Patient Education

When you have a stomach ache, you have pain or discomfort in your belly. Sometimes that’s the only symptom you have. Other times, you can have other symptoms such as:

• Burning in your chest known as heartburn
• Burping
• Bloating (feeling like your belly is filled with air)
• Feeling full too quickly when you start eating

Most people do not need to see a doctor or nurse for a stomach ache. But you should see your doctor or nurse if:

• You have bloody bowel movements, diarrhea, or vomiting
• Your pain is severe and lasts more than an hour or comes and goes for more than 24 hours
• You cannot eat or drink for hours
• You have a fever higher than 102°F (39°C)
• You lose a lot of weight without trying to, or lose interest in food

In some cases, stomach aches are caused by a specific problem, such as:

• A stomach ulcer, which is a sore on the inside of the stomach
• A condition called “diverticulitis,” in which small pouches in your large intestine get infected

In other cases, doctors do not know what causes stomach aches or the other symptoms that happen with them. Even so, there are usually ways to treat the symptoms of stomach ache.

If your symptoms are caused by a specific problem, such as an ulcer, treating that problem will likely relieve your symptoms. But if your doctor or nurse does not know what is causing your pain, they might recommend medicines that reduce the amount of acid in your stomach. These medicines often relieve stomach ache and the symptoms that come with it. Some of these medicines are available without a prescription.

Yes. The foods you eat and the way you eat them can have a big effect on whether or not you feel pain.

To lower your chances of getting a stomach ache:

• Avoid fatty foods, such as red meat, butter, fried foods, and cheese
• Eat a bunch of small meals each day, rather than 2 or 3 big meals
• Stay away from foods that seem to make your symptoms worse
• Avoid taking over-the-counter medicines that seem to make your symptoms worse – Examples include aspirinor ibuprofen(sample brand names: Advil, Motrin).

Some people – especially kids – sometimes get a stomach ache after drinking milk or eating cheese, ice cream, or other foods that have milk in them. They have a problem called “lactose intolerance,” which means that they cannot fully break down foods that have milk in them.

People with lactose intolerance can avoid problems caused by milk if they take something called lactase. Lactase (sample brand name: Lactaid) helps your body break down milk. Some foods come with it already added.

If your stomach ache seems to be related to constipation, meaning that you do not have enough bowel movements, you might need more fiber or a medicine called a laxative. (Laxatives are medicines that increase the number of bowel movements you have.)

Taking in a lot of fiber helps to increase the number of bowel movements you have. You can get more fiber by:

• Eating plenty of fruits, vegetables, and whole grains
• Taking fiber pills, powders, or wafers

In general, yes. Children get stomach aches for most of the same reasons that adults do. But in children, stomach pain is often triggered by stress or anxiety. For them, it’s especially important to pay attention to psychological or emotional problems that might be making pain worse.

Yes. “Abdominal pain” means pain in the abdomen (or belly), which is the part of the body between the chest and the genital area. This pain can happen for different reasons. It can be “chronic,” which means it develops over time, or “acute,” which means it starts suddenly. It can be mild or severe. A person might feel the pain all over their abdomen, or only in 1 part.

Abdominal pain can feel different for different people. It can feel sharp or crampy, or dull and steady. Some people feel better if they curl into a ball, while others need to lie flat and completely still. People often feel sick to their stomach and retch or vomit.

Doctors use the term “acute abdomen” to describe an episode of severe abdominal pain that starts suddenly and lasts for a few hours or longer. It can cause pain so severe that the person has a hard time moving or breathing and it makes them want to go to the hospital or see their doctor or nurse right away. A true acute abdomen is a medical emergency.

Lots of different things can cause abdominal pain. When pain is less severe, it can be due to something like a virus or a stomach inflammation (called “gastritis”).

Acute pain that is more severe can be caused by problems with 1 or more organs in the abdomen. Organs in the abdomen can be part of the digestive, urinary, or reproductive systems.

Conditions that affect organs in the chest or genital area can also cause pain. Even though these organs aren’t in the abdomen, people might still have abdominal pain.

Common causes of acute abdominal pain in adults include:

• Appendicitis – Appendicitis is the term for when the appendix (a long, thin pouch that hangs down from the large intestine) gets infected and inflamed.
• Diverticulitis – Diverticulitis is an infection that develops in small pouches that can form in the intestine. This is common in older people.
• Gallstones – Gallstones are small stones that form inside an organ called the gallbladder, which stores bile, a fluid that helps the body break down fat.
• Abscess – An abscess is a collection of pus. An abscess can form in the abdomen, typically near the intestine.
• Kidney stones – Kidney stones can form when salts and minerals that are normally in the urine build up and harden. They can cause pain when they pass through the ureters, which are the tubes that carry urine from the kidney to the bladder.
• Bowel perforation – This is a hole in the bowel wall.
• Perforated ulcer – This is a hole in the wall of the stomach or intestine.
• Pancreatitis – This is the term for when the pancreas gets inflamed.
• Ruptured cyst in the ovary – Cysts in the ovary are fluid-filled sacs that can form in some women. They sometimes rupture, which means that they break open and spill out.
• Ectopic pregnancy – An ectopic pregnancy is a pregnancy that develops outside the uterus.

Yes. If you have sudden or severe abdominal pain, call your doctor or nurse or go to the hospital right away. Depending on the cause of your pain, you might need immediate treatment.

Probably. The doctor or nurse will ask about your symptoms, including where your pain is and what it feels like. The location of the pain can be an important clue to the cause.

Your doctor will ask about your current and past medical conditions, and do a physical exam. They might do repeat exams over time to follow your symptoms.

Your doctor will decide which tests you should have based on your symptoms and individual situation. The tests might include:

• Blood tests
• Urine tests
• X-rays
• An ultrasound, CT scan, or other imaging test – Imaging tests create pictures of the inside of the body.

Treatment depends on what’s causing the pain. It might include 1 or more of the following:

• Fluids given by IV
• Pain medicines
• Antibiotic medicines to treat an infection
• Other medicines to treat other medical conditions
• Surgery

Constipation is a common problem that makes it hard to have bowel movements. Your bowel movements might be:

• Too hard
• Too small
• Hard to get out
• Happening fewer than 3 times a week

Constipation can be caused by:

• Side effects of some medicines
• Poor diet
• Diseases of the digestive system

These symptoms could signal a more serious problem:

• Blood in the toilet or on the toilet paper after having a bowel movement
• Fever
• Weight loss
• Feeling weak

It could also be a sign of a problem if you have new constipation without a change in your medicines or diet, and have never had constipation in the past.

Yes. Try these steps:

• Eat foods that have a lot of fiber. Good choices are fruits, vegetables, prune juice, and cereal.
• Drink plenty of water and other fluids.
• When you feel the need to go to the bathroom, go to the bathroom. Don’t hold it.
• Take laxatives. These are medicines that help make bowel movements easier to get out. Some are pills that you swallow. Others go into the rectum. These are called “suppositories.”

See your doctor or nurse if:

• Your symptoms are new or not normal for you
• You do not have a bowel movement for a few days
• The problem comes and goes, but lasts for longer than 3 weeks
• You are in a lot of pain
• You have other symptoms that also worry you (for example, bleeding, weakness, weight loss, or fever)
• Other people in your family have had colorectal cancer or inflammatory bowel disease

Your doctor or nurse will decide which tests you should have based on your age, other symptoms, and individual situation. There are lots of tests, but you might not need any.

Here are the most common tests doctors use to find the cause of constipation:

• Rectal exam – Your doctor will look at the outside of your anus. They will also use a finger to feel inside the opening.
• Sigmoidoscopy or colonoscopy – For these tests, the doctor puts a thin tube into your anus. Then, they advance the tube into your large intestine. The large intestine is also called the colon. The tube has a camera attached to it, so the doctor can look inside your intestines. During these tests, the doctor can also take samples of tissue to look at under a microscope.
• X-rays, CT scan, or MRI – These create images of the inside of your body.
• Manometry studies – Manometry allows the doctor to measure the pressure inside the rectum at various points. It can help the doctor find out if the muscles that control bowel movements are working right. The test also shows whether the person’s rectum can feel normally.

That depends on what is causing your constipation. First, your doctor will want you to try eating more fiber and drinking more water. If that doesn’t help, your doctor might suggest:

• Medicines that you swallow or put in your rectum
• Changing the medicines you are taking for other conditions
• A treatment called an “enema” – For this treatment, a doctor or nurse will squirt water into your rectum. They might also use a thin tool to help break up bowel movements that are still inside you.
  You might also be able to give yourself enema treatments at home, too. Enemas can be just water, or they can contain medicine to help with constipation.
• Biofeedback – This is a technique that teaches you to relax your muscles so you can let go and push bowel movements out.

