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Can heavy intestinal massage to relieve constipation cause abdominal pain?

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Posted on Tue, 26 Sep 2017
Question: 62 year old, male, quadriplegic, 25 years post injury. I've had bouts of constipation, for about 3 weeks. I have no specific pain due to the paralysis but every time I try to eat there is horrible pains in my abdominal area. Any motion also triggers severe pain. This have started after using a large heavy massager on my stomach to counter bouts of constipation. What is the best course of action to get my system work properly again? Can I manage this at home or should I visit an ER? The pain is extreme. Thank you in advance

also,i have lost 46 lbs without dieting. Could the weight loss be associated with an ulcerative (or other) condition? TY again..... XXXXXXX
doctor
Answered by Dr. Vasudha Jayant Athavale (2 hours later)
Brief Answer:
Some more information please.

Detailed Answer:
Hi XXXX,

Thanks for the query. I have read it & understand your concern,
Very heavy intestinal massage as you say can cause irritation/ trauma to underlying stomach to cause pain... but before that it would lead to abdominal muscle pain... which protect underlying digestive organs.This pain would be dull ache through out the day/ more intense with certain movements & last for few days to fade away naturally...
- The type of pain with slightest movement -you have is likely to be due to sore abdominal muscles soreness .
- Is the abdominal pain same as the pain while movement?What is exact site of pain in abdomen ?
- Is abdominal pain burning / Is is associated with nausea, vomiting& Is there abdominal bloating?
-What type of diet you take ?
- Please provide details of the accident you had 25 years back
* I would be able to answer more specifically if I get this information... please send it.
* The abdominal pain if unbearable does need evaluation,, but it's more essential to find cause of your weight loss.
waiting for the answer.
thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Vasudha Jayant Athavale (44 minutes later)
Thank you for your response.

My injury was a 9mm gunshot to my throat completely severing the spinal cord at C5/6/7. That said; it's difficult to describe the exact location and sensation of what my body interprets as pain. The working pathway is the autonomic, not central nervous system. A complete SCI injury means no accurate feeling from my upper chest and everything below (below C-6).

Managing neurogenic bowel and bladder is difficult and complex. Perhaps you know something of this. My diet is pretty normal, I stay away from spicy foods and eat healthy. I don't have diabetes but colo-rectal issues run in my family.

The burning pain seems to be in my lower, more than upper abdomen. There is nausea but I seldom vomit. No black stool but sometimes red blood (hemorrhoids I think). Today, the pain is almost unbearable.

I don't eat much, but as I said, what I eat is pretty healthy. My body looks bad from rapid, excessive weight loss. Over the course of my injury I deal with chronic UTI's from intermittent self catheterizations (4x per day).

I hope these details will help with your analysis and diagnosis. Please advice and I anxiously await your response.

One other thing to mention. As a complete SCI injury, I deal with Autonomic Dysreflexia. Very important to factor this into a thorough diagnosis.
Thank you,
-XXXX
doctor
Answered by Dr. Vasudha Jayant Athavale (14 hours later)
Brief Answer:
The possible causative factors are as follows.

Detailed Answer:
Hi XXXX,
Thanks for the information. That adds in getting some connections in your symptoms & possible causes. I would explain it as follows.
* Your concern at present being severe pain in lower abdomen ( mainly ) when you eat .I see multiple contributory factors for it-
1. Autonomic disreflexia - a condition caused by total imbalance between sympathetic & parasympathetic nerve activities due to spinal injury above spinal vertebra T6... This leads to an excess surge of sympathetic nerve to cause raised blood pressure. This information is carried to brain by raised peripheral hypertension & brain in turn send descending inhibitory impulses through vagus nerve ( a parasympathetic nerve ) which can control blood pressure... But it can not act because of spinal injury & vagus nerve gets stressed, under active .
The under active vagus can lead to delayed digestion, impaired peristalsis & all the digestive disturbances including constipation. Under active Vagus also can hamper bladder emptying .
2.The family history of Colo rectal issues you have- ( could be Crohn's disease/ ulcerative colitis/Irritable Bowel syndrome or rarely malignancy)- It is known to cause severe pain in lower abdomen specially related to eating.
3 History of heavy intestinal massage has all the possibility of making already sore colon & abdominal muscles painful.
4. The repeated catheterization with chronic UTI can add to the pain.
5. Neurogenic bowel/ bladder- I do have idea about how complex & tough the management is. It have all the possibility of increasing the intensity of pain.
* So all these factors make the problem complex in origin & also tough ( but not impossible to manage )
Management would include self management along with medicinal help offered by expert physician.
- To get expert advise after needful investigations for finding presence of ileo rectal problem with management by cause specific treatment/ diet advise.
- Constipation can be managed by sufficient fibers in diet & also 4-6 big glasses of water./ no smoking, alcohol or caffeine / Using glycerin suppository/ mild stool softener ( Lactulose )/ mild type of abdominal massage ./
Acupressure can give good results in few patients.
* I would again stress for a through check up for possible colorectal problem (with history of bleeding with stools- which could be due to piles/ fissure /infection )...& can be managed well with early diagnosis.
I hope that helps you. Any more information you need .. please feel free to ask.
Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Vasudha Jayant Athavale

General & Family Physician

Practicing since :1970

Answered : 8354 Questions

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Can heavy intestinal massage to relieve constipation cause abdominal pain?

Brief Answer: Some more information please. Detailed Answer: Hi XXXX, Thanks for the query. I have read it & understand your concern, Very heavy intestinal massage as you say can cause irritation/ trauma to underlying stomach to cause pain... but before that it would lead to abdominal muscle pain... which protect underlying digestive organs.This pain would be dull ache through out the day/ more intense with certain movements & last for few days to fade away naturally... - The type of pain with slightest movement -you have is likely to be due to sore abdominal muscles soreness . - Is the abdominal pain same as the pain while movement?What is exact site of pain in abdomen ? - Is abdominal pain burning / Is is associated with nausea, vomiting& Is there abdominal bloating? -What type of diet you take ? - Please provide details of the accident you had 25 years back * I would be able to answer more specifically if I get this information... please send it. * The abdominal pain if unbearable does need evaluation,, but it's more essential to find cause of your weight loss. waiting for the answer. thanks.