Chronic Abdominal Pain and Bloating: Causes and Solutions

Q: Chronic Abdominal Pain and Bloating: Causes and Solutions

Hello Mr. <br>Easy： Based on the information provided, major diseases have mostly been ruled out (only colonoscopy and small bowel endoscopy have not been performed), so there should be no significant issues. <br>You may discuss related medications and lifestyle adjustments with

Abdominal bloating and lower abdominal discomfort?

Hello Doctor,
I have a history of stomach pain and discomfort in the lower abdomen for about four years.
Over the past four years, I have undergone regular gastroscopy and abdominal ultrasound examinations, with results showing no lesions in the stomach, only a 0.4 cm gallbladder polyp that has not changed in size (deemed benign by the doctor, requiring only annual follow-up).
However, I frequently experience gastroesophageal reflux and bile reflux.
Since the beginning of this year, I have started to experience severe gastrointestinal bloating and a feeling of pressure, particularly in an area about ten centimeters below my navel, extending approximately fifteen centimeters to the left.
This area becomes intensely painful when I lie down and gently press or tap on it.
I often have difficulty sleeping at night due to abdominal bloating and discomfort.

Therefore, I sought medical attention again, and in October of this year, the doctor arranged for an abdominal CT scan (with contrast injection, consisting of three large X-ray images, each with 60 slices).
The results showed everything to be normal with no lesions.
During a routine health check, my platelet count was low (approximately 143,000), but everything else was normal.
My weight has stabilized at 60 kg after dropping from 75 kg four years ago, and I have not lost or gained weight since then.
My bowel movements are normal, occurring about once or twice a day, with occasional diarrhea.
My appetite and diet are normal.
I would like to ask the doctor the following questions:
1.
Since all tests have returned normal and I have been on medication for a long time, why do my symptoms persist? Could it be related to my diet?
2.
I had an appendectomy about 22 years ago; could this be related (such as intestinal adhesions)? If so, how should I address this?
3.
Is the abdominal CT scan the final diagnostic tool? If not, what other tests should I undergo to determine the cause of my symptoms?
I apologize for the lengthy description and appreciate your understanding.
I look forward to your response and assistance, and I am extremely grateful.
Thank you! Wishing you a Merry Christmas and a Happy New Year, with all the best in the coming year.

yi zi, 40~49 year old female. Ask Date: 2006/12/26

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello Mr.
Easy: Based on the information provided, major diseases have mostly been ruled out (only colonoscopy and small bowel endoscopy have not been performed), so there should be no significant issues.
You may discuss related medications and lifestyle adjustments with your physician (it is likely irritable bowel syndrome, commonly referred to as dyspepsia) and manage your emotions, particularly anxiety.
Weight loss should be considered in the context of potential metabolic disorders.
Changhua Hospital cares about your health.
Chen Shidian

Reply Date: 2006/12/26

More Info

Chronic abdominal pain and bloating can be particularly challenging to diagnose and manage, especially when extensive testing yields normal results. Your case, with a history of gastrointestinal discomfort, normal imaging studies, and a benign gallbladder polyp, raises several important considerations.

1. Persistent Symptoms Despite Normal Tests: It is not uncommon for patients to experience ongoing symptoms even when diagnostic tests return normal results. This can be particularly true in cases of functional gastrointestinal disorders, such as Irritable Bowel Syndrome (IBS). IBS is characterized by abdominal pain and changes in bowel habits without any identifiable structural abnormalities. Stress, diet, and gut motility can all play significant roles in exacerbating symptoms. Given your history of gastrointestinal discomfort and the recent onset of bloating, it may be worthwhile to explore dietary triggers, such as lactose intolerance or gluten sensitivity, which can contribute to bloating and discomfort.

2. Previous Appendectomy and Adhesions: Your history of appendectomy could potentially be relevant. Surgical procedures can lead to the formation of adhesions, which are bands of scar tissue that can cause organs to stick together or to the abdominal wall. These adhesions can lead to chronic pain and gastrointestinal symptoms, including bloating and discomfort. If adhesions are suspected, a surgical consultation may be warranted to discuss the possibility of laparoscopic exploration, which can help identify and potentially treat any adhesions.

3. Further Diagnostic Testing: While a CT scan is a powerful tool for diagnosing many abdominal conditions, it may not always reveal functional issues or subtle problems like small bowel obstruction due to adhesions. Depending on your symptoms, additional tests such as an upper gastrointestinal series, endoscopy, or even a small bowel follow-through may be helpful. Additionally, a referral to a gastroenterologist specializing in functional gastrointestinal disorders could provide further insights and management options.

4. Management Strategies: Since your symptoms include significant bloating and discomfort, dietary modifications may be beneficial. Keeping a food diary can help identify potential triggers. Many patients find relief by following a low-FODMAP diet, which reduces certain fermentable carbohydrates that can cause bloating. Additionally, stress management techniques, such as cognitive-behavioral therapy or mindfulness practices, can also be effective in managing symptoms related to IBS.

5. Medication Review: If you are currently on medication for your symptoms, it may be worth reviewing these with your healthcare provider. Some medications can cause gastrointestinal side effects, including bloating and discomfort. A tailored approach to medication management, possibly including the use of probiotics or medications specifically targeting IBS, could be beneficial.

In summary, while your extensive testing has not revealed any significant pathology, your ongoing symptoms warrant a comprehensive approach that includes dietary management, potential evaluation for adhesions, and possibly further diagnostic testing. Collaborating closely with your healthcare team, including a gastroenterologist, can help you navigate these persistent symptoms and improve your quality of life. Remember, chronic abdominal pain is often multifactorial, and a holistic approach is essential for effective management.

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