Abdominal Pain: Normal Endoscopy Results and Hidden Causes

Why are the results of the gastroscopy and colonoscopy normal, yet the cause of my abdominal pain cannot be identified?

Dr.
Chen: After undergoing gastroscopy and colonoscopy, the doctor diagnosed me with Helicobacter pylori and wrote in English—peptic ulcer.
Therefore, I am unsure whether it is a duodenal ulcer or a gastric ulcer, and the doctor did not ask me to return for a follow-up.
My symptoms are as follows: 1.
I experience pain around my navel, below the ribs on both sides, and on both sides of the pelvis in the front of my body.
This pain occurs every 3 to 5 years, and usually, the only painful area is below the ribs.
Sometimes it feels like a mass of gas is stuck in the middle, unable to rise or fall.
Each time, the symptoms are accompanied by shaking, cold sweats, and nausea.
2.
Recently, my stool has been mixed with some thin membranes (like jellyfish) that are getting larger, with a diameter of about 2 centimeters, and the quantity is increasing.
3.
The doctor said I do not have hemorrhoids—so why does it hurt? The doctor also mentioned that I do not have a fractured coccyx, and if I did, it would be visible with an endoscope—wouldn't my coccyx need to penetrate the colon for it to be seen? (I previously fainted and sat on the bar of exercise equipment without any pain at the time, so I did not get checked and cannot confirm whether I have a fractured coccyx.) 4.
Because I have a family history—my grandmother had rectal cancer, my father had rectal cancer, my maternal grandmother had skin cancer, and my mother had breast cancer—along with my recent bowel and abdominal pain, I was worried and decided to undergo gastroscopy and colonoscopy early.

I would like to ask: 1.
Is it normal to have thin membranes (like jellyfish) mixed in my stool? Does the size or color of the membranes matter? After the gastroscopy and colonoscopy, starting from the day after the examination (not counting the day of the examination), I only passed a small amount of membrane— is this normal? 2.
Given that the results of the gastroscopy and colonoscopy were normal, could my abdominal pain really not be caused by gastrointestinal issues? Could it be related to the uterus, ovaries, or liver? 3.
The doctor said I do not have hemorrhoids, so why does it hurt? I would appreciate your answers, Dr.
Chen.
Thank you.

cweywey, 20~29 year old female. Ask Date: 2009/04/20

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, based on the symptoms, it may just be functional issues such as bloating or indigestion.
In theory, if there is a peptic ulcer, it should be treated; however, even if the coccyx is fractured, it should not penetrate the gastrointestinal tract.
Having a family history of cancer certainly warrants caution, but there is no need to panic.
Just follow your physician's recommendations for screening and follow-up.
If you are concerned about gynecological issues, please consult a gynecologist.
Wishing you good health.
Sincerely, Dr.
Chi-Feng Chen, Taoyuan Hospital, Department of Health.

Reply Date: 2009/04/20

More Info

Abdominal pain can be a complex and multifaceted issue, often requiring careful evaluation to determine its underlying cause. In your case, you've undergone endoscopic examinations that revealed the presence of Helicobacter pylori and a diagnosis of peptic ulcer disease, which could be either gastric or duodenal. However, the persistence of your symptoms, particularly the pain around your navel and the sides of your rib cage, raises additional concerns.

1. Nature of Your Symptoms: The description of your pain, which occurs every few years and is accompanied by sensations of pressure or gas, suggests that it may not solely be related to your gastrointestinal tract. The intermittent nature of the pain, along with symptoms like sweating and nausea, could indicate a more systemic issue or a functional gastrointestinal disorder, such as irritable bowel syndrome (IBS).
2. Bowel Movements and Membrane-like Material: The presence of thin, membrane-like material in your stool is unusual and warrants further investigation. This could be related to mucosal shedding or other gastrointestinal issues. While it might not be immediately alarming, the increasing size and frequency of these occurrences should be discussed with your healthcare provider. It is essential to monitor any changes in your bowel habits, as they can provide critical clues about your digestive health.

3. Family History of Cancer: Given your family history of various cancers, including colorectal cancer, it is understandable that you are concerned about your symptoms. While your endoscopic examinations returned normal results, it is crucial to remain vigilant. The absence of findings during these procedures does not entirely rule out the possibility of other conditions, including gynecological issues (such as ovarian cysts or endometriosis) or liver-related problems.
4. Pain Without Hemorrhoids: The fact that your physician has ruled out hemorrhoids does not necessarily explain your pain. Abdominal pain can arise from various sources, including muscular strain, nerve irritation, or referred pain from other organs. Conditions affecting the uterus or ovaries, such as fibroids or ovarian cysts, could also manifest as abdominal pain, particularly if they are located in a way that irritates surrounding tissues.

5. Next Steps: Given the complexity of your symptoms and the potential for underlying issues, it may be beneficial to seek a second opinion or further evaluation from a specialist, such as a gastroenterologist or a gynecologist. They may recommend additional imaging studies, such as an ultrasound or MRI, to assess your abdominal and pelvic organs more thoroughly.
In summary, while your endoscopic results are reassuring, the combination of your symptoms, family history, and the unusual findings in your stool suggests that further investigation is warranted. It is essential to communicate openly with your healthcare provider about your concerns and to advocate for a comprehensive evaluation to rule out any serious conditions. Remember, early detection and intervention are key to managing health issues effectively.

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