You can reduce your chances of getting constipation again by:

• Eating a diet that is full of fiber (table 1)
• Drinking water and other fluids during the day
• Going to the bathroom at regular times every day

Colon and rectal cancer screening is a way in which doctors check the colon and rectum for signs of cancer or growths (called polyps) that might become cancer. It is done in people who have no symptoms and no reason to think they have cancer. The goal is to find and remove polyps before they become cancer, or to find cancer early, before it grows, spreads, or causes problems.

The colon and rectum are the last part of the digestive tract. When doctors talk about colon and rectal cancer screening, they use the term “colorectal.” That is just a shorter way of saying “colon and rectal.” It’s also possible to say just colon cancer screening.

Studies show that having colon cancer screening lowers the chance of dying from colon cancer. There are several different types of screening test that can do this.

They include:

• Colonoscopy– Colonoscopy allows the doctor to see directly inside the entire colon. Before you can have a colonoscopy, you must clean out your colon. You do this at home by drinking a special liquid that causes watery diarrhea for several hours. On the day of the test, you get medicine to help you relax, if you want. Then a doctor puts a thin tube into your anus and advances it into your colon. The tube has a tiny camera attached to it, so the doctor can see inside your colon. The tube also has tiny tools on the end, so the doctor can remove pieces of tissue or polyps if they are there. After polyps or pieces of tissue are removed, they are sent to a lab to be checked for cancer.
• Advantages of this test – Colonoscopy finds most small polyps and almost all large polyps and cancers. If found, polyps can be removed right away. This test gives the most accurate results. If any other screening tests are done first and come back positive (abnormal), a colonoscopy will need to be done for follow-up. If you have a colonoscopy as your first test, you will probably not need a second follow-up test soon after.
• Drawbacks to this test – Colonoscopy has some risks. It can cause bleeding or tear the inside of the colon, but this only happens in 1 out of 1,000 people. Also, cleaning out the bowel beforehand can be unpleasant. Plus, people usually cannot work or drive for the rest of the day after the test, because of the relaxation medicine they take during the test.
  In certain situations, a doctor might do something called a “capsule” colonoscopy. For this test, you swallow a special capsule that contains tiny wireless video cameras. This might be done if your doctor was not able to see all of your colon during a regular colonoscopy.
• CT colonography(also known as virtual colonoscopy or CTC) – CTC looks for cancer and polyps using a special X-ray called a “CT scan.” For most CTC tests, the preparation is the same as it is for colonoscopy.
• Advantages of this test – CTC can find polyps and cancers in the whole colon without the need for medicines to relax.
• Drawbacks to this test – If doctors find polyps or cancer with CTC, they usually follow up with a colonoscopy. CTC sometimes finds areas that look abnormal but that turn out to be healthy. This means that CTC can lead to tests and procedures you did not need. Plus, CTC exposes you to radiation. In most cases, the preparation needed to clean the bowel is the same as the one needed for a colonoscopy. The test is expensive, and some insurance companies might not cover this test for screening.
• Stool test for blood– “Stool” is another word for bowel movements. Stool tests most commonly check for blood in samples of stool. Cancers and polyps can bleed, and if they bleed around the time you do the stool test, then blood will show up on the test. The test can find even small amounts of blood that you can’t see in your stool. Other less serious conditions can also cause small amounts of blood in the stool, and that will show up in this test. You will have to collect small samples from your bowel movements, which you will put in a special container you get from your doctor or nurse. Then you follow the instructions to mail the container out for the testing.
• Advantages of this test – This test does not involve cleaning out the colon or having any procedures.
• Drawbacks to this test – Stool tests are less likely to find polyps than other screening tests. These tests also often come up abnormal even in people who do not have cancer. If a stool test shows something abnormal, doctors usually follow up with a colonoscopy.
• Sigmoidoscopy– A sigmoidoscopy is similar in some ways to a colonoscopy. The difference is that this test looks only at the last part of the colon, and a colonoscopy looks at the whole colon. Before you have a sigmoidoscopy, you must clean out the lower part of your colon using an enema. This bowel cleaning is not as thorough or unpleasant as the one for colonoscopy. For this test, you do not need to take medicines to help you relax, so you can drive and work afterward if you want.
• Advantages of this test – Sigmoidoscopy can find polyps and cancers in the rectum and the last part of the colon. If polyps are found, they can be removed right away.
• Drawbacks to this test – In about 2 out of 10,000 people, sigmoidoscopy tears the inside of the colon. The test also can’t find polyps or cancers that are in the part of the colon the test does not view (figure 3). If doctors find polyps or cancer during a sigmoidoscopy, they usually follow up with a colonoscopy.
• Stool DNA test– The stool DNA test checks for genetic markers of cancer, as well as for signs of blood. For this test, you get a special kit in order to collect a whole bowel movement. Then you follow the instructions about how and where to ship it.
• Advantages of this test – This test does not involve cleaning out the colon or having any procedures. When cancer is not present, it is less likely to be falsely abnormal than a stool test for blood. That means it leads to fewer unnecessary colonoscopies.
• Drawbacks to this test – It might be unpleasant to collect and ship a whole bowel movement. If a DNA test shows something abnormal, doctors usually follow up with a colonoscopy.

There is no blood test that most experts think is accurate enough to use for screening.

Work with your doctor or nurse to decide which test is best for you. Some doctors might choose to combine screening tests, for example, sigmoidoscopy plus stool testing for blood. Being screened–no matter how–is more important than which test you choose.

 Doctors recommend that most people begin having colon cancer screening at age 45. People who have an increased risk of getting colon cancer sometimes begin screening at a younger age. That might include people with a strong family history of colon cancer, and people with diseases of the colon called “Crohn’s disease” and “ulcerative colitis.”

Most people can stop being screened around the age of 75, or at the latest 85.

That depends on your risk of colon cancer and which test you have. People who have a high risk of colon cancer often need to be tested more often and should have a colonoscopy.

Most people are not at high risk, so they can choose one of these schedules:

• Colonoscopy every 10 years
• CT colonography (CTC) every 5 years
• Stool testing for blood once a year
• Sigmoidoscopy every 5 to 10 years
• Stool DNA testing every 3 years (but doctors are not yet sure of the best time frame for repeating the test)

A colonoscopy is a test that looks at the inner lining of a person’s large intestine. The large intestine is also called the colon.

Often, people have a colonoscopy as a screening test to check for polyps or for cancer in the colon or rectum. Polyps are growths in the colon that might turn into cancer. If you have polyps, the doctor can usually take them out during the colonoscopy. Taking polyps out lowers your chances of getting cancer. People can also have a colonoscopy if they have any of the symptoms listed below.

Cancer screening tests are tests that are done to try and find cancer early, before a person has symptoms. Cancer that is found early often is small and can be cured or treated easily.

Doctors can use 5 or 6 different tests to screen for colon cancer. But most doctors think that colonoscopy is the best test to screen for colon cancer.

Doctors recommend that most people begin having colon cancer screening at age 45. Some people have an increased chance of getting colon cancer, because of a strong family history or certain medical conditions. These people might begin screening at a younger age.

Your doctor might order a colonoscopy if you have:

• Blood in your bowel movements
• A change in your bowel habits
• A condition called anemia that can make you feel tired and weak
• Long-term belly or rectal pain that you cannot explain
• Abnormal results from a different type of colon test
• A history of colon cancer or polyps in your colon

Your doctor will give you instructions about what to do before a colonoscopy. They will tell you what foods you can and cannot eat. They will also tell you if you need to stop taking any of your usual medicines beforehand. Make sure to read the instructions as soon as you get them. You might have to stop some medicines up to a week before the test.

The colon needs to be cleaned out before a colonoscopy. Your doctor will give you a special drink that causes watery diarrhea. It is important to drink all of it to make sure your colon is clean. If your colon is clean, your doctor will get a better look at the inside lining of the colon. A clean colon also makes the test easier to do and more comfortable. Let your doctor know if you have trouble getting ready for your colonoscopy.

Your doctor will give you medicine to make you feel relaxed. Then they will put a thin tube with a camera and light on the end into your anus and up into the rectum and colon. Your doctor will look at the inside lining of the whole colon.

During the procedure, your doctor might do a test called a biopsy. During a biopsy, a doctor takes a small piece of tissue from the colon. Then they look at the tissue under a microscope to see if it has cancer. Your doctor might also remove growths that they see in the colon. You will not feel it if the doctor takes a biopsy or removes a growth.

