Persistent Stomach Pain and Constipation: Seeking Relief and Answers

Q: Persistent Stomach Pain and Constipation: Seeking Relief and Answers

Dear Miss Ruohan： Your upper abdominal pain symptoms may require further confirmation through gastroscopy and ultrasound examinations, especially since you are experiencing weight loss (but the examination costs are quite high abroad?). <br>Additionally, difficulty in bowel movem

Persistent stomach pain day and night, with bowel movements occurring only once every three to four days?

Hello Doctor, I moved to Canada in the summer of 2006.
Starting in early November, I began experiencing persistent bloating and discomfort in my stomach, but I didn't think much of it and did not seek medical attention.
By early December, in addition to the bloating, I started having stomach pain at night.
Therefore, I visited a clinic at the end of December, where the doctor ordered blood tests, and the results came back normal.
The doctor prescribed Nexium 40 mg to take once daily, but it did not alleviate my symptoms at all.
My nighttime stomach pain worsened day by day, evolving into constant pain both day and night.
As the pain intensified, I returned to the doctor, who ordered an abdominal X-ray, which also showed normal results.

In addition to the persistent stomach pain, I have been experiencing difficulty with bowel movements, having a bowel movement only every 4 to 5 days (in Taiwan, I had no issues and would go daily).
Since my pain has been worsening daily but all tests have returned normal, the doctor suggested that it might be due to stress from the new environment, compounded by severe constipation.
However, I do not feel that I am under significant stress as the doctor described.
Regarding bowel movements, despite drinking plenty of water daily, I only find myself urinating frequently and am unable to have a bowel movement.
The doctor prescribed Ratio-Lactulose, instructing me to take 15 ml twice a day.
I took it for three days, which helped with bowel movements, producing soft stools, but after taking it yesterday, I have not been able to have a bowel movement for the past two days.
The doctor had suspected gallstones, but after reviewing my blood tests, which were all normal, he ruled that out.
Currently, my stomach pain is continuous day and night, especially the nighttime pain, which I can hardly tolerate.
I am only able to sleep about 2 to 3 hours each night.
During the day, my stomach also hurts, and I cannot catch up on sleep.
However, during the day, I can distract myself with activities, but at night, the long hours feel unbearable.
In addition to the stomach pain, the inability to sleep has left me feeling very weak, and since I communicate with the doctors here in English, I feel there is some barrier in communication.
The doctor attributes my stomach pain to a stressful lifestyle, and I truly do not know what to do.
Thank you for taking the time to respond to my condition.

Ruo Han, 30~39 year old female. Ask Date: 2007/01/10

Dr. Chen Shidian reply Gastroenterology and Hepatology

Dear Miss Ruohan: Your upper abdominal pain symptoms may require further confirmation through gastroscopy and ultrasound examinations, especially since you are experiencing weight loss (but the examination costs are quite high abroad?).
Additionally, difficulty in bowel movements is often due to emotional factors or dietary habits; if there is no blood in the stool or significant weight loss, medication adjustments may suffice.
Changhua Hospital cares about your health, Chen Shidian.

Reply Date: 2007/01/10

More Info

It sounds like you are experiencing a very challenging situation with persistent stomach pain and constipation, which has significantly affected your quality of life. Based on your description, it seems that despite various medical evaluations and treatments, you are still struggling with symptoms that are not adequately addressed.
Firstly, it’s important to acknowledge that gastrointestinal issues can be complex and multifactorial. Your symptoms of persistent stomach pain, especially at night, along with constipation, could be indicative of several underlying conditions. While your doctors have ruled out gallstones and have found normal blood test results, there are still other possibilities to consider.

One potential cause of your symptoms could be functional gastrointestinal disorders, such as functional dyspepsia or irritable bowel syndrome (IBS). These conditions can manifest with symptoms like bloating, abdominal pain, and changes in bowel habits, and they are often exacerbated by stress or changes in lifestyle. Even if you do not perceive your current life situation as stressful, the transition to a new environment can sometimes lead to subconscious stress responses that affect gut function.

Another possibility is that you may be experiencing a condition known as gastroparesis, where the stomach empties slowly, leading to bloating and pain. This condition can be challenging to diagnose, as it often requires specific tests like gastric emptying studies. Additionally, your symptoms could be related to dietary factors or food intolerances that may have developed after your move to Canada.

Regarding your constipation, the use of lactulose is a common approach, but if it is not providing consistent relief, it may be worth discussing alternative treatments with your doctor. Other options include dietary changes, such as increasing fiber intake through fruits, vegetables, and whole grains, as well as considering over-the-counter fiber supplements. Staying hydrated is also crucial, but it sounds like you are already doing this.
In terms of managing your pain and improving your sleep, it may be beneficial to explore medications that can help with both gastrointestinal symptoms and anxiety, as anxiety can exacerbate gastrointestinal issues. Medications like proton pump inhibitors (PPIs) can help reduce stomach acid, but if they are not effective, your doctor may consider other options.
Cognitive-behavioral therapy (CBT) or other forms of psychological support may also be beneficial, especially if there is an underlying anxiety component contributing to your symptoms. Stress management techniques, such as mindfulness, yoga, or relaxation exercises, can also help alleviate some of the discomfort you are experiencing.

Given the complexity of your symptoms and the impact they are having on your life, it may be worthwhile to seek a second opinion from a gastroenterologist who specializes in functional gastrointestinal disorders. They may have additional insights or treatment options that could be more effective for your situation.

In summary, while it is understandable that you feel frustrated with your current treatment plan, there are still avenues to explore. Open communication with your healthcare provider about your ongoing symptoms and concerns is essential. You deserve to find relief and regain your quality of life.

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