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Dr. Andrew Rynne

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IBS, GERD, anxiety and herniated disks in back. On prilosec and zoloft. Having cramps in the lower abdomen

Answered by
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Dr. Rakesh Karanwal

Internal Medicine Specialist

Practicing since :1980

Answered : 1357 Questions

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Posted on Tue, 19 Nov 2013 in Bones, Muscles and Joints
Question: I am 60 yrs old female. I have physical and mental disabilites. I suffer with IBS,GERD, BAD ANXIETY , I have a herniated disks/bulging in my neck/back. I have pain everyday, it runs down my arm into my arms, headaches... My question is : I have had cramps( like period type) but don't have a period anymore for 18 years!! The cramps swing around to my back... and my back hurts too... but I am not sure if its the ibs and herniated disk thing hitting me at once. But yesterday I had colon spasms?? not sure but it felt like a baby kicking me.. it was jumping in there.. it was a little the day before yesterday and off and on yesterday.. today its calm... could this all be anxiety or a combination of a few things... ibs, back, and anxiety?? I take prilosec, zoloft, xanax, and over the counter meds for pain... I had a pab smear, 2 cultures for female issues, stomach xray, bloodwork, all was good... this was a few months ago for the testing.... thanks
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Answered by Dr. Rakesh Karanwal 44 minutes later
Brief Answer:
Colonoscopy and Uterus ultrasound required.

Detailed Answer:
Hi Mrs. XXXXXXX

Thanks for your query.

I wish you had mentioned about whether a colonoscopy was done or not; nature of bowel movements; vaginal discharge.

* The cramps in the lower abdomen could be due to either a disease of the terminal colon or a lesion within the uterus. A PAP smear would not indicate if there is an infection or a fibroid within the uterus. Uterine Fibroid (a benign) also causes similar cramps in post-menopausal women. If you have discomfort/heaviness in the pelvic region, possibility of pelvic inflammatory disease needs exclusion.

Further, similar cramps in the terminal colon are seen in constipation, those who take food with scanty fiber content or presence of a polyp. Of course, acute anxiety is known to cause intestinal hyperactivity --> cramps.

I would therefore suggest the following :-

1. Get an ultrasound of the uterus/ovaries/pelvis done to exclude/confirm lesion in the uterus or, pelvic infection.

2. If the ultrasound is normal, a Colonoscopy should be carried out to see for polyps/ growth(s) in the colon or diverticulosis.

3. You should take a 10-14 days' course of anti-H.pylori kit, followed by 3-6 months of regular Prilosec: this course will completely cure your GERD, since in 70-90% of the cases, GERD is due to a bacteria called H.pylori.

4. From your information, I presume that your anxiety is still under-corrected. Dose of Xanax and, may be, even Zoloft, needs to be increased, as anxiety tends to aggravate symptoms of IBS.

5. Your diet should contain plenty of fibers : take a plateful of green salads with each meal. Avoid constipation : if present, a short course of laxatives will take care of it. Addition of Probiotics, such as, lactobacilli will help in IBS.

You may discuss my expert opinion/views/recommendations with your treating doctor, who has to be in agreement with my opinion, before he takes necessary actions.

Hope I have answered your query, and will be happy to answer further clarifications, if any.

Fond regards,

Dr. Rakesh Karanwal
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Rakesh Karanwal 14 minutes later
No vaginal discharge.... colonoscsopy was done 41/2 yrs ago, it was good. Had my digestive system xrayed from stomach to the large instestine last year.. and the stomach xray done 3 months ago.. bowel movements are everyday.. don't really have constipation... only a handful of times in my lifetime.
doctor
Answered by Dr. Rakesh Karanwal 16 minutes later
Brief Answer:
Cramps due to low fibers or fibroid uterus

Detailed Answer:
Hi Mrs. XXXXXXX

Welcome back.

Well, in the light of additional information, the cramps are most likely due to lack of high fiber diet; or, fibroid in the uterus.

Please get an ultrasound of the uterus done; take high fiber diet. I would suggest the 20-30 grams of Psyllium husk/powder would be adequate.

Further, the H.pylori infection is diagnosed by a tiny biopsy of the inner lining of stomach, done through the endoscope. Stomach X-ray will not diagnose it. I am highly confident that the suggested course of anti-H.pylori therapy, following by Prilosec will cure your GERD. HAVE FAITH IN ME. In fact, H.pylori infection can also affect the colon and cause similar cramps.

Moreover, Zoloft and Xanax in adequate doses will keep your IBS under complete control.

Do not forget to add Probiotics as already advised.

Fond regards,

Dr. Rakesh Karanwal
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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