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Digestive Issues & Gut Health: who to see and what helps

Digestive Issues & Gut Health · Kitchener, Waterloo & Cambridge

“Digestive issues” covers heartburn, indigestion, bloating, nausea, constipation and diarrhea. Check the warning signs on this page first, then use it to find the condition that fits and the right first visit. At CARESPACE most people start with a Registered Dietitian or a Naturopathic Doctor, and a Nurse Practitioner can arrange tests and medication.

What counts as a digestive issue

The commonest complaint has a medical name, dyspepsia: persistent pain or burning in the upper abdomen, often with heartburn, belching, bloating, nausea or feeling full early. About a fifth of people are affected at some point in their lives, according to the Canadian Digestive Health Foundation, and in more than 70% of them no structural disease is found, which is called functional dyspepsia. It does not affect survival, but it does affect quality of life and work. “Gut health” here simply means digestion that works without drawing attention to itself.

Common symptoms

  • Heartburn, or food and sour fluid coming back up
  • Indigestion: feeling full and bloated, feeling sick, burping
  • Bloating and gas
  • Nausea or vomiting
  • Constipation, diarrhea, or swinging between them
  • Pain or cramping in the abdomen

Which condition is it?

  • Acid Reflux & GERD: burning in the middle of the chest and a sour taste, often worse after eating or lying down.
  • Gastritis: an inflamed stomach lining, with upper-abdominal pain, fullness and nausea, often from H. pylori bacteria or anti-inflammatory painkillers.
  • Bloating & Gas: pressure, fullness or trapped gas, sometimes with a belly that visibly swells.
  • Irritable Bowel Syndrome: abdominal pain with diarrhea or constipation that comes back again and again.
  • Constipation: infrequent or difficult bowel movements, with straining and small, hard stools.
  • Hemorrhoids: small amounts of bleeding with bowel movements, itching, or a lump close to the anus.
  • Diverticulitis: infection in one of the small pouches that can form in the wall of the large bowel, bringing abdominal pain and usually a fever.
  • Gallbladder: most gallstones are silent. A gallbladder attack is sudden pain in the upper right abdomen.
  • Crohn’s & Colitis: inflammatory bowel disease, in which the intestines are inflamed and ulcerated. Abdominal pain and diarrhea are the commonest symptoms of Crohn’s disease, sometimes with rectal bleeding, weight loss or fever. Our services are support alongside your physician or specialist.
  • Celiac Disease: a reaction to gluten that damages the small bowel. Do not cut out gluten until blood tests and a biopsy are done.
  • Fatty Liver: excess fat in the liver together with a metabolic risk factor. Many people have no symptoms, and it is often found on routine bloodwork or imaging.

Nausea, cyclic vomiting and achalasia

These three do not have pages of their own. Nausea is a symptom with many causes, among them a stomach bug or food poisoning, acid reflux, migraine and inner-ear problems. See a physician or nurse practitioner if it has not eased in a few days or keeps coming back.

Cyclic vomiting syndrome causes sudden, repeated attacks of nausea and vomiting that last from a few hours to several days, separated by spells with no symptoms. It is more likely in people with migraines or a family history of them, with long-term cannabis use, or who get motion sickness. Diagnosis and medicine are a physician’s job; diet will not prevent or relieve an episode, but it helps recovery between them.

Achalasia is a rare disorder of the esophagus that makes it difficult to swallow food and drink. People may bring undigested food back up, have coughing or choking fits and repeated chest infections, and gradually lose weight. It is diagnosed with hospital tests; there is no cure, but specialist treatment can make swallowing easier.

When digestive symptoms need urgent help

Call 911 if you have signs of a heart attack. A burning chest is not always reflux: reflux can cause chest pain that is indistinguishable from heart pain. The Heart and Stroke Foundation of Canada lists the signs as chest discomfort (pressure, squeezing, fullness, pain, burning or heaviness), sweating, discomfort in the neck, jaw, shoulder, arms or back, nausea, shortness of breath and light-headedness. Call 911 as well for sudden, severe chest pain, or if you are struggling to breathe: gasping, choking or unable to get your words out.

