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Suggest Treatment For Severe Abdominal Pressure
Question: Hello, I am a 42 year old male and I have had a pressure in my lower right abdomen. Also, I can not put my legs together or lay on my stomach because it feels like someone is squeezing my testicles and causes me to be nauseous. Also, I get these pains throughout my body (muscles in chest and back) that feels like gas. I had an EKG and the heart is fine. I have had a CT scan of the abdomen as well as an ultrasound of the testicles as well as other organs and other than the liver being a little fatty, they said everything looks fine. I also had a colonoscopy and that looked fine. I have had these pains for about 7 months and they don't seem to be going away. Some days are worse than others, but I can always feel it to some degree. Do you have any idea of what it could be? Thank you for your time.
Brief Answer:
more information required.
Detailed Answer:
dear,
Welcome to the HCM
I totally empathise with the discomfort you are going through currenlty.
We shall consider possibiliies of various differential conditions and try to narrow in to a specific with help of more details.
Besides the information given, I would want to know
1) How did the pain begin( gradual or sudden), an how did it progressed in intensity over the seven month course?
2) is it continuous/ intermittent/ episodic? On doing what it subsides? and what are possible triggering factors?
3) Is it associated with vomitting, loose motions, constipation, fever, etc?
4) when were the mentioned investigations done? were the Blood counts checked in recent time?
5) If you had consulted any doctor or surgeon in past, what was his opinion about it?
6) Lastly, how intense your pain is, on the scale of 1 to 10?
The above list of questions may appear a bit lengthy, however it is imperative that we consider essential information before committing to a specific diagnosis and treatment.
Kindly revert back soon with the information. Thank you.
regards
Note: If there is associated vomitting, loose motions or fever, it is strongly advised to consult a nearby physician asap.
more information required.
Detailed Answer:
dear,
Welcome to the HCM
I totally empathise with the discomfort you are going through currenlty.
We shall consider possibiliies of various differential conditions and try to narrow in to a specific with help of more details.
Besides the information given, I would want to know
1) How did the pain begin( gradual or sudden), an how did it progressed in intensity over the seven month course?
2) is it continuous/ intermittent/ episodic? On doing what it subsides? and what are possible triggering factors?
3) Is it associated with vomitting, loose motions, constipation, fever, etc?
4) when were the mentioned investigations done? were the Blood counts checked in recent time?
5) If you had consulted any doctor or surgeon in past, what was his opinion about it?
6) Lastly, how intense your pain is, on the scale of 1 to 10?
The above list of questions may appear a bit lengthy, however it is imperative that we consider essential information before committing to a specific diagnosis and treatment.
Kindly revert back soon with the information. Thank you.
regards
Note: If there is associated vomitting, loose motions or fever, it is strongly advised to consult a nearby physician asap.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
The first symptom that occurred was a pain behind the right testicle. I was checked for epididymitis and torsion. Then i started having bad heartburn and was put on Omeprezole and that helped the heartburn. I then started to feel some pressure in the right side of my abdomen. The pain in the testicle happened over night and the other things came on gradually.
The discomfort is worse at night, but some days are better than others. When I feel the worst, I have heat sensations that radiates through my chest and I feel nauseous. I don't know if anything seems to be a trigger.
When I am nauseous, I burp a lot, but have not thrown up. I feel warm but don't think I have a fever during the episodes.
I had these tests done in the last couple of months with the CT scan done a couple weeks ago. I have had blood work done multiple times and everything looks good.
My doctor doesn't know what the problem could be. He has had me go in for multiple tests including checking my gallbladder, prostate, and colon. I have had some constipation, but not real bad and my stool is not dark or does not contain blood.
The pain is only at about a 2 or 3. When it is at its worst, maybe a 4. The nausea and discomfort over a long period of time is more of the issue. It effects my sleep, especially since I can only lay on my back with my legs spread apart. I always have slept on my side before.
The discomfort is worse at night, but some days are better than others. When I feel the worst, I have heat sensations that radiates through my chest and I feel nauseous. I don't know if anything seems to be a trigger.
When I am nauseous, I burp a lot, but have not thrown up. I feel warm but don't think I have a fever during the episodes.
I had these tests done in the last couple of months with the CT scan done a couple weeks ago. I have had blood work done multiple times and everything looks good.
