Abdominal Tightness and Pain: A Gastroenterology Perspective

Abdominal pain with a feeling of tightness?

Hello, doctor.
I have been experiencing abdominal discomfort for a long time, and recently it has intensified.
I feel tightness in the right side of my abdomen, as if something is being squeezed inside.
Sometimes, the area around my stomach feels like a hard ball, and the area around my navel is also tight and hard.
The lower right abdomen remains persistently tight, and I even feel pain there.
Additionally, I have soreness in my right shoulder blade and right back.
During my last few menstrual periods, the tightness in my lower right abdomen seems to be associated with pain, whereas it didn't used to hurt as much during my periods.

In my medical records, I had an ultrasound last June that showed mild fatty liver, and in July, I underwent an endoscopy that revealed mild gastroesophageal reflux disease.
In October, I visited a gynecologist for an ultrasound and CA-125 test, both of which were normal.
In February of this year, I had an X-ray that showed some gas in the lower right abdomen, but it appeared to be okay.
I have been taking medication from both Western and traditional Chinese medicine for a long time without improvement, which is quite frustrating.

Since receiving the vaccine, I have been experiencing joint pain and need to take one pill of Biologics daily.
I have regular blood and urine tests every three months, all of which are normal, except for some autoimmune rheumatic markers that are elevated: Anti-Cell Ab Positive, ANA 1:160, RF, IgG originally 8.9, now 5.3, Mi-2α +, Positive SAE1 +/-, Borderline.

Nìmíng, 30~39 year old female. Ask Date: 2023/04/25

Dr. Chen Shidian reply Gastroenterology and Hepatology

Please discuss with an immunologist or gastroenterologist whether there is an autoimmune enteritis and consider medication and dietary adjustments.

Reply Date: 2023/04/25

More Info

Understanding abdominal tightness and pain can be complex, especially when symptoms persist over time. Based on your description, it seems that you are experiencing a combination of abdominal tightness, localized pain, and referred discomfort in the right shoulder blade area. This could be indicative of several underlying issues, and it's essential to consider both gastrointestinal and gynecological factors, especially given your history of gastrointestinal conditions and recent menstrual pain.

Firstly, the sensation of tightness and pain in the right side of the abdomen could be related to several gastrointestinal issues. Given your previous diagnosis of mild fatty liver and gastroesophageal reflux disease (GERD), these conditions can contribute to discomfort in the abdominal area. Fatty liver can lead to inflammation and discomfort, while GERD can cause referred pain that may feel like tightness in the abdomen. The presence of gas in the right lower abdomen, as noted in your X-ray, could also indicate gastrointestinal distress, such as irritable bowel syndrome (IBS) or functional dyspepsia, which can cause bloating and discomfort.

Moreover, the connection between your menstrual cycle and the increase in pain suggests a possible gynecological component. Conditions such as endometriosis or ovarian cysts can cause referred pain to the abdomen and back, particularly during menstruation. The fact that you have had a normal CA-125 test is reassuring, as elevated levels can indicate ovarian cancer or other serious conditions, but it does not rule out other benign gynecological issues.

The tightness you describe, especially if it feels like a "ball" in the stomach, could also be related to muscle tension or spasms. Stress and anxiety can lead to muscle tension in the abdominal area, which may exacerbate the perception of pain. Your mention of anxiety and the physical symptoms it brings, such as cold sweats and tingling, suggests that psychological factors may also play a role in your abdominal discomfort.

Given your ongoing symptoms and the lack of improvement despite treatment, it is crucial to follow up with your healthcare provider. A comprehensive evaluation by a gastroenterologist is warranted, as they can assess for conditions like IBS, functional dyspepsia, or other gastrointestinal disorders. Additionally, a gynecological evaluation may be necessary to rule out any reproductive health issues that could be contributing to your symptoms.

In the meantime, consider lifestyle modifications that may help alleviate some of your symptoms. These include:
1. Dietary Adjustments: Keeping a food diary to identify any potential triggers for your symptoms can be beneficial. Avoiding high-fat, spicy, or acidic foods may help reduce GERD symptoms.

2. Stress Management: Techniques such as mindfulness, yoga, or relaxation exercises can help manage stress and reduce muscle tension in the abdomen.

3. Regular Exercise: Engaging in regular physical activity can improve gastrointestinal motility and reduce stress levels.

4. Hydration: Ensuring adequate fluid intake can help with digestion and reduce bloating.

5. Medication Review: Discuss with your healthcare provider any medications you are taking, including over-the-counter supplements, to ensure they are not contributing to your symptoms.

In conclusion, your symptoms of abdominal tightness and pain could stem from a combination of gastrointestinal and gynecological factors, exacerbated by stress and anxiety. A thorough evaluation by your healthcare provider is essential to determine the underlying cause and develop an effective treatment plan.

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