Digestive Health 265

Digestive Health

Everyone has digestive problems from time to time—an 

upset stomach, gas, heartburn, constipation, or diarrhea. Many 

digestive problems may be uncomfortable or embarrassing, but 

they are not serious and don’t last long. Others can be controlled 

with simple changes in your diet. But sometimes even common 

digestive symptoms can be signs of a more serious problem. 

Knowing when you should talk to your doctor can help you take 

care of your digestive health.

Digestive System

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How your digestive system works

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(e-SAW-fuh-guhss), stomach, small 

intestine, large intestine (colon), rectum, 

and anus—through which food and 
266 The Healthy Woman: A Complete Guide for All Ages

liquids pass and are absorbed or eliminated. Along the way, two solid digestive 

organs, the liver and the pancreas, add 

digestive juices. These juices help break 

down food into nutrients that can be absorbed by the body. Another organ, the 

gallbladder, stores bile between meals. 

Bile is the digestive juice produced by 

the liver that helps digest fats. At mealtime, the gallbladder empties bile into 

the small intestine. 

Most nutrients in digested food are absorbed through the walls of the small 

intestine and travel through the bloodstream to other parts of the body. There, 

they are used to build and nourish cells 

and provide energy. Waste products, 

including the undigested parts of food 

known as fiber, leave the body through a 

bowel movement.

Common signs of a digestive 

system problem

Common digestive complaints such as 

nausea, vomiting, bloating, gas, heartburn, diarrhea, and constipation can be 

temporary. They can be caused by:

l	 certain types of food

l	 food contaminated with harmful 

bacteria

l	 flu or other short-term illness

l	 menstruation

l	 pregnancy

But sometimes these symptoms are signs 

of a more serious digestive disease or 

other health problem such as colon cancer or ovarian cancer. (See pages 57 and 

60 of the Cancer chapter for more information.)

Digestive problems that affect 

women

Some digestive problems, such as 

irritable bowel syndrome and gallstones, 

are more common in women than men. 

Others occur equally in both sexes, but 

affect women in unique ways. For example, women with inflammatory bowel 

disease may have irregular menstrual 

periods. Some women with celiac (SEElee-ak) disease experience infertility or 

miscarriage. And heartburn caused by 

gastroesophageal (GASS-troh-uhSOF-uh-JEE-uhl) reflux is common in 

pregnancy.

Common Digestive Problems in Pregnancy

Problem What you can do

Nausea and vomiting • Avoid smells that bother you.

• Eat smaller, more frequent meals.

• Eat crackers before getting out of bed in the morning.

Heartburn • Eat smaller, more frequent meals.

• Avoid lying down after eating.

• Ask your doctor what kind of antacid you can take.

Constipation • Eat more fiber.

• Drink plenty of water.

• Take a daily walk.
Digestive Health 267

Irritable bowel syndrome 

Irritable bowel syndrome (IBS) is not 

a disease but a syndrome, meaning a 

group of symptoms. People with IBS 

most often have abdominal pain, bloating, and discomfort. Some people have 

constipation—infrequent bowel movements with hard, dry, or difficult-to-pass 

stools. Other people with IBS have 

diarrhea—frequent loose, watery stools. 

Still others go back and forth between 

constipation and diarrhea. Symptoms 

may go away for a few months, then return. Or symptoms may be constant and 

get worse over time.

IBS does not damage the intestines. Instead, it affects the way the digestive tract 

functions, and so is called a “functional 

disorder.” The exact cause is unknown, 

but in people with IBS, the colon seems 

to be extra sensitive to certain foods and 

stress. Normally, women are more sensitive to irritants in the digestive tract than 

men. This may help explain why IBS is 

more common in women. Hormones 

may play a role as well. Symptoms often 

become worse just before or at the start 

of a woman’s period.

Having IBS can disrupt your everyday 

life. Pain that comes on without warning and the need for frequent bathroom 

trips can get in the way of social activities and work. You may be embarrassed, 

frustrated, or anxious about the lack of 

control over your symptoms. IBS might 

cause problems in your sex life, such as 

painful intercourse or loss of interest in 

sex. These stressful feelings in turn can 

make symptoms worse.

