#MedicalCase
Recurrent abdominal bloating and eructations. Need help with the diagnosis (Internal Medicine)
Dr. Sheetal Kamble., BHMS
Medical Case Details:
32 years old male, software engineer by profession, complains of recurrent abdominal bloating and eructations. Pain all over abdomen due to bloating. No tenderness. Cannot pass stool satisfactorily. Feels as if stool has not completely passed. Sometimes gets urge to pass the stool but cannot pass. He is involved in some physical activity (30 mins to 1 hour) every day like walking, and work out. He usually eats home cooked food, lots of fruits and vegetables. Diet also includes non veg food and very occasional alcohol. This seems to be chronic but at least he would pass satisfactory stool every 2-3 days of unsatisfactory stools. However, since 2-3 weeks the sensation to pass the stool has reduced.4 weeks back he has injured his back while workout which has lead to Sciatica pain, radiating pan from buttocks till the foot with tingling and numbness. Some medication, physical therapy and heat/cold fomentation has reduced this pain to some extent.
My question is, is there any chance that lack of sensation to pass stool is due to the sciatica or nerve compression anywhere in the lower back? Abdominal examination is normal and palpation, percussion and auscultation - normal.
What can be the diagnosis in this case?
Any advise would be helpful. Thanks
Discussions
Dr. Isaac Gana
Cardiologist
Your patient is unlikely to be having these complaints due to the injury he sustained, he seems to have a long history of chronic constipation from he's eating lifestyle of low veg. You can prescribe stool laxative to ease help him pass stool and a change in eating habit will help in the long run. He will also be a good candidate for an enema.
Cardiologist
Your patient is unlikely to be having these complaints due to the injury he sustained, he seems to have a long history of chronic constipation from he's eating lifestyle of low veg. You can prescribe stool laxative to ease help him pass stool and a change in eating habit will help in the long run. He will also be a good candidate for an enema.
18.Mar, 05:01am
Dr. Saumya Mittal
Internal Medicine Physician
You will need to take the history of symptom onset. Did the bowel issue start before or after injury. Besides, anal and bulbocavernous reflex will have to be tested. Sensory level is another crucial piece of information.
With unilateral pain, in LL , it's unlikely to be a myelopathy. In fact, the bowel symptoms do sound like IBS C.
MRI LS spine , NCS all 4 limbs, colonoscopy , and stool test may help the diagnosis.
Best of luck
Best comment
18.Mar, 10:42am
Internal Medicine Physician
You will need to take the history of symptom onset. Did the bowel issue start before or after injury. Besides, anal and bulbocavernous reflex will have to be tested. Sensory level is another crucial piece of information.
With unilateral pain, in LL , it's unlikely to be a myelopathy. In fact, the bowel symptoms do sound like IBS C.
MRI LS spine , NCS all 4 limbs, colonoscopy , and stool test may help the diagnosis.
Best of luck
▲ 1
Best comment
18.Mar, 10:42am
Dr. Shobhit Shah
Internal Medicine Physician
Hello,
As there is no bladder involvement, its unlikely that there will be bowel involvement due to myelopathy or radiculopathy.
Anyway, if lesion at L1 then there will be loss of cremastic reflex but abdominal reflexes will be intact.
Internal Medicine Physician
Hello,
As there is no bladder involvement, its unlikely that there will be bowel involvement due to myelopathy or radiculopathy.
Anyway, if lesion at L1 then there will be loss of cremastic reflex but abdominal reflexes will be intact.
18.Mar, 10:43am
Dr. Sheetal Kamble
Homeopathic Physician
Thank you all for the suggestions. Actually this patient lives in USA and doctors here rarely go for investigative treatments (other than blood tests) like MRI or NCS. I have advised him to go for MRI Spine. Waiting to hear back from him.
Thanks again..
Homeopathic Physician
Thank you all for the suggestions. Actually this patient lives in USA and doctors here rarely go for investigative treatments (other than blood tests) like MRI or NCS. I have advised him to go for MRI Spine. Waiting to hear back from him.
Thanks again..
