What causes buttock and thigh pain with IBS symptoms?

Hi doctor,

This case of suspected IBS is related to my wife who is 34 years old. Symptoms mentioned below in sequence since seven months back are:

1. Stabbing pain in lower part of left buttocks only which radiated down to the knee. The timing of pain occurrence is not specific, sometimes during the day, suddenly while getting down from the car, while walking along the road and then would go off suddenly.
2. At times, the pain was severe that made her stay awake at midnight and she could not walk properly. This happened for one week, this would not be eased with Voveran gel or other oil massages.
3. No morning stiffness observed.
4. Abdominal pain and bloating followed in the morning.
5. Often all the above symptoms would lessen after passing stool or gas and would worsen with a treadmill exercise (pain would start).
6. She was taken to a GP who treated her for gastritis but symptoms of stabbing pain were not relievedwhich also occurred in the daytime but did not happen night but the abdominal pain was there with bloating.
7. She also visited a gastro, who suspected IBS. Gave medicine for nerve pain (no NSAIDs), symptoms of gas, etc., reduced. Stabbing pain relived mostly, no abdominal pain.
8. X-ray of SI and spine were fine.
9. ANA was fine.
10. Only ESR was high 74 but three months later it was 54.

Currently, she is taking Levosulpiride, Esomeprazole Domsta, and Lactifiber NP.

Kindly help.

Hi doctor,

Thank you for the reply.

As suggested, she is taking Levosulpiride (75 mg) and Esomeprazole (40 mg). Is it fine for now? After the current strip exhausts, I shall switch over to Pantoprazole and Levosulpride as you had advised. As for Pregabalin and Nortriptyline, she is taking the same under the brand name Neurotrat NP. Some query:

1. My doctor (gastro) told me that she would require a colonoscopy as her USG suggested a mild mural thickness of 7 mm of the terminal ileum and caecum. How serious is this? Can this be cured using the drug? Is it a gastric ulcer or pointing to something serious?
2. She is a thyroid patient taking Thyroxin 25 mg and is under control. But her triglycerides are 167. Should she be taking medicine?
3. Now her IBS and pain systems have gone for the last 20 days or so, and the pain, as described earlier, has subsided. Do we need to worry?
4. Any other concerns? Her urine flow is fine, with no diarrhea, and no visible blood in the stool. The color of the stool is fine, and its nature is semi-solid.Her ESR is also reducing (from 74 to 54).

Hi doctor,

Thank you for the reply.

As you said before, advising repeat USG, a lot many times, is a normal finding. It is true. No thickening of the terminal ileum was observed. Following the USG, our doctor advised us to stop the above medicine and consult an ortho (for pain in the buttock or inner thigh, or calf only left side). He suggested Esomeprazole with Domperidone with Paracetamol (700 mg SR and 300 mg IR) and also told me to continue Pregabalin and Nortriptyline.

She said that this pain happens in women and is nothing serious. But it is over a week since her pain is increasing with walking and reducing with rest. Could not follow your advice as MRI with a good doctor is difficult to access in this part of the world. Moreover, her menstrual cycle got delayed by 10 days, and my query:

1. Is it fine to go for MRI and test for serum RA and anti-CCP and ESR blood tests suggested by Orthopedic?
2. She is taking Betamethasone 0.5 mg two times daily for the last few days and her pain frequency has reduced by 90 %.
3. Will nerve compression respond to steroids?
4. What is the disease prognosis?
5. Should we visit the rheumatologist or neurologist (medicine) for an MRI of LS and SI?
6. Will the blood tests be fine with her menstrual cycle?

Please advise.