Tummy troubles: We all have them from time to time. But while a bout of gas, cramps, or diarrhea every now and then (hello, late-night junk food!) isn’t usually cause for alarm, what if your pain is a regular thing? Not only is it seriously uncomfortable—it could signal a deeper issue.
Here are the four most common causes of persistent stomach pain, along with moves for potential relief. Just keep in mind that each of the following conditions needs to be diagnosed by a doc, and treatments vary.
1. You’re Lactose Intolerant
Your favorite dairy products (looking at you, cheese) contain lactose, a sugar that needs to be broken down in your small intestine by an enzyme called lactase.
“If you have lactose intolerance, you were either born without or at some point lost the enzyme that breaks down lactose,” says Niket Sonpal, M.D., assistant clinical professor of medicine at Touro College of Osteopathic Medicine. “If you don’t have that enzyme, the sugar lactose molecule ferments and creates bacteria—and a lot of gas—in the gut.”
What that means for you: You might experience severe abdominal bloating, explosive diarrhea, and even nausea after noshing on some cheddar Jack or ice cream. Fun times.
Not all lactose intolerance is created equal, though—it varies by individual. “Some people can handle cheese but not ice cream or milk,” says Sonpal. The fix may be as simple as taking a lactase supplement with your meals—or you may find you need to quit dairy altogether.
As far as dairy alternatives go, Sofia Sanchez, R.D., nutritionist and co-founder of Ubuntu Fitness, is a big fan of almond milk, since its calcium levels are pretty similar to cow’s milk. (An average cup of almond milk contains about 400 milligrams of calcium, while a cup cow’s milk contains somewhere around 300 milligrams.) Coconut milk is another popular option, but Sanchez points out that coconut-based products are high in fat, and should be used in moderation.
If you cut dairy out completely, it’s a good idea to supplement with a multivitamin, since you won’t be getting the calcium or vitamin D found in milk, says David Bernstein, M.D., chief of hepatology at Northwell Health’s Sandra Atlas Bass Center for Liver Diseases in Manhasset, New York. The National Institutes of Health (NIH) recommends adults get 600 IUs of vitamin D per day—a number many Americans fall short of—and either 1,000 milligrams (men) or 1,200 milligrams (women) of calcium per day.
2. You Have Acid Reflux
Feeling the burn in your muscles after a workout? Awesome. Feeling the burn in your chest after eating a spicy meal? Er, not so much.
Gastroesophageal reflux disease (GERD) happens when stomach acid flows back into your esophagus, causing irritation. The thing is, while your stomach has a lining that protects it from acid, your poor ol’ esophagus does not, says Bernstein. Hence the discomfort and pain.
And when you have GERD, “the sphincter at the end of the esophagus that controls the passage of food to the stomach is too loose,” says Sonpal. This ineffective barrier is what causes the dreaded burning in your chest—but people with GERD may also deal with gas, bloating, hoarseness, and a sore throat, says Sonpal.
While occasional reflux is NBD, it may threaten your health when it occurs regularly. “Daily reflux for five to 10 years can put you at risk for cancer,” says Sonpal, so managing the condition is definitely important. The first line of treatment against acid reflux is making a lifestyle (a.k.a. diet) change, says Bernstein. “You want to avoid foods that are acidic,” he says. Beyond that, reflux can usually be controlled with OTC drugs as needed.
Related: 10 Possible Reasons Why You’re Suddenly So Bloated
The most common trigger foods are tomatoes, chocolate, red wine, peppermint, red meat, and caffeine, says Sonpal. (You know, all the good stuff.) In addition to avoiding these foods, people with reflux shouldn’t eat within at least four hours of bedtime, says Bernstein. When you lay down, it’s easier for that stomach acid to creep back up into your esophagus. Sleeping with your head propped up at a 45-degree angle can also help ward off nighttime discomfort, he suggests.
Even losing weight can help with GERD. “The number one risk factor for acid reflux is obesity,” says Sonpal. (According to a study published in the New England Journal of Medicine, weight gain exacerbates symptoms.) Just another reason to clean up your kitchen and get moving.
3. You Have Irritable Bowel Syndrome
Although irritable bowel syndrome (IBS) is super-common (anywhere from 25-45 million Americans have it, according to the International Foundation for Functional Gastrointestinal Disorders), it’s still hard to treat, says Bernstein.
“When you have IBS, your stomach either contracts too much or doesn’t at all,” he says. So you’ll likely find yourself alternating between bouts of diarrhea and constipation—as well as experiencing bloating and discomfort.
Sonpal says stress has a lot to do with the disease. “A lot of IBS is due to emotional, traumatic, and stress-related conditions,” says Bernstein. Think of the condition as an increased response to stress in the gut.
Treatments typically involve lifestyle modifications, says Bernstein. Your doc will help you identify which trigger foods you should avoid, and suggest you steer clear of alcohol (which can trigger symptoms), up your fiber intake (to help keep your bowel movements regular), and cut down on stress. Sanchez suggests getting fiber from fruits and veggies—not packaged foods, since processed food products may contribute to symptoms.
Related: 12 Natural Ways To Kick Your Stress To The Curb
For some, following a low-FODMAP diet can ease IBS-related stomach pain, says Sanchez.
FODMAPs are a group of sugars found in certain foods, including dairy, wheat, legumes, and some fruits, according to Stanford University Medical Center. Low-FODMAP foods include bananas, carrots, fish, chicken, and almonds.
Everyone is different, however, so what works for one person won’t necessarily be the answer for another, says Bernstein. And sometimes, an IBS treatment that used to get the job done stops working, so you’ll need to try something else—which is why the disorder has a reputation for being so tricky.
4. You Have a Peptic Ulcer
There are two types of peptic ulcers—gastric ulcers, which occur in the stomach and are marked by inflammation, and duodenal ulcers, which occur in the small intestine and are marked by craters that have formed, says Bernstein.
When you have an ulcer, you’ll likely experience severe, feels-like-you’re-going-to-fall-over stomach pain, says Sonpal. If you have a gastric ulcer, you’ll notice worsening stomach pain soon after eating; if you a duodenal ulcer, your stomach pain might actually get better after you eat, but worsen on an empty stomach, says Sonpal.
Related: How To Move On With Your Life When You Have IBS
You’ll most likely notice pain in the middle of your abdomen, and it can feel like a gnawing or shooting sensation, adds Bernstein. Sometimes, you might even vomit or see blood in your stool. (Your stool will look black and tarry, says Sonpal).
There are a few common causes of both types of peptic ulcers, like overuse of nonsteroidal anti-inflammatories (NSAIDs), which reduce the blood clotting action in your body, and an overgrowth of bacteria called H. plyori, which stimulates acid secretions and breaks your stomach’s protective layer, Sonpal says. Unchecked stress can also cause a gastric or duodenal ulcer, says Sonpal.
If your ulcer is due to NSAID use, you’ll obviously need to stop taking them—and you’ll also have to pop antacids until it heals. If it’s caused by H. pylori, you’ll need to take antibiotics in addition to antacids. Meanwhile, a large ulcer requires surgical repair, since it can cause bleeding, say Sonpal.
Since antibiotics can actually wipe out a lot of the healthy bacteria in your gut, you may want to supplement your diet with fermented foods (like sauerkraut and kimchi) and probiotics (like yogurt) because they contain good bacteria, says Sanchez.
Your doc won’t be able to diagnose you based on your symptoms alone, says Bernstein. You’ll need to have an endoscopy (a procedure in which a long, flexible tube with a camera is inserted into your upper GI tract) to find out for sure.
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