Chronic Abdominal Pain: When to Consider a Colonoscopy

Long-term distress?

Doctor, I have been suffering from long-term pain in my upper and lower abdomen.
The doctor prescribed medication for irritable bowel syndrome, but I still experience intermittent abdominal pain.
I have undergone stool tests, gastroscopy, colon X-rays, and liver and gallbladder ultrasounds, all of which showed no issues.
When I asked the doctor to perform a colonoscopy, he said that since my colon X-ray was normal, there was no need for a colonoscopy.
I would like to ask if a normal colon X-ray truly means that a colonoscopy is unnecessary.
Additionally, how long does a colonoscopy take? Will it be very painful? (I have heard it is more painful than childbirth.)

Yu, 20~29 year old female. Ask Date: 2012/07/09

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello, are you referring to a barium enema when you mention a colon X-ray? If it is indeed a barium enema, then under the condition of complete bowel preparation, polyps, ulcers, or tumors of a certain size in the colon can be detected.
However, each examination has its own accuracy and sensitivity, and a barium enema can be affected by factors such as the completeness of bowel preparation, the angle of imaging, and the size of the lesions, among others.
A colonoscopy is the most direct method for examining the colon.
Your attending physician mentioned that since the colon X-ray results were normal, there is no need for further testing, and I believe there are reasons and judgments behind that.
If you have any doubts, you may need to discuss it further with him.
Individual pain tolerance, previous abdominal surgeries, body type, and various other factors can all influence the level of discomfort experienced during a colonoscopy.
If there is a necessity for a colonoscopy but fear of pain is a concern, you might consider a painless colonoscopy.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2012/07/09

More Info

Chronic abdominal pain can be a perplexing issue, especially when multiple diagnostic tests, such as stool tests, endoscopies, and imaging studies, yield normal results. In your case, it seems you have undergone a comprehensive evaluation, including stool tests, gastroscopy, colon X-rays, and abdominal ultrasound, all of which have not indicated any significant abnormalities. However, you continue to experience intermittent abdominal pain, which can be frustrating and concerning.

When it comes to the decision of whether to proceed with a colonoscopy after a normal colon X-ray, it is essential to understand the differences between these two diagnostic tools. A colon X-ray (also known as a barium enema) can provide valuable information about the structure of the colon and can help identify issues such as blockages or significant abnormalities. However, it is not as sensitive as a colonoscopy for detecting certain conditions, such as polyps, early-stage cancers, or inflammatory bowel diseases (IBD) like Crohn's disease and ulcerative colitis. Colonoscopy allows for direct visualization of the colon's inner lining and the opportunity to take biopsies if necessary.

Given your ongoing symptoms and the family history of colorectal cancer, it may be prudent to discuss the possibility of a colonoscopy with your healthcare provider. The American College of Gastroenterology recommends that individuals with a family history of colorectal cancer or polyps undergo screening earlier and more frequently than the general population. If your symptoms persist or worsen, or if you have any new concerning symptoms (such as changes in bowel habits, weight loss, or blood in the stool), a colonoscopy may be warranted regardless of previous imaging results.

Regarding the duration and discomfort associated with a colonoscopy, the procedure typically takes about 30 minutes to an hour. Patients are usually sedated, which helps minimize discomfort. While some individuals report feeling pressure or cramping during the procedure, most find it tolerable due to the sedation. It is important to communicate any concerns about pain or discomfort with your healthcare provider, as they can adjust sedation levels to ensure your comfort.

In summary, while a normal colon X-ray is reassuring, it does not entirely rule out the need for a colonoscopy, especially in the context of chronic abdominal pain and a family history of colorectal cancer. It is crucial to have an open dialogue with your healthcare provider about your symptoms and concerns. They can help determine the most appropriate next steps in your evaluation and management. Remember, early detection and intervention are key in addressing potential gastrointestinal issues effectively.

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