Chronic Abdominal Pain and Its Unexplained Symptoms - Gastroenterology and Hepatology

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What should I do?


Supplementing from the previous post, the following conditions have already affected my daily life...
After more than a year of consultations, there have been no results...
I have been experiencing intermittent abdominal pain for a long time, which has progressed to almost 24-hour pain in both lower back and rib areas, with a constant feeling of pressure, tightness, and an indescribable sense of discomfort.
The abdominal pain does not occur every day for 24 hours, but the discomfort in the lower back and rib area is daily.
I often have unexplained bruises without any impact, and my body has developed some dark moles, which also began when the abdominal pain started.
The discomfort in the lower back and rib area is not fixed; it tends to occur in the same place for several consecutive days before shifting to another location.
Sometimes it is in the front right lower back, sometimes in the front left lower back, and sometimes in both.
It can also occur in the back right lower back, back left lower back, or both.
Occasionally, it affects the front left rib, front right rib, back left rib, or back right rib.
In summary, the discomfort is in various locations and has persisted for over a year.
The abdominal pain has also lasted for more than a year, but it does not occur daily, while the discomfort in the lower back and rib area is constant.
This discomfort began with the onset of abdominal pain, which was not present before.
I have consulted gastroenterology, gynecology, urology, and allergy/rheumatology, all of which found no issues.
The gastroenterologist diagnosed me with irritable bowel syndrome, but after taking medication for over a year, there has been no improvement in either the abdominal pain or the discomfort in the lower back.
The gastroenterologist stated that he could not determine whether the discomfort in the lower back and rib area was related to gastrointestinal issues.
I have undergone gastroscopy, barium enema, abdominal ultrasound, and stool tests, all of which returned normal results.
I am currently under evaluation by a neurologist, who mentioned that my condition is quite unusual.

I would like to ask a professional doctor for advice on the following:
1.
What should I do if all tests come back normal? The medication for irritable bowel syndrome has not improved my condition.
2.
What should I do about the discomfort in my lower back and rib area?
3.
Is there a connection between the unexplained bruising and dark moles that started with the abdominal pain?
4.
Is it concerning that I have started to develop dark moles? (My family is worried that the appearance of dark moles could indicate a problem.)

JJ, 20~29 year old female. Ask Date: 2012/09/21

Dr. Chen Qifeng reply Gastroenterology and Hepatology


Hello, regarding gastrointestinal issues, if there is pain from the waist to the rib cage, especially after undergoing examinations such as gastroscopy, colon X-ray, and abdominal ultrasound, and all results are normal, then the likelihood of gastrointestinal problems is further reduced.
As for the dark spots or moles, they may not necessarily be directly related to the gastrointestinal tract.
It might be necessary to consider blood tests.
Wishing you good health, Dr.
Chen Chih-Feng, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2012/09/21

More Info


Chronic abdominal pain can be a complex and frustrating condition, especially when it persists for an extended period without a clear diagnosis. Your symptoms, including persistent abdominal pain, discomfort in the lower back and rib area, and the presence of unexplained bruising and new moles, warrant a thorough evaluation. Here’s a breakdown of your concerns and some insights into potential underlying issues.

1. Unexplained Symptoms and Diagnostic Challenges: Chronic abdominal pain can stem from various causes, including gastrointestinal disorders, musculoskeletal issues, or even psychological factors. Given that you've undergone extensive testing with no definitive diagnosis, it may be beneficial to consider less common conditions or overlapping syndromes. Conditions like irritable bowel syndrome (IBS) can present with abdominal pain and discomfort, but they often require a multifaceted approach to management, including dietary changes, stress management, and sometimes medication.

2. Pain Location and Characteristics: The fact that your pain is not localized and shifts between different areas of your abdomen and back could suggest a few possibilities. For instance, referred pain from internal organs can sometimes manifest in unexpected locations. Additionally, conditions such as fibromyalgia or myofascial pain syndrome could lead to widespread discomfort and tenderness, which might explain the variability in your symptoms.

3. Bruising and Skin Changes: The appearance of unexplained bruising and new moles is concerning and should not be overlooked. While some individuals may bruise easily due to minor trauma or certain medications, it’s essential to rule out any underlying hematological conditions, such as clotting disorders or platelet dysfunction. The development of new moles, particularly if they change in size, shape, or color, should be evaluated by a dermatologist to rule out skin cancer or other dermatological conditions.

4. Psychological Factors: Chronic pain can often be exacerbated by psychological factors such as anxiety and depression. These conditions can amplify the perception of pain and lead to a cycle of discomfort and distress. It might be beneficial to consider a holistic approach that includes mental health support, which can help in managing both the psychological and physical aspects of your symptoms.

5. Next Steps: Since you are currently under the care of a neurologist, it may be worthwhile to continue exploring neurological causes, particularly if your symptoms include any neurological signs (e.g., numbness, tingling). Additionally, seeking a second opinion from a specialist in pain management or a multidisciplinary clinic that focuses on chronic pain could provide new insights.
6. Lifestyle and Dietary Considerations: While you mentioned that medications for IBS have not improved your symptoms, dietary modifications can still play a crucial role. Keeping a food diary to identify potential triggers, along with incorporating a balanced diet rich in fiber, may help alleviate some gastrointestinal symptoms. Regular physical activity, tailored to your comfort level, can also improve overall well-being and potentially reduce pain.

In summary, chronic abdominal pain with associated symptoms like back pain, bruising, and skin changes requires a comprehensive approach. It’s essential to continue working closely with your healthcare providers, advocating for further evaluations as needed, and considering a multidisciplinary approach that addresses both physical and psychological aspects of your health. If you have concerns about the new moles or bruising, do not hesitate to consult a dermatologist or a hematologist for further evaluation. Your health is paramount, and finding the right path to diagnosis and treatment is crucial for improving your quality of life.

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