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Regional Digestive ConsultantsDr. Behara, MD, AGAFDr. Shailaja BeharaRDCRegional Digestive Consultants

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Women’s Gastrointestinal Health

Dr. Shailaja Behara understands that the digestive health of women is unique and women are more susceptible than men to certain GI problems because of the physiological differences in their digestive tracts; she has the knowledge, skills, and abilities unique to women’s GI health and can formulate a diagnostic plan that takes into account the differences between women and men. She encourages women to feel comfortable in addressing their gastrointestinal health needs and concerns they may be having, and to know that treatment options exist.

Women deal with distinct GI issues related to the following: Hormonal fluctuations, pregnancy and child birth, and stress. Certain GI disorders occur more frequently in women and some medications used to treat gastrointestinal disorders are processed differently by the female body.

Women and Colorectal Cancer: A Population at Risk:

Colon cancer is the third most diagnosed cancer in women behind breast and lung cancer. Women get mammograms and pelvic exams regularly but often ignore the importance of colon screening and putting them at risk to develop colon cancer. Embarrassment or fear often plays a part in preventing women from having a screening colonoscopy.

The myth that colon cancer is just a man’s disease is wrong. Colon cancer strikes both men and women equally and has no racial bias. The recommended screening test for colon cancer is a colonoscopy.

Colonoscopies in women require special attention from a specialist, as women’s colons tend to be longer than men’s due to the deeper pelvic area, changes from childbirth, or frequency of adhesions from pelvic surgery. Also, flexures (or turns) of the colon are tighter and polyps are higher up in women than in men. Dr. Behara is sensitive to these differences and uses her expertise to provide women with a very thorough colonoscopy. When caught early, colon cancer is 90% curable. Protect yourself against colon cancer. For any questions or to schedule an appointment, call us at 281-528-1511.

Digestive Diseases Which May Affect Women in Particular:

Irritable Bowel Syndrome (IBS)

IBS occurs 2 to 6 times more often in women than in men. In patients with IBS, there is super-sensitivity to irritants (such as intestinal gas) that would not be bothersome to other people. The etiology is believed to be due to the way intestinal nerves send messages to the brain, the interpretation that the brain makes, and its response back to the gut. If a person has emotional stress, the IBS response appears to be worse. The good news is that there is no damage to the intestinal lining. This is a “functional” problem - that is, the bowel is not functioning at a normal level, but at a super- or suboptimal- level. Symptoms often include diarrhea, constipation, or a combination of both. Bloating and abdominal pain are part of the syndrome, and often improve after bowel movements. The diagnosis is made based upon specific criteria and lack of other objective findings. Currently, there is no one treatment to cure this disorder, but many effective management strategies exist. Lifestyle changes are recommended, which include the development of coping strategies for life stressors. This is a chronic condition and many patients have reached satisfactory results working with their physicians as a team.

Inflammatory Bowel Disease (IBD)

IBD includes both Crohn’s and Ulcerative Colitis. IBD is more frequent in women than in men with a ratio of about 2:1. Women may have a milder course of Crohn’s, especially if they have given birth to several children. Hormones during pregnancy could improve or worsen the disease; this is not similar for all subsequent pregnancies in the same patient. Symptoms may include diarrhea, blood in the stool, weight loss, and anemia. Diagnosis is generally made after colonoscopy and review of biopsy specimens by pathology. Treatment can vary but often requires long-term medications, many of which are safe in pregnancy.

Functional Dyspepsia (FD)

Studies showed possible gender differences among patients with functional dyspepsia (FD). Women typically experience a lesser sense of wellbeing and decreased health-related quality of life compared to men.

Functional dyspepsia is a condition where there are stomach symptoms like burning sensation or discomfort in the upper abdomen or lower chest, abdominal bloating, excessive belching, feeling of fullness when eating, and nausea, without relation to any identifiable stomach disease. In other words there may be no underlying cause like gastritis or peptic ulcers, hence the term non-ulcer dyspepsia. The term dyspepsia is also used interchangeably with indigestion. This is a common condition, and it is estimated that 1 out of 4 adults will experience functional dyspepsia at least once a year.

Medications used for functional dyspepsia include: antacids to neutralize the stomach acid, Proton pump inhibitors and H-2 receptor blockers to reduce gastric acid production, Simethicone to relieve gas in the digestive tract, Prokinetic agents (like metoclopramide) to speed up gastric emptying, and Tricyclic antidepressants to ease pain associated with increased nerve activity.

