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Having internal pulsating sensations between the naval area and rectum. Lower cat scan could not find anything. Reason?

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Son is having XXXXXXX pulsating sensations between the naval area and rectum. Says it feels like an electric pulse and sometimes like a parasite. He has been check by a gastroenterologist and had a lower cat scan and nothing can be found. They are treating him for anxiety, but his medication does not alleviate any of these sensations. What is curious about this, is he received 10 innoculations from the Dept. of Defense, one being Anthrax, Chickenpox, Shingles, Meningitis, TB, MMR, and others I can't remember. These sensations started about a week to week and a half afterwards. He does not know where to go for further evaluation. He is functioning, but these sensations are getting worse and as a firefighter, he must be alert and healthy to perform his job. Also, states when he lies down, and tries to calm down, he is very conscious of these feelings.
Posted Sun, 9 Dec 2012 in Digestion and Bowels
Answered by Dr. Jonas Sundarakumar 5 hours later
Hello and welcome to Healthcare Magic. Thanks for your query.

I understand that your son must be going through a difficult time with his undiagnosed symptoms. You have mentioned that an evaluation by a gastroenterologist and all relevant medical tests have turned out negative. Moreover, considering his age, your son is unlikely to have any major medical risk factors also. In such cases, where there are medically unexplainable symptoms, one of the possibilities to be considered is indeed an anxiety-related disorder.

It is important to understand that anxiety can present with not only psychological symptoms but also with physical or somatic symptoms. People often mistunderstand thinking that anxiety-related disorders are possible only when a person is under any emotional stress or when there are obvious psychological symptoms of anxiety. This is not the case and some people can have 'internal' or somatic anxiety, which can manifest purely as physical symptoms.

Now, this does NOT mean that 'everything is in his head' and that he is simply imagining the symptoms. Not at all. It has been found that anxiety disorders are associated with certain neuro-chemical imbalance in the brain and this can cause the person's pain threshold to get lowered and he can become 'hypersensitive' to sensory stimuli, and therefore can have tingling, shock-like sensations, and other several other abnormal sensations. The underlying anxiety also causes a person to become more worried as to why his problems are undiagnosed after multiple tests, and then this worry / anxiety itself then starts worsening the symptoms more. Soon this becomes a viscious cycle, leaving the person with more symptoms and suffering.

You have mentioned that he is currently being treated for anxiety, but that does not relieve his symptoms. Often, in such cases, merely prescribing some anti-anxiety medication doesn't do much good. The best approach in these cases, is a wholistic approach - where we don't focus on just prescribing medication alone, but rather try to help the person on the whole manage and cope up with this chronic condition. A skilled and dedicated therapist, who can assess him in detail, understand his problems and work systematically is required. Therapy should include a combination of psychological techniques as well as medication. There are certain specific anti-depressants like Duloxetine, Milnacipran, etc. which are found to be specifically effective for chronic undiagnosed pain or somatic symptoms. Certain centrally-acting medication like Gabapentin have also been found to be effective. Certain central muscle relaxants like Baclofen are also used in these cases. In addition, there are several effective and proven psychological techniques, which can help you handle the physical symptoms as well as the stress due to the pain.

So, I would advise you to discuss these above mentioned treatment options with your doctor. It would be worthwhile to have a consultation with a good psychiatrist for a detailed psychological assessment and plan further management options.

Best wishes,

Dr. Jonas Sundarakumar
Consultant Psychiatrist
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