Your doctor will give you instructions about what to do after a colonoscopy. Most people can eat as usual. But most doctors recommend that people do not drive or go to work for the rest of the day. Your doctor will tell you when to start taking any medicines you had to stop before the test.

Call your doctor or nurse immediately if you have any of the following problems after your colonoscopy:

• Belly pain that is much worse than gas pain or cramps
• A bloated and hard belly
• Vomiting
• Fever
• A lot of bleeding from your anus

Colon polyps are tiny growths that form on the inside of the large intestine (also known as the colon). Polyps are very common. About one-third to one-half of all adults have them by the time they are 50 years old. They do not usually cause symptoms. But some polyps can be or become cancer, so doctors sometimes remove them.

Colon polyps do not usually cause symptoms.

Doctors usually find colon polyps when they are doing screening tests to check for colon or rectal cancer. Cancer screening tests are tests that are done to try and find cancer early, before a person has symptoms. The screening tests for colon and rectal cancer include:

• Colonoscopy – Before having a colonoscopy, you will get medicine to help you relax. Then a doctor will put a thin tube into your anus and advance it into your colon. The tube has a camera attached to it, so the doctor can look inside your colon. The tube also has tools on the end, so the doctor can remove pieces of tissue, including polyps. After polyps are removed, they usually go to a lab to be tested for cancer and other problems.
• Sigmoidoscopy – A sigmoidoscopy is very similar to a colonoscopy. The only difference is that this test looks only at the first part of the colon, and a colonoscopy looks at the whole colon.
• CT colonography (also known as virtual colonoscopy) – For a virtual colonoscopy, you have a special kind of X-ray taken, called a “CT scan.” This test creates pictures of the colon.
• Stool test – “Stool” is another word for “bowel movements.” Stool tests check for blood or abnormal genes in samples of stool. If a stool test indicates that something might be wrong with the colon, doctors usually follow up with a colonoscopy. Then doctors find polyps, if they are there.
• Capsule colonoscopy – Rarely, your doctor might do something called a “capsule” colonoscopy. For this test, you swallow a special capsule that contains tiny wireless video cameras.

Doctors remove polyps using the same tools they use for a colonoscopy. They can remove polyps either by snipping them off with a special cutting tool, or by catching the polyps in a noose. Most polyps can be removed during a colonoscopy. But sometimes, large polyps need to be removed at a later time, either with another colonoscopy or with surgery.

You might need to have a colonoscopy every few years to check for more polyps. In some people polyps come back. And if you had the kind of polyps that could become cancer, your doctor will want to remove them as they appear. Also, if the polyps you had removed were the kind that could become cancer, people in your family might need to be checked for polyps and colon cancer earlier than if you did not have polyps.

Depending on your situation, your doctor might suggest genetic testing. This can show if your polyps are related to a specific gene that runs in families. If this turns out to be the case, they might recommend other tests that can be done to prevent cancer or find it early.

To reduce your chances of getting polyps or colon cancer:

• Eat a diet that is low in fat and high in fruits, vegetables, and fiber
• Lose weight, if you are overweight
• Do not smoke
• Limit the amount of alcohol you drink.

A colectomy is surgery in which your doctor removes part or all of your large intestine. The large intestine is also called the colon.

Doctors might do a colectomy to treat problems such as:

• Colon cancer
• Digestive tract disorders, such as severe diverticulitis or inflammatory bowel disease
• A blockage in the colon
• An injury to the colon

Your doctor will tell you how to prepare for your colectomy, and how long before the surgery you should stop eating and drinking.

Your doctor will tell you if you need to change or stop any of your medicines before the surgery. They might also give you medicine to take beforehand. For example, you will probably get antibiotics to prevent infection, plus a medicine to empty your intestines (this is called “bowel prep”).

Before the surgery starts, you will get medicines (through a thin tube that goes into a vein, called an “IV”) to make you sleep. You will not be awake for the surgery.

There are 2 main ways doctors can do a colectomy:

• Open surgery – During open surgery, your doctor will make a cut in your belly. They will remove some or all of your colon. How much your doctor removes depends on the reason for your surgery and how severe your condition is.
• Minimally invasive surgery – During minimally invasive surgery, your doctor will make a few small cuts in your belly. Then they will insert long, thin tools through the cuts and into your belly. One of the tools has a camera (called a “laparoscope”) on the end, which sends pictures to a TV screen. Your doctor can look at the screen to know where to cut and what to remove. Then they use the long tools to do the surgery through the small cuts. Sometimes they use a special robot to help move the tools.

After your doctor removes your colon, they will make sure there is a way for bowel movements to exit your body. To do this, your doctor will either:

• Reconnect your intestine – If your doctor can reconnect your intestine, you should be able to have bowel movements normally.
• Do a procedure called a “colostomy” or “ileostomy” – For either of these procedures, your doctor will make a small hole in your belly. Then they will connect your intestine to this opening. If your doctor connects your large intestine to the hole, it’s called a “colostomy.” If your doctor connects your small intestine to the hole, it’s called an “ileostomy.” Your bowel movements will come out through the hole into a bag that is attached to your skin.

An ileostomy is an opening in the belly made by a doctor as a way for waste products from the intestines to leave the body.

An ileostomy is sometimes called a “stoma,” which is a medical word that means “opening.” After you have an ileostomy made, waste products from your intestines will come out through the stoma into a bag that is attached to your skin.

With an ileostomy, the waste products from the intestines that pass into the bag are more frequent and looser than normal bowel movements.

A special nurse (called an ostomy nurse) will teach you how to take care of your ileostomy. They will teach you:

• When and how to empty the bag
• When and how to put on a new bag
• How to check your stoma for problems

There are different types of ileostomy bags that people can use. With some types of bags, you empty, clean, and reuse them. With other types, you throw them out after each use.

You might worry that your bag will leak, or that other people will be able to smell your bowel movements. But these things rarely happen. The bags are made so that they do not leak or smell.

Some people have a certain type of ileostomy. They don’t use a bag to collect their bowel movements. Instead, they have an internal pouch made out of intestine, which they drain through the stoma a few times a day.

Different problems can happen with an ileostomy, either right away or years later. Let your doctor or nurse know if you have any of the following symptoms or problems:

• Your stoma starts turning purple or black instead of pink.
• Your stoma is swollen or larger than usual or you have a bulge to the side of the stoma.
• Your stoma is smaller than usual.
• Your stoma leaks more than usual.
• You have a rash or sores around your stoma.
• You have diarrhea.
• You have sudden belly pain, cramps, or nausea.
• You are dehydrated. Dehydration is when the body loses too much water. Symptoms of dehydration include not making as much urine or having dark yellow urine, or feeling thirsty, tired, dizzy, or confused.
• You haven’t passed gas waste from your stoma for 4 to 6 hours (during the day). These symptoms could mean that your stoma is blocked.

When people have an ileostomy, their body doesn’t always absorb medicines normally. Because of this, try to use liquid medicines instead of pills. Do not take pills labeled “enteric coated,” “time release,” or “extended release.” Your body might not absorb these types of pills well.

Yes. When people have an ileostomy, their body doesn’t always absorb water, vitamins, and salts normally. Because of this, you should drink plenty of fluids to avoid getting dehydrated.

You should avoid eating foods that could easily block your intestine or stoma. Some of these foods include popcorn, mushrooms, dried fruit, and fruits or vegetables with skin.

The foods you eat can also affect the odor of your bowel movements, and how solid or loose they are. Certain foods can also make you have more gas. These are listed in the table.

Foods that can affect bowel movements and gas

You should be able to live an active and normal life with your ileostomy. But many people worry about the following things:

• Clothes – You do not need to wear special clothes. Other people won’t be able to see your bag under your clothes.
• Baths and showers – You can take a bath or shower with or without your bag on.
• Sports – You will probably be able to play most sports. You might want to wear a special belt to protect your bag and keep it in place. Doctors usually recommend that people with an ileostomy not play certain contact sports (such as football) or sports that involve straining, such as lifting weights.
• Swimming – You can swim with your bag on. Make sure to empty your bag before you swim.
• Sex – You can have sex. But you might want to wear a special wrap to protect (and cover) your bag during sex.
• Travel – When you travel, be sure to bring extra supplies for your ileostomy. If you fly, take your supplies in your carry-on luggage.

It is normal to feed sad, upset, or worried when you have an ileostomy. If you have these feelings, try to get help. You can talk with a family member, friend, or counselor. You might also find it helpful to go to a support group for people with an ileostomy.

