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Dr. Andrew Rynne

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Experiencing chronic abdomen pain and bloating. Having Loose stools. Suggest treatment

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Dr. Nsah Bernard

General & Family Physician

Practicing since :2012

Answered : 1704 Questions

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Posted on Wed, 20 Nov 2013 in Digestion and Bowels
Question: Hello, I am a thirty year old female and have been experiencing chronic lower left abdomen pain and bloating for nearly 3 years or so. I have seen a gastroentorologist, a gynocologist, had an ultrasound and have even been changing my diet every few months. I feel as though I have tried just about everything to narrow the possible cause of the persistent pain. It's not a debilitating pain so much as an annoyance and discomfort. The pain can get worse which then causes my entire lower stomach to bloat quite a bit. My bowel movements are normal. No bleeding, loose stools or irregularities with them. I eat healthy, exercise and am at a normal weight. I am also on a budget and uninsured, so I have not been able to be seen as frequently as I would like, to put a final end to my persistent discomfort. Thank you for your time and help!
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Answered by Dr. Nsah Bernard 1 hour later
Brief Answer: Could be originating from the urinary tract Detailed Answer: Hello, Thanks for posting on XXXXXXX I am truly sorry for your misfortune and ill health, and it must be very disturbing not being able to know exactly what might be causing your pain. Being a female of reproductive age and having a chronic left iliac fossa/groin pain of unknown origin could put all health care providers at an embarrassing situation especially when abdominal ultrasound comes our clear plus the fact that you are not insured and using your direct resources might be troubling. Given the loci of the pain, it could be coming from the urinary tract/kidney or female pelvic organs or gut. You did the right thing already seeing a gynecologist and a gastroenterologist but the truth is that if the pain is of neurologic origin i.e neuralgia/nerve injury then it will be difficult to determine by simply visiting the most obvious doctors that can handle female related abdominal pains. Your condition obviously requires medical attention but first we need to be able to determine exactly which organ is affected. Since it is possible that any organ found around that area could be affected, it will require a more thorough medical exams and maybe a CT scan. Neuralgic type pains will only require specific medications such as gabapentin in order to get rid of the pain and since most of the gynecological and gut problems must already likely be eliminated by the specialist you had seen before, it will be wise to start looking at other organs. A condition such as inguinal hernia that is not physically evident can present with left groin pain and this might only be determined through a CT scan. A kidney evaluation is necessary. My suggestion is that you try saving sufficient budget for a clinical visit so that your condition can ones and for all be determined and appropriate treatment provided. Please feel free to ask any further follow-up questions so that I might be able to assist in the best of my ability. Sincerely. Dr. Nsah
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Nsah Bernard 1 hour later
Dr. Nsah, Thank you for the thorough reply. Would you recommend I seek a visit with a gastroenterologist again? The one visit I had was over 2 years ago, and the doctor did a quick physical exam with nothing too conclusive, other than essentially having me determine if my symptoms get bad enough to follow up with a colonoscopy or other invasive procedures. So I have been in a sense waiting things out, but feel at this point, that having any kind of symptoms regularly for years, necessitates some sort of test to determine what is going on. To be more specific, the pain seems as if it is shaped like a hard ball in my lower left abdominal/pelvic area. Almost as if it were cystic, which is why I thought perhaps a gynecologist would be able to determine the presence of something in my ovary or tubes. Does this sound like a pain that is prevalent in neuralgic type pains? If you were to locate the area, you would literally feel a small hard ball in what should otherwise be a smooth surface. I did read that some people are born with their appendix on the left side. Could it be possible that if that is the case, these symptoms are similar to needed my appendix removed? I'm sure it's possible that I somehow injured the area, but I can't think of a single moment that I distinctly remember injuring the area and having immediate and long term pain associated with it. It seems like a number of things may exacerbate my symptoms, such as shortly after sexual intercourse, and certain types of exercise or stretching. I have not had a food allergy test, but have been systematically eliminating and reintroducing foods into my diet, to determine whether or not that plays a role and it seems, if so, it is a minimal difference. I was also even curious to think that my intake of Accutane for 3-4 months had anything to do with it. It seems as if, when I took it back in 2009, a few months after, I started initially getting these symptoms, but it was interesting to have the symptoms show after and not during the medication. One of the requirements to be on this medication is to have a monthly blood draw (which also looked at kidney function) and all of my tests showed normal results. The other main requirement was to be on birth control. My acne cleared up for a while and returned. I started a second bout of the medication from Nov 2012 - May of this year, also following up on kidney function. The tests were still normal. At the same time I noticed the pain and bloating initially in 2009, I had a lot of vaginal bleeding going on in between my cycle, as well. The only thing that worked to stop that was eventually finding the right birth control. There were times when I would still have the random in between cycle bleeding. I have not been on birth control for a few months now and have not had the bleeding issue, but the pain and bloating persist. So you can see how finding the distinction between what specific XXXXXXX disruption is going on is seemingly 50% gynoecologically related and 50% gastro related. Thank you again for your help and understanding.
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Answered by Dr. Nsah Bernard 44 minutes later
Brief Answer: Thanks for updating Detailed Answer: Well the new information you have provided is interesting and throws more light in your issue. As you finally concluded, we are looking at the possibility of the problem originating from two different systems. In the one hand, you are able to get a sensation of an intraabdominal mass which feels like a cyst. That is possible especially if you have a functional ovarian cyst (rarely felt but with very large ones, you can feel). I doubt it will be appendix and even if yours was found on the left, it will rarely be palpable/touched. In the other hand, we could look at an abundance of colonic gases (functional colopathy) or irritable bowel diseases (IBS) which is abnormal bowel with no specific known cause (it is true that you mentioned that you do not experience any loose bowels or constipation etc, but experiencing pain when having gases is possible). In my opinion, I will look first at a gynecological cause (which means, you will have to revisit your gynecologist) and if he rules out any gynecological disorders, then you will have to see a gastroenterologist. From your new update, I believe that neuralgia due to nerve damage is ruled out but still I recommend another abdominal ultrasound and/or CT scan. In some of my patients that I manage for these kind of similar symptoms, I often end up getting them undergo an open abdominal surgery (after of course being able to determine the cause). So saying, surgery might be the end point of your pain (hopefully your doctors will not reach that conclusion). Hope this helps and wish you the best. Do feel free to reply with more questions. Regards Dr. Nsah
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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