Persistent Right Upper Abdomen Pain After Exercise

Q: Persistent Right Upper Abdomen Pain After Exercise

Dear Mr. <br>Steve：<br>1. <br>First of all, I sincerely apologize for the inconvenience. <br>I am unsure whether it is a system issue or if there was an error in handling my files, but <a href="https：//adoctor.tw/article/107015">#107015</a> did not appear in my personal folder. <

Regarding sharp pain in the upper right abdomen after exercise?

Hello Dr.
Hsiao, I previously inquired about a problem here (#107015).
The symptoms of hunger have not disappeared, and I am currently maintaining a small, frequent meal schedule.
I would like to ask another question.
In the upper right abdomen, about two fingerbreadths below the rib cage and approximately five fingerbreadths from the midline, I experience a persistent dull pain.
This dull pain has been ongoing for a long time, but previously it would only hurt occasionally (very rarely as a sharp pain), and changing my body position would alleviate it.
However, recently the dull pain has become continuous.
In February of this year, I mentioned this issue during an upper abdominal ultrasound, but the doctor indicated there were no obvious abnormalities.
The ultrasound did reveal moderate fatty liver and small stones in the right kidney.
Due to gastrointestinal issues (#107015), I had an abdominal X-ray taken at Taipei Mackay Hospital earlier this month, and the gastroenterologist stated that the X-ray appeared normal, with no medication prescribed.
My current BMI is 29, and my waist circumference is 97 cm.

I have recently observed that after exercising (jogging 5 km), if my body is bent, such as in a seated position like the thinker pose, or if my body bends to the left or right, the sharp pain in that area becomes very pronounced.
However, if my body is upright, I experience less pain.
When my body is at rest (not exercising), the same positions almost do not cause pain, with the only consistent factor being that I do not feel pain when my body is upright.
Additionally, if I press on that point without engaging my abdominal muscles, I only feel a slight discomfort, but if I engage my abdominal muscles and then press, I can clearly identify a painful point, though I cannot determine if this pain point is the same as the pain I feel spontaneously.

Could you please advise what these symptoms might indicate, or which specialist I should consult for examination and treatment? Thank you.

Shiti, 30~39 year old female. Ask Date: 2016/06/23

Dr. Xiao Yongxun reply Internal Medicine

Dear Mr.
Steve:
1.
First of all, I sincerely apologize for the inconvenience.
I am unsure whether it is a system issue or if there was an error in handling my files, but #107015 did not appear in my personal folder.
Additionally, I have not found any responses to your inquiries in the sent mail folder over the past seven months.
2.
The abdominal ultrasound examination revealed moderate fatty liver and small stones in the right kidney; clinically, we cannot explain your pain in the right upper abdomen.
Your body mass index (BMI) is 29 kg/m², and your waist circumference is 97 cm.
According to the standards published by our Ministry of Health and Welfare, this falls into the category of mild obesity; however, a waist circumference exceeding 90 cm poses a greater health risk.
It is recommended that you implement dietary control and engage in moderate exercise.
Of course, if you have comorbidities such as diabetes, cardiovascular disease, hypertension, or hyperlipidemia, medication treatment (not referring to weight loss drugs) should be considered.
3.
Regarding the lateral abdominal pain that often occurs after exercise, it primarily refers to sharp or cramp-like pain in the right upper abdomen following physical activity; the cause remains unclear.
A possible explanation is that the diaphragm and intercostal muscles experience ischemic pain due to insufficient blood flow during exercise.
In other words, blood distribution is prioritized to the larger muscle groups, leading to relative hypoxia in the respiratory muscles.
It is generally advised to stop exercising, apply pressure with your fingers to the upper abdominal muscles below the ribs, take a deep exhalation, and then raise your arms to stretch backward; theoretically, this should alleviate the pain.
Similar lateral abdominal pain mainly occurs in novice exercisers or those who do not understand how to regulate their breathing patterns, resulting in ischemic pain in the respiratory muscles due to rapid and shallow breathing.
This is commonly seen in schools, military, and training centers.
The lateral abdominal pain during exercise falls under the scope of rehabilitation medicine.
4.
Of course, if there is no improvement, it is essential to consider whether there are underlying issues with the internal organs.
The right upper abdomen is associated with gastroenterology, thoracic medicine, and even cardiology.
I recommend discussing this matter with your family physician or a trusted attending physician first.

Reply Date: 2016/06/23

More Info

Based on your description of persistent right upper abdomen pain after exercise, it seems that you are experiencing a complex issue that may involve multiple factors. Given your history of abdominal pain, the presence of moderate fatty liver, and right kidney stones, it is essential to approach this situation with a comprehensive understanding of potential causes and appropriate next steps.

Firstly, the location of your pain—just below the rib cage on the right side—could be related to several anatomical structures, including the liver, gallbladder, right kidney, and even the diaphragm. The fact that the pain is exacerbated by certain movements, such as bending or twisting, suggests that it could be musculoskeletal in nature, possibly involving the abdominal muscles or the diaphragm. This is particularly relevant since you mentioned that the pain is less pronounced when your body is in a straight posture.

Your observation that the pain intensifies after exercise, especially with movements that engage your abdominal muscles, indicates that there may be some underlying muscle strain or tension. This could be due to overexertion during your workouts, especially if you are not accustomed to the intensity or duration of the activities you are performing. Additionally, if you have any pre-existing conditions, such as a hernia or muscle imbalances, these could contribute to your symptoms.

Given your BMI of 29 and waist circumference of 97 cm, it's also worth considering that excess abdominal fat can contribute to discomfort and may affect the function of your internal organs. Fatty liver disease can sometimes lead to discomfort in the upper abdomen, and weight management through diet and exercise could potentially alleviate some of your symptoms.

Since you have already undergone an abdominal ultrasound and X-ray, which did not reveal any significant abnormalities, it may be beneficial to consult with a specialist who can further evaluate your symptoms. A gastroenterologist would be a good choice, as they can assess any gastrointestinal issues that may be contributing to your pain. Additionally, a visit to an orthopedic or physical medicine and rehabilitation specialist may help address any musculoskeletal concerns, particularly if there is a possibility of muscle strain or injury.

In the meantime, consider the following recommendations:
1. Modify Your Exercise Routine: If certain movements exacerbate your pain, it may be wise to adjust your workout to avoid those positions. Focus on low-impact activities that do not strain your abdomen, such as walking or swimming, until you can assess the situation further.

2. Strengthening and Stretching: Incorporate gentle stretching and strengthening exercises for your core muscles. This can help improve muscle balance and reduce tension in the abdominal area. However, be cautious and avoid any movements that cause pain.

3. Monitor Your Diet: Since you have fatty liver, adopting a balanced diet low in saturated fats and sugars can help improve liver health and potentially alleviate some discomfort. Consider consulting a nutritionist for personalized dietary advice.

4. Stay Hydrated: Given your history of kidney stones, ensure you are drinking enough water to help prevent stone formation and support overall kidney function.

5. Pain Management: If the pain persists, over-the-counter pain relief medications may help, but consult with a healthcare provider before starting any new medication.

In conclusion, your symptoms warrant further investigation, and a multidisciplinary approach may be beneficial. By consulting with the appropriate specialists and making some lifestyle adjustments, you can work towards alleviating your pain and improving your overall health.

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