Chronic lower right abdominal pain

[Tabs]

Hi,

I'm a 25 year old male. For probably close to 4 years I've had a chronic pain in the lower right portion of my abdomen.  It's a sort of tightness sensation that's always there and the area hurts when I push down on it or when I suck in my stomach for instance.  When I lay flat on my stomach in bed, it really feels like there's something there, like pressure almost.  I also get frequent diarrhea.

I went to general practitioners several times for it, was told IBS and acid reflux.  Around the 3rd time I went in, they ordered a CT scan - I'm not sure exactly what type it was but I had to fast and drink several bottles of a barium solution, they also injected a contrast agent while the scan was happening.  The results of that were normal and I was once again told IBS. (which to me means basically nothing at this point)

(cont.)

[abdula]

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[lizziecee]

Crohn's isn't the only disease that cause your symptoms, so don't get too hung up on it until you have a colonoscopy and a biopsy. This THE only way to see if you have an inflammatory bowel conditions, like Crohn's or Ulcerative Colitis.  I went about a year before my Crohn's was eventually diagnosed, and that was after 5 different hospitals, as it was a very rare disease in 1970. Unusually, I had no pain at all - just constant diarrhea and severe weight loss, although I was eating okay. It was only when I was hospitalised for 3 weeks, as I was severely anaemic and neutropenic by then, that I had pain, and my gastro and surgeon decided to do a laparotomy. There was no such test as colonoscopy in 1970. I was treated with steroids as there were too many places to resect. Crohn's is characterised by "skip lesions", whereas Ulcerative Colitis is an inflamed condition throughout the large intestine.

Appendicitis was a possibility in my case, but the pain would have been severe long before I was hospitalised, so there had to be another reason.
Coeliac disease is another possibility - I was tested for this by endoscopy and biopsy, and the results were negative. I really don't know much about Ulcerative Colitis, the symptoms are similar to Crohn's, but UC is not an auto-immune disease, and is confined to the large intestine, whereas Crohn's can occur from the mouth the anus, and the eyes can also be affected. I now have "panCrohn's colitis", meaning both my large and small intestines are affected.

However - it doesn't mean a life sentence of misery - I am now on an immuno-modulator, methotrexate, and am doing well.

I hope you both get a diagnosis soon, and the appropriate treatment.
Liz.

[christa789]

A couple of months ago I had several attacks in a two week span that literally made me fall to my knees. It was a a severe pain that started in the middle of my back and ran down through my right gut into my hip then into my right lower back. It felt like someone was ringing out a wet towel a twisting tight sensation. Went to the hospital told me it was acid reflux. I am not feeling that pain no longer but I feel a constant pain in my right gut to my lower back that can go from dull to severe to the point I can not think straight. I haver these episodes on the toilet where I feel like I am going to pass out. I never have a solid stool movement. I also feel a sharp pain in my rectum from time to time that is a concern to me I also get grind like stools and alot of diareaha. I am concerned because this pain is daily and feel like now that I have been technially diagnosed they don't want to do further testing. Can acid reflux really cause all these symptoms? Also I feel like my right side is swollen from under breast to hip bone all the time I feel this swollen and my symptoms are mostly at early evening through the night. Can someone help me?

[dlhigh]

Referral to a GI should be in order for additional testing and in the mean time, your family doctor should have you on medication for the IBS if that is what is believed to be causing the pain.

[Tabs]

Kevin,

Thanks for the response.  How concerned should I be about Crohn's Disease?  Some of the sites I've read about it sound awful similar to the type of things I'm experiencing, the pain is in the right spot for it etc...  Would I seriously have been able to go for 4 years with it though without anything really major happening?

Thanks

[Tabs]

Last October, I was referred to a Gastroenterologist for it.  He recommended a colonoscopy, which was scheduled.  Something came up for me in my last semester of school and I was unable to have the procedure done - I turned 25 shortly after and consequently lost my health insurance (was through my parents).  As a result I never had the colonoscopy.

Anyway - I'm still having the problem and some new symptoms like a sort of cramping type pain near the surface from my sternum down toward and around the belly button has been happening every day.  I'm getting increasingly worried that something bad is going on, but I'm in a serious bind having no insurance.  What do you think this all is and what should I do about it?  I can't imagine it's cancer or anything since I've had it for so long right?

Thank you,
Ryan

[lizziecee]

Hi Ryan -  sorry you are suffering with pain in your abdomen. I have had Crohn's since I was 24 yrs (now 62!) and the usual symptoms are diarrhea, weight loss and pain in the abdomen near the appendix (on the rh side). A colonoscopy is I am afraid, the only way to definitively diagnose it. Your previous test sounds like what we call in England a "barium follow through", barium being the white, chalky mixture you have to drink - contrast? This can show strictures in the small intestine, but not sure if it will show inflammation (ulcers, crypt abscesses). I have regular 3-5 yrly endoscopies of the small intestine and 5 yrly colonoscopies of the large bowel. My last upper GI follow through in January showed, for the first time in 37 yrs, a stricture in the small bowel, so I now have to be aware of severe pain and go to the ER when it happens, in case the intestine bursts. IV steroids usually brings an acute flare under control.

My gastro has recently been prescribing a stool test - Calprotectin Assay - which is non-invasive, non-specific, but if the level is elevated, means there is inflammation in the GI tract. It is cheap to do - you just give a stool sample and the lab tests it. I am not sure if this test is available in the US, as it was developed by an English gastro in Nottingham,England. You could google it for further information.

Your symptoms could also be Ulcerative Colitis, which although an inflammatory bowel disease, is quite different forensically to Crohn's, but just as debilitating.

As far as I am aware, the only way to get a proper diagnosis is from biopsies of the intestines, which of course means invasive testing.

As you have no insurance, and some of these procedures are costly, you may find that your local hospital's social worker could help with funding.
Hope you get it sorted soon.
Take care, Liz.

[Kevin Pho, MD]

Lower right pain can be due to the appendix, inflammatory bowel disease, irritable bowel syndrome.  Non-GI causes can include a hernia, kidney stones or musculoskeletal causes.  

I agree with the CT scan, and a negative test would make appendicitis less likely.  I would consider a colonoscopy as well as a small bowel series to look for inflammatory bowel disease.  

The diarrhea can be evaluated with stool cultures and tests for fat malabsorption.  I would also consider a blood test looking for celiac disease.  

These options can be discussed with a GI evaluation.

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_