21.Mar, 12:27am
Dr. Murad Haider
Family Physician
Advice him ultrasound abdomen, mri spine and colonoscopy
Family Physician
Advice him ultrasound abdomen, mri spine and colonoscopy
13.Apr, 08:49pm
Dr. Sheetal Kamble
Homeopathic Physician
MRI Lumbar spine was advised to this patient . Here is the report -
MRI Lumbar Spine -
L1-2: There is mild disc bulging and Schmorl's nodes. The neural
foramina are mildly narrowed bilaterally.
L3-4: There is mild disc bulging and a Schmorl's node. The neural
foramina mildly narrowed bilaterally.
L4-5: There is disc bulging and a a central disc protrusion. The
protrusion deforms the thecal sac. Short pedicles contribute to mild
spinal stenosis. The neural foramina mildly narrowed bilaterally.
L5-S1: There is mild disc bulge and the neural foramina are mildly
narrowed bilaterally. The remainder of the discs, neural foramina and
facets are normal. The vertebral body heights and alignment are
maintained.
There is Modic marrow signal change in the L4 vertebral body.
The visualized conus and cauda equina are normal.. The spinal cord
terminates at theT12-L1 level.
Impression:
1. L4-5 disc protrusion with mild neural foraminal stenosis and mild
spinal stenosis.
2. Multilevel disc bulging and mild foraminal stenoses.
I would really appreciate any advice.
Homeopathic Physician
MRI Lumbar spine was advised to this patient . Here is the report -
MRI Lumbar Spine -
L1-2: There is mild disc bulging and Schmorl's nodes. The neural
foramina are mildly narrowed bilaterally.
L3-4: There is mild disc bulging and a Schmorl's node. The neural
foramina mildly narrowed bilaterally.
L4-5: There is disc bulging and a a central disc protrusion. The
protrusion deforms the thecal sac. Short pedicles contribute to mild
spinal stenosis. The neural foramina mildly narrowed bilaterally.
L5-S1: There is mild disc bulge and the neural foramina are mildly
narrowed bilaterally. The remainder of the discs, neural foramina and
facets are normal. The vertebral body heights and alignment are
maintained.
There is Modic marrow signal change in the L4 vertebral body.
The visualized conus and cauda equina are normal.. The spinal cord
terminates at theT12-L1 level.
Impression:
1. L4-5 disc protrusion with mild neural foraminal stenosis and mild
spinal stenosis.
2. Multilevel disc bulging and mild foraminal stenoses.
I would really appreciate any advice.
16.Apr, 01:10am
Dr. Murad Haider
Family Physician
Manage symptoms associated with foraminal narrowing with exercise, pain medication and/or corticosteroid injections. If symptoms remain after several weeks of conservative treatment, contact any Spine Institute to determine whether a minimally invasive, outpatient procedure known as a foraminotomy may be able to help you find relief from neck or back pain.
Family Physician
Manage symptoms associated with foraminal narrowing with exercise, pain medication and/or corticosteroid injections. If symptoms remain after several weeks of conservative treatment, contact any Spine Institute to determine whether a minimally invasive, outpatient procedure known as a foraminotomy may be able to help you find relief from neck or back pain.
16.Apr, 09:31am
Dr. Vinod Kala
Homeopathic Physician
Are you prescribed any homoeopathic medicines for him?
Homeopathic Physician
Are you prescribed any homoeopathic medicines for him?
25.May, 08:52pm
Dr. Sheetal Kamble
Homeopathic Physician
@ Dr. Vinod Kala,
Yes I have prescribed him Homeo remedy - Natrum Mur based on totality. Initially I gave him some remedies based on acute prescription. He seems to be improving with Natrum Mur. Abdominal issues has reduced to a greater extend. He started physical therapy and have been showing some improvement in lower back pain. Hoping to see progressive improvement.
Homeopathic Physician
@ Dr. Vinod Kala,
Yes I have prescribed him Homeo remedy - Natrum Mur based on totality. Initially I gave him some remedies based on acute prescription. He seems to be improving with Natrum Mur. Abdominal issues has reduced to a greater extend. He started physical therapy and have been showing some improvement in lower back pain. Hoping to see progressive improvement.
27.May, 12:56am
Are you a doctor?
Please Login to comment or ask a question.
New to icliniq? Sign Up Now
