Dale asks:
I have been diagnosed with colonic inertia and a sphincter problem. I have seen multiple GI doctors and surgeons — no one seems to have an answer to this other than an ileostomy. I am looking for another route.

I have been to sphincter therapy at Penn Medicine at Radnor. They tell me my sphincter is working, but the biofeedback checks "holding in" and not "pushing out." My quality of life has been greatly affected for the past two years. Any suggestions would be greatly appreciated.

Anil Rustgi, MD responds:
Colonic inertia is a type of functional constipation caused by a decrease in muscle activity in the colon. Functional constipation means that the bowel is healthy but not working properly. It stems from problems in the structure of the anus. These abnormalities result in an inability to relax the anal sphincters – the rectal and anal muscles that allow stool to exit.

An ileostomy procedure is a type of ostomy surgery in which a surgeon removes the colon and rectum, and attaches the bottom of the small intestine to the stoma (an opening in the abdomen), bypassing the bowel.

A Penn gastroenterologist specializing in motility and bowel disorders can examine you and recommend further diagnostic tests and treatment options. To make an appointment, please call 800.789.PENN or request an appointment online.

Lou asks:
I get really bad gas, bloating and flatulence almost every afternoon and into the night. I was originally diagnosed with constipation so I changed to a high fiber diet and also started taking the supplements Metamucil® and miraLAX®.

Now, I usually have a bowel movement every morning without a problem, but the high fiber diet gave me more gas and bloating. The laxatives originally worked, but then they gave me diarrhea. Now I have stopped with the high fiber diet and the laxatives. I still get the bloating and gas in the afternoons and I do not know what to do. Can you recommend a prescription or test for me? 

Anil Rustgi, MD responds:
Most people produce one to four pints of gas a day and pass gas about 14 times a day. Passing gas through the mouth is called belching or burping. Passing gas through the rectum is called flatulence. Most of the time, gas does not have an odor. The odor comes from bacteria in the large intestine that release small amounts of gases that contain sulfur.

Gas in the digestive tract comes from two sources: air that you swallow and the breakdown of undigested food by bacteria in the large intestine. Certain foods may cause gas, including many fruits and vegetables. Foods that produce gas in one person may not cause gas in another. For people with lactose intolerance, avoiding milk products will help. For most people, changing their diet and using a prescription or over-the-counter medication helps alleviate excessive gas.

A Penn gastroenterologist can help you with diet and medication decisions related to chronic gas and bloating. To schedule an appointment, call 800.789.PENN (7366) or request an appointment online.

Phyllis asks:
Is there a doctor or group of doctors that deal with small intestine bacterial overgrowth (SIBO)? I am from Lancaster, PA and cannot find anyone who is knowledgeable about treating it and its effects.

Anil Rustgi, MD responds:
The main purpose of the small intestine is to digest and absorb food into the body. The entire gastrointestinal tract, including the small intestine, normally contains bacteria. Small intestinal bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria are present in the small intestine.

The coordinated activity of the muscles of the stomach and small intestine moves the food from the stomach, through the small intestine, and into the colon. Even when there is no food in the small intestine, muscular activity sweeps through the small intestine from the stomach to the colon.

This activity is important for the digestion of food, but it also is important because it sweeps bacteria out of the small intestine and thereby limits the numbers of bacteria in the small intestine. Anything that interferes with the progression of normal muscular activity through the small intestine can result in SIBO.

Geoffrey Spencer, MD, is a Penn gastroenterologist who specializes in motility and bowel disorders. He sees patients at the Hospital of the University of Pennsylvania and at Penn Medicine at Radnor.

You can schedule an appointment with Dr. Spencer by calling 800-789-PENN (7366) or you can also request an appointment online.

Trish asks:
I am a type 1 diabetic and have been since 1972. For years I have had minor pain in my lower left abdomen, but not enough to mention. Now, ever since I had the intestinal bug that was going around, I have been having pretty bad pains. I want to get checked out but don't know what doctor to request. Can you help?

Anil Rustgi, MD responds:
Pain in the abdomen doesn't always mean a serious problem but if it lasts more than a week, you should see a health care provider. Seek medical help immediately if you experience any of the following:

• abdominal pain that is sudden and sharp
• additional pain in your chest, neck or shoulder
• a stiff, hard abdomen that is tender to the touch
• blood in your stool or vomit
• inability to move your bowels (especially if you are also vomiting)

I recommend starting with your primary doctor as that person knows you best. If you have abdominal pain, your primary doctor may well consider referring you to a Penn gastroenterologist after evaluating your history, physical tests and an appropriate examination. If you are over 50 or have a family history of colorectal cancer, you should also think about having a colorectal cancer screening performed.

David Metz, MD, is a Penn gastroenterologist who specializes in motility and bowel disorders. To schedule an appointment with Dr. Metz, please call 800.789.PENN (7366) or you can also request an appointment online.