Abdominal Discomfort: Causes, Tests, and Remedies - Gastroenterology and Hepatology

Abdominal discomfort and pain?

Hello Doctor: I have been experiencing abdominal discomfort and pain for over three years, but it does not occur continuously.
Each episode lasts about a week and happens once every three to six months.
Whenever I eat something, within half an hour, I feel a dull pain in my abdomen that is somewhat acidic.
Initially, I consulted a doctor and underwent a stool occult blood test, which was normal, and an upper endoscopy, which also showed normal results.
However, I have not had a colonoscopy.
The doctor prescribed a white pill that helps convert organic matter in the intestines into gas for expulsion, and I usually feel better after about a week.
I often suffer from constipation and frequently worry about it.
The doctor previously prescribed a fiber supplement, but it was not very effective.
Sometimes, when I feel very uncomfortable due to constipation, I use a suppository (bisacodyl 5mg).
I would like to ask the doctor what could be causing my abdominal discomfort and pain? Do I need to undergo any specific tests? Are there any side effects from using suppositories? I tend to avoid cold drinks as they make my abdomen feel worse.
Are there other types of yogurt available? Are over-the-counter probiotic capsules effective? Thank you!

Vicky, 30~39 year old female. Ask Date: 2005/06/23

Dr. Yuan Hongdao reply Gastroenterology and Hepatology

Hello, chronic abdominal pain can have many underlying causes.
It may be due to organic changes (such as chronic inflammation or tumors) or functional issues (such as nerve sensitivity or abnormal intestinal motility).
I would like to know the location of your pain, its intensity, whether it alleviates at times, and if there are any specific triggers or relieving factors.
Additionally, do you experience any accompanying symptoms such as fever, diarrhea, or changes in bowel habits?
If you have been in pain for three years without significant weight loss and your basic blood tests are normal, it is likely a functional issue, with a higher chance of conditions like irritable bowel syndrome (IBS) or functional dyspepsia.
I recommend discussing this further with your primary care physician.

Using suppositories for an extended period may lead to degeneration of the intestinal nerves, resulting in worsened motility and potentially more severe constipation in the future; therefore, frequent use is not advised.
Probiotics or yogurt primarily help beneficial bacteria replace harmful bacteria in the gut, and some reports suggest they may be beneficial for IBS, so you might consider trying them.

Sincerely, Dr.
Yuan Hong-Dao, Internal Medicine.

Reply Date: 2005/06/23

More Info

Abdominal discomfort can be a complex issue, especially when it has persisted for several years, as you described. The symptoms you are experiencing, including the recurring episodes of dull pain that occur after eating, along with a history of constipation, suggest that there may be several underlying factors contributing to your discomfort.

Possible Causes of Abdominal Discomfort
1. Functional Gastrointestinal Disorders: Conditions such as Irritable Bowel Syndrome (IBS) could be a possibility. IBS is characterized by abdominal pain and changes in bowel habits, which can include constipation and diarrhea. The pain often correlates with eating and can be relieved by bowel movements.

2. Gastric Issues: Although your endoscopy was normal, conditions like gastritis or functional dyspepsia can still cause discomfort. These conditions may not always show up on tests but can lead to symptoms like bloating and pain after eating.

3. Constipation: Chronic constipation can lead to abdominal pain and discomfort. The straining and infrequent bowel movements can cause a buildup of gas and pressure in the intestines, leading to pain.

4. Food Intolerances: Sometimes, certain foods can trigger abdominal pain. Lactose intolerance or gluten sensitivity could be potential culprits, especially if you notice discomfort after consuming dairy or wheat products.

5. Bowel Obstruction or Other Structural Issues: Although less likely given your normal tests, structural issues such as adhesions from previous surgeries or other gastrointestinal conditions could cause intermittent pain.

Recommended Tests and Evaluations
Given that you have not undergone a colonoscopy, it may be prudent to discuss this option with your healthcare provider. A colonoscopy can help rule out any significant issues in the colon, such as polyps or inflammatory bowel disease. Additionally, if you have not had imaging studies like an abdominal ultrasound or CT scan, these could provide further insights into any structural abnormalities.

Management and Remedies
1. Dietary Adjustments: Since you mentioned that cold drinks exacerbate your symptoms, it may be beneficial to maintain a diet that avoids triggers. Keeping a food diary can help identify any specific foods that may be causing discomfort.

2. Fiber Supplements: While you mentioned that fiber supplements have not been effective, it may be worth trying different types or brands. Soluble fiber, such as psyllium husk, can be gentler on the digestive system and may help with constipation.

3. Probiotics: You inquired about the effectiveness of over-the-counter probiotics. Some studies suggest that certain strains of probiotics can help with digestive health and may alleviate symptoms of IBS. Look for products that contain live cultures and are specifically formulated for digestive health.

4. Laxatives: The use of bisacodyl (a stimulant laxative) should be approached with caution, as overuse can lead to dependency and worsen constipation in the long run. It's essential to discuss with your doctor the frequency of use and explore other options for managing constipation.

5. Hydration: Increasing water intake can help alleviate constipation and improve overall digestive health. Aim for at least 8 glasses of water a day, adjusting based on your activity level and climate.

Conclusion
In summary, your abdominal discomfort could stem from a variety of causes, including functional gastrointestinal disorders, dietary issues, or chronic constipation. It is essential to work closely with your healthcare provider to explore further testing, such as a colonoscopy, and to discuss dietary changes and management strategies. Keeping a detailed record of your symptoms and any potential triggers can also aid in diagnosing and managing your condition effectively.

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