Constipation and Upper Right Abdominal Pain: Causes and Tests

Constipation, right upper quadrant pain?

About a year ago, I noticed a change in my bowel habits, experiencing constipation and bloating that made it uncomfortable to sleep.
Even eating and drinking became difficult, accompanied by nausea.
My stools have been pellet-like, segmented, resembling sheep feces, and I feel like my intestines are not peristalsing properly.
I have the urge to defecate but cannot, often needing to go multiple times, with a sensation of being completely blocked.
The color of my stool has been darker, and I have had a positive result for occult blood (−/+).
Ferritin levels indicated upper gastrointestinal bleeding.
Previously, I was taking medications to aid bowel movements, but I stopped as the sensation of being blocked improved significantly, although my stools remain segmented and pellet-like.
The color has changed from yellow-brown and banana-shaped to dark and segmented, and this condition has persisted for a year.
Recently, I began to feel a pressure in my upper right abdomen, which has evolved into pain over the past month.
This has raised my concern, and I would like to seek your professional advice.
I would like to know what issues could be causing these symptoms and what examinations you would recommend.
Additionally, if you could explain the specific functions of these tests, it would help me gain a deeper understanding of my health condition.
Thank you.

Nìmíng, 30~39 year old female. Ask Date: 2024/02/29

Dr. Chen Shidian reply Gastroenterology and Hepatology

It is still recommended to perform gastroscopy/colonoscopy to rule out ulcers or polyps.

Reply Date: 2024/02/29

More Info

Understanding the relationship between constipation and upper right abdominal pain is crucial for diagnosing potential underlying issues. Your symptoms, including a year-long history of constipation, changes in stool consistency, and the recent onset of upper right abdominal pain, warrant a thorough evaluation.

Possible Causes
1. Constipation: Chronic constipation can lead to a variety of gastrointestinal issues. When stool remains in the colon for extended periods, it can become hard and dry, making it difficult to pass. This can cause abdominal discomfort, bloating, and pain. The sensation of feeling "stuck" or having difficulty passing stool is common in individuals with constipation.

2. Irritable Bowel Syndrome (IBS): IBS is a functional gastrointestinal disorder characterized by symptoms such as abdominal pain, bloating, and changes in bowel habits. It can manifest as constipation-predominant IBS (IBS-C), which may explain your symptoms.

3. Gastrointestinal Obstruction: A blockage in the intestines can lead to severe constipation and abdominal pain. This could be due to adhesions from previous surgeries, tumors, or other structural abnormalities.

4. Gallbladder Issues: Given your mention of upper right abdominal pain, gallbladder problems, such as gallstones or cholecystitis, could be a concern. These conditions can cause pain in the upper right quadrant, especially after eating fatty meals.

5. Liver Conditions: Liver diseases, including hepatitis or liver cirrhosis, can also present with upper right abdominal pain and changes in bowel habits. The liver's function can affect digestion and stool formation.

6. Peptic Ulcer Disease: Ulcers in the stomach or the first part of the small intestine can cause pain that may be felt in the upper abdomen. If there is bleeding, it can lead to dark stools, which you have noted.

7. Diverticular Disease: Diverticulosis or diverticulitis can cause abdominal pain and changes in bowel habits. This condition is more common in individuals with a low-fiber diet, which can lead to constipation.

Recommended Tests
1. Abdominal Ultrasound: This non-invasive imaging test can help visualize the gallbladder, liver, and other abdominal organs. It can identify gallstones, liver abnormalities, and signs of inflammation.

2. CT Scan of the Abdomen: A CT scan provides detailed images of the abdominal organs and can help diagnose obstructions, tumors, or other structural issues.

3. Colonoscopy: Given your history of constipation and changes in stool characteristics, a colonoscopy may be warranted. This procedure allows direct visualization of the colon and can help identify polyps, diverticulosis, or other abnormalities.

4. Blood Tests: Complete blood count (CBC) can help identify signs of infection or anemia. Liver function tests can assess liver health, and tests for inflammatory markers can help diagnose conditions like diverticulitis.

5. Stool Tests: Testing for occult blood in the stool can help determine if there is gastrointestinal bleeding. Additionally, stool cultures can identify infections.

Conclusion
Your symptoms of constipation and upper right abdominal pain are interconnected and may indicate a range of gastrointestinal issues. It is essential to consult with a healthcare provider who can perform a thorough evaluation, including a detailed history and physical examination, and recommend appropriate tests based on your specific symptoms. Early diagnosis and treatment are crucial for managing any underlying conditions effectively. Additionally, lifestyle modifications, such as increasing dietary fiber, staying hydrated, and regular physical activity, can significantly improve bowel health and alleviate constipation.

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