Q: For many weeks I have had a bloated stomach, gas and diarrhea. My family doctor sent me to a gastroenterologist – very little improvement; an oncologist – no help. The worst diarrhea is between midnight and sunrise; usually none after mid-day. Immodium AD and Maalox help, but not sufficiently. I am 86 and male. My gallbladder was removed in March 2010.

Your help will be greatly appreciated.

A: The causes for a bloated stomach are many, to include the use of specific medications, infection, inactivity, and poor diet. I’ll hit on a few causes that may shed some light on the situation.

A condition known as irritable bowel syndrome (IBS) might be linked with the consumption of some foods or stress in your life. The condition causes bloating, cramping, abdominal pain, and diarrhea that may alternate with constipation, among other problems. Gastroesophageal reflux disease (GERD) occurs when the lower esophageal sphincter muscle fails to work properly, causing the contents of the stomach to incorrectly flow back into the stomach. Bloating, nausea, heartburn and burping result. Lactose intolerance occurs because of an inability to properly digest sugar, the lactose in milk and milk products. Bloating, diarrhea and gas result. We consume sodium daily, and often in excess. If this is the cause of your bloating, you should be conscientious of your daily intake since this simple action can also cause bloating and fluid retention. And, so it goes.

It is important to determine what causes your bloating so you can take appropriate steps to alleviate the problem. One method that comes to mind is to keep a journal to determine if certain foods, beverages, medications or supplements, or activities precede your diarrhea and bloating. Here we can start simple. If for example you find you routinely consume milk daily, you might consider a trial period of eliminating dairy products. If you deal with stress, you might make a concerted effort to displace yourself as much as possible from such situations. It’s great to become involved and concerned but such action can affect your bodily functions. We cook with salt, add it to foods prior to even tasting them and may be consuming a great deal more than we need to without even realizing it. Remove your salt shaker from your table, don’t add it to foods you cook, select foods from your local grocery that are sodium free or very low in sodium and determine if you have better control of your symptoms. When it comes to IBS and GERD, you may require the assistance of a primary care physician or gastroenterologist. IBS might be caused by infection that might require testing such as a stool culture or blood work to check for anemia. GERD may be the result of a medication you are on.

I may appear to be complicating your situation but you have had problems that must be addressed before you can be on the road to recovery. While your specialist wasn’t successful in treating you, I feel you need to return to his or her office, get a referral to another gastroenterologist, and take any test results you may have for review. In the interim, while your antacid may help, they can actually cause diarrhea and constipation. It may be reacting to other drugs you are on – prescription or over-the-counter – to include dietary supplements and herbals. Be sure your current physician and any other you may see in the future has a complete listing of everything you take.

Readers who would like related information can order Dr. Gott’s Health Report “Constipation and Diarrhea” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Dr. Gott’s Health Reports, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.