Chronic Left Abdominal Pain: Is It Functional Bowel Spasm?

Left abdominal pain in the colon that has been cramping for several months?

Hello Doctor, I have a long-standing issue that I would like to consult you about: About three months ago, I discovered a cramping pain in the upper left abdomen, specifically in the area of the colon, which is quite unusual as it is more to the side (not near the navel).
I can pinpoint the pain with my finger, and it does not migrate.
The pain has persisted for several days and has become more severe.

1.
The cramping sensation is similar to a muscle cramp in the calf; it is very painful whenever the intestines move, but it does not feel like the cramping associated with diarrhea.

2.
My bowel movements are normal, with no diarrhea or constipation, and the stool volume and color are normal.

3.
I typically have a bowel movement after breakfast, but every time I experience pain, it occurs after eating, just before a bowel movement.
After I have a bowel movement, the pain alleviates somewhat.

Despite this, the issue has not improved over time.
Each episode of cramping lasts about 5 minutes to 1 hour, but the duration varies.
I have consulted three gastroenterologists:
A doctor mentioned that the pain is located on the side and suggested it resembles neuropathic pain (an ultrasound was performed to check the kidneys, gallbladder, stomach, etc., and no abnormalities were found).

B doctor noted that the pain location is unusual; if it were due to inflammation, it should be centralized around the navel, rather than fixed at one side (this doctor also performed an ultrasound, checking the kidneys, gallbladder, and stomach, and found no abnormalities).

C doctor indicated that the pain is related to the colon and that there are no other accompanying symptoms, suggesting that the spasms occur only before daily bowel movements, attributing it to abnormal colonic motility (stool occult blood and urinalysis tests were normal).

Subsequently, I was prescribed an antispasmodic medication (Dicyclomine) and a medication for gastrointestinal gas (Simethicone).
This issue has persisted for over three months, with no improvement, but it has not worsened.
I take the medication daily, yet I still experience pain every day, essentially acting as a "bowel movement alarm," with spasms occurring before each bowel movement.

I am concerned that if I continue to observe this without seeking appropriate treatment, it could lead to a tumor or intestinal pathology.
This situation has caused me significant anxiety.
I would like to ask the doctor if the symptoms appear to be purely functional bowel spasms.
Should I actively seek treatment, or should I let it resolve on its own? Thank you for taking the time to read this lengthy message.

Lele, 30~39 year old female. Ask Date: 2020/11/19

Dr. Chen Shidian reply Gastroenterology and Hepatology

From a theoretical standpoint, there should be no major issues with the diagnoses made by various physicians.
The discomfort is likely caused by intestinal motility or spasms, which can be managed with medication and local heat application, followed by observation.

Reply Date: 2020/11/19

More Info

Chronic left abdominal pain can be a complex issue, and your symptoms suggest a possible functional bowel disorder, specifically functional bowel spasm or irritable bowel syndrome (IBS). Given your description, let’s break down the symptoms and potential causes.

1. Location and Nature of Pain: You mentioned that the pain is located in the upper left abdomen, near the colon, and feels like a cramping sensation similar to a muscle spasm. This type of pain is often associated with bowel motility issues. The fact that you can pinpoint the pain and it does not migrate suggests that it is likely related to a specific area of the bowel rather than a systemic issue.

2. Timing of Pain: The pain occurring before bowel movements and improving afterward is a classic sign of functional bowel disorders. In IBS, for instance, patients often experience abdominal pain that is relieved by defecation. The fact that your bowel habits are normal (no diarrhea or constipation) is also consistent with IBS, which can present with varying symptoms.

3. Normal Diagnostic Tests: The fact that multiple doctors have performed imaging and other tests (ultrasound, stool tests) without finding any abnormalities is reassuring. It suggests that there is likely no structural issue, such as a tumor or significant inflammation, which is a common concern for patients experiencing chronic abdominal pain.