My doctor doesn't know what the problem could be. He has had me go in for multiple tests including checking my gallbladder, prostate, and colon. I have had some constipation, but not real bad and my stool is not dark or does not contain blood.
The pain is only at about a 2 or 3. When it is at its worst, maybe a 4. The nausea and discomfort over a long period of time is more of the issue. It effects my sleep, especially since I can only lay on my back with my legs spread apart. I always have slept on my side before.
Brief Answer:
Need to consider neurological and psychological cause
Detailed Answer:
Welcome back. Thank you for the information.
After going through the history, its course, investigations done and its reports, I could make following interpretations and observations-
1) The pain is not resembling any classic medical or organic dysfunction. Which means, that it is "atypical", vague and uncertain in the presentation and manner.
- This observation is against the probability for any common medical or organic disease.
2) The course of symptom is also inconsistent, vague and not confined to any particular organic or systemic dysfunction.
3) Most importantly, it has failed to report any abnormality on various investigations. Testis problem could have been detected by clinical examination and sonography, blood counts would have been abnormal in case of any infections, CT scan, sonography, colonoscopy and prostrate examinations have substantially ruled out any organic pathology in abdomen.
4) The symptoms are predominantly neurological, such as heat sensations, pain, feeling of pressure, etc.
Therefore, from the above inferences, it is safer to say that you do not have a serious medical condition. Now we are left to consider other causes such as, some neurological or psychological cause.
My suggestion at this stage is
1) Consult a neurologist, as he can perform detailed clinical neurological examination, which is essential.
2) A consultation to psychiatrist can be sought, as I am suspecting a condition called "pain disorder".
Continuing with your problem-
I want to know
1) Does stress( such as a bad day in office, quarrel in house or with family and friends, lack of sleep, excess of work in office, etc) affect your pain?
2) Do you also experience back ache, extreme fatigue, loss of interest in daily activities, excessive sleepiness/lack of sleep, irritability, etc?
3) Has it happened with you, that when you are happy and in a good mood, the pain and associated symptoms are less?
4) Any history of major ongoing stress in your life?
5) Lastly, use of any drugs, smoking, alcohol, etc?
Information on these can help me further in differentiating into a specific condition.
Thanks again for elaborate information provided.
kindly reply.
Regards
Need to consider neurological and psychological cause
Detailed Answer:
Welcome back. Thank you for the information.
After going through the history, its course, investigations done and its reports, I could make following interpretations and observations-
1) The pain is not resembling any classic medical or organic dysfunction. Which means, that it is "atypical", vague and uncertain in the presentation and manner.
- This observation is against the probability for any common medical or organic disease.
2) The course of symptom is also inconsistent, vague and not confined to any particular organic or systemic dysfunction.
3) Most importantly, it has failed to report any abnormality on various investigations. Testis problem could have been detected by clinical examination and sonography, blood counts would have been abnormal in case of any infections, CT scan, sonography, colonoscopy and prostrate examinations have substantially ruled out any organic pathology in abdomen.
4) The symptoms are predominantly neurological, such as heat sensations, pain, feeling of pressure, etc.
Therefore, from the above inferences, it is safer to say that you do not have a serious medical condition. Now we are left to consider other causes such as, some neurological or psychological cause.
My suggestion at this stage is
1) Consult a neurologist, as he can perform detailed clinical neurological examination, which is essential.
2) A consultation to psychiatrist can be sought, as I am suspecting a condition called "pain disorder".
Continuing with your problem-
I want to know
1) Does stress( such as a bad day in office, quarrel in house or with family and friends, lack of sleep, excess of work in office, etc) affect your pain?
2) Do you also experience back ache, extreme fatigue, loss of interest in daily activities, excessive sleepiness/lack of sleep, irritability, etc?
3) Has it happened with you, that when you are happy and in a good mood, the pain and associated symptoms are less?
4) Any history of major ongoing stress in your life?
5) Lastly, use of any drugs, smoking, alcohol, etc?
Information on these can help me further in differentiating into a specific condition.
Thanks again for elaborate information provided.
kindly reply.
Regards
Above answer was peer-reviewed by :
Dr. Sonia Raina
Yes, I do think that stress seems to make the symptoms worse. And I do experience all of the things that you asked in the second part of your question. When I am happy and in a good mood, I don't notice the symptoms as much. I seem to get stressed pretty easy lately. Nothing has happened out of the ordinary, but small things seem to bother me more than it used to. I have never smoked and I very rarely have any alcohol to drink.
