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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Can nerves and muscles cause continuous stomach-gas problem?

Answered by
Dr.
Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3650 Questions

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Posted on Wed, 4 May 2016 in Headache and Migraines
Question: I am a 74 year old male, in generally good health. I take simvastatin, citalopram, ranitidine, Lisinopril, fluticasone and a low dose aspirin every day. My symptoms started two years ago when I apparently pulled some muscles in my groin area. there was no immediate pain, After about a week or two however, with no stop in general activities around the house, I suffered terrible pain in my right leg. My doctor sent me to a pain specialist (orthopedist) who suggested possible spinal surgery. I put that off and instead went to for physical therapy for two weeks. Things seemed to better after treating the leg with hot then cold compesses. However a month ago I fell backward and twisted and strained my right leg. Cold compress seemed to help. Then I had a bout of upset stomach for about two weeks after eating perhaps bad food from the refrigerator. I went through stool sample test which were negative. My doctor and the gastroenterologist agreed that the stomach muscles and nerves may be the cause of continued stomach trouble-gas mainly. I am now on a bland diet. My question is can the nerves and muscles truly be causing this problem? Thank you.
doctor
Answered by Dr. Olsi Taka 38 minutes later
Brief Answer:
Hard to see the relation.

Detailed Answer:
I read your question carefully and I understand your concern.

I must say I am a little perplexed by what you have been told. If they meant that the spinal issue which caused the leg pain two years ago or the fall of one month ago are the cause the cause for your upset stomach and gas issues then I must say that I disagree, I do not see any relation. I do not know what imaging tests you had a couple of years ago, but I assume that the orthopedist meant there was some herniated disc in your vertebral column or arthrosic changes leading to nerve root compression which in turn caused the leg pain. That though doesn't have any effect on the stomach. Neither does the recent leg strain.

There are some conditions which might have common neurological and gastrointestinal manifestations such as coeliac disease (gluten intolerance), Whipple disease, autoimmune disease like Crohn or ulcerative colitis etc, but it is not that neurve issues cause gastric ones, are simply both manifestations of the disease in different systems and the neuro manifestations are not like yours anyway.
Nerve damage from diabetes may also cause gastrointestinal symptoms as well as neurological ones, but diabetes is the cause and you do not mention to have it. Also again doesn't manifest with the leg pain or muscle strain you mention.
Could perhaps they have meant that gastrointestinal symptoms are related to anxiety, could they have meant anxiety by nerve issue?!

So, while I am trying to guess what they have meant, bottom line is I do not think the gastric issues to be a consequence of a nerve damage from the information currently at my disposal.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 59 minutes later
Thanks for your reply. I believe that the muscle strain/nerve damage leading to gas production theory has to do with the muscles that control the intestines' operation/functioning. That's the way I discussed this with my family doctor and the gastroenterologist. The symptoms are rumbling and grumbling and then gas pressure, with somewhat explosive release with bowel movement. The bowel material is somewhat normal in color and texture, but smaller and lighter, probably due to my bland diet-no fiber at all.

I have not been able to find on the internet any explanation of how the intestines perform their constriction and passage activity, so that is really what I am asking about. Also, I hope that you saw my follow-up post to this site about my doctor's identifying of a groin hernia as part of her examination after the severe leg pain. And by the way I have no back pain at all. Thanks.
doctor
Answered by Dr. Olsi Taka 2 hours later
Brief Answer:
Read below.

Detailed Answer:
I saw you additional post, but because it came when I was typing my answer on my PC, I saw it only after I had posted my answer and I couldn't change the content anymore.
The muscles involved in the work of the intestines are smooth muscles, muscles which are not controlled consciously. They are directed by a plexus of nerve cells, nerve cells embedded in the wall of the intestines, which are connected to each other forming one network. These interconnected cells coordinate their action and the signals which they send to the muscles. These cells are partially independent by the central nervous system, they act by reflex based on signals they receive from the intestinal lining about the content quality and quantity. The central nervous system partially influences their function through what is called the autonomous nervous system, which includes sympathetic nervous system inhibiting digestive activity to concentrate blood flow and energy to other areas in time of stress and parasympathetic nervous system stimulating digestive system when at rest.
So these components the network of the nerve cells in the intestine walls or the autonomic nervous system which runs along the spine shouldn't be affected by factors such as strains or tears of the groin or abdominal wall, which are completely different types of muscles from the musculature in the intestine walls. Autonomous nervous system as I said influences motility, issues like anxiety may play a role, but it is not a question of an identifiable damage at a certain nerve which we can pinpoint, more a matter of predisposition.
The groin hernia, I assume an inguinal hernia, may at times influence intestinal function as when the intestine herniates it may cause transitory compression on its walls, blocking passage, being accompanied as a result by an increase of contractions to force the passage of the content. Hernia also may cause pain and discomfort in the groin and thigh area.
Perhaps when your doctors spoke of muscle as being at fault they meant that the herniation may be due to a weak spot in the muscles of the abdomen leading to the protruding of the intestine. But if that is what they meant it is not necessarily of a tear of the muscle, often such weak spots are born with, in fact inguinal herniation has often a genetic predisposition.