4. Potential Causes: Functional bowel spasms can be triggered by various factors, including stress, dietary changes, or gastrointestinal motility disorders. Since you mentioned that the pain has persisted for over three months without significant improvement, it may be worthwhile to consider lifestyle factors, such as diet and stress management, which can exacerbate symptoms.

5. Management Options: Since you have already been prescribed antispasmodic medication (like Dicyclomine) and medications for gas relief (like simethicone), it may be beneficial to evaluate their effectiveness. If these medications are not providing relief, you might want to discuss alternative treatments with your physician. Some patients find relief through dietary modifications, such as following a low FODMAP diet, which can help reduce symptoms associated with IBS.

6. Psychological Factors: Anxiety and stress can significantly impact gastrointestinal function. If you find that your anxiety about the pain is worsening your symptoms, it may be helpful to explore stress management techniques, such as cognitive-behavioral therapy (CBT), mindfulness, or relaxation exercises.

7. Further Evaluation: If your symptoms continue without improvement, it may be appropriate to seek a second opinion or consult a gastroenterologist who specializes in functional gastrointestinal disorders. They may suggest further evaluation, such as a colonoscopy if not done recently, or other specialized tests to rule out less common conditions.

In conclusion, while your symptoms do align with functional bowel spasm or IBS, it is essential to continue monitoring your condition and maintain open communication with your healthcare provider. If your symptoms worsen or new symptoms arise, do not hesitate to seek further medical advice. Your health and peace of mind are paramount, and addressing these concerns proactively is crucial for your overall well-being.

Similar Q&A

Understanding Left Lower Abdominal Pain and Discomfort: A Gastrointestinal Perspective

Hello, doctor! I had frequent constipation when I was younger, and there is a family history of cancer; my father passed away from colon cancer. However, since early last year, my bowel movements have become very regular, going from every three to five days to now having a daily ...

Dr. Lin Minghui reply Gastroenterology and Hepatology
Left lower abdominal swelling with intermittent pain, sharp pain in the left flank. Differential diagnoses include enteritis, diverticulitis, urinary stones, bowel obstruction, urethritis, and irritable bowel syndrome. There is a family history of colorectal cancer, so attention ...

Chronic Left Lower Abdominal Pain: Seeking Solutions After Years of Discomfort

1. The current symptoms include bloating and pain in the lower left abdomen, which have persisted for four years. There is still abdominal bloating and pain regardless of diet. 2. So far, I have consulted various specialists, including gastroenterology, gynecology, orthopedics,...

Dr. Chen Bozhang reply Family Medicine
Hello: In response to your question, if all relevant specialties have been examined and no abnormalities were found, and organ issues have been ruled out, functional disorders may be considered. For functional gastrointestinal issues, you can seek treatment from a family medicine...

Chronic Left Lower Abdominal Pain: Seeking Effective Treatment Solutions

If a person has experienced chronic diarrhea or unformed stools, along with periodic left lower abdominal pain occurring approximately every three months, lasting about 1 to 3 weeks, and the pain is unrelieved by anti-inflammatory injections, pain relievers, anti-inflammatory med...

Dr. Ke Fangxu reply Surgery
Hello: In response to your question, generally speaking, there are three common categories of left lower abdominal pain. The most common issue is abdominal pain caused by constipation, followed by gynecological problems, and then other colorectal diseases. Based on the patient&#x...

Understanding Left-Sided Back Spasms and Chronic Bloating Issues

Hello, Doctor. I have a sensation in the lower left area between my shoulder and waist, like something is crawling. It feels as if a muscle at a specific point is cramping or a blood vessel is being compressed. I remember this has been happening for over a year, though it doesn&#...

Dr. Xiao Yongxun reply Family Medicine
Dear Ms. Gillian: 1. Since such a thorough examination has been conducted and no cause has been found, I personally believe that you should first pay attention to your diet, exercise, and lifestyle adjustments. This means maintaining a balanced diet, engaging in regular physical ...