You can often control mild symptoms 

by making changes to your diet and 

lifestyle. Fiber supplements or over-thecounter medicines to control diarrhea 

may help. Prescription drugs are sometimes used to treat women with severe 

IBS, but some may have serious side effects. Researchers are studying new drugs 

and other approaches to relieve symptoms of IBS.

Coping With IBS

Learning to cope with IBS can help 

you live a more normal life and control 

your symptoms. Try these steps to 

manage your IBS.

• Find a supportive doctor who has 

experience with IBS.

• Learn your triggers. Large meals 

may make symptoms worse. So can 

certain foods and drinks such as 

chocolate, milk products, caffeinated drinks, and alcohol.

• Get support from your friends and 

family or join a support group.

• Plan ahead when going out; know 

where the public restrooms are.

• Try to reduce stress through regular 

physical activity, relaxation techniques such as meditation, or talking with a professional counselor.
268 The Healthy Woman: A Complete Guide for All Ages

Gallstones

Gallstones form when elements in bile 

harden into small, pebble-like pieces in 

the gallbladder. Most gallstones are made 

mainly of hardened cholesterol (kohLESS-tur-ol). If liquid bile contains 

too much cholesterol, or the gallbladder doesn’t empty completely or often 

enough, gallstones can form.

Women are twice as likely as men to 

have gallstones. Estrogen, a female hormone, raises cholesterol levels in the bile 

and slows gallbladder movement. The 

effect is even greater in pregnancy as estrogen levels rise. This helps explain why 

many women develop gallstones when 

pregnant or after having a baby. Likewise, if you take birth control pills or 

menopausal hormone therapy, you have a 

greater chance of developing gallstones.

You are also more likely to have gallstones if you:

l	 have a family history of gallstones

l	 are overweight

l	 eat a high-fat, high-cholesterol diet

l	 have lost a lot of weight quickly

l	 are older than 60

l	 are American Indian or Mexican 

American

l	 take cholesterol-lowering drugs

l	 have diabetes

Sometime gallstones have no symptoms 

and don’t need treatment. But if gallstones move into the ducts that carry bile 

from the gallbladder or liver to the small 

intestine, they can cause a gallbladder 

“attack.” An attack brings steady pain 

in the right upper abdomen, under the 

right shoulder, or between the shoulder 

blades. Although attacks often pass as 

the gallstones move forward, sometimes 

a stone can become lodged in a bile duct. 

A blocked duct can cause severe damage 

or infection.

Warning Signs of a Blocked 

Bile Duct

If you have any of these symptoms of a 

blocked bile duct, see your doctor right 

away:

• pain lasting more than 5 hours

• nausea and vomiting

• fever

• yellowish skin or eyes

• clay-colored stool

Here are some step you can take to help 

prevent gallstones. 

l	 Maintain a healthy weight.

l	 If you need to lose weight, do it 

slowly—no more than 1⁄2 to 2 pounds a 

week.

l	 Eat a low-fat, low-cholesterol diet.
Digestive Health 269

Can’t drink milk? You may have lactose 

intolerance.

Lactose intolerance is a common digestive disorder. It 

means your body can’t digest lactose, the sugar found in 

milk products. After eating foods with lactose, you may 

have nausea, cramps, bloating, gas, or diarrhea. Lactose 

intolerance is not serious but can be quite uncomfortable. You can easily control it by changing your diet.

You may not have to give up milk products entirely. Some 

people with lactose intolerance can eat yogurt or aged 

cheeses, like cheddar and Swiss, with no problem. 

Lactose-reduced milk is widely available. And taking 

supplements that contain lactase—the enzyme that 

breaks down lactose in the intestines—can help you 

digest dairy foods. You can find lactase supplements at 

most grocery and drug stores.

Gastroesophageal reflux disease (GERD)

If you have ever felt food or fluid rise 

from your stomach into your throat, then 

you know what gastroesophageal reflux 

(GER) feels like. You may know it as 

acid reflux or acid indigestion. GER occurs when the ring of muscle between 

the lower part of the esophagus and 

the stomach opens at the wrong time. 

This muscle, called the lower esophageal sphincter (e-SOF-uh-JEE-uhl 

SFEENK-tur), opens when you swallow 

to let food pass into the stomach, then 

closes again. In GER, the sphincter relaxes when it shouldn’t and allows stomach 

contents to flow back into the esophagus.

