Why do I have chronic abdominal pain despite normal reports?

Question

Hi doctor,

I was diagnosed with irritable bowel syndrome (IBS) when I was 18 years old, and I am now 29. Dealing with bowel issues has become a part of my daily life. However, approximately a year ago, while raking in the yard, I noticed a pulling sensation on my left side a day or so afterward. It felt as if my organs were being compressed together. The sensation was sensitive to movement and highly uncomfortable, sometimes even painful. Over the past year, this issue has resurfaced when I exert myself, and it usually subsides within a few days or weeks.

Recently, it has returned with increased intensity, accompanied by various other problems. The pain is more widespread, often sharp and debilitating in my lower right and upper and lower left abdomen. I consistently feel bloated, occasionally experience nausea, and have noticed several other random symptoms. These include a splinter hemorrhage in my nail, periodic dizziness, persistent exhaustion, a feeling of fullness in my chest and under my breastbone, and alternating constipation and diarrhea. What concerns me the most are the small black specks I see when I wipe after using the restroom. They resemble flakes of pepper and are consistent, although a rectal stool test showed no presence of blood.

I have undergone several medical tests, including a colonoscopy, endoscopy, ultrasound, and CT scan with contrast. All the results indicate that my organs appear fine, with the exception of some sludge in my gallbladder (no signs of stones or dysfunction). My appendix is also fine, according to the tests. Additionally, the blood work I have done shows everything as normal.

However, the colonoscopy revealed aphthous ulcers in my rectum, the CT scan showed reactive lymph nodes in my lower right quadrant, and my spleen was mildly enlarged. The pain and discomfort I am experiencing are disabling, particularly when I am in motion. This is unlike anything I have ever experienced in the 15 years of having IBS, and it has become debilitating.

I am seeking additional opinions on what steps to take next. The presence of ulcers makes me wonder if this could be early-stage Crohn's Disease or a similar condition. Although all the tests suggest that I am otherwise fine, I believe something is being overlooked. I need guidance to help me find the appropriate assistance. I feel like I am deteriorating, and I am desperate for help.

Answer 1

Hello,

I have read your query and understand your concern.

Thank you for choosing icliniq.com.

Based on your symptoms and the tests conducted, it appears that you have irritable bowel syndrome (IBS). This condition requires significant lifestyle changes to manage effectively. Most of the tests performed have returned normal, indicating that IBS is the likely diagnosis after excluding other diseases.

From your history, it seems that you are experiencing symptoms of IBS along with internal hemorrhoids. IBS is usually a diagnosis of exclusion, and since your ultrasound, blood tests, and stool tests are all normal, we can proceed with treating you based on the guidelines for irritable bowel syndrome.

I will provide you with an overview of IBS. It is a common intestinal disorder that causes symptoms such as stomach pain, gas, diarrhea, and constipation. Irritation of the mucosa leads to increased mucous secretion. Although IBS cannot be completely cured, its symptoms can be managed through dietary and lifestyle changes, and in severe cases, with medication and treatment.

IBS occurs when the colon becomes hypersensitive due to increased pressure from external stimulation. This leads to muscle spasms, resulting in diarrhea or constipation. In addition, hormonal alterations in the body cause an imbalance in substances like serotonin and gastrin, which play a role in communication between the brain and the digestive system. This imbalance affects the normal muscle contractions in the bowel, leading to diarrhea or constipation.

All the symptoms you described are typical of IBS, including diarrhea and constipation that alternate, stomach cramps, gas, and bloating. At present, I do not recommend taking any medication. Instead, focus on lifestyle and diet modifications:

Avoid coffee, tea, and sugary sodas.
Drink at least eight glasses of water daily, and your water intake with your meals.
Limit consumption of fatty foods, milk, and cheese.
Increase your intake of wholesome fiber in your diet.
Take Metamucil (Plantago ovata) daily to increase stool bulk.
Regularly take a probiotic supplement.

Regarding your follow-up, please provide clarification on why you are taking Medrol. Additionally, please attach a written copy of your colonoscopy report.

Please let me know if you have any further questions.

I hope this helps.

Regards.