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    What causes sharp pain in the lower left quadrant?

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Posted on Tue, 8 Aug 2017 in Digestion and Bowels
Question: Yes please help me. I have been to emergency room, consulted with my GP and also seen a gastro Doctor and no one can seem to help me. The pain is excruciiating. I have two symptpms; sharp pain in my LLQ and pain in my lower back. I've had x-ray of that area, CT and colonoscopy and Ultrasound. I have had blood work and no one can suggest any condition I have. It is the worst pain I have ever had in my left lower quadrant. The gastro doctor suggested I get a CT of my back to check for a compressed nerve. He said he has eliminated anything that could "kill me". My GP suggested I take Nexium. I do not have heartburn. I have not thrown up, no diarreahea, no fever.

Did anyone get my question? Thank you. XXXX

any thoughts?
doctor
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
i need your detailed history.

Detailed Answer:
Hi,
Thanks for query.


Causes of left quadrant pain include:

diverticulitis
constipation
irritable bowel syndrome
pelvic inflammatory disease
rectal carcinoma
ulcerative colitis
But with a normal usg,colonoscopy or CT scan this can't be your case.
Only possibility out there is-
Irritable bowel symdrome,
In IBS there is some problem in the functional ability of the gut that leads to the symptoms of irritable bowel syndrome. The structure of the intestines is normal, only functional abnormality occurs in this condition.So frankly speaking (IBS) represents a functional disorder of gastrointestinal tract without the presence of an anatomic defect. Some times Tight muscles in the lower back can press onto the nerves going to the hips which could cause that pain to happen or your could have a pinched muscle in the back itself sending the pain around the body to that area to cause that pain. To get rid of pain caused by either of these things you have to free up the muscles in your back for this a MRI back should be done


Now i need a detailed hostory of your to see if i can rule out any possible causs-
Please answer the folowing point wise.
Onset – when did the symptom start? / was the onset acute or gradual?
Duration – minutes / hours / days / weeks / months / years.
Severity – e.g. if symptom is severe oain – how much severe on a scale of 0-10.
Course – is the symptom worsening, improving, or continuing to fluctuate?
Intermittent or continuous? – is the symptom always present or does it come and go?
Precipitating factors – are there any obvious triggers for the symptom?
Relieving factors – does anything appear to improve the symptoms e.g. increasing dietary intake
Associated features – are there other symptoms that appear associated e.g. malaise lassitude
Previous episodes – have you experienced this symptoms previously?
Any weight over how long? – always suspect malignancy
Decreased appetite
Bowel habits and constipation?
Smoking – How many cigarettes a day? How many years have they smoked for?
Alcohol – How many units a week? – be specific about type / volume / strength of alcohol
Recreational drug use – IV drug use is a risk factor for hepatitis
Sexual history – Unisexual bisexual numberer of partners any perversions.

Hope you can understand as normal investigative therapy is not helping i have to follow old school procedures.
Taking history.

Please reply.

Thanks.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ramesh Kumar 27 hours later
Thank you very Dr. XXXXXXX for your evaluation. This started about 5-6 weeks ago. I drive for Uber so I am in the car for 5-6 hours at a time. In my opinion this seated position aggravated my lower back condition which I have had since 1979. My back pain does not happen regularly. Maybe once per year. I usually go to a chiropractor for help. When the pain started it was acute and has remained acute in the beginning until now. Last night was the first time that Tramadol and Bentyl did not curb the pain in my LLQ. I believe my pain is a 8-9. I have never felt such pain, it is almost if someone has stabbed me with a knife. I still find it hard to believe that the pain in my left front area is related to a back problem. At various times my back has no pain but the pain in my LLQ does not subside. It remains very sharp.

Nothing seems to improve the symptoms except Tramadol and Bentyl. Today those medications are not working very well. I have never had anything similar to this problem. I am 63 years old. I do have a decreased appetite and have not gained any weight. I do not eliminate waste normally. I usually go #2 three times per day. I take a probiotic, two products in a half a glass of water- diamotaceous earth (1 teaspoon 2 x per day and Nutribiotics grapefruit seed extract (10 drops 2x per day). I also drink turmeric and ginger 1 x per day. I also take a herbal laxitive called Swiss Kriss 1x per day. I smoke 3-4 cigars per week and never have smoked cigarettes. I do not drink alchohol. I do not use drugs and my sexual committment is to my wife. I hope this answers your questions. I am getting a CT tomorrow of my back.