If you have GER more than twice a 

week, you may have gastroesophageal 

reflux disease (GERD). The main symptom of GERD is frequent heartburn—a 

burning sensation in your chest or throat. 

But some adults and most children with 

GERD don’t have heartburn. Instead, 

they may have a dry cough, asthma 

symptoms, or trouble swallowing.

It’s not always clear why some people get 

GERD, but a hiatal hernia may be one 

factor. In this condition, the upper part 

of the stomach protrudes into the chest 

through the diaphragm—the muscle 

wall that separates the abdomen from 

Complications of GERD

Over time, untreated GERD can damage the lining of the esophagus. This 

damage can cause bleeding or ulcers. 

Scar tissue can narrow the esophagus 

and make it hard to swallow. Some 

people develop abnormal cells in 

the lining of the esophagus, called 

Barrett’s esophagus. This condition 

affects more men than women and 

usually occurs in people older than 60. 

Rarely, Barrett’s esophagus can progress to cancer of the esophagus.
270 The Healthy Woman: A Complete Guide for All Ages

the chest. When this happens, it’s easier 

for stomach contents to rise into the 

esophagus. 

Being overweight puts extra pressure 

on the stomach and diaphragm, making 

acid reflux more likely. So does pregnancy. What’s more, the pregnancy hormone 

progesterone (proh-JESS-tuh-rohn) 

can contribute to GERD. Progesterone 

relaxes many of your muscles, including 

the lower esophageal sphincter.

Smoking can make symptoms worse. 

So can some foods, such as citrus fruits, 

chocolate, caffeinated drinks, and fatty or 

fried foods. 

Making changes in your lifestyle may 

help ease the symptoms of GERD.

l	 If you smoke, stop. 

l	 Avoid foods and drinks that worsen 

symptoms. 

l	 Lose weight if you are overweight. 

l	 Eat small, frequent meals. 

l	 Wear loose-fitting clothes. 

l	 Avoid lying down for 3 hours after a 

meal. 

l	 Raise the head of your bed 6 to 8 

inches by putting wood blocks under 

the bedposts. Just using extra pillows 

will not help.

Autoimmune disorders 

Some digestive diseases are autoimmune 

(aw-toh-ih-MYOON) disorders. (See the 

Autoimmune Diseases chapter on page 83 

for more information.) These disorders ocKeeping Your Digestive 

System Healthy

• Don’t smoke.

• Maintain a healthy weight.

• Eat a balanced diet.

• Get regular physical activity.

• Learn how to reduce stress.

Hepatitis A, B, and C: Preventable Liver Diseases

Hepatitis is inflammation, or swelling, of the liver. It can be caused by the hepatitis A, 

B, or C viruses. Hepatitis A spreads through food or water contaminated by the feces 

of an infected person. You can get hepatitis B through contact with infected blood, 

semen, or other body fluids. The virus can also pass from mother to child during childbirth. Hepatitis C is spread mainly through contact with infected blood. 

Hepatitis A can cause flu-like symptoms and usually resolves on its own in a few 

weeks. But the hepatitis B and C viruses can cause chronic, or long-term, infection. 

Chronic hepatitis can lead to cirrhosis (sur-ROH-suhss), when scar tissue builds up in 

the liver and replaces healthy tissue. 

Good hygiene, avoiding tap water when traveling to developing countries, and a vaccine all protect against hepatitis A. The hepatitis B vaccine protects people who may 

be exposed to the virus. There is no vaccine for hepatitis C. The only way to prevent 

the disease is to avoid sharing drug needles or toothbrushes, razors, and other personal items with an infected person.
Digestive Health 271

cur when the body’s immune system mistakenly attacks different parts of the body. 

Autoimmune digestive diseases include:

l	 inflammatory bowel disease

l	 celiac disease

l	 autoimmune hepatitis

l	 primary biliary cirrhosis

Inflammatory bowel disease 

Inflammatory bowel disease (IBD) is 

chronic inflammation of the digestive tract. The most common forms of 

IBD are Crohn’s (krohnz) disease and 

ulcerative colitis (UHL-sur-uh-tiv kohLEYE-tuhss). Crohn’s disease can affect 

any part of the digestive tract, causing 

swelling that extends deep into the lining of the affected organ. It most often 

affects the lower part of the small intestine. Ulcerative colitis affects the colon 

or rectum, where sores called ulcers form 

on the top layer of the intestinal lining.

