Abdominal Pain Around the Navel: Causes and Gastrointestinal Insights

Periumbilical tenderness and chronic bloating?

Hello doctor, a year or two ago, I visited two or three gastroenterologists due to diarrhea, and I was diagnosed with irritable bowel syndrome.
Recently, I have not experienced diarrhea or constipation, and my bowel movements are normal and smooth, but the issue of abdominal bloating has not improved; my abdomen feels like a drum when I tap it.
Therefore, I have been massaging my abdomen before bed (which helps release gas and slightly reduces bloating), but I feel pain when pressing around my navel, especially in the lower right quadrant, which is very painful.
During a previous abdominal ultrasound in the clinic, the doctor mentioned something unusual, like there was mucus? However, after leaving the clinic, the doctor said it should be fine and just inflammation.
I previously had a cyst that later shrank on its own, and during a follow-up examination with a gynecologist, the doctor told me that my intestines are filled with gas and that my gynecological issues were resolved, but I might need to see a gastroenterologist.
I recalled that many years ago, when I was a child, I saw a long red worm in the toilet after using it, with one end stuck to the toilet wall, standing upright and moving… However, I previously had a normal fecal occult blood test.
Does a fecal occult blood test include checks for parasites? Is it possible that my condition is due to a parasite? (That red worm incident was a long time ago, probably over ten years).
When I visit a gastroenterologist, what tests should I ask the doctor to perform? Thank you.

Tan Tan, 20~29 year old female. Ask Date: 2020/05/19

Dr. Yang Zhichao reply Gastroenterology and Hepatology

Hello, Ms.
Carbon.
1.
If your condition does not improve, you may discuss with your physician the possibility of scheduling a colonoscopy.
2.
The incident with the parasites occurred 10 years ago; if you are concerned, you can ask your physician to arrange for a routine stool examination.

Reply Date: 2020/05/19

More Info

Abdominal pain, especially around the navel, can be a complex issue with various potential causes. Given your history of gastrointestinal symptoms, including a previous diagnosis of irritable bowel syndrome (IBS), it’s important to consider both functional and organic causes of your current discomfort.

Possible Causes of Abdominal Pain Around the Navel
1. Irritable Bowel Syndrome (IBS): Since you have a history of IBS, it’s possible that your symptoms are related to this condition. IBS can cause bloating, abdominal pain, and changes in bowel habits. Even if you are not experiencing diarrhea or constipation currently, IBS can still manifest as abdominal discomfort and bloating.

2. Inflammation or Infection: The mention of "something strange" seen on ultrasound, described as "like mucus," could indicate some form of inflammation or infection in the gastrointestinal tract. Conditions such as appendicitis, diverticulitis, or even inflammatory bowel disease (IBD) could present with localized pain, especially if there is an inflammatory process occurring.

3. Adhesions: If you have had previous abdominal surgeries or conditions that could lead to scarring, adhesions might be causing pain. These can lead to abnormal connections between organs, resulting in discomfort and bloating.

4. Gastrointestinal Motility Disorders: Conditions that affect the motility of the intestines can lead to symptoms like bloating and pain. Gastroparesis, for example, can cause delayed gastric emptying, leading to discomfort.

5. Parasitic Infections: While your past experience with seeing a long red worm in the toilet is concerning, it’s important to note that the presence of parasites can lead to gastrointestinal symptoms. However, routine stool tests for occult blood do not typically include specific tests for parasites. If you suspect a parasitic infection, it would be advisable to request specific stool tests for parasites.

6. Functional Dyspepsia: This condition can cause discomfort in the upper abdomen and may be associated with bloating and pain. It is often related to how the stomach and intestines process food.

Recommended Actions
1. Consultation with a Gastroenterologist: Given your ongoing symptoms and history, it would be prudent to see a gastroenterologist. They may recommend further diagnostic tests, such as a CT scan or MRI, to evaluate for any structural abnormalities, or an endoscopy to assess the upper gastrointestinal tract.

2. Stool Tests: Request specific stool tests to check for parasites, especially if you have concerns about past infections. This can help rule out any parasitic causes of your symptoms.

3. Dietary Modifications: Keeping a food diary may help identify any dietary triggers that exacerbate your symptoms. Some individuals with IBS find relief by following a low-FODMAP diet, which reduces certain fermentable carbohydrates that can cause bloating and gas.

4. Symptom Management: Continue with abdominal massages if they provide relief, and consider discussing the use of over-the-counter medications like simethicone, which can help reduce gas and bloating.

5. Follow-Up Imaging: If your symptoms persist or worsen, follow up with imaging studies to ensure there are no underlying issues that need to be addressed.

Conclusion
Abdominal pain around the navel can stem from a variety of causes, ranging from functional disorders like IBS to potential organic issues such as inflammation or infections. Given your symptoms and history, it is essential to work closely with a healthcare provider to explore these possibilities thoroughly. By doing so, you can receive appropriate treatment and management for your condition, leading to improved quality of life.

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