Gastrointestinal Issues: Insights on Pain and Surgery

Health Consultation

1.
I have been experiencing stomach pain since I gave birth, which has lasted for 4 years.
I have had an endoscopy done once a year, but the report has not come out yet.
What could be the cause of this? I have also done a stool test that showed trace blood, and a colonoscopy that indicated no issues.
2.
After the endoscopy, I experienced pain between the two points on my chest.
The nurse mentioned that my throat might feel uncomfortable, but I did not experience any throat pain.
Is this normal?
3.
I had a cesarean section, and 4 years later, I discovered a hard lump above the incision.
A CT scan indicated that it was due to poor suturing by the previous doctor (or it could be that my skin is more sensitive).
The recommendation was to have it surgically removed.
Is it possible to leave it as is without surgery?

mei, 30~39 year old female. Ask Date: 2004/10/07

Dr. Zhao Chongliang reply Internal Medicine

The results of an upper gastrointestinal endoscopy can typically be discussed directly with the performing physician, without the need to wait for a report.
The presence of occult blood in the stool indicates that there may be bleeding somewhere in the gastrointestinal tract or that there has been consumption of substances that can interfere with the test, such as certain meats, pig's blood, or oxidizing agents.
Given the presence of stomach pain, the likelihood of gastric or duodenal ulcers is high; however, it could also simply be gastritis or gastritis combined with bleeding from the lower gastrointestinal tract, such as from the colon, rectum, or hemorrhoids.
If the endoscopy results show only gastritis, but occult blood persists after ruling out interfering factors, a sigmoidoscopy or even a colonoscopy should be performed to exclude malignant tumors in the lower gastrointestinal tract.

During an upper endoscopy, in addition to local anesthesia, the patient must be able to cooperate with swallowing actions; otherwise, there is a risk of injury to the throat and esophagus during insertion.
Chest pain without throat pain may indicate esophageal injury, but it is not necessarily due to abrasion caused by the endoscopy.
Most often, it is due to gastric acid refluxing into the esophagus after the endoscope enters the stomach, leading to reflux esophagitis.
The physician may prescribe ulcer medications.

The hardening of the wound after surgery may be a keloid, which is common among individuals of Asian descent.
Simply excising the keloid may lead to recurrence and potentially larger growth.
It is advisable to administer local steroid injections simultaneously; however, there are now new topical ointments available that can eliminate keloids without the need for surgery, and patients can seek consultation at a dermatology clinic.

Reply Date: 2004/10/07

More Info

Understanding gastrointestinal issues, especially in the context of surgery and pain, can be complex. Based on your questions, let's break down the concerns and provide insights into each aspect.

1. Chronic Gastric Pain: You mentioned experiencing stomach pain since childbirth, which has persisted for four years. The fact that you've undergone a gastroscopy (endoscopy) and a colonoscopy, with the latter showing no issues, is a good sign. However, the presence of superficial blood in your stool is concerning and should not be overlooked. This could indicate several conditions, including hemorrhoids, diverticular disease, or even more serious concerns like gastrointestinal bleeding. The intermittent nature of your pain could be related to functional gastrointestinal disorders, such as gastritis or irritable bowel syndrome (IBS). It’s crucial to follow up with your healthcare provider to discuss these symptoms further, especially since the pain has been recurrent and debilitating.

2. Post-Endoscopy Discomfort: It's not uncommon to experience some discomfort in the throat after a gastroscopy due to the insertion of the endoscope. This discomfort can manifest as soreness or a feeling of tightness. If you did not experience throat pain but had discomfort in the chest area, it could be due to the positioning during the procedure or irritation of the esophagus. If this discomfort persists or worsens, it would be wise to consult your physician for further evaluation.

3. Post-Surgical Complications: You mentioned discovering a hard lump at the site of your previous cesarean section four years later, which was identified as a possible issue with the suturing technique. This could be a form of scar tissue or a keloid, which is a thickened area of scar tissue that can develop after surgery. While some individuals may choose to leave such lumps untreated, if they cause discomfort or concern, surgical removal may be recommended. The decision to proceed with surgery should be made in consultation with your surgeon, considering factors such as the size of the lump, any associated symptoms, and your overall health.

Additional Considerations:
- Pain Management: Chronic pain can significantly impact your quality of life. It’s essential to discuss pain management strategies with your healthcare provider. This may include medications, dietary changes, or alternative therapies such as physical therapy or acupuncture.

- Dietary Modifications: Since gastrointestinal issues can often be exacerbated by diet, consider keeping a food diary to identify any potential triggers for your symptoms. Foods that are high in fat, spicy, or acidic can sometimes worsen gastric discomfort.

- Follow-Up Care: Regular follow-ups with your healthcare provider are crucial, especially given your history of gastrointestinal issues and surgeries. If your symptoms change or worsen, do not hesitate to seek immediate medical attention.

- Mental Health: Chronic pain and gastrointestinal issues can lead to anxiety and depression. It’s important to address these aspects of your health as well. Support groups or counseling can be beneficial.

In conclusion, while some discomfort after procedures and surgeries can be normal, persistent or worsening symptoms warrant further investigation. Always advocate for your health and seek second opinions if you feel your concerns are not being adequately addressed. Your well-being is paramount, and understanding the underlying causes of your symptoms is the first step toward effective treatment.

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