A colostomy is an opening in the belly made by a doctor as a way for bowel movements to leave the body not through the anus. To make a colostomy, your doctor will do a procedure to make a small opening in your belly. Then they will connect your large intestine to this opening.

A colostomy is sometimes called a “stoma,” which is a medical word that means “opening.” After a colostomy is made, your bowel movements will come out through the stoma into a bag that is attached to your skin.

You will probably have about 4 to 8 bowel movements a day. Your bowel movements might be less solid than they used to be.

A special nurse (called an ostomy nurse) will teach you how to manage your colostomy. They will teach you:

• When and how to empty the bag that collects your bowel movements
• When and how to put on a new bag to collect your bowel movements
• How to check your stoma for problems

There are different types of colostomy bags. With some types of bags, you empty, clean, and reuse them. With other types, you throw them out after each use.

Some people worry that their bag will leak, or that other people will be able to smell their bowel movements. But this is not common. The bags are made so that they do not leak or smell.

If you have a certain type of colostomy, you might be able to manage it with a process called “irrigation.” This is a way to make your bowel movements regular. It involves squirting water into your stoma on a regular basis to

Different problems can happen with a colostomy, either right away or years later. Let your doctor or nurse know if you have any of the following symptoms or problems:

• Your stoma is swollen or larger than usual.
• Your stoma is smaller than usual.
• Your stoma leaks more than usual.
• You have a rash or sores around your stoma.
• The inside of the stoma sticks out through the opening more than usual.
• You notice a bulge under the stoma or next to it.
• You have sudden belly pain, cramps, or nausea.
• You had a lot of diarrhea come out of the stoma and are dehydrated. Dehydration is when the body loses too much water. Symptoms of dehydration include not making as much urine or having dark yellow urine, or feeling thirsty, tired, dizzy, or confused.
• You haven’t had any gas or bowel movements through the stoma for 4 to 6 hours (during the day). These symptoms could mean that your stoma is blocked.

Probably not. But you should avoid getting constipated. (Constipation means trouble having bowel movements.) To avoid constipation, you can:

• Eat foods that have a lot of fiber

Amount of fiber in different foods

To learn how much fiber and other nutrients are in different foods, visit the United States Department of Agriculture (USDA) FoodData Central website.

• Drink plenty of water and other fluids

The foods you eat can affect the odor of your bowel movements, and how solid or soft they are. Certain foods can also make you have more gas. The foods that can affect your bowel movements and gas are listed in the table.

You should be able to live an active and normal life with your colostomy. But many people worry about the following things:

• Clothes – You do not need to wear special clothes. Other people won’t be able to see your bag under your clothes.
• Baths and showers – You can take a bath or shower with or without your bag on.
• Sports – You will probably be able to play most sports. You might want to wear a special belt to protect your bag and keep it in place. Doctors usually recommend that people with a colostomy not play certain contact sports (such as football) or lift weights.
• Swimming – You can swim with your bag on. Make sure to empty your bag before you swim.
• Sex – You can have sex. But you might want to wear a special wrap to protect (and cover) your bag during sex.
• Travel – When you travel, be sure to bring extra supplies to manage your colostomy. If you fly, take your supplies in your carry-on luggage.

It is normal to feel sad, upset, or worried when you have a colostomy. If you have these feelings, try to get help. You can talk with a family member, friend, or counselor. You might also find it helpful to go to a support group for people who have a colostomy.

The appendix is a long, thin pouch that is shaped like a finger. It hangs down from the large intestine, which is also called the colon.

Appendicitis is the name for when the appendix gets infected and inflamed. If that happens, it can swell and, in some cases, burst. That’s dangerous, because a burst appendix can cause infection in the belly.

The usual symptoms include:

• Severe pain in the lower part of the belly, on the right side. (For many people, the pain starts near the belly button and then moves to the lower right side.)
• Loss of appetite
• Nausea and vomiting
• Fever

Some people can have different symptoms, such as:

• Stomach upset
• Having a lot of gas
• Irregular bowel movements
• Diarrhea
• Feeling ill

If you have appendicitis, your doctor might be able to diagnose it just by doing an exam. They can learn a lot about your condition by pressing on your belly and talking with you about your symptoms.

If your doctor is not certain after the exam, they can do imaging tests to see what is causing your symptoms. Imaging tests create pictures of the inside of your body. They might include:

• A CT scan, which is a special kind of X-ray
• An ultrasound, which uses sound waves to look inside your belly

Yes. Call your doctor or nurse right away if you have the symptoms listed above. The risk of your appendix bursting is much higher after the first 24 hours of symptoms. If the appendix bursts, the surgery to treat it will be more complicated.

The main treatment for appendicitis is surgery to remove the appendix. This surgery can be done in 2 ways:

• Open surgery– During an open surgery, the doctor makes a cut near the appendix that is big enough to pull the appendix through.
• Laparoscopic surgery– During laparoscopic surgery, the doctor makes a few cuts that are much smaller than those used in open surgery. Then they insert long, thin tools into the belly. One of the tools has a camera (called a “laparoscope”) on the end, which sends pictures to a TV screen. The doctor can look at the image on the screen to know where to cut and what to remove. Then they use the long tools to do the surgery.

If your appendix has burst, your surgery will probably be more complicated than it would be if it had not burst. Your doctor will need to wash away the material that spills out when an appendix bursts. As a result, your cuts might be larger or you might spend more time in surgery.

Yes. But your options will depend on whether or not your appendix has burst.

If your appendix has not burst, it’s possible to treat appendicitis with just antibiotics. But, without surgery, there is a chance your appendicitis will come back again. So surgery is still the best treatment in most cases, but talk with your doctor if you wish to try to avoid surgery.

If your appendix has burst, but it has been a few days since this happened and you are feeling well, your doctor might decide not to do surgery right away. That’s because the body sometimes forms a pocket around the appendix to block off the infection. In this case, your doctor will probably give you antibiotics and watch you carefully until you are well. But you will still need surgery later to remove your appendix. That’s because at least 1 in 10 people with a burst appendix have a tumor in their appendix that can only be removed by surgery.

If you are pregnant and think you have signs of appendicitis, make sure you tell your doctors that you are pregnant. Doctors use ultrasound or a test called an “MRI” to check for appendicitis in people who are pregnant.

Diverticulitis is a disorder that can cause belly pain, fever, and problems with bowel movements.

The food we eat travels from the stomach through a long tube called the intestine. The last part of that tube is the colon. The colon sometimes has small pouches in its walls. These pouches are called “diverticula.” Many people who have these pouches have no symptoms. Diverticulitis happens when these pouches develop a small tear also known as a “microperforation,” which then become infected and cause symptoms.

The most common symptom of diverticulitis is pain, which is usually in the lower part of the belly. Other symptoms can include:

• Fever
• Constipation
• Diarrhea
• Nausea and vomiting

Yes. There are a few tests your doctor can do to find out if you have diverticulitis. But tests are not always needed. If you do have a test, you might have a:

• CT scan– A CT scan is a kind of imaging test. Imaging tests create pictures of the inside of your body.
• Abdominal ultrasound– This test uses sound waves to create pictures of your intestines.

Diverticulitis is typically treated with antibiotics. You might also need to go on a clear liquid diet for a short time. If you only have mild symptoms, this might be all the treatment you need.

But if you have severe symptoms, or if you get a fever, you might need to stay in the hospital. There, you can get fluids and antibiotics through a thin tube that goes into your vein, called an “IV.” That way you can stop eating and drinking until you get better.

If you have a serious infection, the doctor might put a tube into your belly to drain the infection. In very bad cases, people need surgery to remove the part of the colon that is affected.

A few months after your infection has been treated, your doctor might recommend that you have a procedure called a colonoscopy. During a colonoscopy, the doctor can look directly inside your colon to get an idea of the number of diverticula in your colon and to find out where they are. At the same time, they can check for signs of cancer.

If you have had diverticulitis, it’s a good idea to eat a lot of fiber. Good sources of fiber include fruits, oats, beans, peas, and green leafy vegetables. If you do not already eat fiber-rich foods, wait until after your symptoms get better to start.

You do not need to avoid seeds, nuts, popcorn, or other similar foods.

A peptic ulcer is a sore that can form on the lining of the stomach or duodenum. The duodenum is the first part of the small intestine.

Some people with peptic ulcers have no symptoms. Other people can have symptoms that include:

• Pain in the upper belly – Ulcers in the stomach often cause pain soon after a person eats. Ulcers in the duodenum often cause pain or burning when a person’s stomach is empty.
• Bloating, or feeling full after eating a small amount of food
• Not feeling hungry
• Nausea or vomiting

All of these symptoms can also be caused by other conditions. But if you have these symptoms, let your doctor or nurse know.

