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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Having slight bulging below rib cage during bending. What may be the cause?

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Dr. Ivan R. Rommstein

General Surgeon

Practicing since :2008

Answered : 10202 Questions

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Posted on Tue, 10 Dec 2013 in General Health
Question: i get slight bulging below rib cage when bending over to tie shoes. Feels like momentary muscle cramp but not painfull. bulging then goes away. very fit and not overwieght...55 yrs old. Athletic whole life. I can sense it but no pain. What may be causes. no cancer in family or other stomache issues. More specifically a single line muscle bulge both sides momentarily below rib cage after bending over only.I am a professional golf caddie who walks or slow jogs 50 miles a week every week. No other tenderness or soreness throughout body.Symptoms started only recently. 5'9 165 lbs. May not be of significance however I just began 3 months ago to drink a high fiber high calorie protein drink 1000 cal. to subsidies diet and maintain weight and strenght. Stools appear normal.Do have 2 or3 stools per morning after coffee.
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Answered by Dr. Ivan R. Rommstein 2 hours later
Brief Answer: Hi and welcome to XXXXXXX Detailed Answer: Thanks for the query. It sounds to me like possible ventral hernia which sometimes occur at this place. Also, it may be subcutaneous lesion such as lipoma or fibroma or just muscular protrusion. Second possibility is enlarged liver and rarely it can be some more serious diagnosis. I suggest to do ultrasound which may reveal the exact diagnosis. Your dietary changes can cause stomach and intestinal bloating so it can be felt as bulge,or such bloating can cause hernia to be more prominent. Try to eat food that dont make you gassy and avoid weight lifting and see will it help. If notmyou should do ultrasound for the beginning and after it some more detailed gastroenterologic work up. Wish you good health.Feel fee to ask. Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ivan R. Rommstein 3 hours later
Thank you Dr.Romic for timely response. Was a little apprehensive initially about web site but have confidence now..thank you again. Ventral hernia is caused by what...because of work schedual I work late and eat late but don't get gas,good appetite ...but I do get leg and other cramps at night possible dehydration because of miles a week I walk..I drink alot of water. Don't weight lift now but what about liver enlargement caused by what..I drink less than maybe 10 beer a week actually less cause not every day but do not understand what may cause this.No family history of gastroenterolgic issues . Ultrasound discovers what ?...appreciate your advice only...thank you Bill..what are the potential lesions and caused by what? thank you. No hurries...no worries on follow up. My ear is yours .Please feel free to reply at your earliest convenience. Thank you XXXXX
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Answered by Dr. Ivan R. Rommstein 2 hours later
Brief Answer: Hi. Detailed Answer: I ll try to explain everything you asked. YOu can always ask any new question,I am here for you and hope I can help. Alcohol is just one of possible cause of enlarged and swollen liver. there are various other conditions such as fatty liver,viral hepatitis, blood disorders, bile duct obstruction or any other systemic infection. However, your problem sounds to me more like abdominal wall issue then intraabdominal pathology. It means that there can be some disorder in fatty tissue,fascia or muscle of your abdominal wall.Most commonly this is hernia,but also it can be rectal muscle diastasis,muscle rupture or lipoma,fibroma, etc.In all cases this is benign and it shouldnt cause serious consequances. Ventral hernia is usually seen in patients who underwent surgery,but it can also occur in healthy people with no obvious cause. There are risk factors such as obesity,weight lifting and some connective tissue diseases,but as I said,it can be seen in any men. The other one, hiatal hernia is hernia of stomach and it may be felt as bulging while bending or sitting or coughing. Ultrasound can reveal is there liver pathology or any other intraabdominal pathology which may cause such bulging despite hiatal hernia which can be investigated only by gastroscopy. Also US can see certain abdominal wall problems,consistency of possible mass and some other features. Of course,it is much less specific that ct scan,but for start you should do at least US and liver functional tests. Leg cramping is something else. It is usually seen in people with decreased leg blood flow due to atherosclerosis or diabetes or in calcim and potasioum defficiency. But,long walks and physical activity can definitely cause it as well. If this persists you should do doppler US of legs and check pottasisum/calcium blood levels.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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