Persistent Abdominal Pain and Bloating: Causes and Solutions

Abdominal pain for 2 to 3 weeks?

For the past two to three weeks, I have been experiencing a persistent feeling of bloating in my intestines, along with abdominal pain when I apply pressure.
Could it be related to consuming cold foods? The bloating and pain are very severe, and I have already visited a major hospital and a clinic for examinations five to six times without any improvement.
I have undergone stool and urine tests, as well as ultrasound and X-ray examinations (gynecological diseases have been ruled out).
Even with the use of suppositories, I still cannot have a bowel movement, and the bloating and pain persist, causing overall weakness and fatigue.
I have been taking medication for a while, but why is there no improvement? I am unsure if there is something growing in my intestines.
I follow a strict vegetarian diet and rarely consume processed dairy or eggs, eating very lightly.
I also exercise regularly.
The doctor mentioned that foods like soy and certain vegetables can cause bloating, but I have stopped eating those as well.
Why is the situation still so severe?

Lei, 10~19 year old female. Ask Date: 2016/10/23

Dr. Chen Qifeng reply Gastroenterology and Hepatology

It is recommended to consult a gastroenterologist and, if necessary, undergo a barium enema examination to rule out any organ-related conditions.

Reply Date: 2016/10/23

More Info

Persistent abdominal pain and bloating can be distressing and debilitating, especially when they interfere with daily activities. Given your description of symptoms, including a sensation of incomplete bowel evacuation, significant abdominal pain upon palpation, and a feeling of fatigue, it is essential to consider a range of potential causes and solutions.

Possible Causes
1. Functional Gastrointestinal Disorders: Conditions such as Irritable Bowel Syndrome (IBS) are common causes of chronic abdominal pain and bloating. IBS can lead to symptoms like bloating, gas, and altered bowel habits, including constipation or diarrhea. Stress and anxiety can exacerbate these symptoms, even if you feel you are not under significant stress.

2. Gastrointestinal Obstruction: Although you have undergone imaging studies, it is crucial to consider the possibility of a partial obstruction in the intestines. This can occur due to adhesions from previous surgeries, hernias, or other structural abnormalities.

3. Food Intolerances: Even with a vegetarian diet, certain foods can lead to bloating and discomfort. Common culprits include lactose (found in dairy), gluten (found in wheat), and certain fermentable carbohydrates (FODMAPs). It might be beneficial to keep a food diary to identify any potential triggers.

4. Infections or Inflammatory Conditions: Chronic infections, such as those caused by parasites or bacteria, can lead to persistent abdominal symptoms. Inflammatory bowel diseases (IBD), such as Crohn's disease or ulcerative colitis, can also present with similar symptoms and require specific diagnostic tests.

5. Psychological Factors: Anxiety and depression can manifest physically, leading to gastrointestinal symptoms. The gut-brain connection is well-documented, and psychological stress can lead to or exacerbate gastrointestinal issues.

Recommended Solutions
1. Dietary Modifications: Since you are already eating a light diet, consider consulting with a registered dietitian who specializes in gastrointestinal health. They can help you identify potential food intolerances and suggest an elimination diet to pinpoint triggers.

2. Probiotics: Introducing probiotics may help restore the balance of gut flora, which can alleviate bloating and improve bowel function. Look for a high-quality probiotic supplement or consider fermented foods like yogurt (if tolerated), kefir, or sauerkraut.

3. Hydration and Fiber: Ensure you are drinking enough water and consuming adequate fiber. While you mentioned avoiding certain fibrous foods, a gradual reintroduction of soluble fiber (like oats, bananas, and apples) may help with bowel regularity.

4. Stress Management: Techniques such as mindfulness, yoga, or cognitive-behavioral therapy can help manage anxiety and stress, which may, in turn, alleviate gastrointestinal symptoms.

5. Follow-Up with Healthcare Providers: Since you have already seen multiple healthcare providers, it may be beneficial to return to your primary care physician or a gastroenterologist for further evaluation. Discuss the possibility of additional tests, such as a colonoscopy or specialized imaging, to rule out any underlying conditions that may have been missed.

6. Medication Review: If you are currently taking medications, review them with your doctor to ensure they are not contributing to your symptoms. Sometimes, medications can lead to side effects like constipation or bloating.

Conclusion
Persistent abdominal pain and bloating can arise from various causes, and it often requires a multifaceted approach to diagnosis and management. Given your ongoing symptoms despite multiple evaluations, it is crucial to continue working closely with your healthcare team to explore all potential avenues for relief. Keeping a detailed symptom diary, including food intake, stress levels, and physical activity, can provide valuable insights for both you and your healthcare providers. Remember, you are not alone in this journey, and with persistence and the right support, improvement is possible.

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