Q. I have abdominal, back, and joint pain with vaginal discharge. What could be the cause?

Answered by
Dr. Ajeet Kumar Lohana
and medically reviewed by Dr. Preetha J
This is a premium question & answer published on Oct 28, 2020 and last reviewed on: Nov 05, 2020

Hi doctor,

I am a 21-year-old young woman. I have abdominal pain for the past year. In the beginning, I consulted a gastroenterologist who diagnosed me with Helicobacter Pylori. I took the antibiotic treatment except that two months later, I had sepsis without a cause. At the start of my pain, I had a high inflammatory marker and leukocytes too. Now I have a lot of stomach pain with several symptoms: back pain, joint pain (knees), absence of menstruation, left and right hypochondrium pain that radiates to the back, vaginal discharge, constipation, and cystitis. I am splenectomized 14 years back. In the past, I took Inexium, antibiotics, and antifungal drugs. Now I am taking probiotics, but it does not work on me. What should I do? Nobody seems to know what I have, and my symptoms are still here. Is it possible that my gut bacteria are gone because of the antibiotics treatments, and now I developed SIBO (small intestinal bacterial overgrowth) or IBS (Irritable bowel syndrome)? I hope to have an answer from you soon. And have a great day.

#

Hello,

Welcome to icliniq.com.

I can understand that you must be very upset regarding your ongoing undiagnosed abdominal pain. The description of pain, joint pain, younger age, and weight loss with the absence of menstruation suggest some common disorders. Celiac disease, Crohn's disease vascular causes such SMA (superior mesenteric artery) artery syndrome, celiac artery syndrome pancreatitis idiopathic or genetic, and some chronic infections (since you have splenectomy), such as TB (tuberculosis), fungal infections, may be a cause of unreasoned sepsis. And lastly, functional abdominal pain syndromes (FAPS) and one of which is IBS. SIBO seems less likely a reason for recurrent abdominal pain. Now, first of all, I would like to know details about your abdominal pain. Then I would need you to upload all testing that has been done.

Only then would I be able to guide you to the next best step in managing your condition.

  1. Where exactly do you feel the pain?
  2. Are this like a cramp or stabbing or piercing sharp pain?
  3. How would you score this pain on a scale of 1 to 10?
  4. Does this pain bother you in the middle of the night?
  5. Does this pain go to the back?
  6. Do meals or water intake worsen this pain?
  7. Do you ever notice blood in stools?
  8. Or any change in the color of stools?
  9. Does this come in episodes?
  10. What are the times when you think the pain is in remission?
  11. Does any family members have a history of celiac disease?
  12. Do you have any history of allergies?
  13. Do you have any history of abdominal cancers?
  14. Do you have pets at home?
  15. Do you have any invasive procedures like gastroscopy or colonoscopy performed or suggested?
  16. Are you sexually active?
  17. Do you smoke or take alcohol?
  18. Did any ultrasound, CT (computed tomography), or MRI (magnetic resonance imaging) abdomen are performed for these symptoms before?

I would need all the above information and all your testing if available before I can recommend what you should do now. This is a tedious list of questions, but I am sure we would be at some conclusion at the end of this conversation. If you would like to talk to me via phone or video consultation, I would be happy to do that. We probably wrap things faster.


The Probable causes:

As mentioned above.

Hi doctor,

Thank you for your reply.

I have attached the file.

#

Hello,

Welcome back to icliniq.com.

They are not yet uploaded. Kindly upload it again. And I would appreciate it if you could provide answers to the above questions.

Hi doctor,

Thank you for your reply.

It is hard for me to describe the pain that I am feeling now. It is like inflammatory pain. Most of the time, I have left and right hypochondrium pain radiating to the back and lower abdomen pelvic pain. I have seen my gynecologist; she says everything is fine. So I think the pain starts from the intestines. And also, joint pain and my right knee hurt me the most.

The scale of pain 8/10. Sometimes it hurts even at night. Yes, the pain irradiate to the back (I have already seen a specialist I do not have any problem). The pain is always here; it does not change with or without eating food. There is no blood in stools, but it changes its color, lot of constipation, and white mucus in the stool. There is no history of celiac disease in the family. And have no history of food allergy or abdominal cancer. I do not have any pets at home (dog or cat).

I already had fibroscopy and colonoscopy with biopsy. I do not smoke or drink. I am a virgin. I already had CT and MRI scans, and everything was fine.

Two months before I had sepsis, I took antifungal drugs. Nobody knows why I had sepsis and why I have all these symptoms.

The symptoms are palpitations in the abdomen, left and right hypochondrium pain, extreme fatigue, white mucus in stool, constipation, joint pain (knees), back pain, absence of menstruation, vaginal discharge, cystitis, and weight loss.

#

Hello,

Welcome back to icliniq.com.

Thanks for providing the further information.

I was unable to read some of your reports, which are not written in English. These are probably CT, MRI reports, and biopsy reports, or colonoscopy or gastroscopy reports. And some of the doctor's notes, I guess, which I could not read. I have seen the other tests which you uploaded (attachment removed to protect patient identity). Acute intermittent porphyria (AIP), and C1 esterase deficiency, are two important causes of abdominal pain, which are essentially ruled out by investigations. After all my assessment (however little compromised by the absence of English), I want you to do the following things. Kindly arrange CT, MRI, biopsy, endoscopies report, and doctor notes in English and upload.

The pain you describe, which is continuous, severe, radiating to back, and bother you in the middle of the night, suggest two to three possibilities.

Pancreas related are, Sphincter of Oddi dysfunction (SOD), functional abdominal pain syndrome (FAPS), and lastly, irritable bowel syndrome constipation-predominant (IBS-C) are functional causes of abdominal pain. Meaning there is no structural abnormality that can be observed or picked on CT scan or blood tests.

Your calprotectin is high, a stool test that determines inflammation in the large bowel (colon). And I also see that your colonoscopy report showed chronic inflammation. However, as I could not interpret the whole report, so not sure what this high calprotectin is exactly mean in your case.

From a treatment point of view, I think of giving you some low-dose antidepressant medications, namely Tricyclic antidepressant (TCA), which are pain modulators which modulate pain arising from the abdomen in functional conditions as mentioned above. Have you tried such medicines before? I want to know your opinion about starting you on TCA. I used many patients with irritable bowel syndrome and FAPS and improved their pain and quality of life.

Kindly arrange the reports in English as I have asked.


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