Brief Answer:
somatic symptom disorder, anxiety condition, a psychiatric consultation is advised
Detailed Answer:
Welcome back.
These evidences are strongly suggestive of stress induced somatic(physical) symptom disorder.
It is a well established fact that the Stress, which could be both physical or psychological, has a significant impact on the body and various organs.
Especially the gastric related symptoms such as heart burn, acidity, regurgitation, nausea, diarrhoea, constipation, etc are commonly associated with chronic stress and anxiety.
"Pain" and its modulation is heavily influenced by the emotional state of an individual, which again is vulnerable to stress. This explains why one experiences less pain when happy and more pain while one is angry and irritable. For example, persons who hit their head while happy at a party can seem to experience less pain than when they hit their head while angry and at work.
Stress makes individual sensitive to pain and bodily symptoms such that even a minor discomfort can be experienced as a significant one.
Therefore, I strongly consider the condition of "somatic symptom disorder" in your case. It is a state in which the psychological stress is manifested as organic and somatic symptoms.
The current evidence we have is strongly in support of this.
My suggestion at this point are
1) A consultation to nearby psychiatrist can be very helpful, as a detailed work up of history and stressful life events is required to plan a comprehensive management. While you visit, ensure that you take along all your past records and reports with you. You also can discuss about my opinion with him.
2) The treatment could comprise of few drugs(SSRI, anxiolytics) and verbal interactive therapies, that again depends on the associated symptoms.
Now, I would still want to ask you few more questions, so that we do not miss any co occurring problem, because this condition is commonly associated with chronic anxiety and mild to moderate depressive symptoms. Therefore, my questions are
1) Do you tend to get apprehensive and anxious over minor matters, tend to worry excessively?
2) excessive worry about you suffering from a major illness or disorder?
3) Do you feel yourself as being anxious most of the day, restless, unable to relax and chill out? Fearful?
4) Any difficulty in falling asleep at night? Frequent awakenings at night? Vivid dreams, nightmares, etc?
5) Any interpersonal relationship problems in family?
Lastly, there is no reason to be worried as it is a common, easily manageable but an important issue that needs timely attention.
kindly consider replying to above questions. Thanks again.
regards
somatic symptom disorder, anxiety condition, a psychiatric consultation is advised
Detailed Answer:
Welcome back.
These evidences are strongly suggestive of stress induced somatic(physical) symptom disorder.
It is a well established fact that the Stress, which could be both physical or psychological, has a significant impact on the body and various organs.
Especially the gastric related symptoms such as heart burn, acidity, regurgitation, nausea, diarrhoea, constipation, etc are commonly associated with chronic stress and anxiety.
"Pain" and its modulation is heavily influenced by the emotional state of an individual, which again is vulnerable to stress. This explains why one experiences less pain when happy and more pain while one is angry and irritable. For example, persons who hit their head while happy at a party can seem to experience less pain than when they hit their head while angry and at work.
Stress makes individual sensitive to pain and bodily symptoms such that even a minor discomfort can be experienced as a significant one.
Therefore, I strongly consider the condition of "somatic symptom disorder" in your case. It is a state in which the psychological stress is manifested as organic and somatic symptoms.
The current evidence we have is strongly in support of this.
My suggestion at this point are
1) A consultation to nearby psychiatrist can be very helpful, as a detailed work up of history and stressful life events is required to plan a comprehensive management. While you visit, ensure that you take along all your past records and reports with you. You also can discuss about my opinion with him.
2) The treatment could comprise of few drugs(SSRI, anxiolytics) and verbal interactive therapies, that again depends on the associated symptoms.
Now, I would still want to ask you few more questions, so that we do not miss any co occurring problem, because this condition is commonly associated with chronic anxiety and mild to moderate depressive symptoms. Therefore, my questions are
1) Do you tend to get apprehensive and anxious over minor matters, tend to worry excessively?
2) excessive worry about you suffering from a major illness or disorder?
3) Do you feel yourself as being anxious most of the day, restless, unable to relax and chill out? Fearful?
4) Any difficulty in falling asleep at night? Frequent awakenings at night? Vivid dreams, nightmares, etc?
5) Any interpersonal relationship problems in family?
Lastly, there is no reason to be worried as it is a common, easily manageable but an important issue that needs timely attention.
kindly consider replying to above questions. Thanks again.
regards
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Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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