Gastrointestinal Issues Consider them Before Returning to Diving By Dr. David Vote. INTRODUCTION Specific medical problems with the a medical condition. Articles such as 1) Scuba diving in remote locations gastrointestinal tract (GI system) do this help address this need for new or from a boat with minimal or no not generate many calls on the DAN divers and aid the instructors and definitive medical care for Medical Information Line. But each stores that are responsible for emergencies; year, however, callers ask DAN providing training. Although study about fitness-to-dive questions data linking medical illnesses to 2) Fluid and electrolyte losses that involving the GI system. diving is limited, we will continue to can occur with acute conditions and do our best to find answers for some rendering the individual more Since the GI system contains air of these difficult questions. susceptible to DCI and heat stroke; spaces, we should view them in relation to scuba diving, along with 3) Head-down positions, common in diseases of the oesophagus, Don’t Overlook It diving, which increase tendency to stomach, small and large intestines. Fitness to dive with gastrointestinal regurgitate; and Like diseases of other body systems, conditions doesn’t have as high a GI problems can weaken individuals profile as other conditions, but divers 4) Chronic bowel inflammation, and restrict them from certain types should not be complacent about which can cause poor nutrition and of physical activity. obtaining such a medical evaluation. hence a general lack of Several GI conditions can cardiovascular fitness. In this series of frequently asked significantly affect dive safety. questions, physicians have Those with either condition should determined which disease conditions The No-Nos recover general strength and fitness and then resume diving. might not be compatible with the Two classes of conditions can physiology of scuba diving. Many contain absolute contraindications: individuals with chronic, long-term COMMON ACUTE disease stop diving altogether, while 1) those that can cause gastric and CONDITIONS others experiencing more acute intestinal gas-trapping at depth; this Gastroenteritis disease may only have to wait out can lead to subsequent expansion - with Vomiting / Diarrhoea their current illness to resume diving. and possible rupture - on ascent; and Condition: This irritation of the Physicians use their experience and large and small bowel can lead to theory to make the most prudent 2) conditions that increase the risk diarrhoea, vomiting, fever, decision when or if one should return of vomiting underwater, which can abdominal pain and cramping, loss to diving. That is what DAN tries to lead to panic, rapid ascent, aspiration of appetite and general weakness. provide with this article and others or drowning. Caused by various bacteria or like it. viruses, it may also indicate other Relative contraindications involve gastrointestinal disease. Often mild More and more individuals with conditions that can be surgically and lasting only a day or two, it can special health concerns are repaired or have a pattern of acute be severe and cause life-threatening considering scuba for their episodes followed by long symptom- dehydration. recreational activity; others may wish free periods. Many factors prevent to remain in scuba after they develop patients with such gastrointestinal conditions from diving: 1 abnormal contractions that replace Fitness and Diving: Malaise and • drinking alcohol dehydration can both adversely the normal movement of the affect divers; one should postpone • smoking oesophagus. diving until symptoms have subsided • an ulcer or hiatal hernia Fitness and Diving: Food and and hydration is normal. To maintain • certain medications such as secretions can collect in a pool in the or regain hydration, take extra fluid aspirin or non-steroidal anti- as tolerated. Divers should lower oesophagus and cause inflammatory drugs (NSAIDs) regurgitation when the diver is in the remember that medications used to • a tight-fitting belt or wetsuit. control nausea, vomiting and head-down position. As with reflux, diarrhoea may have some adverse diving is not recommended. Physicians treat reflux with side effects, such as sedation. medications or through surgery. Inflammatory Bowel Disease Small Bowel Obstruction Condition: Inflammatory bowel Condition: Obstruction of the disease (IBD) can result from small bowel refers to the ulcerative colitis or Crohn’s intestinal blockage due to disease. The major symptoms are adhesions (external bands), diarrhoea, which can be bloody; scarring, external compression, abdominal pain; nausea; and twisting or entrapment of the vomiting, often with fever and bowel within a hernia (see weight loss. Hernias). Vomiting and abdominal pain are symptoms. Commonly, IBD usually occurs to divers aged 20 to 40 years and Fitness and Diving: Almost who experience the following: all individuals with bowel obstruction will be hospitalised. 