Chronic Abdominal Pain: Seeking Answers Beyond Gastrointestinal Issues

I'm not sure where the problem is?

Hello Doctor: I have been suffering from prolonged abdominal pain for many years.
Especially in the past year, I have been experiencing pain around my navel! Every morning when I wake up, it feels like a pain from coughing for a long time! Additionally, my bowel movements have noticeably become thinner (about the size of my index or middle finger).
I often have to lean back on the toilet to barely pass a little bit.
Recently, I had a colonoscopy, and the doctor said my intestines are very healthy, with no polyps.
The doctor mentioned that many illnesses are self-perceived...
is that really the case? However, the feeling of obstruction during bowel movements is so evident for me, and I also experience this sensation when urinating.
If it’s not a problem with my intestines, I don’t know which specialty I should consult.
PS: I had an upper endoscopy and abdominal ultrasound last July and August, both of which were normal.
Do I need to undergo these two tests again this year?

Die, 30~39 year old female. Ask Date: 2013/08/04

Dr. Lin Shunfa reply Internal Medicine

Dear Butterfly, regarding your abdominal pain and bowel movement issues, you may want to consult a gastroenterologist for further evaluation and treatment.

Reply Date: 2013/08/04

More Info

Chronic abdominal pain can be a perplexing and frustrating issue, especially when multiple tests and examinations yield normal results. Your description of pain around the navel, changes in bowel habits, and the sensation of needing to lean back to relieve discomfort during bowel movements suggests that there may be underlying factors that are not strictly gastrointestinal in nature.

Firstly, it’s important to recognize that abdominal pain can stem from a wide range of causes, including gastrointestinal, gynecological, urological, musculoskeletal, and even psychological factors. Since you have already undergone a colonoscopy and other imaging studies that have ruled out significant gastrointestinal pathology, it may be beneficial to consider other potential causes.

1. Functional Gastrointestinal Disorders: Conditions such as Irritable Bowel Syndrome (IBS) can cause chronic abdominal pain, bloating, and changes in bowel habits without any structural abnormalities. Stress and anxiety can exacerbate these symptoms, leading to a cycle of discomfort. It may be worthwhile to explore dietary changes, stress management techniques, and possibly medications that target IBS symptoms.

2. Pelvic Floor Dysfunction: Given your symptoms of difficulty with bowel movements and the sensation of obstruction, pelvic floor dysfunction could be a contributing factor. This condition can affect both bowel and bladder function, leading to symptoms like straining during bowel movements and urinary urgency or frequency. A referral to a pelvic floor specialist or a physical therapist trained in this area may provide insights and therapeutic options.

3. Musculoskeletal Issues: Sometimes, abdominal pain can be referred from musculoskeletal sources, such as the abdominal wall or diaphragm. Conditions like muscle strain or trigger points in the abdominal muscles can mimic visceral pain. A thorough physical examination focusing on the abdominal wall may help identify any musculoskeletal contributors.

4. Psychological Factors: Chronic pain can often be influenced by psychological factors. Anxiety, depression, and stress can manifest as physical symptoms, including abdominal pain. Cognitive-behavioral therapy (CBT) or other forms of psychological support may be beneficial in managing your symptoms.

5. Urological Concerns: Since you mentioned experiencing discomfort during urination, it may be worthwhile to consult a urologist to rule out any urological conditions, such as interstitial cystitis or urinary tract infections, which can sometimes present with abdominal pain.

Regarding your question about repeating the endoscopic examinations, it may not be necessary to undergo these tests again if your symptoms have not changed significantly and previous results were normal. However, if new symptoms arise or if your current symptoms worsen, discussing the need for further evaluation with your healthcare provider would be prudent.

In conclusion, chronic abdominal pain is often multifactorial, and a comprehensive approach that considers various systems in the body is essential. Collaborating with a multidisciplinary team, including gastroenterologists, urologists, pelvic floor specialists, and mental health professionals, may provide a more holistic understanding of your symptoms and lead to effective management strategies. It’s crucial to continue advocating for your health and seeking answers until you find a resolution that improves your quality of life.

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