Sometimes, peptic ulcers can lead to serious problems. These include:

• Bleeding – This can cause smelly and black-colored bowel movements, vomiting blood, or more rarely, bright red bowel movements.
• A hole in the wall of the stomach or duodenum – This can cause sudden and severe belly pain.
• Obstruction – This is a blockage of the intestine. It can cause a feeling of fullness, bloating, indigestion, nausea, vomiting, belly pain shortly after eating, and weight loss.

Common causes of peptic ulcers include:

• An infection in the stomach or duodenum – This kind of infection is caused by a type of bacteria called “Helicobacter pylori” or “H. pylori.”
• Medicines called “nonsteroidal antiinflammatory drugs” (NSAIDs) – NSAIDs include pain-relieving medicines such as aspirin, ibuprofen(sample brand names: Advil, Motrin), and naproxen(sample brand names: Aleve, Naprosyn).

Yes. If you have symptoms of a peptic ulcer, your doctor might do:

• Tests to check for H. pyloriinfection – Doctors can check for H. pylori infection by doing:
• Breath tests – These tests measure substances in a person’s breath after they have been given a special liquid to drink
• Lab tests that check a sample of a bowel movement for the infection
• A procedure called an “upper endoscopy” – During an upper endoscopy, a doctor puts a thin tube with a camera on the end into a person’s mouth and down into the stomach and duodenum. Then they check the lining of the stomach and duodenum for ulcers.

Treatment depends on the cause, but most peptic ulcers are treated with medicines.

People with H. pylori infection are often treated with 3 or more medicines for 2 weeks to get rid of the infection. This treatment can include:

• Medicine to reduce the amount of acid that the stomach makes
• Different types of antibiotics

Some people need to take medicines that reduce the amount of acid for a longer amount of time. Some people take these medicines for the rest of their life.

It is important to follow all your doctors’ instructions about taking your medicines. Let your doctor or nurse know if you have any side effects from your medicines.

People who have serious problems from their peptic ulcers might also need to be treated with surgery.

After treatment, people often have follow-up tests. These can include:

• Tests to check that the H. pyloriinfection has gone away
• An upper endoscopy to check that the peptic ulcer has healed

To help a peptic ulcer heal and to prevent future peptic ulcers, you can:

• Not smoke
• Not take NSAIDs (if possible)

Pancreatitis is a condition that can cause severe belly pain.

The pancreas is an organ that makes hormones and juices that help break down food. Pancreatitis is the term for when this organ gets irritated or swollen.

Most people get over pancreatitis without any long-lasting effects. But a few people get very sick.

There are many causes of pancreatitis. But most cases are caused by gallstones or alcohol abuse:

• Gallstones – Gallstones are hard lumps that form inside an organ called the gallbladder. Both the pancreas and the gallbladder drain into a single tube. If that tube gets clogged by a gallstone, neither of the organs can drain. When that happens, the fluids from both organs get backed up. That can cause pain.
• Alcohol abuse – People who drink too much alcohol for too long sometimes get alcohol-related pancreatitis. People with this form of pancreatitis usually start to feel pain 1 to 3 days after drinking a lot of alcohol or after they suddenly stop drinking. They usually also have nausea and vomiting.

There are a few blood tests that can help your doctor or nurse figure out if you have pancreatitis. It’s also possible that your doctor will order a special kind of X-ray called a “CT scan” of your belly to check if belly pain is due to pancreatitis or other conditions.

Pancreatitis is usually treated in the hospital. There, your doctor or nurse can give you fluids and pain medicines to help you feel better. If you cannot eat, they can give you food through a tube.

Some people with pancreatitis get an infection, which can be treated with antibiotics. Other possible problems caused by pancreatitis are fluid buildup around the pancreas or organ failure. Fluid buildup around pancreas often goes away on its own but sometimes needs to be drained or treated with surgery. Organ failure is usually handled by a team of doctors in intensive care.

Another important part of treatment is to get rid of the cause of the pancreatitis. If your pancreatitis is caused by gallstones, your doctor might need to treat them, too. People with pancreatitis from alcohol use must learn to give up alcohol to keep from getting pancreatitis again.

The gallbladder is a small, pear-shaped organ that is tucked under your liver.  It stores bile, a fluid that helps the body break down fat.

Gallstones are small stones that form inside the gallbladder. They can be tiny specks or get as big as the whole gallbladder, which can be up to 6 inches long.

Normally, the gallbladder fills with bile in between meals. Then, when you eat fatty foods, the gallbladder empties the bile into the intestine. Sometimes, though, gallstones clog the gallbladder and keep it from draining. Other times, gallstones just irritate the gallbladder. If the gallstones are pushed out of the gallbladder, they can keep the liver or pancreas from draining.

In most cases, gallstones do not cause any symptoms. When they do cause symptoms, gallstones can cause:

• Belly pain – Often on the right side just under the rib cage or in the middle top portion of the belly
• Pain in the back or right shoulder
• Nausea and vomiting

If you know that you have gallstones but have no symptoms, you probably will not need treatment. But if you start having symptoms, you should get treated. The symptoms can come and go, but they often get worse over time.

Not usually. In some cases they can lead to serious problems, including:

• Jaundice, a condition that turns your skin and eyes yellow
• Infection of the gallbladder
• Tears in the gallbladder, which can lead to death
• Inflammation of the pancreas (the pancreas is an organ that makes hormones and juices involved in food breakdown)

Yes, doctors can find out if you have gallstones by doing an imaging test, such as an ultrasound. An ultrasound is a painless test that uses sound waves to create a picture of your gallbladder.

Even if tests show that you have gallstones, that does not mean they are causing symptoms. Your doctor might need to do other tests to make sure your stones and your symptoms are related.

People with gallstones generally have 3 treatment options. They can have:

• No treatment– This option is best for most people who have no symptoms. If they start having symptoms, they can think about treatment then.
• Surgery to remove the gallbladder and the stones– Gallbladder surgery is routine in the United States. But it involves using anesthesia, so it has some risks. The surgery does not affect digestion very much. But about half the people who have surgery have mild symptoms afterward, including watery bowel movements, gas, or bloating. These symptoms usually get better. People who have their gallbladder removed do not need to worry about gallstones coming back.
• Treatment to get rid of the stones but keep the gallbladder– People who choose this approach can take medicines to break up gallstones. In rare cases, doctors can use with a device to break up and remove stones. Medicines only work with some stones, and even then they take time – months to years. The stones can also come back after these treatments.  

The right treatment for you will depend on:

• How large your stones are
• Whether you have symptoms, and how bad the symptoms are
• How you feel about the treatment options

Ask your doctor or nurse how each treatment might affect you. Then work with them to find the treatment that makes the most sense for you.

Yes. You can try to keep yourself at a healthy weight. People who are overweight are more likely to get gallstones.

If you plan to lose weight quickly – even if you have never had gallstones – ask your doctor or nurse what you can do to keep from getting gallstones. Losing weight quickly – for example, through weight loss surgery – can lead to gallstones. But your doctor or nurse can give you medicines to keep that from happening.

The gallbladder is a small, pear-shaped organ that is tucked under the liver. It stores bile, a fluid that is made in the liver and helps the body break down fat. When you eat a meal that has fat in it, the gallbladder empties the bile into a tube called the “bile duct.” The bile duct carries the bile into the small intestine to help with digestion.

Gallbladder removal is surgery to remove the gallbladder. This surgery is also called “cholecystectomy.”

There are 2 main ways to remove the gallbladder:

• Laparoscopic surgery– This means the surgeon uses a “laparoscope,” a long, thin tube that has a light and a tiny camera on the end to see inside the body. (The laparoscope is sometimes called a “scope” for short.) For this type of surgery, the surgeon makes a few small incisions. Then they insert the scope through 1 of the incisions and other special tools through the other incisions. Next the surgeon uses the scope and the tools to do the operation. Most gallbladder removals in the US are done using laparoscopic surgery. Sometimes, though, open surgery is necessary because the gallbladder and bile duct are too infected or scarred to do laparoscopic surgery safely.
• Open surgery– This means the surgeon makes an incision in your belly big enough to do the surgery directly.

The most common reason is to treat gallstones. Gallstones are small stones that form inside the gallbladder. These stones can block the ducts that bile flows through. The stones can cause inflammation, pain, and other symptoms.

This article is about gallbladder removal to treat gallstones. People can also have gallbladder removal to treat cancer of the gallbladder. But if cancer is the reason for the surgery, it usually involves removing more than just the gallbladder.

