Chronic Right Lower Abdominal Pain: Seeking Answers After 4 Years

Persistent pain in the lower right abdomen for four years, with a trend of increasing severity... however, all examinations have returned normal results?

Hello Doctor, about four years ago, I started experiencing discomfort in my lower right abdomen.
During the first year of discomfort, I underwent a colonoscopy, and I also had blood tests and stool occult blood tests, all of which did not reveal any issues.
The doctors have all said that I simply have irritable bowel syndrome.
So, after not being able to find anything wrong and with the doctors advising me not to worry too much, four years have passed.
However, the discomfort has become increasingly severe and frequent.
Now, I even feel very uncomfortable when breathing.
Over these four years, I have lost about 4 kilograms, which I think is normal.
It seems like my right abdomen is naturally more distended than the left; could this be related? However, I cannot feel any hard masses.
I have seen many doctors, but they all unanimously believe I have irritable bowel syndrome upon seeing my previous test results.
I do not think I have irritable bowel syndrome because my discomfort does not seem to be related to my mood or the food I eat.
The discomfort is almost constant, with only occasional periods of increased discomfort.
Moreover, it is getting worse, which really worries me.
Additionally, my stool often appears discolored, with small dark pieces on it; I cannot tell if they are black, dark red, or green.
I frequently feel dizzy, possibly due to anemia.
What should I do? I have undergone all the necessary tests, and the doctors have reviewed the results and told me not to overthink it, yet they cannot explain why the discomfort is worsening, even affecting my breathing.
The sensation has progressed from bloating and pain to sharp pain, then to soreness, and now it feels like an inflammatory burning pain.
Most importantly, I often feel very uncomfortable even when I am not doing anything unusual, and my mood fluctuations are minimal.
Therefore, I truly feel it is not irritable bowel syndrome.
Please advise me, thank you.

olimyna, 20~29 year old female. Ask Date: 2006/11/29

Dr. Lin Minghui reply Gastroenterology and Hepatology

1.
Is dizziness related to anemia? A blood test to check hemoglobin levels can determine this.

2.
If there are abnormalities in the stool, a stool test can be performed to check for occult blood, parasites, etc.

3.
Currently, there are no tests that can confirm or rule out irritable bowel syndrome (IBS), but psychological factors can affect physiological conditions.

4.
The normal motility of the gastrointestinal tract is influenced by absorption and the neuroendocrine system; prolonged stress can stimulate the sympathetic nervous system, leading to vasoconstriction in the intestines, reduced secretion of digestive fluids and mucus, and decreased intestinal motility, which can cause indigestion and difficulty in bowel movements, resulting in gastrointestinal symptoms.

5.
If there is blood in the stool, weight loss, or poor appetite, it is advisable to investigate further for other issues, such as hyperthyroidism, liver, pancreatic, or colorectal tumors, and inflammatory bowel disease.
Wishing you good health.

Reply Date: 2006/11/29

More Info

Chronic right lower abdominal pain can be a complex issue, especially when it has persisted for four years without a clear diagnosis. Your situation is concerning, particularly given the progression of your symptoms and the impact they have on your daily life. It’s important to approach this matter with a comprehensive understanding of potential underlying causes and the appropriate steps to take.

First, it’s essential to recognize that chronic abdominal pain can arise from various sources, including gastrointestinal, musculoskeletal, and even psychological factors. Given that you have undergone several tests, including colonoscopy, blood tests, and stool tests, and have been diagnosed with irritable bowel syndrome (IBS), it’s understandable that you might feel frustrated with the lack of clarity regarding your condition.

IBS is a common functional gastrointestinal disorder characterized by symptoms such as abdominal pain, bloating, and changes in bowel habits. However, it is crucial to note that IBS is a diagnosis of exclusion, meaning that other potential causes of your symptoms should be ruled out before concluding that IBS is the sole issue. The fact that your discomfort has intensified and is now affecting your breathing is particularly concerning and warrants further investigation.

The description of your symptoms evolving from bloating to sharp pain and now to a burning sensation suggests that there may be an underlying inflammatory process or another condition at play. The presence of changes in your stool color and consistency, along with symptoms of dizziness and potential anemia, raises additional red flags. These symptoms could indicate gastrointestinal bleeding or other serious conditions that require immediate attention.

Here are some potential avenues for further investigation:
1. Imaging Studies: If you haven’t already, consider requesting abdominal imaging studies such as an ultrasound or a CT scan. These tests can help identify structural abnormalities, such as hernias, tumors, or inflammatory conditions like appendicitis or diverticulitis.

2. Gastroenterology Referral: If you haven’t seen a gastroenterologist recently, it may be beneficial to seek a second opinion. A specialist may recommend additional tests, such as an upper endoscopy or a capsule endoscopy, to evaluate the upper gastrointestinal tract or small intestine.

3. Food Intolerance Testing: Sometimes, food intolerances or allergies can contribute to chronic abdominal pain. Consider discussing with your doctor the possibility of undergoing tests for food sensitivities or trying an elimination diet to identify potential triggers.

4. Psychological Factors: While you mentioned that your symptoms do not seem to correlate with your mood or diet, it’s worth considering that chronic pain can sometimes have psychological components. Stress and anxiety can exacerbate physical symptoms, and addressing these factors through therapy or stress management techniques may provide some relief.

5. Nutritional Assessment: Given your weight loss and changes in bowel habits, a consultation with a nutritionist may help ensure that you are meeting your nutritional needs and identify any dietary factors that could be contributing to your symptoms.

6. Follow-Up on Anemia: If you suspect anemia, it’s crucial to investigate the cause. This could involve further blood tests to assess iron levels, vitamin B12, and folate, as well as potential sources of gastrointestinal bleeding.

In conclusion, while IBS may be a part of your symptomatology, the worsening nature of your discomfort and the new symptoms you are experiencing necessitate a thorough reevaluation. It’s essential to advocate for your health and seek further testing and specialist opinions until you find a satisfactory explanation for your chronic pain. Remember, your health is paramount, and persistent symptoms should never be dismissed.

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