tight budget but have mild tummy probs...are they worth the money?
11:10 Mr Richard Cohen: 
Hi Lucy
Interesting question
There is increasing interest in the use of pre biotics and pro biotics for treating a whole host of every symptoms and some bad diseases.
I tell patients to try them and see if they make a difference, but i would not use valuable resource if you are on a tight budget

11:11 [Comment From GuestGuest: ] 
For digetive health, what's better, 3 main meals at set time or eat when you are hungry? Messages are confusing in the media...

11:11 Mr Richard Cohen: 
Good question Mr Guest
I think regular meals are better than just eating when hungry

11:12 [Comment From RoisinRoisin: ] 
a web chat on weight loss would be great! thanks

11:12 Mr Richard Cohen: 
I will put this to the powers that be....I think it would be really useful
Thank you

11:13 [Comment From BobBob: ] 
I am feeling bloated and permanently full and it's not even christmas yet...i have loads more dinners etc in my diary, what are your top tips for getting thru the festive season

11:15 Mr Richard Cohen: 
Thanks Bob
Always good to have a festive enquiry!
I suppose I would have to answer that you need to do everything in moderation, especially at this time of year!"

11:15 [Comment From KathleenKathleen: ] 
I am worried about my 22 yr old son's drinking - not from a dependency point of view but from what he is doing to his health - lots of very socialbe weekends, he is often sick etc - could this be an ulcer etc?

11:16 Mr Richard Cohen: 
Hi Kathleen.
Sorry to hear that you are worried about your son.
It sounds like he needs a motherly chat about the balance of enjoying himself and not hurting himself. Good luck!

11:17 [Comment From Nigel SmithNigel Smith: ] 
Dear Mr Cohen, I had an operation on 21 August 2014 for a laparotomy and small bowel resection for necrotic small bowel. Since then I have intermittent stomach/bowel pains, rumblings, and a lot of farting, plus burping – presumably too much wind down and up. How do I reduce the pain & wind? An Xray on 20 Nov said ‘There is a short segment of the small bowel which is distended and could be due to an ileus’

11:19 [Comment From Clare Michelle LinleyClare Michelle Linley: ] 
to Jonelle why not try carob instead of chocolate.

11:19 Mr Richard Cohen: 
Hi Mr Smith
Sometimes it takes a long time for the gut to recover after major abdominal surgery with a bowel resection. It is difficult to comment without all the information to hand.
I am sure your team will be happy to help when you next meet them
I wish you better

11:20 [Comment From GuestGuest: ] 
i am a fit and healthy 75 year old but have excess wind - walking up steps etc causes me to break's v embarrassing. What can I do?

11:22 Mr Richard Cohen: 
Hi Guest

Thank you.
Wind is produced by the bugs that line your lower bowel.
You can try lining the bowel with different bugs by using probiotics.
Alternatively you should worry less about what others think!

11:23 [Comment From beverleybeverley: ] 
Thank you

11:23 [Comment From JulieJulie: ] 
are bowel movements and the menstrual cycle linked? I get v bad bowel problems at my time of the month.

11:25 Mr Richard Cohen: 
Hi Julie
You are right that bowel symptoms can be linked to the menstrual cycle in some ladies. We don't always understand the mechanism.
Sometimes adjusting hormones such as the type of contraceptive a lady may take can help.

11:26 [Comment From MarinaMarina: ] 
When I need to go i need to GO. Straight away - this is making long car journeys v difficult - I'm 52 and a new problem!

11:28 Mr Richard Cohen: 
Hello Marina
Dont worry you are not alone!
In some ladies who have had multiple or difficult childbirth, the rectal and sphincter mechanisms can be affected causing urgency as you describe.
If the problem persists or is a big issue for you I suggest you talk to your GP about having this checked out

11:29 [Comment From Clare Michelle LinleyClare Michelle Linley: ] 
Thank you for taking the time to do the webinar.

11:29 Mr Richard Cohen: 
Thank you and I am sorry that I have not had time to go into detail with complex questions

11:31 UCLH: 
Thank you for joining us today in our live web chat. We hope you found the chat useful and some of your questions have been answered. It has been a very popular web chat and we haven’t managed to answer all questions within the short time available. We may have to do another one in 2015!


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