Before the surgery:

• Your doctor will order blood tests to check if your liver is working normally.
• Your doctor will order an imaging test called an ultrasound, which uses sound waves to create pictures of the inside of your body. This test will show if you have gallstones and if the bile duct is enlarged or blocked.
• If the bile duct is blocked by a stone, your doctor might order a procedure called “ERCP.” ERCP stands for “endoscopic retrograde cholangiopancreatography.” During this procedure, a doctor slides a tube called an “endoscope” down your throat. The endoscope has a tiny camera and a light on the end. The doctor advances the tube past your stomach and into your intestine to the spot where the bile duct empties into the intestine. Then the doctor injects a special dye that shows up on X-ray into the ducts that leads to the gallbladder, liver, and pancreas and takes an X-ray. That way they can see where the dye goes. In some cases, the doctor might also use the endoscope to remove some gallstones or widen the duct opening so that small stones can pass through.
• Your doctor might give you antibiotics through a thin tube that goes into a vein, called an “IV,” to reduce the risk of infection during and after surgery.

If you have the surgery to treat gallstones, the main benefit is that it will make your symptoms go away.

The risks of the surgery are low, but they can include:

• Damage to other bile ducts near the gallbladder
• Bile leaks
• Bleeding
• Damage to the bowels
• Infection
• Leaving gallstones “trapped” in the bile duct (which would need to be removed with ERCP after surgery)

In some cases, a person will continue to have belly pain even after the gallbladder is removed.

Recovery is a little different depending on whether you have laparoscopic or open surgery.

• If you have laparoscopic surgery, you will probably be able to leave the hospital the same day you have surgery. But there is some chance you will need to stay overnight. Even though the cuts on the belly are small, the operation inside was the same as if you had open surgery. Your doctor will want you to rest and avoid heavy lifting, sports, and swimming for at least a week.
• If you have open surgery, you will probably stay in the hospital for 1 to 2 days. While there, do your best to start walking as soon as possible. Also, do the breathing exercises that your nurse recommends. After you go home, you should be able to do most of your normal activities, but you should avoid heavy lifting, sports, and swimming for a few weeks.

If you are taking narcotic pain medicine during recovery, you might get constipated. Take a stool softener to prevent this problem.

If you develop any the following symptoms in the weeks after surgery, call your doctor:

• Fever or chills
• Redness or swelling around the cuts from your surgery
• Nausea or vomiting
• Cramping or more severe belly pain
• Bloating (feeling like your belly is full of gas)
• Yellow skin or eyes
• Urine that is very dark in color

The surgery does not affect digestion very much. But about half the people who have surgery have mild symptoms afterward, including loose bowel movements, gas, or bloating. These symptoms usually get better.

Minimally invasive surgery is a type of surgery that uses special tools designed to decrease the size of incisions and reduce how much the body’s tissues get damaged.

One kind of minimally invasive surgery involves the use of a “scope,” a viewing device that allows surgeons to look inside the body without opening it up all the way. Another type, called “endovascular surgery,” uses X-rays to see inside the body while the surgeon uses special devices that fit inside the blood vessels. This article is about the type of surgery that involves scopes.

There are several different types of scopes, but they all work in about the same way. They consist of a long, thin tube with a tiny camera and a light on the end. The camera sends pictures of the inside of the body to a TV screen. When doing this type of surgery, the surgeon makes a small incision just big enough for the scope to fit through. They also make 2 or more other incisions that slim tools can fit through. These tools include clamps, scissors, and stitching devices, which the surgeon can control from outside the body. While looking at the picture on the screen, the surgeon uses those tools to do the operation.

There are lots of different types . Their names are based on the body parts that are involved. The scopes used for the different types of surgery are named that way, too:

• Thoracoscopes are used in the chest for “thoracoscopic surgery.” (“Thorax” is Greek for chest.) This type of surgery can be used to remove pieces of lung or to do certain types of heart surgery.
• Laparoscopes are used in the belly for “laparoscopic surgery.” (“Lapara” is Greek for the space between the bottom of the rib cage and the hips.) This type of surgery can be used to remove the gallbladder, appendix, or uterus, or to do lots of other different procedures.
• Hysteroscopes are used in the uterus and vagina for “hysteroscopic surgery.” (“Hystera” is Greek for uterus.) This type of surgery can be used to remove abnormal growths in the uterus, or to do a number of different procedures on the uterus and vagina.
• Arthroscopes are used inside joints for “arthroscopic surgery.” (“Arthron” is Greek for joint.) This type of surgery can be used to repair or rebuild joints in the knee, shoulder, and hip.

Some minimally invasive surgeries involve a surgical “robot,” which is a machine that the surgeon controls. This is called “robot-assisted minimally invasive surgery” or simply “robotic surgery.” The tools used in robotic surgery allows for more controlled movements than regular tools.

In general – but not always – this type of surgery makes recovery easier. That’s because:

• It usually involves several small wounds, rather than one big one
• The organs don’t get moved around as much

Despite all of the differences with regular surgery, minimally invasive surgery is still surgery. People who have it do have some pain, they do often need stitches, and they can develop infections or other problems because of the surgery.

No. Many procedures can now be done through a minimally invasive approach. But it’s not entirely up to the person to choose what type of surgery they will have. Whether or not a person can have this type of surgery will depend on:

• Whether there is a surgeon available with enough experience doing the type of surgery the person needs
• Why the person needs surgery. (As an example, people who need surgery to remove very large cancers cannot always have minimally invasive procedures.)
• What other health problems the person might have (As an example, people who have serious heart or lung problems cannot tolerate minimally invasive surgery.)

Even when a person starts out having minimally invasive surgery, there’s no guarantee that the surgery will stay that way. Sometimes surgeons start out doing minimally invasive surgery and then switch to open surgery because they find something unexpected. This doesn’t mean the surgeon has done anything wrong. It is usually done to protect the person’s safety.

A small bowel obstruction (SBO) is a condition in which the small intestine gets blocked. “Small bowel” is another term for the small intestine. In an SBO, air, fluid, and food get stuck in the intestine. They can’t move through the small intestine the way they normally would.

The intestine can be partly or completely blocked in an SBO. A complete block can lead to serious problems. That’s because:

• The intestine can get swollen from the trapped air, fluid, and food. This swelling can make the intestine less able to absorb fluid, which can lead to dehydration and kidney failure.
• If the intestine wall tears, the fluid in the intestine can leak out. This can cause a belly infection.
• When the intestine is blocked, the blood vessels that bring oxygen to the intestine can get blocked, too. Without blood, parts of the intestine can die.

In some cases, the small intestine looks blocked on tests even when it isn’t. This could be from either intestinal “ileus” or “pseudo-obstruction.” This article is only about real obstruction.

The most common causes of an SBO are:

• Past surgery in the belly – After surgery, scar tissue can form in the belly and press on the intestine.
• Hernias – A hernia is an opening in the muscle or tissue that covers the muscle. Part of the intestine can slide through that opening and get trapped in a hernia. A hernia inside the belly can also cause SBO.
• Twisting of the intestines

●Tumor – Tumors (cancerous and noncancerous) can grow inside or outside the intestine and block it.

Symptoms depend on where your intestine is blocked and how blocked it is. The most common symptoms are:

• Nausea and vomiting
• Belly pain
• Belly swelling and bloating
• Not being able to have a bowel movement or pass gas

Yes. Your doctor will ask about your symptoms and do an exam. If your doctor thinks that you have an SBO, they will do imaging tests of your belly and blood tests.

The imaging tests can include an X-ray, CT scan, or a series of X-rays called a “GI series.” For the CT scan and GI series, you might drink a liquid called “contrast” beforehand. The contrast will show up on the CT scan or X-rays. It can help the doctor see what’s causing the blockage.

Treatment depends on the blockage and your symptoms.

If you have an SBO, you will be treated in the hospital. Your doctor will give you fluids and medicines. You will not be allowed to eat or drink. You will also get something called a “nasogastric tube.” This is a thin tube that goes in your nose, down your esophagus, and into your stomach. The tube can suck up the fluid and air in your stomach. This will make your stomach feel better and help keep you from vomiting.

Most people will not need any other treatment. That’s because, many times, an SBO can get better on its own. This is often the case for a partial SBO, or an SBO that has happened after earlier belly surgery.

Some people will need surgery. You are likely to need surgery if you have a belly infection, you have a complete blockage, or your SBO does not get better with fluids and the nasogastric tube in a few days. You also need surgery if the SBO is caused by a hernia, a tumor, or a twist in the intestine.

