Chronic Abdominal Pain: Is It Related to Rib Discomfort?

Q: Chronic Abdominal Pain: Is It Related to Rib Discomfort?

Hello： You may consider using a topical analgesic ointment. <br>Changhua Hospital cares about your health. <br>Dr. <br>Tsai An-shun.

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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 and a feeling of pressure and bloating in the rib area.
I also occasionally feel pain in my right lower back, but it’s not as frequent.
I have undergone various tests in the gastroenterology department, 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, my rib discomfort has not, and it seems to be getting worse.
I consulted the deputy chief of gastroenterology, who provided a conclusion, but the rib doctor could not explain my symptoms, so I sought opinions from rheumatology, pulmonology, urology, and neurology, all of which 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 medications prescribed by the neurologist, my rib discomfort has not improved.

I would like to ask if gastrointestinal issues can cause persistent feelings of pressure, bloating, and cramping in the rib area, along with intermittent sharp pain? I have been quite troubled by this for a long time.

For your reference, my height is 166 cm and my weight is 49 kg (my weight has consistently ranged from 48 to 50 kg over the past year, six months, and two months).
The frequency of my pain is about twice a month, and when it occurs, it lasts from 3 to 14 days, but it does not persist continuously.
My past medical history includes treated thyroid issues, with all levels currently within normal ranges.
The medications I am currently taking include: Catilon (40 mg), Normacol Plus, Vioment, and Xanax (0.25 mg).
I have bowel movements almost daily, occasionally every three days.
My abdominal pain has improved somewhat, but I still experience almost daily pressure, cramping, bloating, and sharp pain in my left rib area, which began when my abdominal pain started.
What should I do?

BB, 20~29 year old female. Ask Date: 2012/10/23

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: You may consider using a topical analgesic ointment.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2012/10/23

More Info

Chronic abdominal pain, especially when accompanied by rib discomfort, can be a complex issue that often requires a multifaceted approach to diagnosis and treatment. Based on your description, it seems that you have been experiencing persistent lower abdominal pain for nearly two years, which has now evolved into discomfort in the rib area, characterized by pressure, bloating, and intermittent sharp pains. Despite undergoing various diagnostic tests—including stool tests, endoscopy, and imaging studies—results have returned normal, leading to a diagnosis of irritable bowel syndrome (IBS). However, the rib discomfort remains unexplained.

Firstly, it’s important to understand that the gastrointestinal (GI) system and the musculoskeletal system can be interconnected. Conditions like IBS can lead to referred pain, where discomfort is felt in areas other than where the problem originates. The abdominal organs, including the intestines, are innervated by a network of nerves that can sometimes cause sensations of pain or discomfort in the rib cage or back. This could explain the pressure and discomfort you are experiencing in the rib area.

Additionally, chronic abdominal pain can lead to muscle tension and spasms in the surrounding areas, including the rib cage and lower back. If you have been experiencing abdominal pain for an extended period, it’s possible that your body has developed compensatory muscle patterns that could contribute to rib discomfort. This is particularly relevant if you have altered your posture or movement patterns to avoid pain, which can lead to muscle imbalances and discomfort in other areas.

You mentioned that you have consulted various specialists, including rheumatology, thoracic medicine, urology, and neurology, without finding a definitive cause for your rib discomfort. This is not uncommon in cases where pain is multifactorial. It may be beneficial to consider a multidisciplinary approach that includes physical therapy, which can help address any musculoskeletal issues that may be contributing to your symptoms. A physical therapist can work with you to develop a tailored exercise program that focuses on strengthening and stretching the muscles around your abdomen and rib cage, potentially alleviating some of the discomfort.

In terms of your current medications, it’s worth discussing with your healthcare provider whether they are adequately addressing your symptoms. While medications like Xanax can help with anxiety, they may not directly address the physical discomfort you are experiencing. It may be helpful to explore other options, such as medications specifically aimed at managing IBS symptoms or muscle relaxants if muscle tension is a contributing factor.

Lastly, it’s essential to consider the role of stress and anxiety in your overall health. Chronic pain can be exacerbated by psychological factors, and managing stress through techniques such as cognitive-behavioral therapy, mindfulness, or relaxation exercises may provide additional relief.
In summary, while your gastrointestinal evaluations have returned normal, the connection between your abdominal pain and rib discomfort may be related to referred pain, muscle tension, or even psychological factors. A comprehensive approach that includes physical therapy, medication review, and stress management may be beneficial in addressing your symptoms. If your discomfort persists or worsens, it is crucial to continue working with your healthcare providers to explore further diagnostic options or treatment strategies.

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