Right Side Abdominal Pain: Insights from Gastroenterology

I have pain on the right side of my xiphoid process?

Hello Dr.
Yang: I previously sought medical attention due to unbearable pain from chronic gastritis, and I mentioned intermittent pain in my right abdomen.
The doctor suggested it might be caused by gas, considering I have had severe constipation for many years.
I thought that could be the case! However, after the treatment, I experienced persistent diarrhea, having bowel movements about three times a day.
My right-sided abdominal pain did not improve; instead, it escalated from once or twice a week to several times a day (after three months of treatment).
Whenever I stop the medication, I become constipated again.
Consequently, I underwent a gastrointestinal imaging study, and the technician informed me that there was a narrowing in the diameter of a section on the right side (which corresponds to my pain location).
After the doctor reviewed the images, he recommended a colonoscopy.
Today, after the examination, another doctor told me that my intestines were fine, but he could not explain the reason for my pain (I also had an abdominal ultrasound).
I would like to ask if a colonoscopy is necessarily more accurate than imaging studies, as the area highlighted in the imaging corresponds to my pain point!

momo, 20~29 year old female. Ask Date: 2001/03/15

Dr. Yang Guojun reply Gastroenterology and Hepatology

You have been diagnosed with irritable bowel syndrome (IBS), which causes alternating episodes of constipation and diarrhea accompanied by abdominal pain.
This condition tends to recur, and often visits to the doctor may not yield effective results, as tests typically return normal.
Please consult a gastroenterologist for further evaluation and management.

Reply Date: 2001/03/15

More Info

Understanding right-sided abdominal pain can be complex, especially when considering various gastrointestinal conditions. Your experience with chronic pain, constipation, and subsequent diarrhea after treatment raises several important points about gastrointestinal health and the diagnostic process.

Firstly, right-sided abdominal pain can stem from various sources, including the gastrointestinal tract, urinary system, and even musculoskeletal issues. In your case, the pain's location and your history of gastrointestinal issues suggest that it may be related to your digestive system. Conditions such as gallbladder disease, appendicitis, kidney stones, or even referred pain from other organs can manifest as right-sided abdominal pain.

The fact that you have a history of severe constipation is particularly relevant. Chronic constipation can lead to distension and discomfort in the abdomen, which may contribute to pain. When the bowel is obstructed or not functioning properly, it can cause increased pressure and discomfort, potentially leading to pain that may be misinterpreted as originating from other areas.

Regarding your treatment and the side effects you experienced, it is not uncommon for medications aimed at alleviating gastrointestinal symptoms to cause changes in bowel habits. For instance, proton pump inhibitors (like Lansoprazole) can sometimes lead to diarrhea in some patients, as they alter the stomach's acidity and can affect gut flora. This change in bowel habits can further complicate the clinical picture, making it difficult to pinpoint the exact cause of your pain.

You mentioned undergoing a gastrointestinal imaging study that indicated a narrowing in the area corresponding to your pain. This finding is significant and warrants further investigation. While imaging studies such as X-rays or CT scans can provide valuable information about the structure of the intestines, they may not always reveal functional issues or subtle pathologies. This is where a colonoscopy becomes particularly useful. A colonoscopy allows direct visualization of the intestinal lining and can help identify conditions such as inflammatory bowel disease, polyps, or other abnormalities that might not be visible on imaging studies.

It is also important to consider the possibility of functional gastrointestinal disorders, such as irritable bowel syndrome (IBS), which can cause pain and changes in bowel habits without any identifiable structural abnormalities. Stress, diet, and lifestyle factors can significantly influence these conditions, and addressing these aspects can sometimes alleviate symptoms.

In conclusion, while imaging studies like colonoscopy are generally more accurate for diagnosing certain conditions compared to X-rays, the interpretation of results must be done in conjunction with clinical symptoms and history. If your pain persists despite normal findings, it may be beneficial to consult a gastroenterologist who specializes in functional gastrointestinal disorders. They can help explore dietary modifications, stress management techniques, and possibly other therapeutic options to address your symptoms holistically.

In the meantime, maintaining a balanced diet rich in fiber, staying hydrated, and engaging in regular physical activity can help manage constipation and improve overall gastrointestinal health. If you experience any new or worsening symptoms, such as fever, significant weight loss, or changes in bowel habits, it is crucial to seek medical attention promptly.

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