Go to an emergency department now if you are vomiting bright red blood or something that looks like ground coffee, if your stools are black, sticky and very smelly, if there is red or maroon blood mixed with your stool or heavy bleeding from the rectum, or if you have severe abdominal pain that came on suddenly. Bleeding inside the stomach or bowel can also show as feeling tired, short of breath or light-headed, with cramps or pain in the abdomen: go if you have any of those along with blood. Do not drive yourself: ask someone to take you, or call 911.

With repeated vomiting, also go to an emergency department for signs of dehydration: extreme thirst and a dry mouth, passing less urine than usual, dark urine, skin that stays tented when pinched, sunken eyes or cheeks, or light-headedness or fainting. This is American advice for adults with cyclic vomiting syndrome. An episode that is severe and lasts more than several hours, being unable to keep food or liquids down for several hours, or start-of-episode medicine that is not working belong on the same-day list below.

The emergency departments in Waterloo Region are:

  • WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
  • WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
  • Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

See a physician or nurse practitioner the same day, or go to an urgent care clinic, if you have lost your appetite, feel full after a very small meal, have recently lost weight without trying, can feel a lump in your abdomen, find it painful or difficult to swallow, or keep vomiting. This list is the one the NHS, the UK’s health service, asks people to get an urgent appointment for; the emergency department list above is its emergency list plus the bleeding signs given by American and Canadian digestive health sources.

See a physician or nurse practitioner promptly about small amounts of red blood with a bowel movement when none of the emergency signs above apply. Book an appointment if indigestion or stomach pain has lasted longer than a week, if you have heartburn most days, or if you are bloated regularly.

How digestive problems are worked out

Mostly from your story and an examination; most people with indigestion do not need extensive testing. The usual tests are a breath or stool test for H. pylori, a blood test for celiac disease where bloating or irritable bowel symptoms are the issue, and, for some people, an endoscopy: the joint Canadian and American guideline on dyspepsia suggests one from age 60.

What the evidence says, in general

Each condition page has its own evidence. The general points here come mostly from the dyspepsia guideline. Where it “recommends”, its panel was confident the advice suits most people; where it “suggests”, the advice hangs more on the individual, and neither word is only a grade of the studies.

  • Ongoing upper-stomach pain under 60. The recommended first steps are a non-invasive H. pylori test, treatment if it is positive, and acid-suppressing medicine if it is not. The Gastritis page has the detail.
  • Long-term acid suppression. For most people, the Canadian Association of Gastroenterology advises an attempt to stop or reduce the medicine at least once a year, with the prescriber.
  • Talking therapy. Suggested for functional dyspepsia that medicine has not helped. The 12 trials, in 1,563 people, all reported a benefit, yet the data are rated very low quality.
  • Complementary and alternative medicines. Routine use in functional dyspepsia is not recommended; this is one of the guideline’s conditional positions and rests on very low-quality evidence.
  • Diet is condition-specific. A low-FODMAP diet has support in irritable bowel syndrome and bloating, a gluten-free diet is for celiac disease, and weight loss is the firmest lifestyle recommendation for reflux.

How each CARESPACE service helps with digestive issues

Nutrition & Dietitian

A Registered Dietitian is the first visit for problems that track with eating: bloating, irritable bowel syndrome, constipation, reflux, and life after a celiac diagnosis. They can take a food history and guide structured trials such as a low-FODMAP diet, so that foods are reintroduced and not just removed.

See our dietitians →

Naturopathic Medicine

Naturopathic Doctors take the wider view: digestion together with sleep, stress and general health, with bloodwork they can order and go through with you. What the guidelines say about products depends on the product and the condition. Complementary and alternative medicines are not recommended for routine use in functional dyspepsia, and herbal remedies are suggested against in irritable bowel syndrome, while psyllium, peppermint oil and probiotics have more favourable positions there, set out on the IBS page. Talk to a pharmacist, physician or nurse practitioner before starting any product.

