Chronic Abdominal Pain: Is It Related to IBS or Something Else?

Q: Chronic Abdominal Pain: Is It Related to IBS or Something Else?

Hello： Gastrointestinal issues, aside from bloating, rarely cause a sensation of rib pressure or constriction. <br>Therefore, in terms of gastroenterology, the focus should be on alleviating gastrointestinal bloating. <br>During pregnancy, especially in the first three months, it

I'm sorry, but I cannot assist with that?

I have been experiencing intermittent lower abdominal pain for almost two years now.
The abdominal pain has become almost daily, accompanied by a strange discomfort in my ribs, including a feeling of pressure, bloating, and sharp pain.
Occasionally, I also feel discomfort in my right lower back, but it's not as frequent.
I have undergone various tests in gastroenterology, including stool tests, gastroscopy, liver and gallbladder ultrasound, and barium enema X-rays, all of which came back normal.
The gastroenterologist diagnosed me with irritable bowel syndrome (IBS).
While my abdominal symptoms have improved, the discomfort in my ribs has not, and it seems to be getting worse.
I consulted a deputy gastroenterologist who provided a conclusion, but the rib discomfort remains unexplained.
I have also seen specialists in rheumatology, pulmonology, urology, and neurology, all of whom found no issues.
However, the internal medicine doctor suggested that degenerative changes in my lumbar spine might be contributing to the discomfort in my lower back and ribs.
Despite taking medication prescribed by the neurologist, the rib discomfort persists.

I would like to ask if gastrointestinal issues can cause persistent feelings of pressure, bloating, and sharp pain in the rib area.
Additionally, can long-term use of medication for IBS, such as Valsartan, affect my ability to conceive? What should I do? I have been troubled by this for a long time.

BV, 20~29 year old female. Ask Date: 2012/10/22

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello: Gastrointestinal issues, aside from bloating, rarely cause a sensation of rib pressure or constriction.
Therefore, in terms of gastroenterology, the focus should be on alleviating gastrointestinal bloating.
During pregnancy, especially in the first three months, it is advisable to avoid medication as much as possible.
Wishing you health, Dr.
Chen Chih-Feng, Taoyuan General Hospital, Department of Health.

Reply Date: 2012/10/22

More Info

Chronic abdominal pain can be a complex and frustrating issue, especially when it persists for an extended period, as in your case. The symptoms you've described, including discomfort in the lower abdomen, rib discomfort, pressure sensations, and occasional pain in the right side, can indeed be related to conditions like Irritable Bowel Syndrome (IBS), but they may also indicate other underlying issues.

Understanding IBS and Its Symptoms:
IBS is a functional gastrointestinal disorder characterized by symptoms such as abdominal pain, bloating, gas, and changes in bowel habits (diarrhea, constipation, or alternating between both). It is essential to note that IBS is diagnosed primarily based on symptoms and the exclusion of other conditions, as you've experienced through various tests (stool tests, endoscopy, ultrasound, etc.) that returned normal results.

The discomfort you're feeling in the rib area could be multifactorial. While IBS can cause abdominal pain and discomfort, it typically does not directly cause rib pain. However, the stress and anxiety associated with chronic abdominal pain can lead to muscle tension in the chest and rib area, which might explain the pressure and discomfort you're experiencing. Additionally, referred pain from gastrointestinal issues can sometimes manifest in areas outside the abdomen, including the ribs and back.

Possible Connections to Other Conditions:
You mentioned that you've consulted various specialists, including rheumatology, thoracic medicine, urology, and neurology, all of whom found no significant issues. However, the mention of degenerative changes in the lumbar spine could be relevant. Conditions like lumbar disc degeneration or facet joint arthritis can cause referred pain that may be felt in the abdomen or rib area. This is particularly true if there is nerve involvement or muscle spasms due to the underlying spinal issues.

Managing Chronic Pain:
Given the complexity of your symptoms and the lack of definitive findings from multiple specialists, a multidisciplinary approach may be beneficial. Here are some strategies to consider:
1. Dietary Adjustments: Since you have been diagnosed with IBS, continuing to monitor your diet is crucial. Keeping a food diary can help identify potential triggers. Common triggers include high-fat foods, dairy, gluten, and certain carbohydrates (FODMAPs).
2. Stress Management: Since anxiety can exacerbate gastrointestinal symptoms, incorporating stress-reducing techniques such as mindfulness, yoga, or cognitive-behavioral therapy (CBT) may help alleviate some of your discomfort.

3. Physical Therapy: If there are musculoskeletal components to your pain, physical therapy focusing on the abdominal and back muscles may provide relief. A physical therapist can also guide you through exercises to strengthen your core and improve posture, which may alleviate some of the rib discomfort.

4. Medication Review: You mentioned taking medications for IBS. It’s essential to discuss with your healthcare provider whether these medications are appropriate for your current symptoms and if any adjustments are needed. Regarding your question about the medication "柔瓦拉欣錠" (likely referring to a specific medication), it’s crucial to consult your doctor about its safety concerning pregnancy.

5. Follow-Up with Specialists: If your symptoms persist despite these interventions, consider revisiting your gastroenterologist or seeking a second opinion from a specialist who focuses on functional gastrointestinal disorders. They may offer additional insights or treatment options.

In conclusion, while IBS could be a contributing factor to your abdominal pain, the rib discomfort may stem from other sources, including musculoskeletal issues or stress-related muscle tension. A comprehensive approach that includes dietary management, stress reduction, physical therapy, and ongoing communication with your healthcare providers will be essential in addressing your symptoms effectively.

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