Persistent Lower Abdominal Pain: Seeking Answers Beyond Standard Tests

Lower abdominal discomfort and pain for nearly four months?

Hello, doctor.
Since March, after experiencing a severe episode of gastroesophageal reflux, I have been feeling discomfort in my abdomen.
I have a history of gastrointestinal issues, but this time it feels different.
In the past, my acid reflux only affected my tonsils, but this time I am experiencing abdominal pressure and pain for the first time.
Initially, I had upper abdominal discomfort, followed by bowel sounds, and then very weak flatulence (even when I try to pass gas, there is no sound, just a faint hissing noise).
This progressed to a half-month of foul-smelling gas and constipation that persists to this day.
I have lost two kilograms in three months, and the lower abdominal discomfort continues.
Among these symptoms, only the bowel sounds have noticeably disappeared, but I still experience gurgling sounds near the lower abdomen close to the rectum.
I underwent an upper endoscopy and colonoscopy at a gastroenterology clinic, but no significant abnormalities were found.
An X-ray at the hospital only indicated mild gastric distension.
Throughout this, my appetite has remained normal, and despite taking medication for over three months, my symptoms have not improved.
Are there any diagnostic tests or imaging studies that can more clearly identify the underlying cause? I would prefer not to continue taking Western medications that may harm my body without addressing my symptoms.
Honestly, I am unsure if the lower abdominal pain is related to my bladder, as urine tests and X-rays did not reveal anything.
I feel that the abdominal discomfort is causing both physical and mental exhaustion.

xia t, 20~29 year old female. Ask Date: 2018/07/08

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Basically, this symptom is related to gastrointestinal dysfunction.
It is recommended to consume low-fat, low-dairy, and non-irritating foods, with a focus on white meat.
If there is no improvement, a consultation with a gastroenterologist is advised.

Reply Date: 2018/07/08

More Info

Persistent lower abdominal pain can be a complex issue, especially when standard tests such as endoscopy and X-rays do not reveal any significant abnormalities. Your symptoms, which began after a severe episode of gastroesophageal reflux disease (GERD), suggest a possible connection between your gastrointestinal issues and the discomfort you're experiencing.
The progression of your symptoms—starting with upper abdominal discomfort, followed by changes in bowel habits, and the presence of foul-smelling gas—raises several possibilities. It is important to consider conditions such as functional gastrointestinal disorders, which can include irritable bowel syndrome (IBS), as well as potential food intolerances or sensitivities. These conditions often do not show up on standard imaging or endoscopic examinations but can cause significant discomfort and changes in bowel habits.

The fact that you are experiencing persistent constipation and a sensation of incomplete evacuation could indicate a functional issue with your bowel motility. This can sometimes be exacerbated by stress or anxiety, which can affect gut function. Given your history of anxiety, it may be worthwhile to explore whether your mental health is contributing to your gastrointestinal symptoms. Stress can lead to increased muscle tension in the gut, altered gut motility, and changes in the gut microbiome, all of which can exacerbate symptoms.

In terms of further diagnostic testing, you might consider discussing the following options with your healthcare provider:
1. Gastric Emptying Study: This test can help determine if your stomach is emptying properly, which can be a factor in your symptoms.

2. Hydrogen Breath Tests: These can help diagnose conditions like lactose intolerance or small intestinal bacterial overgrowth (SIBO), which can lead to bloating, gas, and changes in bowel habits.

3. Pelvic Ultrasound: Since you mentioned concerns about your bladder, a pelvic ultrasound can help assess the reproductive organs and bladder for any abnormalities.

4. Colonic Transit Study: This test evaluates how well food moves through your colon and can help diagnose constipation-related disorders.

5. Psychological Assessment: Given the potential link between anxiety and gastrointestinal symptoms, a referral to a mental health professional could be beneficial. Cognitive-behavioral therapy (CBT) has been shown to help manage symptoms in individuals with functional gastrointestinal disorders.

In the meantime, consider dietary modifications that may alleviate your symptoms. A diet high in fiber can help with constipation, but it’s essential to introduce fiber gradually to avoid exacerbating bloating. Additionally, keeping a food diary may help identify any potential food triggers.

Lastly, it’s crucial to maintain open communication with your healthcare provider. If your symptoms persist or worsen, do not hesitate to seek further evaluation. Chronic abdominal pain can significantly impact your quality of life, and finding the underlying cause is essential for effective management. Remember, you are not alone in this, and many people experience similar challenges with gastrointestinal health.

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