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The lower gastrointestinal tract

All the food and liquids you eat and drink end up in your digestive system, the gastrointestinal (GI) tract. The body absorbs the nutrients it needs for energy and growth and eliminates what is left over.

The tract runs from the mouth to the bottom and is referred to as the upper and lower bowel..

Remember that some medicines for bowel problems like constipation can interfere with the absorption of medicines you are taking for other medical conditions. Ask your pharmacist for advice first.

Condition Constipation
Symptoms Hard and dry faeces that can be painful and difficult to remove; stomach pain.
OTC Treatment Laxatives are useful if you have gone 2 – 3 days longer than usual without a bowel movement.
- Bulk forming laxatives include bran, psyllium ispaghula husk, methylcellulose and sterculia. They work by absorbing water and swelling to form a gel. This retains water in the faeces, avoiding impaction and making removal of the faeces easier by increasing the bulk of the stool.
- Hyperosmotic laxatives include glycerine suppositories, lactulose and lactitol. They retain water in the bowel and faeces.
- Stimulant laxatives include bisacodyl, aloin, cascara and senna. These promote bowel action by acting directly on the muscle in the gut wall.
- Emollient laxatives include docusate sodium and docusate calcium. These help aqueous and fatty substances in the intestines to mix, softening the stools and promoting defaecation.
- Lubricant laxatives include liquid paraffin and mineral oil. They work by coating the stools and preventing reabsorption of water in the large intestine. This keeps the stools fairly soft and easy to release.
- Saline laxatives include magnesium salts and sodium phosphate. The magnesium or sodium ions draw water into the colon, increasing the volume of the faeces and increasing pressure within the colon and rectum.
For OTC products, read Constipation
Other self-help

The best way to avoid constipation is to eat a high-fibre diet with plenty of fluids. The best sources of dietary fibre are: unrefined cereals; fresh fruit; leafy green vegetables; peas; beans; lentils and root vegetables. Keeping active is also very important. People who are restricted from performing regular activity often suffer from constipation.

Other information

Laxatives should not be used on a regular basis, or ‘just in case’ you can’t have a bowel movement. Prolonged use of laxatives can cause the bowel muscles to stop working properly actually causing constipation.

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Condition Diarrhoea

Loose, watery stools

OTC Treatment

- Salt and glucose remedies to rebalance the body’s salts.
- Loperamide and morphine help to control diarrhoea.
For OTC products, read Diarrhoea

Other self-help

Make sure you drink plenty of extra fluids to allow for the extra fluid being lost when you have diarrhoea.

Other information Diarrhoea may be a short-term problem or a symptom of a more chronic or intermittent condition such as Crohn’s disease and ulcerative colitis.
Short-term diarrhoea can be caused by bacteria, as in food poisoning due to eating contaminated food, or as part of a viral infection. It can also be caused by some medicines.
Diarrhoea can also be caused by the accumulation of non-absorbed substances in the GI tract such as in lactase deficiency, or from gastrointestinal effects of secretory stimuli.
If you see red, fresh blood in your diarrhoea see your GP immediately as this can be a sign of infection or other serious bowel conditions. Black, tarry blood may be caused by conditions such as a peptic ulcer.
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Condition Flatulence/wind
Symptoms Release of gases from the bottom; bloated stomach and stomach ache. This is almost always normal and caused by the particular foods you have eaten.
OTC Treatment

- ‘Health salts’ form a fizzy antacid drink when mixed with water to make burping easier and therefore reduce discomfort.
- Antacids also help wind to pass out of the bottom.
For OTC products, read Trapped Wind

Other self-help

Herbal remedies containing cardamon, dill or capsicum can be effective in helping gas to be passed out of the body.
If you are prone to wind avoiding foods such as beans and cabbage, which are known to cause foul smelling gases, may be helpful. It is worth remembering however, that these foods may protect you from bowel cancer.

Other information

Health salts contain large amounts of sodium and should be avoided if you have poor kidney function or a heart condition.
Gas trapped in the stomach or intestines may be caused by air that has been swallowed whilst eating or drinking. This does not usually smell.

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Nausea and vomiting
Condition Nausea and vomiting
OTC Treatment

- Domperidone is the only available OTC treatment for the relief of fullness, nausea, bloating and burping.
- Medicines containing bismuth salts may help with mild nausea, whilst antihistamines and anticholinergenics help in travel sickness.
For OTC products, read Nausea/Upset Stomach

Other information

There are many causes of nausea and vomiting e.g. peptic ulcers, obstruction of the intestinal tract, migraine, drug and alcohol abuse, travel sickness, psychological problems.
If nausea and vomiting persists you should visit your GP.

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Abdominal Pain

Abdominal pain should always be taken seriously as it can indicate a range of potentially serious conditions. You should see a GP if pain persists.

In general, treating the cause of the pain best relieves abdominal pain, whether it be inflammation, distension or muscle spasm.

Condition Infant colic
Symptoms Babies may draw their legs up to their chests and cry.
OTC Treatment

- Analgesics can help to relieve the symptoms of pain.
- Gripe water contains sodium bicarbonate, which helps the baby to get rid of excess gas through belching. It also helps to reduce acidity in the gastrointestinal tract.
- Other remedies contain dimethicone or simethicone.
- Products containing peppermint oil, hyoscine, mebeverine or alverine will relax the muscles
- Antispasmodics.
For OTC products, read Infant Colic/Gripe

Other self-help ‘Winding’ or ‘burping’ the baby will help to remove gas.
Other information

Infant colic is very common in the first few months after birth.

