Abdominal Pain and Bloating: A Gastrointestinal Perspective

Abdominal distension and lower abdominal pain?

Last month, one day after just waking up, I experienced severe abdominal cramps, sweating, and persistent diarrhea.
This was unusual for me, as I typically suffer from constipation.
I had occasionally taken probiotics to help with bowel movements, but I hadn't taken any the day before the diarrhea.
At that moment, I took a few spoonfuls of a gastrointestinal medication, which alleviated the cramping symptoms.
A few days later, while lying down, I felt a sensation of swelling in my lower left abdomen, which then developed into a daily feeling of bloating, as if there were a water balloon inside, accompanied by intermittent sharp pains.
I also experienced a dull, aching sensation in my vagina, and my urination became slower and less frequent, although the urine was light in color.
I consulted a gynecologist who said there were no significant issues with my uterus or ovaries, and a urinalysis showed no signs of a urinary tract infection.
I then saw a gastroenterologist who prescribed five medications: Losec, Gascon, MGO, Mosapride, and Cimetidine.
After taking these, my symptoms improved significantly; the bloating and vaginal pressure disappeared, and my urination increased.
I continued taking the medications for two weeks, but once I finished them, the bloating and pain returned.
What could be the underlying issue?

Mimi, 40~49 year old female. Ask Date: 2022/11/11

Dr. Chen Shidian reply Gastroenterology and Hepatology

Fecal occult blood testing can be performed for reference; if the results are normal, it should still be considered as abnormal gastrointestinal motility.

Reply Date: 2022/11/11

More Info

Abdominal pain and bloating can be quite distressing and challenging to diagnose, especially when symptoms are intermittent and vary in intensity. Based on your description, it seems that you have experienced a range of gastrointestinal symptoms, including severe abdominal pain, diarrhea, and a sensation of bloating, particularly in the left lower abdomen. Additionally, you mentioned experiencing discomfort in the vaginal area and changes in urination.

Understanding Your Symptoms
1. Abdominal Pain and Diarrhea: The acute onset of severe abdominal pain accompanied by diarrhea could suggest a gastrointestinal disturbance, such as gastroenteritis, which is often caused by infections (viral or bacterial). However, since you mentioned that you have a history of constipation, it is also possible that a sudden change in bowel habits could be related to a functional gastrointestinal disorder, such as irritable bowel syndrome (IBS).

2. Bloating and Sensation of Pressure: The feeling of bloating and the sensation of having a "water balloon" in your abdomen can be indicative of gas accumulation or fluid retention. This can occur due to various reasons, including dietary factors, stress, or underlying gastrointestinal conditions. The fact that your symptoms improved with medication suggests that they may be related to gastric motility or acid secretion.

3. Pelvic Discomfort: The discomfort you described in the vaginal area could be related to pelvic floor dysfunction or referred pain from gastrointestinal issues. Since your gynecological evaluations have ruled out significant issues with the uterus and ovaries, it may be worth considering that the discomfort could be linked to gastrointestinal disturbances.

4. Urinary Changes: The changes in urination, such as decreased frequency and volume, could be related to dehydration from diarrhea or could indicate a separate urinary issue. Since your urine was tested and found to be clear of infection, this may suggest that the urinary symptoms are secondary to your gastrointestinal issues.

Possible Diagnoses
Given your symptoms and the results of your examinations, several potential diagnoses could be considered:
- Irritable Bowel Syndrome (IBS): This is a common functional gastrointestinal disorder characterized by abdominal pain, bloating, and changes in bowel habits. Stress and dietary factors often exacerbate symptoms.

- Gastroenteritis: An infection or inflammation of the gastrointestinal tract could explain the acute pain and diarrhea. If this was viral, symptoms may resolve quickly, but if bacterial, further evaluation may be necessary.

- Functional Dyspepsia: This condition can cause bloating and discomfort in the upper abdomen, often related to gastric motility issues.

- Pelvic Floor Dysfunction: This could explain the sensation of pressure in the pelvic area and may require a multidisciplinary approach for management.

Recommendations
1. Dietary Modifications: Keeping a food diary may help identify any dietary triggers that exacerbate your symptoms. Consider reducing intake of gas-producing foods (e.g., beans, carbonated beverages) and increasing fiber gradually to manage constipation.

2. Medication Review: Since your symptoms improved with the medications prescribed, it may be beneficial to discuss a longer-term management plan with your gastroenterologist. This could include a combination of medications to manage symptoms and possibly probiotics to support gut health.

3. Follow-Up: If symptoms persist or worsen, further investigations may be warranted, such as imaging studies (e.g., ultrasound or CT scan) to rule out structural abnormalities or additional gastrointestinal evaluations (e.g., endoscopy).

4. Stress Management: Since stress can significantly impact gastrointestinal function, consider incorporating stress-reducing techniques such as mindfulness, yoga, or counseling.

5. Multidisciplinary Approach: If pelvic discomfort continues, consider consulting a pelvic floor physical therapist who can provide targeted exercises and therapies to address any dysfunction.

In conclusion, while your symptoms have shown improvement with medication, it is essential to continue monitoring your condition and maintain open communication with your healthcare providers to ensure a comprehensive approach to your abdominal pain and bloating.

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