Headaches and digestion
Stomach problems
For stomach pain, diarrhea, constipation and indigestion
with a medical interpreter
24 hours a day, 365 days a year
OK to consult together
payment information
About
About Stomach problems
We treat digestive symptoms such as stomach pain, diarrhea, constipation, indigestion and heartburn. Many people also consult us when food or water abroad doesn't agree with them.
Why it happens
Stomach problems have many causes, including infectious gastroenteritis from viruses or bacteria, irritation from food or drink, changes in how the bowel works due to stress or autonomic imbalance (such as irritable bowel syndrome), and imbalances in stomach acid. Diarrhea is also a defensive response by which the bowel tries to expel germs and harmful substances quickly. Constipation is linked to lack of fluids, lack of dietary fiber, lack of exercise and changes in daily routine, and tends to occur right after a change of environment.
What's happening in the body
What happens inside the body with stomach problems depends on the cause. In infectious diarrhea, bacteria or viruses attach to the lining of the bowel and release toxins or damage the lining. The bowel then absorbs less water and moves faster to get rid of the cause quickly. That's diarrhea. In other words, diarrhea itself is also a way of protecting the body. In functional abdominal pain, on the other hand, there's no visible problem such as inflammation or ulcers, but the bowel's movement and sensitivity become heightened, causing pain and discomfort. Stress and disrupted routines are known to play a role, and changes in environment from living abroad can be a trigger. Treatment depends on which it is, so we assess how symptoms have developed together with your situation.
Main symptoms
- Stomach pain (sharp or dull)
- Diarrhea, watery stools, more frequent bowel movements
- Constipation, hard stools, feeling of incomplete emptying
- Bloating, feeling of trapped gas
- Indigestion, discomfort in the upper stomach
- Heartburn, burping, acid coming up
- With loss of appetite or nausea
- Stomach pain with fever
When you can wait and see
What you can do yourself
- Replace fluids and electrolytes often, for example with oral rehydration solution (small amounts, frequently)
- Gradually return to eating, starting with easily digestible food (avoid fatty food, spices and alcohol)
- For constipation, get enough fluids and fiber, exercise moderately and keep a regular bowel routine
- Don't use strong anti-diarrhea medicine on your own (with an infection, it can slow recovery)
- Wash your hands thoroughly to prevent spreading it within your household
Please consult us
If any of the following apply
- Stomach pain or diarrhea won't go away
- Indigestion or heartburn is bothering you
- You've been constipated for a while
Seek care right away
If any of the following apply
- Severe pain when the abdomen is pressed, which feels hard like a board (possible peritonitis)
- Black, tar-like stools, a lot of blood in the stool, or vomiting blood
- Severe stomach pain with cold sweats, feeling faint, or drowsiness and confusion
- Passing almost no urine, or too weak to stand (possible severe dehydration)
- Unable to pass stool or gas, with a swollen abdomen and repeated vomiting (possible bowel obstruction)
Don't wait for a Cotovia consultation; call the emergency number in your country.
See the emergency guide for each countryIf you're not sure, ask us on LINE
Differential
Telling it apart from similar conditions
Symptoms that look the same may need different care depending on the cause. Use this as a guide to find what's closest to your situation.
Traveler's diarrhea
Watery diarrhea starting 1–2 days after eating out or drinking untreated water, often with only mild fever
Replacing fluids and electrolytes comes first. Most cases improve in 2–5 days
Bacterial enteritis
High fever, severe stomach pain, bloody stools
Early care and assessment including a stool test are needed
Viral gastroenteritis
Vomiting comes first, and people around you have the same symptoms
The focus is on preventing dehydration
Irritable bowel syndrome
Repeated stomach pain with diarrhea or constipation despite normal tests, relieved by a bowel movement
We consider lifestyle adjustments and treatment as needed
Appendicitis
Pain that moves from the upper stomach to the lower right abdomen and hurts more when walking
Seek care urgently. Surgery may be needed
Parasitic infection
Diarrhea lasting several weeks or more, weight loss, lots of gas
Assessment with a stool test is needed
* This is not a complete list. If you're not sure, please consult us.
When it might be something else
Course
Typical course
This is the general course. Actual progress varies from person to person.
- Onset to 12 hours
Stomach pain and diarrhea begin, sometimes with vomiting
Replace fluids and electrolytes with oral rehydration solution. There's no need to force yourself to eat
- Days 1–2
This is when diarrhea is most frequent
Check the amount and color of your urine. See a doctor if you haven't passed urine for half a day or more
- Days 3–5
For most people, it becomes less frequent and stools start to return to normal
Gradually start eating again, beginning with easily digestible food
- 1 week or more
If it continues, causes other than infection are considered
Assessment including parasites and inflammatory conditions is needed
Local Insight
For people living in Southeast Asia
The climate, healthcare and access to medication differ from Japan. Here are points specific to this region.
Southeast Asia is considered a high-risk region for traveler's diarrhea, and street food, tap water, ice, raw vegetables and cut fruit can be causes. Particular care is needed shortly after arrival.
High rates of resistance to fluoroquinolone antibiotics have been reported in this region for bacteria such as Campylobacter, so it's important for a doctor to choose treatment with local conditions in mind. Buying and taking antibiotics from a pharmacy on your own is not recommended.
In tropical heat, you lose a lot of fluid and electrolytes through sweating, and diarrhea on top of that can cause dehydration quickly. Young children and older adults need particular care.