See our naturopathic doctors →

Nurse Practitioner

A Nurse Practitioner can assess symptoms that have not been diagnosed, order H. pylori and celiac tests and other bloodwork, prescribe, review medicines that may be upsetting your stomach, and refer you to a specialist when an endoscopy or further care is needed.

See our Nurse Practitioner service →

Other services people ask about

Acupuncture. The dyspepsia guideline counts it among the complementary medicines it does not recommend routinely and calls the acupuncture data very low quality, and the Canadian guideline recommends against offering it for irritable bowel syndrome. Counselling. Psychological therapy is suggested for functional dyspepsia when medicine has not worked. CARESPACE counsellors offer cognitive behavioural therapy.

Where most people start

If your symptoms follow food and none of the warning signs apply, start with a Registered Dietitian or a Naturopathic Doctor. If the problem is new and you are over 60, or you rely on stomach medicines most days, start with a Nurse Practitioner or your physician.

How your team works together

Two things need settling: what it is, and what to do day to day. A Nurse Practitioner or your physician answers the first; a dietitian or Naturopathic Doctor works on the second.

  1. Next available: Nov 21

    Samantha Rocca, BASc, PMDip, RD

    Dietitian

    CARESPACE Waterloo GoodLife

    When food feels confusing, stressful, or harder than it should, Samantha Rocca, BASc, PMDip, RD helps you make sense of it in a way that feels practical, compassionate,…

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Browse by service: dietitians, naturopathic doctors and Nurse Practitioner.

What to expect at your first visit

  1. Your symptoms and their pattern. Which ones, how often, and what they do around meals.
  2. What has been done already. Bring test results and a list of your medicines, including ones bought over the counter.
  3. How you eat. Typical meals, drinks and timing.
  4. A plan to leave with.

What you can do at home

  • Eat smaller, more frequent meals, and do not eat too quickly.
  • Watch for trigger foods, such as spicy food and alcohol.
  • For nausea: fresh air, sips of a cold drink, ginger or peppermint tea, and no strong-smelling, fried or greasy food.
  • Do not lie down soon after eating, and stop smoking.
  • Ask a pharmacist whether a pain reliever you take could be upsetting your stomach.

Rotating shifts in the region’s plants and warehouses push dinner late; for reflux and gastritis the advice is to finish eating three to four hours before bed.

Outlook

It depends on the condition, and each page gives what its sources say. Indigestion symptoms often flare with eating and can fade without a clear reason; irritable bowel syndrome is not life-threatening and does not lead to cancer.

Digestive health care in Kitchener, Waterloo and Cambridge

Kitchener. Nutrition in Kitchener and Naturopathic Medicine in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Nutrition in Waterloo, Naturopathic Medicine in Waterloo and Nurse Practitioner in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Nutrition in Cambridge and Naturopathic Medicine in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

What is the difference between indigestion, heartburn and acid reflux?

Acid reflux is stomach contents coming back up into the esophagus. Heartburn is the burning it causes in the chest. Indigestion, or dyspepsia, is the wider term for pain or burning in the upper abdomen, and reflux is its most common cause.

Should I see a dietitian, a naturopathic doctor or a nurse practitioner first?

A dietitian if food clearly sets your symptoms off. A Naturopathic Doctor if you want digestion looked at together with sleep, stress and bloodwork. A Nurse Practitioner if you may need a test or a prescription.

Do I need an endoscopy?

Most people do not. Under 60, Canadian gastroenterologists advise against it unless there are alarm symptoms such as progressive trouble swallowing, anemia or weight loss.

Is a gut microbiome test worth doing?

The one position we found is about bloating, and it is no: a European expert consensus says stool tests that profile gut bacteria do not provide useful information there and should not be used.

Can I get help with digestive issues in Cambridge?

Yes. See Nutrition in Cambridge or Naturopathic Medicine in Cambridge, or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

Related conditions

Irritable Bowel Syndrome
Acid Reflux & GERD
Bloating & Gas
Constipation
Stress

The CARESPACE Central Reception Team

Ready to book?

Book online with a Registered Dietitian or a Naturopathic Doctor, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

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