Thank you very much. XXXX
doctor
Answered by Dr. Ramesh Kumar 45 minutes later
Brief Answer:
can be due to constipation.

Detailed Answer:
Hey again,
You have written that you can't elevate waste normally.Constipation and impacted stools are one of the most common cause of left lower quadrant pain.Get your CT done and if its normal follow what i advice.

I would strongly recommend you to take Lactulose 15 ml twice daily(laxative).

A drastic change in life style is required to cure constipation. Not exercising enough, not drinking enough water and delaying a bowel movement can worsen constipation symptoms.The most important factor in curing constipation is a natural and simple diet. This should consist of unrefined food such as whole grain cereals, XXXXXXX honey and lentils; green leafy vegetables, like spinach, beans, lettuce, celery, asparagus, carrot. Adding some fat to meals or increasing the size of a meal such as breakfast can help create the urge to defecate. Individuals suffering from constipation should increase the amount of plant foods they consume to get more fiber in their diet. Constipation can be treated by changing diets.
Secondly human gastrointestinal tract is colonized by 1013-14 bacteria of 400 different species and subspecies.They are responsible for proper digestion of food.Depletion of this flora due to surgery can lead to severe constipation and digestive problems.
Intestinal flora are types of microorganisms known as probiotics that live normally as part of the intestinal tract. These organisms have several functions that help the body.The most plentiful and important bacteria in the small intestine is the Lactobacillus species. Lactobacillus helps ferment indigestible carbohydrates. It also helps to stimulate the digestive process and aid the absorption of nutrients,as well as increase the motility of the gastro intestinal tract.I would suggest her to start taking probiotics regularly.Probiotics are live bacteria and yeasts that are good for digestion.As her gut flora will improve her constipation would be relieved and well formed stools will pass.

Apart from this other recommendations are-
-Linseed: is extremely useful in difficult cases of constipation. One teaspoon of linseed with warm water should be taken at night for bulk and lubrication.
-Proper chewing: The diet alone is not enough. Food should be properly chewed-each morsel for at least 20 times.
-Taking a short walk is a good way to get some light exercise. Walking time should be gradually increased until it reaches 20 minutes.
-She should drink at least eight glasses of water daily. Water helps push the food through the intestines and also helps lubricate intestinal tissues. When the body is dehydrated, the intestines absorb the fluids from the food waste, which in turn leads to hardened stools
- Avoiding alcohol and caffeine is also important as these substances contribute to dehydration.
-Use fish oil and castor oil-Fish oil is believed to encourage healthy digestion and castor oil produces a laxative effect when ingested
-Fruits and vegetables, which contain high amounts of fiber, aid in alleviating symptoms of constipation,Whole-grain bread, XXXXXXX oatmeal, beans and lentils can also relieve the problem so use it Instead of highly processed rice, eat brown rice, millet or bulgur.
-Eat 2 cups of fruit 3 cups of vegetables and about 35 grams of fiber per day
fruits: Generally all fruits, except banana and XXXXXXX fruit, are beneficial in the treatment of constipation.
Pears are beneficial in the treatment of constipation.
Guava fruit when eaten with seeds, gives roughage to the diet and helps in the normal evacuation of the bowels.
Grapes: have also proved highly beneficial in overcoming constipation. The grapes have the cellulose; natural sugar and organic acid make them a natural laxative fruit. Not only they clean the bowel, but also tones up the stomach and intestines to relieve the chronic constipation
All these things will increase the bulk of your stool,Will soften it and will clear your ileum of the compacted faecal material.
-While sitting on the toilet, support the feet on a small stool in order to achieve a normal position that aids in bowel movement.
Don't stop laxative,initially start following all these advices then gradually taper the doses of laxatives she is on.
Take Fybogel husk-Fybogel sachets and Fybogel Hi-Fibre sachets both contain the active ingredient ispaghula husk, which is a type of medicine called a bulk-forming laxative. Ispaghula is a type of fibre. It swells when it comes into contact with fluid in the gut and thus increases the volume of the faeces.It increases the bulk in your stool, an effect that helps to cause movement of the intestines. It also works by increasing the amount of water in the stool, making the stool softer and easier to pass.


Follow all this for 14 days and revert me how you feel.


Thanks.
Above answer was peer-reviewed by : Dr. Prasad
doctor
Answered by
Dr.
Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2445 Questions

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