During surgery, your doctor will remove what is causing the blockage and, if needed, any unhealthy parts of your small intestine. If your doctor removes the unhealthy intestine, they will usually reconnect your intestines so you will not need an ostomy bag. (An ostomy bag is a bag that attaches to the skin and collects bowel movements. It is used if the intestines cannot be reconnected after a surgery.)

Intussusception is a condition that can cause severe belly pain. It happens when one part of the intestine slides into another part of the intestine. Intussusception can happen with either the small or large intestine.

When one part of the intestine slides into another, it causes a blockage. When the intestine is blocked, air, fluid, and food get stuck. They can’t move through the intestine the way they normally would. This causes symptoms.

Intussusception happens most often in babies and children, especially those younger than 3 years old. In some cases, intussusception is caused by another medical condition. But in most cases, doctors don’t know what caused the intussusception.

Symptoms usually start suddenly. They can include:

• Severe belly pain – The pain comes in waves. At first, episodes of pain happen about every 15 to 20 minutes, but the episodes get closer over time. The pain usually makes children cry and pull their knees up into their belly.
• Vomiting
• Bloody bowel movements
• Being very sleepy and hard to wake up

Some children with intussusception have only 1 or 2 of these symptoms. Other children with a small intussusception do not have any symptoms, although this is uncommon. Their doctor might find that they have an intussusception when the child has a test for another reason. Children who have no symptoms might not need treatment.

Yes. Call your child’s doctor or nurse right away if your child has symptoms of an intussusception.

Yes. The doctor or nurse will ask about your child’s symptoms and do an exam. They will do an imaging test of the belly, such as an X-ray or ultrasound. Imaging tests create pictures of the inside of the body.

The doctor will do a few things to treat your child’s intussusception.

First, they will probably give your child fluids through a thin tube that goes into a vein, called an “IV.”

Then, the doctor will fix the intussusception. There are different ways to do this. They include:

• A procedure called “nonoperative reduction” – This is also sometimes called an “air enema” or “contrast enema.” It is not surgery. For this procedure, the doctor will put a tube into your child’s rectum and push air or a special fluid into the tube. The air or fluid will go into the rectum and through the intestine. As the air or fluid reaches the intussusception, it makes the stuck intestine slide back out of the other part of the intestine. To see what they are doing, the doctor will do an ultrasound or X-ray during this procedure.

Some children will get a “nasogastric tube.” This is a tube that goes into the nose, down the esophagus, and into the stomach. The tube will suck up the fluid and air in the stomach. This will help your child feel better and keep them from vomiting.

• Surgery – If the intussusception could not be fixed with the nonoperative reduction, or if the intussusception has caused problems, your child will probably need surgery.

Ischemic bowel disease is a condition in which there is not enough blood flow to the intestines. This happens when veins or arteries in the intestines are blocked. It can happen in the large intestine or the small intestine. It can cause belly pain, nausea, diarrhea, and other symptoms.

The symptoms include:

• Belly pain – This can be mild or severe. It can:
• Start suddenly, or happen over several days or years.
• Start about 1 hour after eating, and last about 2 hours. Eating a big meal can make this pain even worse.
• Nausea, vomiting, or both
• Blood in bowel movements – This can be bloody diarrhea
• Weight loss, when not trying to lose weight
• Eating problems, such as:
• Food fear – Not wanting to eat because pain starts after eating
• Feeling full too quickly when eating

Yes. The doctor or nurse will ask about the symptoms and do an exam. They will also order one or more tests. These can include:

• X-ray, CT scan, or ultrasound of the belly – These imaging tests create pictures of the inside of the body. They can help show the cause of symptoms.
• Blood tests – These can show signs of not enough nutrition. Or they might show that a different condition is causing symptoms.
• Tests called “endoscopy,” “upper endoscopy,” “sigmoidoscopy,” or “colonoscopy” (figure 2) – For these tests, the doctor puts a thin tube down your throat and into your stomach, or up your rectum and into your colon. The tube has a camera attached so the doctor can look inside your body. The tube also has tools attached to it, which the doctor can use to take samples of tissue. These samples can go to the lab to be checked for problems.
• A test called an “angiogram” – For this test, the doctor injects a dye into the vessels that carry blood to the bowel. This dye can be seen with an imaging test such as a CT, MR, or fluoroscopy (a moving X-ray). The test can show if arteries around the bowel are blocked. If they are, this could be keeping part of the bowel from getting enough blood.
• Laparoscopy – This is a procedure that the doctor does in the operating room. The doctor makes a small cut near the belly button. Then they put a small device called a “laparoscope” inside. The doctor looks through the laparoscope to see if they can find the cause of symptoms.

Treatment for ischemic bowel disease depends on:

• What is blocking the blood vessels
• What type of vessel is blocked, an artery (which brings blood to the bowel) or a vein (which drains blood from the bowel)
• Whether the symptoms started suddenly or came on over a long time

Most people with ischemic bowel disease need treatment in the hospital. In the hospital, the doctor can:

• Give you fluids and nutrition through a small tube that goes into a vein, called an “IV”
• Put a thin tube called a “nasogastric tube” in your nose, down your esophagus, and into your stomach. If there is extra fluid and air in your stomach or intestines, the tube can suck it up. This will make you feel better and help keep you from vomiting.

Other treatments can include:

• Antibiotics to treat infection
• A procedure or surgery to open a blocked artery
• Anti-clotting medicines (sometimes called “blood thinners”) to treat clots in the vessels
• Surgery to take out part of the bowel if it is not healthy

These treatments can help the bowel work correctly again.

Splenectomy is surgery in which your spleen is removed. The spleen is an organ in the upper left part of the belly. It is part of the body’s infection-fighting system, or “immune system.” It makes blood cells that help you fight infection. The spleen also filters the blood. It removes things that could cause problems, including damaged blood cells and bacteria.

You might have a splenectomy to treat problems such as:

• Damage to the spleen – If your spleen gets injured, it can cause serious internal bleeding. This most often happens because a person is hit in the belly area, for example, in a car accident or while playing a contact sport. If the spleen gets badly injured, it might have to be removed.
• Certain disorders that affect blood cells – Examples include:
• Immune thrombocytopenia or “ITP,” a disorder in which a person’s own immune system destroys their platelets (a type of blood cell that helps blood clot)
• Autoimmune hemolytic anemia, a disorder in which a person’s own immune system destroys their red blood cells
• Beta thalassemia major (a condition some people are born with), in which the body does not make enough red blood cells

Usually, doctors try other treatments for these problems before they consider doing a splenectomy.

●A spleen that is much larger than usual – Doctors call this “splenomegaly.” Certain cancers or non-cancerous tumors or cysts can sometimes cause this. If it leads to symptoms, such as pain, you might need to have your spleen removed.

If possible, you will need to get vaccines before your surgery. The spleen helps protect the body from infections, so you will be more likely to get some kinds of serious infections after your spleen is removed. Vaccines help prevent this. They work by teaching your body how to fight the germs that cause infections. The vaccines you’ll need include those that protect against certain infections, called pneumococcus, meningococcus, and Haemophilus influenzae type b (or “Hib”). You should also get the usual vaccines that doctors recommend for everyone, such as the flu vaccine.

The vaccines you get will depend on which ones you’ve already had and when you got them. Ideally, you will get your vaccines at least 2 weeks before your surgery. This might not be possible if your spleen needs to be removed right away.

Your medical team will tell how long before the surgery you should stop eating and drinking. They will also tell you if you need to stop taking any of your medicines or start any new medicines.

Before the surgery starts, you will get medicines (through a thin tube that goes into a vein, called an “IV”) to make you sleep. You will not be awake for the surgery.

There are 2 different ways a splenectomy can be done:

• Open surgery – During open surgery, the doctor will make a cut, often in the middle of your belly, take out your spleen, and close the cut with special staples or stitches. If your spleen is very large or has been badly injured, you will most likely need open surgery.
• Laparoscopic surgery – During laparoscopic surgery, the doctor will make a few very small cuts in your belly and remove the spleen through one of these cuts. This is done by putting long, thin tools through the cuts. One of the tools (called a “laparoscope”) has a camera on the end, which sends pictures to a video screen. The doctor can look at the screen to see inside your body.

It depends on which type of surgery you had. If you had open surgery, you will need to stay in the hospital for a few days. If you had laparoscopic surgery, you might be able to go home the same day or the next day.

If you didn’t get all your vaccines before your surgery, you will get them afterwards. You might also get antibiotics to help your body prevent infections, since you no longer have a spleen to do this. You will get instructions about getting help quickly if you have a fever.

