Dear Dr Nina: 'I'm concerned about the pain in my stomach in the mornings'

Q I am a 38-year-old woman and I’m a little bit overweight. I have a pretty healthy diet – porridge for breakfast, a salad or sandwich for lunch and meat and vegetables for dinner. Most mornings – an hour or so after getting up – I suffer from pain in my tummy. It happens only in the mornings, which is relieved when I have a bowel movement. Sometimes, the pain is unbearable, particularly when I have my period and I can be on the toilet for a long time. Other times it’s quiet mild. The symptoms are the same, even when my diet varies. What could this be?

Dr Nina replies: Constipation, trapped wind and diverticular disease are all common causes of the pain you describe, and although you describe it as a pain in your “tummy”, I am guessing that the problem area is your intestines/colon and linked to one of these issues. The colon is the tube that makes up the last part of the intestines. Most of the nutrients we eat get absorbed in the stomach and small intestine. Undigested material enters the colon and travels through here resulting in the absorption of water and the production of a solid stool.

If food moves slowly through the gut we may become constipated. Constipation is the passage of infrequent hard stool. A normal stool should have the consistency of toothpaste and be similar in size to a banana. A constipated stool is hard, small and pellet-like. The most common cause of constipation is poor diet and inactive lifestyle. If constipation occurs, gas may get trapped and over time you may be at risk of developing a condition called diverticular disease.

Excess gas is not dangerous, but it may make you uncomfortable. You may experience large amounts of burping and farting. Abdominal cramping and bloating can be particularly problematic.

Your pain may be exacerbated by your bowel trying to push a hard stool or gas through your gut after your first meal of the day. The bowel reflex is strongest after eating a meal. Eating triggers gut motility.

Certain foods can help encourage gut motility. Prunes are a common remedy. Fruits containing the sugar sorbitol may also help. This sugar isn’t easily absorbed and draws fluid into the bowel, which may move things along.

Dried fruits are particularly high in sorbitol. Apples, apricots, grapes, strawberries and raspberries, peaches pears and plums also contain this sugar.

Approximately 50pc of people will have diverticular disease by the age of 50 and 70pc will have it by the age of 80. If waste material passing through the colon is hard it can put pressure on the walls of the intestine resulting in the formation of small out-pouches called diverticulae. Occasionally these pouches may become infected leading to a condition called diverticulitis.

Early symptoms of diverticular disease include abdominal pain and cramping. Pain is usually left-sided and may be made worse by eating and relieved by passing wind.

Bloating and constipation may also feature and you may feel tender on touching the lower abdomen.

If your symptoms don’t settle despite treating constipation you should have a colonoscopy. Diverticular disease is normally picked up here and this may be what you have, but the message is simple: altered bowels should never be ignored. A visit to your GP is in order.

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