Chronic Abdominal Pain: Complications and Treatment Options

Abdominal pain persisting for over a year accompanied by multiple complications?

Hello, doctor.
Since February of last year, I have been experiencing abdominal pain every night, and sometimes I have to rush to the bathroom in the middle of the night.
At that time, my bowel movements had a fishy odor, the color was abnormal, and they were not well-formed.
However, since it wasn't too bothersome, I initially didn't pay much attention to it.
By May of last year, I began to experience constipation, often sitting on the toilet for an hour at a time, with recurrent cramping in my abdomen, but no matter how hard I tried, I couldn't pass anything.
In the morning, I would have diarrhea, along with symptoms of gastroesophageal reflux, which left me feeling exhausted.
These issues significantly affected my quality of life, so I later visited a gastroenterology clinic.
The doctor diagnosed me with gastroenteritis, but after taking medication for one to two weeks, there was no improvement.
I had several follow-up visits, and eventually, the doctor referred me to another hepatobiliary and gastroenterology clinic, where I underwent an upper endoscopy.
However, I did not have a colonoscopy due to concerns about the risks of general anesthesia, and the doctor mentioned that it was unlikely there would be any issues at my age.
I was later diagnosed with irritable bowel syndrome and prescribed medications for softening stools and for diarrhea—taking one for constipation and the other for diarrhea.
I continued this regimen, but there was still no improvement.

In the following months, for reasons unknown, in addition to abdominal pain, I began to feel a dull pain around the area beneath my ribs.
At night, while lying in bed, I would suddenly feel uncomfortable or experience abdominal pain that would wake me up.
Now, I have somewhat given up on treatment and am no longer taking medication, but my condition has worsened.
Besides acid reflux, I often feel the urge to burp (even when drinking water), and it feels like the water doesn't go down immediately; after drinking, I still feel something near my throat that causes me to burp.
Additionally, I experience soreness in my back and lower back when lying down (this may not be related to the digestive system, but I mention it just in case).
At night, I struggle to sleep or wake up suddenly due to these symptoms.
In the morning, I wake up with abdominal pain and the urge to burp, and by noon, due to long-term reflux, I feel uncomfortable when eating, which greatly impacts my quality of life.
These symptoms have been worsening recently, and I would like to ask the doctor what diseases I might have.
Should I continue to see a hepatobiliary and gastroenterology specialist? Should I undergo a colonoscopy or laparoscopic examination? Or are there other better management options? I apologize for the lengthy description, as this issue has troubled me for a long time.
Thank you for your patience in reading this, and I hope you can help clarify my concerns!

Niming, 10~19 year old female. Ask Date: 2024/06/12

Dr. Chen Shidian reply Gastroenterology and Hepatology

If the weight is normal, irritable bowel syndrome (IBS) may be the most likely cause.
In addition to using gastrointestinal medications for management, a stool occult blood test can be conducted.
If necessary, a referral to a mental health specialist may help with anxiety control.
It is also important to maintain a regular eating schedule and avoid excessive consumption of milk and greasy foods.

Reply Date: 2024/06/12

More Info

Chronic abdominal pain can be a complex and multifaceted issue, often requiring a thorough investigation to identify the underlying causes. Based on your description, it seems you have been experiencing a range of gastrointestinal symptoms, including abdominal pain, changes in bowel habits (alternating between constipation and diarrhea), gastroesophageal reflux, and discomfort in the rib area. These symptoms have significantly impacted your quality of life, leading to frustration and a sense of helplessness regarding your treatment.

The first step in addressing chronic abdominal pain is to understand the potential causes. Given your symptoms, several conditions could be contributing to your discomfort:
1. Irritable Bowel Syndrome (IBS): This is a common functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits. It can present with symptoms like bloating, gas, diarrhea, and constipation. Stress and anxiety often exacerbate IBS symptoms.

2. Gastroesophageal Reflux Disease (GERD): Your mention of acid reflux and discomfort when lying down suggests that GERD could be a significant factor. This condition occurs when stomach acid frequently flows back into the esophagus, leading to irritation and discomfort.

3. Gastritis or Peptic Ulcer Disease: Inflammation of the stomach lining (gastritis) or ulcers can cause abdominal pain, especially after eating. These conditions can be exacerbated by certain medications, alcohol, and stress.

4. Functional Dyspepsia: This condition involves chronic pain or discomfort in the upper abdomen without an identifiable cause, often linked to eating.

5. Gallbladder Issues: Given your history of gallbladder surgery, it’s essential to consider post-cholecystectomy syndrome, which can occur when patients experience gastrointestinal symptoms after gallbladder removal.

6. Other Gastrointestinal Disorders: Conditions such as inflammatory bowel disease (IBD), celiac disease, or even infections could also be at play, especially if there are changes in bowel habits and stool characteristics.

Given the complexity of your symptoms and the lack of improvement with initial treatments, it is advisable to pursue further evaluation. Here are some recommendations:
- Consult a Gastroenterologist: Since you have already seen a gastroenterologist, it may be beneficial to return for a follow-up. Discuss your ongoing symptoms in detail, emphasizing the impact on your daily life.

- Consider a Colonoscopy: Although your doctor deemed it unnecessary due to your age and previous assessments, a colonoscopy can provide valuable insights, especially if there are concerns about inflammatory bowel disease or other structural issues.

- Upper Endoscopy (EGD): This procedure can help evaluate the esophagus, stomach, and duodenum for any abnormalities that could explain your symptoms.

- Dietary Modifications: Keeping a food diary may help identify any dietary triggers. A low-FODMAP diet is often recommended for IBS patients and can help alleviate symptoms.

- Stress Management: Since stress and anxiety can exacerbate gastrointestinal symptoms, consider incorporating stress-reduction techniques such as mindfulness, yoga, or therapy.

- Medication Review: If you have been prescribed medications for IBS or GERD, discuss their effectiveness with your doctor. Sometimes, a combination of medications or a different class of drugs may be necessary.

- Lifestyle Changes: Regular exercise, adequate hydration, and avoiding late-night meals can also help manage symptoms.

In conclusion, chronic abdominal pain can stem from various causes, and a comprehensive approach is essential for effective management. It’s crucial to maintain open communication with your healthcare provider, advocate for further testing if necessary, and explore lifestyle modifications that may alleviate your symptoms. Your quality of life is paramount, and with the right approach, improvement is possible.

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