1) Intermittent disease with long Because of possible over- periods of normal bowel distension and rupture, those functioning; and with such an obstruction should avoid diving until the 2) Complications including underlying problem has been anaemia, electrolyte disturbances, de-hydration, poor absorption of corrected. Fitness and Diving: While most fluids, liver disease and generalised people may experience occasional fatigue. CHRONIC CONDITIONS mild heartburn, if reflux of gastric These conditions are lifelong or of contents occurs while one is diving, Drug treatment often involves long duration. a diver could be at significant risk. corticosteroids, which can impair Aspirating food or acid into the lungs one’s ability to fight infections. Gastro-oesophageal Reflux or into the regulator could be fatal. Individuals with significant reflux (“Heartburn” or “Waterbrash”) Fitness and Diving: Someone with should not dive. Condition: “Reflux” is a backward symptomatic IBD should not dive flow of acid or food from the until treatment has caused remission. Achalasia stomach into the oesophagus. A person experiencing no significant Condition: A disorder of the Symptoms include burning upper complication of IBD or its treatment oesophageal smooth muscle, abdominal or chest pain, sour taste and has adequate cardiovascular achalasia has two components: the or food regurgitation, which can fitness could consider diving. lower oesophageal sphincter that happen when divers are in the head- does not relax with swallowing and down position. Symptoms can be exacerbated by: Alert Diver, SEAP 2 Abdominal Surgery supplying the thigh, through an since they have different implications Condition: This is a surgical unhealed, surgical incision) or in the for fitness to dive. procedure in which a portion of the diaphragm. Hernias can also occur intra-abdominal contents or the internally, when the bowel protrudes In a sliding hiatal hernia, the upper abdominal wall has been removed, through a narrow opening or pocket portion of the stomach slides manipulated or repaired. in the peritoneum, the abdomen’s upward in the space occupied by the internal lining. oesophagus. This hernia can cause Fitness and Diving: Diving in the gastro-oesophageal reflux, but it ocean exposes the skin to Bowel protruding into a hernia can often has no symptoms. A para- innumerable microorganisms. To become entrapped, causing an oesophageal hernia is a protrusion of minimise infection, divers should obstruction or damage to the bowel. the stomach through a separate allow surgical wounds to heal fully Surgical repair is usually opening of the diaphragm. before diving. A small proportion of recommended for hernias. abdominal wounds may develop into Fitness and Diving: Significant incisional hernias, gastro-oesophageal leading to bowel reflux should be entrapment. One treated before diving, should avoid but a sliding hiatal swimming or lifting hernia does not by heavy objects such itself contraindicate as scuba tanks until diving. Part of the the abdominal stomach can become muscles have fully trapped within a recovered from para-oesophageal surgery (4-6 hiatal hernia, and, weeks). As for during ascent, could when to resume rupture. Thus, para- swimming and oesophageal hiatal diving, a surgeon hernia is considered a can best assess the contraindication to wound’s status. diving. In addition, the fatigue and lack of Fitness and Diving: During an A few who have had surgical repair general fitness present after any ascent, a trapped segment of bowel of their hiatal hernia (e.g., surgery can limit a diver. Gradual containing gas will expand; it could fundoplication) can suffer from gas- exercise under the direction of a rupture and compromise its blood bloat syndrome, which is associated doctor may help the diver regain supply. For this reason, individuals with gaseous distension of the cardiovascular performance and should not dive with an unrepaired stomach. This is believed to occur general fitness. hernia. due to one’s inability to expel swallowed air by belching. During an Hernias Hiatal Hernia ascent, this distension can also lead Condition: A hernia is the Condition: In a hiatal hernia, part of to gastric rupture. The symptom protrusion of a loop or portion of the stomach protrudes into the chest usually resolves within a few weeks. an organ or tissue through an cavity through the diaphragm’s If the distension persists, however, abnormal opening, usually in the oesophageal opening. Two main diving is not advised. abdominal wall (in