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Gastroenterology (Expert Forum)
Abdominal/hip, pelvic bone (?) extreme pain
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Abdominal/hip, pelvic bone (?) extreme pain
by Rockmist, Oct 19, 2006 12:00AM
Related History (most decades ago): colitis (age 20); 4 adom exploratory adom surgies for endrometrosis (from age 19-35); complete radical hysterectomy-also took appendix. Had adhesion problems with every surgery. I am a very, otherwise, healthy 58 yr old female.
Pain began in low back right hip bone 2 1/2 mos. ago; progressed to sciatica type pain that increased weekly; extreme tenderness with even "fly wing" touch at protruding bone that attaches back muscle to hip; had 2-4 episodes of extreme stabbing pain around right only anus & gripping pain top hip bone/front hip bone areas; sit, walk, stand = severe pain; progressed to increased pain in hip/pelvic/adom areas after drinking, full bladder (pain retreats somewhat in front hip bone/adom area after urination)-even worse adom pain after eating (pain level diminishes slowly after); progressed to right adom pain between top hip & ribs/front hip/back above hip bone; pain is constant since began; pain has continued to escalate every week and rate very high level now(#7-9)except adom mostly after eat/drink (still pain but decreases); some constipation. The worst, constant pain is in low right back (as it began with) and "sit" bone area; progresses to abdom after eat/drink.
Tests/treatment: hot/cold packs; Naproxen 10 days; steroids 7 days; xray/mri spine (clear); saw neurosurgeon-gave cocktail shot in the "spot" where worset pain is; PT w/TENS-could not tolerate stretchng exercises, massage at all; was referred to pain clinic.
Doc from very strict HMO; HMO does not allow consults w/o doc referral and MUST be within HMO & I am on disablility (for unrelated reasons) so can not afford to pay for one myself. Doc has refused blood/urine/stool tests, adom/hip scans, & referrals to abdom specialist as she says "there are no more tests that can be done for your symptoms." (I have anxiety disorder; assume she thinks this is cause but I do not have nor ever had physical phobias, nor do I see her often - only seen her 2 times in 2 years before this issue arose.) I am VERY sure this is a physical problem!
I have read all can online & see possibilities but would require further testing to determine, obviously.
I want to approach doc w/options these symptoms could be so she will test/scan. I am scared w/o determining cause may find self in an emergent/deadly situation. I don't tend to see doc, etc unless bad (had 3 emerg surgeries due to my not going soon enough, or missed by docs)
Could be nerve pressure &/or adom? Could adhesions be there now since last surgery was in '85? Could any adom issue cause pressure on nerves that would cause sciatic-like pain as well as right-sided only anus pain that last about 4 hours? Could kidney problem affect my low back bone/area? Could I have two separate issues going on?
Pain began in low back right hip bone 2 1/2 mos. ago; progressed to sciatica type pain that increased weekly; extreme tenderness with even "fly wing" touch at protruding bone that attaches back muscle to hip; had 2-4 episodes of extreme stabbing pain around right only anus & gripping pain top hip bone/front hip bone areas; sit, walk, stand = severe pain; progressed to increased pain in hip/pelvic/adom areas after drinking, full bladder (pain retreats somewhat in front hip bone/adom area after urination)-even worse adom pain after eating (pain level diminishes slowly after); progressed to right adom pain between top hip & ribs/front hip/back above hip bone; pain is constant since began; pain has continued to escalate every week and rate very high level now(#7-9)except adom mostly after eat/drink (still pain but decreases); some constipation. The worst, constant pain is in low right back (as it began with) and "sit" bone area; progresses to abdom after eat/drink.
Tests/treatment: hot/cold packs; Naproxen 10 days; steroids 7 days; xray/mri spine (clear); saw neurosurgeon-gave cocktail shot in the "spot" where worset pain is; PT w/TENS-could not tolerate stretchng exercises, massage at all; was referred to pain clinic.
Doc from very strict HMO; HMO does not allow consults w/o doc referral and MUST be within HMO & I am on disablility (for unrelated reasons) so can not afford to pay for one myself. Doc has refused blood/urine/stool tests, adom/hip scans, & referrals to abdom specialist as she says "there are no more tests that can be done for your symptoms." (I have anxiety disorder; assume she thinks this is cause but I do not have nor ever had physical phobias, nor do I see her often - only seen her 2 times in 2 years before this issue arose.) I am VERY sure this is a physical problem!
I have read all can online & see possibilities but would require further testing to determine, obviously.
I want to approach doc w/options these symptoms could be so she will test/scan. I am scared w/o determining cause may find self in an emergent/deadly situation. I don't tend to see doc, etc unless bad (had 3 emerg surgeries due to my not going soon enough, or missed by docs)
Could be nerve pressure &/or adom? Could adhesions be there now since last surgery was in '85? Could any adom issue cause pressure on nerves that would cause sciatic-like pain as well as right-sided only anus pain that last about 4 hours? Could kidney problem affect my low back bone/area? Could I have two separate issues going on?
Doctor's Answer
by Kevin Pho, MD, Oct 20, 2006 12:00AM
, Oct 20, 2006 12:00AM
Difficult to say without examination. Certainly if you are concerned about the care you are receiving, a second opinion can be considered.
I would consider doing some imaging studies to rule out possible orthopedic causes. This can include hip and pelvic films, as well as a back MRI to look at the disks. Ultrasound can be considered to look for any kidney pathology that can lead to the symptoms.
If negative, I agree with the PT approach. A referral to a physiatrist can be considered for possible trigger point or steroid injections.
If there is concern about adhesions, a CT would be helpful. I am not aware of adhesions leading to sciatic-like pain.
These options can be discussed with your personal physician, or in conjunction with another opinion.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
I would consider doing some imaging studies to rule out possible orthopedic causes. This can include hip and pelvic films, as well as a back MRI to look at the disks. Ultrasound can be considered to look for any kidney pathology that can lead to the symptoms.
If negative, I agree with the PT approach. A referral to a physiatrist can be considered for possible trigger point or steroid injections.
If there is concern about adhesions, a CT would be helpful. I am not aware of adhesions leading to sciatic-like pain.
These options can be discussed with your personal physician, or in conjunction with another opinion.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
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How do I know this? Because I said I COULD NOT GET A SECOND OPINION and the reasons. I told you I had already had an MRI.
THAT WAS THE BIGGEST WASTE OF $16 I HAVE EVER SPENT! And when you only make $693 a month, believe me, that is A GREAT DEAL OF MONEY!!
Why didn't you just say, I don't bother reading the whole post and don't feel comfortable giving you a REAL opinion!