Abdominal Discomfort: Possible Causes and Solutions - Gastroenterology and Hepatology

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The entire abdomen feels off?


About two weeks ago (on June 24), I experienced a dull pain in my left abdomen that lasted for approximately 20 minutes and then subsided.
However, after this symptom resolved, I began to feel tightness in my lower back on both sides, with the left side being more pronounced.
The area of tightness extends from a small portion of my abdomen (approximately from the descending colon to the sigmoid colon) to my lower back and a small part of my upper back.
I also have some discomfort in my right abdomen and a bit of tightness in my right lower back, but the discomfort is more towards the upper right side, where I feel a slight swelling, although it is not painful.
My bowel movements have occasionally been diarrhea, with some episodes of yellow diarrhea previously, but now it tends to be brown.
Sometimes I experience diarrhea without accompanying abdominal pain, and my appetite is normal.
Last week, I visited Mackay Memorial Hospital for a family medicine consultation, where they performed an abdominal X-ray and a urinalysis, both of which showed no issues.
The X-ray only indicated some mild intestinal gas without any significant abnormalities.
Today, July 8, when I exert pressure on my abdomen, I start to feel a slight stabbing pain, especially when pressing down about three fingerbreadths to the right of my navel, and directly below the navel also elicits a bit of a stabbing sensation.

Zheng Nan, 20~29 year old female. Ask Date: 2017/07/08

Dr. Lin Minghui reply Gastroenterology and Hepatology


Hello: You have abdominal pain, pain on both sides of the lower back, occasional diarrhea with changes in stool color.
X-rays show no bowel obstruction, and urinalysis is normal.
Differential diagnoses for the right lower abdominal pain include gastroenteritis, colitis, appendicitis, diverticulitis, and fecal impaction.
Due to the persistent abdominal pain and abnormal bowel movements, please follow up for outpatient treatment.
Wishing you peace and health.
Sincerely, Dr.
Lin Ming-Hui, Attending Physician, Gastroenterology Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2017/07/08

More Info


Abdominal discomfort can be a perplexing issue, especially when it persists over time and presents with varying symptoms. Based on your description, it seems you are experiencing a combination of left abdominal discomfort, tightness in the lower back, and changes in bowel habits, including diarrhea. These symptoms can be indicative of several underlying conditions, and it is crucial to approach this systematically.


Possible Causes
1. Gastrointestinal Issues: Given your symptoms of diarrhea and abdominal discomfort, gastrointestinal conditions such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or even infections could be potential culprits. IBS is characterized by abdominal pain and altered bowel habits, which can include diarrhea or constipation. IBD, which includes Crohn's disease and ulcerative colitis, can cause similar symptoms but is usually accompanied by more severe signs like weight loss or blood in the stool.

2. Musculoskeletal Factors: The tightness in your lower back and the discomfort in your abdomen could also be related to musculoskeletal issues. Strain or injury to the muscles in the abdominal wall or lower back can lead to referred pain, which might explain the discomfort you are feeling in both areas.

3. Urinary Tract Issues: Although your urinalysis showed no abnormalities, urinary tract infections (UTIs) or kidney stones can sometimes present with abdominal pain and discomfort. The fact that you have experienced a tightness in the lower back could suggest a possible renal issue, even if initial tests did not reveal anything significant.

4. Reproductive System: In females, conditions such as ovarian cysts or endometriosis can cause abdominal pain and discomfort, particularly if the pain is cyclical or associated with your menstrual cycle. Given the complexity of the female reproductive system, it is essential to consider these factors, especially if you have a history of gynecological issues.

5. Psychosomatic Factors: Anxiety and stress can manifest physically, leading to symptoms such as abdominal pain and tightness. If you have a history of anxiety, it might be worth exploring whether your symptoms correlate with periods of increased stress or anxiety.


Recommended Solutions
1. Further Evaluation: Since you have already undergone some initial tests, it may be beneficial to pursue further evaluation. This could include a referral to a gastroenterologist for a comprehensive assessment, including possible endoscopy or colonoscopy, especially if your symptoms persist or worsen.

2. Dietary Modifications: Keeping a food diary to track what you eat and any subsequent symptoms can help identify potential food intolerances or triggers. A diet low in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) may be beneficial if IBS is suspected.

3. Hydration and Fiber Intake: Ensuring adequate hydration and a diet rich in fiber can help regulate bowel movements and alleviate some gastrointestinal discomfort.
4. Physical Therapy: If musculoskeletal issues are suspected, physical therapy may help alleviate tightness and discomfort in the back and abdomen through targeted exercises and stretches.

5. Stress Management: If anxiety is a contributing factor, consider incorporating stress management techniques such as mindfulness, yoga, or counseling to help manage symptoms.

6. Follow-Up: Regular follow-ups with your healthcare provider are essential to monitor your symptoms and adjust your management plan as necessary. If your symptoms escalate or new symptoms arise, do not hesitate to seek immediate medical attention.

In conclusion, while your symptoms can stem from various causes, a thorough evaluation and a multidisciplinary approach to management will be key in addressing your abdominal discomfort effectively. It is essential to remain proactive in your healthcare and communicate openly with your healthcare providers about your symptoms and concerns.

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