Most people with IBD have abdominal 

pain and diarrhea, which may be bloody. 

Other people have rectal bleeding, fever, or weight loss. IBD can also cause 

problems in other parts of the body. 

Some people develop swelling in the eye, 

arthritis, liver disease, skin rashes, or kidney stones. 

In people with Crohn’s disease, swelling and scar tissue can thicken the wall 

of the intestine and create a blockage. 

Ulcers can tunnel through the wall into 

nearby organs such as the bladder or 

vagina. The tunnels, called fistulas, can 

become infected and may need surgery.

No one knows for sure what causes IBD, 

but researchers think it may be an abnormal immune response to bacteria that 

live in the intestines. Heredity may play 

a role, because it tends to run in families. 

IBD is more common among people 

of Jewish heritage. Stress or diet alone 

does not cause IBD, but both can trigger 

symptoms. IBD occurs most often during the reproductive years.

IBD and Pregnancy

It’s best to get pregnant when your IBD 

is not active (in remission). Women 

with IBD usually don’t have more trouble getting pregnant than other women. But if you have had a certain type 

of surgery to treat IBD, you may find it 

harder to get pregnant. Also, women 

with active IBD are more likely to 

miscarry or have preterm or low-birthweight babies. If you are pregnant, 

work closely with your doctors throughout pregnancy to keep your disease 

under control. Many of the drugs used 

to treat IBD are safe for the developing 

fetus.
272 The Healthy Woman: A Complete Guide for All Ages

IBD can affect your life in other ways. 

Some women with IBD have discomfort 

or pain during sex. This may be a result 

of surgery or the disease itself. Fatigue, 

poor body image, or fear of passing gas 

or stool can also interfere with your sex 

life. Even though it may be embarrassing, be sure to tell your doctor if you 

are having sexual problems. Painful sex 

could be a sign that your disease is getting worse. And talking with your doctor, 

a counselor, or a support group may 

help you find ways to address emotional 

issues.

Currently, IBD cannot be prevented. But 

you can make some lifestyle changes that 

can ease your symptoms.

l	 Learn what foods trigger your symptoms and avoid them.

l	 Eat a nutritious diet.

l	 Try to reduce stress through physical 

activity, meditation, or counseling.

Researchers are studying many new 

treatments for IBD. These include new 

drugs, supplements of “good” bacteria 

that help keep your intestines healthy, 

and other ways to reduce the body’s immune response.

Celiac disease

People who have celiac disease (also 

known as celiac sprue) can’t tolerate gluten, a protein found in wheat, rye, and 

barley. Gluten is even in some medicines. 

When people with celiac disease eat 

foods or use products that have gluten 

in them, the immune system responds 

by damaging the lining of the small intestine. This damage interferes with the 

body’s ability to absorb nutrients from 

food. As a result, a person with celiac 

disease becomes malnourished, no matter how much food she eats.

Celiac disease runs in families. Sometimes the disease is triggered—or becomes active for the first time—after 

surgery, pregnancy, childbirth, a viral 

infection, or severe emotional stress.

Celiac disease affects people differently. 

Symptoms may occur in the digestive 

system or in other parts of the body. For 

example, one person might have diarrhea 

and abdominal pain, whereas another 

person may be irritable or depressed. 

Some people have no symptoms.

Because malnutrition affects many parts 

of the body, the impact of celiac disease 

goes beyond the digestive system. Celiac 

disease can lead to anemia (uh-NEEmee-uh) or the bone-thinning disease 

osteoporosis (OSS-tee-oh-puh-ROHsuhss). Women with celiac disease may 

face infertility or miscarriage.

The only treatment for celiac disease is 

to follow a gluten-free diet. If you have 

celiac disease, work with your doctor or 

a dietitian to develop a gluten-free diet 

plan. A dietitian can help you learn how 

to read ingredient lists and identify foods 
Digestive Health 273

that contain gluten. These skills will help 

you make the right choices at the grocery 

store and when eating out.

The chart below lists examples of foods 

you can eat and foods you should avoid if 

you have celiac disease.