Chronic Constipation

Constipation is common in women and tends to worsen with age. Treatment includes at least 20-35 grams of dietary fiber per day, adequate fluid intake, and regular exercise. Non-prescription medications may include stool softeners and laxatives. If you do not respond to these therapies, your doctor may order additional testing or medications.

Gallstones and other Biliary Tract Disorders

Normally, women have slower gallbladder emptying than men and are twice as likely to develop gallstones as men. This effect is exaggerated during pregnancy due to unique female hormones, and may be one reason why many women develop gallstones after having a baby. Symptoms of gallbladder disease may include right upper abdominal pain after eating, nausea or vomiting. Gallbladder disease can often be diagnosed by your doctor based upon history and ultrasound results.

Pregnancy-Related Digestive Problems

Pregnancy is associated with nausea, which occurs early in the pregnancy. This effect may result from a slowing of the stomach emptying, beyond what is seen normally in women. One of the pregnancy hormones, progesterone, is associated with delaying muscle contraction, and it is believed that this is a major cause of the nausea seen with pregnancy. Women also experience heartburn during pregnancy. This seems to be caused by the increasing levels of progesterone during pregnancy as well as the increasing size of the baby. It is most prominent during the second half of the pregnancy. Constipation is common for similar reasons.

The muscle coordinating moving one's bowels can be damaged by a tear during childbirth, leading to possible long-term problems. Therefore, it is important for pregnant women to perform the Kegel exercises, which help to strengthen this area, and to discuss any concerns with their obstetrician.

Gastroesophageal Reflux Disease (GERD)

Most commonly known as ‘acid reflux’, GERD occurs when liquid content of the stomach backs up into the esophagus and irritates the esophageal lining. Chronic GERD symptoms can damage your esophagus and, if left untreated, can cause more serious digestive disorders such as esophageal cancer. The management of reflux in pregnancy is also important given its increased frequency due to multiple physiologic and hormonal factors – 80% of pregnant women suffer from reflux in their second and third trimesters.

Dr. Behara provides lifestyle/nutritional recommendations that may improve symptom relief without the need for long-term medications however, medical therapy may be required in some cases. She also performs endoscopic surveillance for Barrett’s esophagus and refers for ablative therapies such as radiofrequency ablation if needed. Our service also includes pH testing which can be done with 24-hr pH-impedance testing or with a 48-hr endoscopically placed Bravo device.

Pelvic Floor Disorders and Fecal Incontinence

Pelvic floor dysfunction can present itself as constipation or fecal incontinence. High resolution anorectal manometry can help identify abnormalities in the mechanism of defecation, or an inadequate anal sphincter, which may be amenable to biofeedback therapy or surgical intervention. Newer modalities available for the treatment of fecal incontinence include sacral nerve stimulation and injectable preparations like Solesta.

Liver Diseases in Women

Liver disease is a disorder that causes the liver to function improperly or stop functioning. Signs and symptoms of liver disease in both men and women may include swelling in the ankles and legs, abdominal swelling or pain, chronic fatigue and loss of appetite, yellowish skin and eyes, itchy skin, nausea or vomiting, and a dark urine color.

Some liver diseases, such as autoimmune hepatitis and primary biliary cirrhosis, affect women far more often than men. Other diseases, such as alcohol-related disease, progress more rapidly in women than in men, and women more commonly present with acute liver failure. Toxin-mediated hepatotoxicity such as alcohol- and drug-induced liver disease, have an increased prevalence of acute liver failure. Benign liver lesions that predominantly occur in women include cavernous hemangioma, focal nodular hyperplasia (FNH), hepatic adenoma, biliary cystadenoma, and solitary hepatic cysts.

Reasons for the differences in the incidence, natural history, and outcomes of common liver diseases in females as compared to males is not completely understood, but the effects of sex hormones appear to play a role at the metabolic and genetic level.

Tips to Keep Your Digestive System Healthy

  • Do not smoke

  • Maintain a healthy weight

  • Eat a balanced diet

  • Do regular physical activity

  • Learn how to manage stress

  • If you have any questions or concerns or would like to schedule
    an appointment with Dr. Shailaja Behara, please call 281-528-1511.

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