I hope to have been of help.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 42 hours later
Thanks again for your reply, especially for the detailed description of how the intestines work. I sort of remember that now from biology class over 50 years ago!

Regarding your second paragraph, and your comment "the herniation may be due to a weak spot in the muscles of the abdomen leading to the protruding of the intestine," if this is the case, would even mild exercise, such as washing the car yesterday, cause discomfort in the groin area, and then later on, more rumbling and formation of gas, as I had last night? Is so, what do you think the proper treatment should be? Cold on the groin, and warm on the abdomen itself? My treatment last night and this morning was cold over the abdomen and groin and upper right thigh. Again, that cold brings on waves of tension release in my head. Should I get some imaging work on this problem?
Thanks!
doctor
Answered by Dr. Olsi Taka 3 hours later
Brief Answer:
Read below

Detailed Answer:
Physical efforts can cause symptom exacerbation in the case of a hernia as abdominal muscle contraction leads to increased pressure on the abdomen content and increased protrusion of the herniated segment.
However since you say that the surgeon thinks hernia is small other causes must be considered as well such as irritable bowel syndrome. If the issue has been previous since only two weeks when you possibly ate the bad food then it might be simply a temporary process until your intestinal flora (the bacteria present in the intestine which are involved in digestion) returns to normal.
As for the hot and cold measures I do not think there is any benefit. I recommend hot applications at times for muscle strains, but I do not believe there to be any benefit for intestinal issues.
As for imaging, I do not see any red flags which might require imaging such as a palpable mass, anemia, weight loss etc, however when symptoms persist or increase in time a CT scan may be considered.

Hopefully you'll get better soon and that won't be necessary.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 47 hours later
Thanks again for your comments above. With regard to hot and cold treatment, perhaps I was not clear about this issue. Looking back at the first incident two years ago, after feeling something was wrong-a twitch or pull- even though there was no serious pain, I continued to lead a very active life, pushing a mower, cutting tree limbs, bending over a auto engine, etc., I finally wound up with very sever pain in my right thigh, extending around the front and into the knee area as well as the groin. Heat did nothing to help, and finally cold treatment worked.

Now I still get a twitch, or other similar sensation in the groin, and upper thigh, which discomfort is alleviated by cold treatment.

And gas build up even now means discomfort beyond normal in the abdomen.

As I wrote before, medical opinion about that first severe pain was not very helpful - grin and bear it, basically, or take pain killer. I would like a better understanding about the neurology of that pain and the subsequent sensations now, if you will. Thanks!
doctor
Answered by Dr. Olsi Taka 5 hours later
Brief Answer:
Read below

Detailed Answer:
Hello again.

Naturally it's hard for me to assess the origin of a pain without being able to examine you at the time and without having any information on what were the results of imaging tests (I suppose the orthopedist didn't offer you surgery without some type of imaging). Pain in that location may be due to different causes, nerve root compression in the spine or more distal along its path, hip joint, sacroiliac joint and there are manouvers on physical exam helping you identify the source, if necessary confirmed by imaging.

Anyway my guess is that the suspected diagnosis at the time was compression of a nerve root in the spine causing the pain and abnormal sensations along the nerve trajectory as those nerves contain fibers carrying information on sensation. The fact you continued physical activity despite the symptoms may have led to an increase of the inflammation at the compression site. With time with inflammation subsiding symptoms improved, but either due to there persisting some mild compression or because of some irreversible damage to some of the nerve fibers you continue to feel the abnormal sensations. I do not think they are responsible for your abdominal symptoms though, as I explained before they are not involved in digestive function.

Wishing you good health.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 2 days later
Hello again,

Yes I had an MRI done at the time of the leg pain. That was at the advice of the spinal specialist. It showed compression of one or two discs.

Thanks for your explanation of the nervous system related to the leg pain. I have to admit that the nervous system is difficult one for me to make sense of. Too much electrical impulse stuff for me. :) I am limited to mechanical things, mainly.

I decided to stop the cold treatments to see if there was any change. Actually I think doing without the cold helped a bit, or maybe the stomach flora issue is improving. Though I still am having the gas problem. I have been researching how stomach acid balance can be improved/maintained. But you have given me much to read about and I feel more ready to converse with the gastroenterologist.

Thanks very much for all of your explanations and support, and I wish you much success in your work.

Dave Radile

doctor
Answered by Dr. Olsi Taka 3 hours later
Brief Answer:
Thank you!

Detailed Answer:
Thank you for your kind words. I tried to be understandable but as you say neurology anatomy and physiology is the most complex of medical specialties perhaps, I know plenty of fellow doctors who have problems with it as well. Certainly neuroanatomy is the most worn out book in my library.

I hope things will work out for the best for your health.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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