Gluten-Free Diet Examples

Gluten-free grains and 

starches

• Amaranth

• Arrowroot

• Buckwheat

• Cassava

• Corn

• Flax

• Indian rice grass

• 

• 

• 

• 

• 

• 

• 

Job’s tears

Legumes

Millet

Nuts

Potatoes

Quinoa

Rice

Wheat, including:

• einkorn

• emmer

• spelt

• kamut

Graham flour

Phosphated flour

Plain flour

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

Sago

Seeds

Soy

Sorghum

Tapioca

Wild rice

Yucca

• wheat starch

• wheat bran

• wheat germ

• cracked wheat

• hydrolyzed wheat 

protein

Self-rising flour

Semolina

White flour

Foods to avoid • 

• 

• 

Barley

Rye

Triticale (a cross 

between wheat 

and rye)

• 

Other terms for wheat • 

• 

• 

• 

Bromated flour

Durum flour

Enriched flour

Farina

• 

• 

• 

© American Dietetic Association. Adapted with permission.

Autoimmune Liver Diseases

Autoimmune hepatitis and primary biliary cirrhosis (BIL-ee-air-ee sur-ROH-suhss) are 

rare liver diseases that affect mainly women. In autoimmune hepatitis, the body’s 

immune system attacks and damages liver cells. In primary biliary cirrhosis, the bile 

ducts are slowly destroyed. Both diseases can lead to cirrhosis. Symptoms include 

fatigue, itchy skin, and yellowing skin and eyes. Autoimmune hepatitis can also cause 

joint pain and abdominal discomfort. Dry eyes and mouth are common in primary biliary cirrhosis.

If caught early, autoimmune hepatitis can usually be controlled with drugs that suppress, or slow down, an overactive immune system. This helps keep the immune system from attacking and damaging liver cells. Treatment for primary biliary cirrhosis is 

aimed at slowing the progress of the disease and relieving symptoms. In both conditions, a liver transplant may be needed if liver damage is severe.
274 The Healthy Woman: A Complete Guide for All Ages

Diagnosis and Treatment of Digestive Disorders

Irritable bowel syndrome

Symptoms • Cramping

• Abdominal pain or discomfort

• Bloating

• Constipation

• Diarrhea 

Diagnosis • Review of symptoms

• Diagnostic tests to rule out other gastrointestinal problems

Treatment • No cure, but symptoms can be treated

• Dietary changes

• Medications (over-the-counter and prescription)

• Stress management

Gallstones

Symptoms • Pain in right upper abdomen, under right shoulder, or between shoulder blades

• Nausea and vomiting

• Fever

• Yellowish skin or eyes

• Clay-colored stool

Diagnosis • Ultrasound

• Sometimes other tests, such as a computed tomography (tuh-MOG-ruh-fee) (CT) scan 

or an endoscopic procedure that uses a long, flexible tube with a camera inserted 

down the throat, through the stomach, and into the small intestine to detect problems 

in the nearby gallbladder and bile ducts

Treatment • Gallbladder removal

• Stone removal with an endoscope

• Sometimes drugs to dissolve gallstones

GERD

Symptoms • Frequent heartburn (in adults)

• Sometimes dry cough, asthma symptoms, or trouble swallowing

Diagnosis • Review of symptoms

• Diagnostic tests such as x-rays or endoscopic procedure to look for abnormalities if 

symptoms don’t respond to lifestyle changes or medication

Treatment • Lifestyle changes

• Medications (over-the-counter and prescription)

• Surgery to strengthen the sphincter or repair a hiatal hernia
Digestive Health 275

Diagnosis and Treatment of Digestive Disorders

Inflammatory bowel disease

Symptoms • Abdominal pain

• Diarrhea, which may be bloody

• Less common symptoms

• rectal bleeding 

• weight loss

• fever

• fatigue

• mouth ulcers (in Crohn’s disease)

• painful or difficult bowel movements (in ulcerative colitis)

Diagnosis • Blood tests

• Stool sample

• Colonoscopy (KOH-luhn-OSS-kuh-pee) or sigmoidoscopy (SIG-moi-DOSS-kuh-pee), using 

a long, flexible tube with a camera that is inserted through the rectum into the intestine

• Barium x-rays

Treatment • Medication

• Surgery

Celiac disease

Symptoms • Abdominal bloating and pain 

• Diarrhea or constipation 

• Weight loss or weight gain 

• Fatigue 

• Missed menstrual periods 

• Itchy skin rash called dermatitis herpetiformis (DUR-muh-TEYE-tuhss hur-PET-uh-FORmuhss)

