Maybe you’re sore after working out a little too hard, you need relief from menstrual cramps or you’re coming down with a fever.
You probably reach for over-the-counter (OTC) pain relievers like ibuprofen (Advil, Motrin), naproxen (Aleve) or aspirin. These types of medications, called non-steroidal anti-inflammatory drugs or NSAIDs, are easy to find in pharmacies, grocery stores and discount chains.
NSAIDs block enzymes that lead to inflammation and they’re useful for reducing pain, swelling and fever. But there’s a risk that they could damage your gut lining if you use them too often.
How NSAIDs affect the gut lining
Your stomach and intestines are lined with a layer of mucus that protects them from harsh substances, including stomach acid. NSAIDs can interfere with this protective barrier, so it’s easier for stomach acid to irritate and damage the lining of your gut. They also slow the blood flow that feeds your gut.
“NSAIDs can cause injury in the upper and lower GI tract,” said Karen Rico, MD, an internal medicine specialist with Banner - University Medicine.
NSAIDs can lead to:
- Peptic ulcer disease (PUD), an ulcer in the stomach or the first part of the small intestine
- Bleeding and ulcers (sores) throughout the small intestine, called NSAID enteropathy
- Gastritis (inflammation of the stomach lining)
- Gastrointestinal bleeding
- Microscopic colitis, which causes inflammation in the colon
- Disruption in the balance of bacteria in your gut, so bad bacteria grow and cause inflammation and damage
These issues can be serious, so it’s important to be aware of the risks of using NSAIDs regularly.
Why gut health matters
Your gut digests food, absorbs nutrients and supports your immune system. It produces hormones and neurotransmitters that impact your mood and energy levels.
“There is a strong brain-gut connection. We have an enteric nervous system in the gut that aids digestion and can be seen as a second brain. Our gut health strongly influences our mood and mental health,” Dr. Rico said.
When your gut lining is damaged, it can affect your digestion and your overall health. “Your gut plays a major role in your well-being. Poor gut health has been linked to autoimmune diseases, cardiovascular disease, cancer, depression, anxiety and irritable bowel syndrome (IBS),” Dr. Rico said. Gut damage may also lead to food sensitivities and more frequent infections.
Signs you might be damaging your gut
If you take NSAIDs regularly and notice any of these symptoms, your gut could be under stress:
- Stomach pain or discomfort
- Heartburn or acid reflux
- Bloating or excessive gas
- Indigestion
- Nausea or vomiting
- Diarrhea
- Constipation
- Blood in vomit or stool
Talk to a health care provider if you have any of these symptoms. They can help figure out if NSAIDs are causing your symptoms and recommend safer alternatives.
Even if you don’t have any symptoms, talk to your provider if you take NSAIDs often or if you need to take higher doses to get pain relief.
Safer ways to use NSAIDs and alternatives
NSAIDs can be effective if you are in pain or inflamed. If you take them, it can help to:
- Take the lowest possible dose
- Take them with food, not on an empty stomach
- Avoid using them for a long period of time
- Talk to your provider about taking stomach-acid-reducing medication along with them
- Choose ibuprofen over diclofenac or naproxen
There are also other treatments you may want to try that are less harsh on your gut lining.
Medications
“Acetaminophen (Tylenol) is a good OTC alternative if it’s safe for you to take it,” Dr. Rico said. Follow the dosing instructions carefully to avoid liver damage. Prescription options include muscle relaxants such as gabapentin and, for chronic pain, tetracyclic antidepressants and serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressants.
Gels or creams
Medications you apply to the skin can give you relief without the risks to your gut. Dr. Rico suggests topical ointments such as diclofenac or lidocaine gel and lidocaine patches. Products that contain menthol or capsaicin can also soothe pain and inflammation.
Other options to try
You may also get pain relief from:
- Applying heat, ice or compression
- Physical therapy
- Acupuncture
- Massage
- Natural remedies such as turmeric, ginger, omega-3-rich foods and herbal teas, depending on the location of your pain
Lifestyle changes
Making a few lifestyle adjustments can also help reduce pain and inflammation:
- Exercise: Regular physical activity can help reduce inflammation and improve your overall health.
- Diet: Eating a balanced diet centered around fruits, vegetables, whole grains and healthy fats can support gut and joint health.
- Stress management: Chronic stress can increase inflammation in the body, so techniques like meditation, yoga or deep breathing may help.
When to seek professional advice
“Be sure to get medical care for vomit that contains blood, stool with blood, abdominal pain or changes in your bowel habits, such as diarrhea,” Dr. Rico said.
Before you change your medication or try new treatments, speak with your health care provider. They can help you figure out what’s causing your symptoms and suggest the best course of action, whether it’s changing your medication or trying a different treatment.
Even if you’re trying a natural treatment, it’s a good idea to talk with your provider. Some natural remedies can be effective, but they might not be right for everyone. Your provider can help you make the best choices based on your health.
The bottom line
NSAIDs like ibuprofen, naproxen and aspirin are popular options for managing pain and inflammation, but they can damage your gut lining if you use them too often.
Talk to your health care provider or an expert at Banner Health about safer alternatives like treatments you apply to your skin, acetaminophen, natural remedies and lifestyle changes. That way, you can protect your gut and control your pain.