Food- and waterborne infections that are rare in Japan, such as typhoid, hepatitis A and amoebic dysentery, occur in this region. If you have diarrhea with fever or diarrhea that won't go away, don't decide on your own; please consult us.
Care
What Cotovia can do
- Assessing your symptoms through a consultation
- Prescriptions for probiotics, antacids and antispasmodics (prescribing is at the doctor's discretion)
- Guidance on where to go if you have severe stomach pain, bloody stools or a high fever
Tests you may have
Not knowing what will happen can make people hesitate to seek care, so here's what actually takes place.
Consultation and abdominal examination
Checking where it hurts and how it responds to pressure
Stool test
Identifying bacteria or parasites causing the illness
Blood test
Assessing dehydration, inflammation and the possibility of other conditions
Abdominal imaging
Assessing conditions that need surgery, such as appendicitis
Treatment options
Rehydration with oral rehydration solution
Prevents dehydration
This is the basic treatment for diarrhea. Water or tea alone can't replace lost electrolytes
Probiotics
Support a healthy gut
Considered according to your symptoms
Antibiotics
Used when a bacterial infection is confirmed
Campylobacter and fluoroquinolone resistance are problems in Southeast Asia, so medication must be chosen with local conditions in mind. Please don't use antibiotics brought from Japan on your own
Antidiarrheal medication
Reduces how often you have diarrhea
Should be avoided with fever or bloody stools because it stops the cause from being flushed out. Please ask us before using it
* Tests, procedures and prescriptions are decided by the doctor after a consultation. Services may vary by country and location.
Preparation
Before your visit
When seeing a doctor abroad, simply organizing what you need to say makes a big difference.
What to bring
- Passport or residence card
- Insurance card and your insurer's contact details
- Your medication record and the medication you take
- If possible, a record of what your stools are like
What to tell us
- When it started and how many times in 1 day you have diarrhea
- What your stools are like (watery, or with blood or mucus)
- What you ate before it started, and whether you had untreated water or ice
- Whether you have fever or vomiting
- Where you've recently traveled, and whether people around you have the same symptoms
Self Care
What you can do yourself
Along with seeing a doctor, here are things to keep in mind in daily life.
Prevention
- Choose sealed bottled drinks and be careful with ice
- Choose thoroughly cooked food and be careful with raw food and cut fruit
- Wash your hands before cooking and eating
- Avoid stress and lack of sleep, and keep regular mealtimes
How to Consult
How to be seen
Choose from 3 ways to be seen, depending on your symptoms and schedule. If you're not sure, we'll guide you on LINE.
Online consultations
See a doctor by video call from home or the office. Medication delivered or from a pharmacy.
Available for this symptom
In-person care
In-person consultations at our clinics and partner hospitals, including tests and procedures.
Available for this symptom
Cotovia Counter
Support with an interpreter for visits to general hospitals.
Available for this symptom
If an online consultation finds that tests or procedures are needed, we'll guide you to in-person care or Cotovia Counter.
From consultation to receiving medication
Add us on LINE and consult
Tell us your symptoms, and we'll recommend the right way to be seen.
Book and be seen
See a doctor online or at the nearest location, with an interpreter present.
Receive your medication
Have it delivered or pick it up at a pharmacy or the clinic (varies by country).
Follow-up
You can also consult us on LINE about how you're doing afterward.
Special Care
People who need extra care
Children
Dehydration sets in quickly. Seek care urgently if your child is limp, hasn't passed urine for half a day or more, or cries without tears
Older adults
They may not notice they're dehydrated. People around them should check fluid intake and urine output
Pregnant women
Some medications can't be used. Dehydration also affects the mother, so please consult us early
People taking medication for a chronic condition
Diarrhea can change how your medication is absorbed. Please tell us what you're taking
FAQ
FAQ
Common questions before a visit, and common assumptions that lead people to judge for themselves.
QI've had diarrhea since eating at a street stall.
It may be traveler's diarrhea. The most important thing first is to stay hydrated. If you have bloody stools, a high fever or severe stomach pain, or if it lasts 3 days or more, please consult us about whether tests or treatment are needed.
QCan I take anti-diarrhea medicine?
If an infection is suspected, it may stop your body from flushing out the germs and slow your recovery, so it needs careful consideration. Please consult a doctor.
QI've been constipated since moving here.
Changes in environment, diet, lack of fluids, lack of exercise and stress may be involved. You can consult us, and we'll also look at your daily habits.
QCan I get an IV drip?
Depending on how dehydrated you are, we may be able to arrange an IV drip in person. Please start by consulting us online about your condition.
Common misconceptions
Myth Diarrhea should be stopped right away
Fact Diarrhea is also a way of expelling the cause. Forcing it to stop when you have fever or bloody stools can make things worse
Myth Drinking lots of water is enough
Fact Water alone can't replace salt and glucose. Oral rehydration solution is recommended
Myth I can just take the antibiotics I brought from Japan
Fact Resistant bacteria are a problem in this region, so they may not only fail to work but also spread resistance
Myth Cooking food always prevents food poisoning
Fact Infection can also come from how food is handled after cooking, and from ice, raw vegetables and cut fruit
Myth Once you get used to it, you won't get diarrhea anymore
Fact Even after a long stay, it's not unusual for symptoms to return when you're run down or stressed
Feel free to ask us on LINE first
It's fine to contact us even if you're not sure you need to see a doctor. We're available in Japanese 24 hours a day, 365 days a year.
- Symptoms
- When it started
- Your country of residence
- How you'd like to be seen
Sending these 4 things helps us respond faster. It's fine if you don't have them all.
Ask us on LINE