Lower right side abdominal pain...for last 3 years

[invest6]

This is my first post on this forum.  For the past 3 years I have had a very strange pain in my lower right abdomen and I am really at a loss for what it is.  I have access to good doctors and have seen an internist and gastroenterologist, but they were really stumped.  I'm 26, been an athlete my entire life, run and exercise regularly, am fit, and eat pretty healthy.  My condition started, as I said, about 3 years ago, when I noticed a strange "gnawing" pain in my lower right abdomen - and what feels like possibly my lower right back as well.  I thought it was caused by drinking, eating bad foods, etc.  But now I have a new theory: exercise.  A few key points about the pain: when it sets in I'm usually standing up - and if I stay standing up it continues and really bothers me.  If I sit down, it abates immediately (it's very strange how quickly), until I stand up again.  After a lot of tracking to see what sets it off, I'm convinced that working out/exercise is the culprit.  I run/work out about 6 times a week.  There have been times when I have gotten off my routine (stop working out for a week or so) and the pain goes away.  It also depends on the kind of workout I do.  When I strain my back/stomach or run on the treadmill for an extended period of time (30 - 60 min) the pain seems to invariably set in.  In some of my longer runs (60+ min) I've had a little blood in my urine, which I've been told all my life is normal for distance runners.

I had a c/t scan done, an endoscopy, and blood/urine tests and everything checks out.  However, this pain has really been plaguing me for the past 3 years.  I feel very stuck and would appreciate any guidance.

I haven't shared the fact that I think this pain is set off my exercise with my internist yet, as this is a recent revelation.  However, he doesn't seem to know where to start, so I thought this forum may be more helpful.

I hope someone out there has some kind of answer/suggestion!

[ashley144]

A related discussion, What tests did they do to you?? was started.

[Jigisha S. Amin, MD]

You are a young person with a chronic issue of right lower quadrant adominal pain, worse with exercise and running and better with rest.  Like you said, you probably have a muscle strain or a cramp in the side while running too much.  It’s always good to listen to what your body is telling you and to exercise not too much and not too little, but just enough.  

Other things that are lower down the list of possibilities and sound like they have been ruled out by your internist and gastroenterologist include: chronic appendicitis(rare), kidney stones (make sure you drink plenty of fluids), a hernia, diverticulitis (Meckel’s or cecal), Crohn’s disease, ileocecal TB, cancers, infections/lymphadenitis, and drugs like NSAIDs (which can cause small ulcers in the intestines in some people).

Occasionally diseases of neighboring organs other than those described above can localize in the right lower quadrant of the abdomen.  But, usually the pain occurs elsewhere in the abdomen.  For example, gallbladder pain usually occurs in the right upper quadrant of the abdomen and the first radiologic test performed is usually a gallbladder ultrasound, rather than a Tc-HIDA scan.

It sounds like your doctor has done a pretty thorough work-up to look for other causes, so you are probably right about having muscle cramping during exercise, a common occurrence.

[margypops]

I know that you can have pain from Gall bladder attacks gallstones,, they seem to start under the right ribs and radiate into the shoulder and around into the back, this is food related, and a low fat diet seems to help, no eating in the evenings late, I think it can also be triggered by lifting , so possibly exercise comes into that .Sometimes it has to come out but I have read there is a lot of pain even after it comes out , best to ask the Doctor if he will do a test see I believe its called a Hida test .