Condition Gastrointestinal spasm (colic)
Symptoms Pain of spasm in the intestines.
OTC Treatment

- Analgesics can help to relieve the symptoms of pain.
- Other remedies contain dimethicone or simethicone.
- Products containing peppermint oil, hyoscine, mebeverine or alverine will relax the muscles
- Antispasmodics.
For OTC products, read All Bowel Symptoms

Other information

GI spasm can be caused by:
- Irritable Bowel Syndrome which occurs when a section of the gut revolves and causes an obstruction
- Intussuception which occurs in children where a section of the gut ‘telescopes’, as if swallowing itself, and causes an obstruction
- Air which is swallowed with food, causing distension that can trigger smooth muscle contraction.

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Condition Itching
Symptoms Itching around the bottom. Can be caused by haemorrhoids or threadworm infection. It can also be caused by liquid paraffin, a lubricant laxative. Unfortunately there is often no obvious cause and simple creams can help.
OTC Treatment

- Haemorrhoid creams and ointments will help to reduce the itching even when there are no haemorrhoids present.
- Threadworm can be treated with mebendazole and piperazine.
For OTC products, read Worms

Other information

Threadworm should be treated immediately as it can be passed on to others but other than the irritating itch does not cause any serious harm

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Rectal bleeding
Condition Rectal bleeding
Symptoms Bleeding from the bottom.
OTC Treatment For OTC products, read All Bowel Symptoms
Other information

Bleeding from the rectum can be caused by several conditions of the lower gastrointestinal tract such as anal fissure, haemorrhoids or bowel cancer. You should see your GP.

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Irritable Bowel Syndrome (IBS)
Condition Irritable Bowel Syndrome (IBS)
Symptoms IBS has many symptoms and is usually diagnosed when four or more occur with no other obvious cause. Symptoms are:
- abdominal distension
- bloating
- abdominal pain (may be sharp, or a dull ache, widespread or localised to the lower abdomen)
- loose and watery stools (diarrhoea)
- hard, impacted stools (constipation)
- mucus in the stools
- persistent feelings of wanting to go to the toilet
- muscle cramps in the abdomen
OTC Treatment

- Laxatives can help constipation, but can also cause bloating and trapped wind.
- Loperamide can help with diarrhoea.
- Antispasmodic drugs, such as hyoscine, mebeverine and alverine They are not generally suitable for children or breastfeeding women.
For OTC products, read Irritable Bowel Syndrome

Other self-help If you suffer from constipation including more dietary fibre in your diet should help.
Peppermint oil, in specially coated capsules that do not release their contents until they are in the intestines is said to have a direct benefit on the muscles of the colon.
IBS sufferers should avoid eating gas-producing foods such as beans, peas and cabbage. Plain live yoghurt can help to normalise the gut contents. Exercise and relaxation techniques can help reduce stress, which is thought to be a contributing factor of IBS. Hynotherapy may also help.
Other information

Irritable Bowel Syndrome may be associated with psychological problems such as depression.

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Haemorrhoids (Piles)
Condition Haemorrhoids (Piles)
Symptoms - Itching and pain caused by swollen blood vessels in the anus.
- Pain when passing a stool.
- Bleeding when passing a stool (and occasionally spontaneously) can indicate internal piles.
- Spots of blood on toilet paper indicate external piles. These external piles may go back into the bottom after you have been to the toilet. Try gently returning them while having a warm bath.
OTC Treatment

- Anti-inflammatory agents, e.g. hydrocortisone and heparinoids
to reduce the pain, redness, swelling and temperature of the affected area.
Hydrocortisone should only be used short-term and should be avoided during pregnancy.
- Antiseptics, e.g. Peru balsam and phenolic compounds – help prevent infection and encourage healing in the haemorrhoidal area.
- Astringents, e.g. allantoin, hamamelis (with hazel), tannic acid and bismuth compounds – shrink piles, harden the surrounding skin, dry up soggy areas of damaged skin or mucous membrane and reduce minor bleeding.
- Local anaesthetics, e.g. lidocaine – relieve the pain of the piles; they should not be used long-term as they cause irritation.
- Soothing creams and ointments, e.g. zinc oxide – widely used as a base for creams and ointments because it’s soothing and mildly antiseptic.
- Laxatives of the osmotic type or bulking agents – ease the pain of a stool and prevent constipation.
Some products contain combinations of one or more of these ingredients.
For OTC products, read Haemorrhoids/Piles

Other self-help If you suffer from piles including more dietary fibre in your diet may help.
Other information

Haemorrhoids are associated with constipation. Straining to pass a stool increases the pressure in anal blood vessels and can cause piles, or make them worse.
Piles are also common during pregnancy, but often clear up after the birth.
Severe piles may need to be treated surgically.

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Coeliac disease
Condition Coeliac disease
Symptoms Foul, fatty and frothy stools; anaemia and failure to thrive
OTC Treatment

- Gluten-free foods
For OTC products, read All Bowel Symptoms

Other information

Coeliac disease is caused by an intolerance to gluten.
If you suffer from Coeliac check with your pharmacist that any medicines you are taking are gluten-free.

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