Diagnosis • Blood tests

• Small intestine biopsy

Treatment • Gluten-free diet

Digestive problems can range from 

mild to severe. You can overcome many 

problems by making simple lifestyle 

changes—watch what you eat, maintain a healthy weight, learn to deal with 

stress, and if you smoke, quit. Other digestive problems require medication or 

even surgery. New treatments for IBS, 

IBD, and even celiac disease are on the 

horizon. If you are concerned about your 

digestive health, work with your doctor 

to find the solution that’s right for you. n
276 The Healthy Woman: A Complete Guide for All Ages

One Woman’s Story

I

was fresh out of graduate school, working at my first job, living in my first house with 

a new dog, and serving as a bridesmaid in a horrible wedding. I didn’t have time for 

health problems. But a constant dull pain and trouble “going” in the morning, combined 

with mucus, blood, and more pain, proved me wrong and sent me to a gastroenterologist.

My grandfather’s death from colon cancer 

weighed at the back of my mind, but luckily I wasn’t at that point. The doctor quickly 

and easily diagnosed me with ulcerative ...listening to my 

colitis and scheduled a colonoscopy. After 

the pain of the disease and the less-thanpleasant diagnostic procedure, the first ste- body, not following 

roid treatment made me feel like a million 

bucks! I had a surge of energy and endur- a specific diet, 

ance that encouraged my obsession with 

physical activity. The aftereffects were not 

so pleasant, though. I puffed up with chip- was best.

munk cheeks, lost 30 to 40 percent of my 

hair, and broke out in a rash. A sulfa drug 

was the next treatment, but my reactions 

were no better: extreme sensitivity to the sun and flu-like symptoms, which did nothing to 

help me maintain my physical activity. Eventually, I found that 12 tablets a day of yet another medicine would barely keep the issue under control. Not wanting to be dependant 

on 12 pills a day forever, I did my own research on healthy eating for people diagnosed 

with irritable bowel syndrome, colitis, ulcers, and other digestive issues.

I soon found that eliminating or eating more of any one type of food didn’t help, and that 

listening to my body, not following a specific diet, was best. I got to know what foods my 

body needed and which to avoid. For me, I found it helpful to avoid fruit after noon and 

fluids with meals and to make sure I have carbohydrates at every meal. 

I also changed my physical activity routine. While I still enjoy intense workouts like cycling, 

running, or hiking, yoga has really helped me be more in tune with how outside experiences affect me and also how foods affect me. Now that I am in control of my disease, 

I hope I will be able to work with my doctor to eliminate medication slowly and replace it 

with alternative methods of eating well and practicing yoga. 

Susan

Denver, Pennsylvania
Digestive Health 277

For More Information...

Office on Women’s Health, HHS

200 Independence Ave SW, Room 712E

Washington, DC 20201

Web site: www.womenshealth.gov/faq/

ibd.htm

www.womenshealth.gov/faq/ibs.htm 

Phone number: (800) 994-9662, 

(888) 220-5446 TDD

National Digestive Diseases Information 

Clearinghouse, NIH

2 Information Way

Bethesda, MD 20892-3570

Web site: www.digestive.niddk.nih.gov 

Phone number: (800) 891-5389

American College of Gastroenterology

PO Box 342260 

Bethesda, MD 20827-2260 

Web site: www.acg.gi.org/patients

American Gastroenterological 

Association

4930 Del Ray Ave

Bethesda, MD 20814

Web site: www.gastro.org/patient

American Liver Foundation

75 Maiden Ln, Suite 603

New York, NY 10038

Web site: www.liverfoundation.org

Phone number: (800) 465-4837

Crohn’s and Colitis Foundation of 

America

386 Park Ave S, 17th floor

New York, NY 10016

Web site: www.ccfa.org 

Phone number: (888) 964-8872

International Foundation for Functional 

Gastrointestinal Disorders

PO Box 170864

Milwaukee, WI 53217-8076

Web site: www.iffgd.org,

www.aboutibs.org,

www.aboutgimotility.org

Phone number: (888) 964-2001

National Foundation for Celiac 

Awareness

PO Box 544

Ambler, PA 19002-0544

Web site: www.celiaccentral.org 

Phone number: (215) 325-1306