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Please HELP! Chronic lower abdominal cramping/pain and gas for 4 months...
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Please HELP! Chronic lower abdominal cramping/pain and gas for 4 months!

Hello. 22 year old white male here in hopes of finding an answer to a problem that has plagued me for over four months now.  I'm hoping somebody can help me.
Four months ago, I began having strange symptoms very suddenly. I had started going to the bathroom more than usual, I had diarrhea, mild cramping/gas in the lower middle part of my abdomen (right below the belly button), narrower stools, and it also felt like the bowel wasn't completely empty after a bowel movement.  I had a stool test performed to look for evidence of bleeding/infection, and it came back normal.  The symptoms began to go away a little, and I thought I was getting better. Then, I noticed there was a little bit of blood on the toilet paper after I wiped.  It also itched and burned really bad at times. This prompted me to go back to my doctor, who did a digital rectal exam, and also checked my prostate. Prostate was normal, but he discovered two hemorrhoids and gave me some suppositories.  He also referred me to a gastroenterologist, who I saw the next week.
The gastroenterologist listened to my story, and immediately asked me if I had gone camping lately and if I had drank mountain stream water.  I said yes to both questions, and he immediately suspected giardia.  He suggested I get another stool test done looking for the giardia antigen, and he wanted me to schedule an upper GI and small bowel series X-ray, and a colonoscopy.  I took the giardia test, which came back negative, and he started me on Flagyl "just in case." He claimed that giardia sometimes doesn't show up on the test. At this point, I no longer had narrow stools or watery diarrhea, but the stools I did have were loose.  They would come out feeling solid, but would quickly break up in water and would almost liquify when the toilet was flushed.  Also, I noticed air bubbles being released as the stool broke up in water.  I finished the Flagyl, but the symptoms remained.  
I had my colonoscopy today, and he found one small polyp that he said definitely wasn't cancerous.  Other than that, it was clear.  I haven't had the Upper GI small bowel series Xrays yet because I am paranoid about Xrays and the risk they have in actually CAUSING cancer.  I was trying to set up an abdominal ultrasound first and I wanted to put off the Xray as long as possible.   He told me again today to get that done before going to see him again.  
So what's wrong with me? I believe the colonoscopy ruled out colon cancer, ulcerative colitis, and a bowel obstruction, so what else could be causing this?  Keep in mind, the gas and cramping seem to come from the lower/middle of my abdomen (below belly button.) I feel better after a bowel movement. The worst pain I ever had was after eating pizza. SHARP pains and gas that would come and go quickly. Could this be a hernia? Or is it most likely related to my small intestine? Or IBS? Parasites? Lactose intolerance? I'm scared and confused. Please help!
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The planned GI workup is a comprehensive one.  The colonoscopy would rule out many of the major lower GI disease.  

I would consider pursuing the upper GI workup.  If there is concern about the radiation, you can consider an upper endoscopy - which is a more comprehensive test.

If the tests continue to be negative, an abdominal CT can be considered.  I would also send the stool off for tests for fat malabsorption as well as parasites and culture.  Lactose intolerance can be evaluated with specialized breath tests.

If the tests continue to be negative, then treatment for irritable bowel syndrome can be considered (i.e. by increasing the fiber in the diet or with antispasmodic agents).

These options can be discussed with your personal GI physician.

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_b
3 Comments
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What kind of foods do you eat? Have you considered making a food diary?  Often this can help you elucidate if a certain food is making you feel this way.  Have you tried cutting out milk containing products?  I noticed that you suffered quite a bit after some pizza which has a lot of cheese.
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Nobody's mentioned it, so I thought I should, Crohn's sounds like it could be a possibility. It sounds worth it to keep a food diary and cut out the things that seem to give you problems.
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Hey cjoklb.

I have a very similar problem. My doctor said it was IBS about two years ago.

Ive still been having problems and recently went for an xray (still awaiting results).

If your still having problems, try some of the IBS sites and change your diet. see if that helps. Changing my diet has helped big time. Basically cut out fatty foods, dairy, sugar. Eating a salad every day and using digestive aids.

Excerise has also helped me alot. I think my metabolism was non-exisitent after i started work (no excercise).

Hope that helps!

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A related discussion, Lower Stomach cramps with diahrrea with certain foods.. was started.
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