Most people can go back to their daily lives once they recover. But it is important to be aware of certain problems that can happen. These include:

• Infection – The spleen helps protect the body from infections. After your spleen has been removed, your body has a harder time fighting off certain infections. Also, without a spleen, even minor infections are more likely to turn into a serious problem called “sepsis.” Sepsis is a serious illness that happens when an infection travels through the whole body. If some serious infections are not treated right away, you can die.

Getting all the vaccines your doctor recommends helps prevent many infections. But it’s still possible to get an infection if you’ve had your vaccines. Your medical team will work with you to plan for what to do if you notice any signs of infection.

Because any infection could cause serious illness or even death, you will probably get antibiotics to keep at home. This way, you can start taking them at the first sign that you might have an infection. Signs of infection can include:

• Fever (temperature higher than 100.4°F or 38°C)
• Chills or shivering
• Sore throat
• Cough
• Earache
• Stuffy nose or sinus pain
• Headache
• Feeling sleepy or confused
• Nausea, vomiting, or diarrhea
• Feeling dizzy, or like you might pass out
• A fast heartbeat
• Small purple-red dots on the skin, or unexplained bruises

Your doctor will talk to you about what to do if you have any of these symptoms. If you have symptoms that could mean a serious infection, like fever or chills, you will need to go straight to the nearest emergency department. Do this even if you do not feel very sick. In the emergency department, they can check you for infection and decide if you need more or different treatment. For less serious symptoms, your doctor might tell you to call their office for advice on what to do next.

Depending on your age and the reason your spleen was removed, your doctor might also tell you to take an antibiotic every day. This will help prevent infection.

• Blood clots – The risk of blood clots also goes up after splenectomy. If a blood clot happens, it is most often in the legs (called a “deep vein thrombosis” or “DVT”) or the lungs (called a “pulmonary embolism” or “PE”). Symptoms of DVT can include swelling, pain, or warmth and redness in the leg. Symptoms of PE can include trouble breathing, chest pain when you breathe in, or coughing.

There are things you can do to help lower your risk of blood clots. On a long car trip or airplane flight, get up and walk around or move your legs frequently, every hour or so if possible. If you have surgery, make sure to let the doctors know that your spleen was removed so they know about this risk.

Some hormones can also increase the risk of blood clots. If you plan to take a hormonal treatment, such as birth control pills, let the doctor or nurse prescribing it know that you have had a splenectomy.

It is important to carry an alert card, or wear a medical bracelet, so others know you do not have a spleen. This will help doctors and nurses give you the best care if there is ever an emergency.

Hemorrhoids are swollen veins in the rectum. They can cause itching, bleeding, and pain. Hemorrhoids are very common.

In some cases, you can see or feel hemorrhoids around the outside of the rectum. In other cases, you cannot see them because they are hidden inside the rectum.

Hemorrhoids do not always cause symptoms. But when they do, symptoms can include:

• Itching of the skin around the anus
• Bleeding – Bleeding is usually painless. You might see bright red blood after using the toilet.
• Pain – If a blood clot forms inside a hemorrhoid, this can cause pain. It can also cause a lump that you might be able to feel.
• Swelling – Hemorrhoids can swell or dangle outside of the rectum during a bowel movement.

You should see a doctor or nurse if you have any symptoms, especially bleeding or if your bowel movements look like tar. Bleeding could be caused by something other than hemorrhoids, so you should have it checked out.

If you do have hemorrhoids, your doctor or nurse can suggest treatments. But there some steps you can try on your own first.

The most important thing you can do is to keep from getting constipated. You should have a bowel movement at least a few times a week. When you have a bowel movement, you also should not have to push too much. Plus, your bowel movements should not be too hard, and you should not spend too much time on the toilet (for example, reading).

Being constipated and having hard bowel movements can make hemorrhoids worse. Here are some steps you can take to avoid getting constipated or having hard stools:

• Eat lots of fruits, vegetables, and other foods with fiber. Fiber helps to increase bowel movements.

You need 20 to 35 grams of fiber a day to keep your bowel movements regular. If you do not get enough fiber from your diet, you can take fiber supplements. These come in the form of powders, wafers, or pills. They include psyllium seed (sample brand names: Metamucil, Konsyl), methylcellulose (sample brand name: Citrucel), polycarbophil (sample brand name: FiberCon), and wheat dextrin (sample brand name: Benefiber). If you take a fiber supplement, be sure to read the label so you know how much to take. If you’re not sure, ask your doctor nurse.

• Take medicines called “stool softeners” such as docusatesodium (sample brand names: Colace, Dulcolax). These medicines increase the number of bowel movements you have. They are safe to take and they can prevent problems later.

Some people feel better if they soak their buttocks in 2 or 3 inches of warm water. You can do this up to 2 to 3 times a day for 10 to 15 minutes. Do not add soap, bubble bath, or anything to the water.

There are also medicines that you can get without a prescription. They are usually creams or ointments that you rub on your anus to relieve pain, itching, and swelling. Some hemorrhoid medicines come in a capsule (called a suppository) that you put inside your rectum. Others come in a cream that comes in a bottle with a nozzle that you put inside your rectum. It is OK to try these medicines. But do not use medicines that have hydrocortisone (a steroid medicine) for more than a week, unless your doctor or nurse approves.

If you still have symptoms after trying the steps listed above, you might need treatments to destroy or remove the hemorrhoids.

One popular treatment for hemorrhoids inside the rectum is called “rubber band ligation.” For this treatment, the doctor ties tiny rubber bands around the hemorrhoids. A few days later the hemorrhoids shrink and stop bleeding. Doctors can also use lasers, heat, or chemicals to destroy hemorrhoids. But if none of these options works, your doctor might suggest surgery to remove or tie off the blood vessels of the hemorrhoids. Hemorrhoids on the outside of the rectum can only be removed with surgery.

An anal fissure is a tear in the lining of the anus, the opening where your bowel movements come out. Anal fissures cause pain, especially during a bowel movement.

There is a muscle that wraps around the anus and holds it shut. It is called the “anal sphincter.” The sphincter gets tense when the anus is injured. In people with anal fissures, the sphincter goes into spasms, which can lead to further injury.

An anal fissure is most often caused by having a hard, dry bowel movement.

Most people who have an anal fissure feel a tearing, ripping, or burning pain when they have a bowel movement. This pain can last for hours. Some people also bleed slightly when they have a bowel movement. They might see bright red blood on the toilet paper or on the surface of the bowel movement. Some people with an anal fissure also have itching or irritation around the anus.

Yes. See your doctor or nurse if you bleed when you have a bowel movement.

Your doctor or nurse can check whether you have anal fissure by gently spreading your buttocks apart and looking at your anus.

If you have had bleeding, your doctor or nurse might send you for more testing after the fissure has healed. This involves a “sigmoidoscopy” or “colonoscopy” . For these tests, the doctor puts a thin tube into your anus and up into your colon. The tube has a camera attached to it, so the doctor can look inside your colon and check for causes of bleeding.

For the first month of treatment, doctors recommend trying to keep your bowel movements soft so they are easier to pass. To do this, you can:

• Take fiber supplements along with plenty of water. Supplements include:
• Psyllium(sample brand name: Metamucil)
• Methylcellulose(sample brand name: Citrucel)
• Calcium polycarbophil(sample brand name: FiberCon)
• Wheat dextrin(sample brand name: Benefiber)
• Take a stool softener if the fiber supplements are not enough. An example of a stool softener is docusate(sample brand name: Colace).

Your doctor can also prescribe a medicine that relaxes the anal sphincter muscle. This helps the fissure heal. The most commonly used medicine is nitroglycerin or nifedipine cream. You will need smear the cream around the fissure twice a day every day. It’s important to keep doing this for as long as your doctor tells you to, even if you do not have pain every day. This will allow your fissure to heal completely.

You can also soak your buttocks in 2 or 3 inches of warm water. This is called taking a “sitz bath.” Sitz baths can help relieve pain by relaxing the sphincter. If you find that Sitz bath helps, do it 2 to 3 times a day for 10 to 15 minutes. Do not add soap, bubble bath, or anything else to the water.

If these steps to do not work in 1 to 2 months, doctors can try other treatments, such as:

• Botulinum toxin (“BoTox”) – This is a shot that can help the anal sphincter muscle relax and heal. It can help, but it can also cause short-term problems with leaking of gas or bowel movements.
• Surgery – During surgery, the doctor makes a small cut in the sphincter to help it relax. This surgery works in most patients, but doctors offer it only to people who do not get better with other treatments. Surgery can cause lasting problems with leaking of gas or bowel movements.