Abdominal Pain

[chris1971]

I am a 32 year old Male who has had Abdominal pain for the past 2 years. My main symptoms in the past were Bloating, painful gas and constipation (never diarreha). I saw a GI specialist and he gave me a sigmoidoscopy and a test for wheat intolerance which both turned out negative(I felt extreme!! pain during the sigmoidoscopy when air was pumped into my system). I was told I have IBS and began a high fiber diet and avoided Milk products. I also tried NuLev which did not work. I've been on this program for at least 1 year and i'm not getting better. In addition the pressure pain in my middle to left abdominal area I now have pressure and pain radiating up around my belly button. I have a many sounds, popping, sloshing liquid and sharper pains as if bubbles of air were racing through my upper GI system. Many times urinating will relieve the pressure and pain temporarily. My constipation has improved but bowel movements usually temporaraly relieve the pressure pain. Passing gas releives pressure but it usually comes right back.

I will be seeing a new Doctor soon and wanted to know what else could be done or investigated.

[Kevin Pho, MD]

Hello - thanks for asking your question.

You note abdominal pain, bloating, gas, constipation.  Sigmoidoscopy and a test for wheat intolerance were non-revealing.  

You may want to consider a full colonoscopy and abdominal CT scan as was suggested by surgeon below.  Diseases such as inflammatory bowel or masses/tumors would be better evaluated by the full colonoscopy.  

If those tests are negative, then you may want to consider more specialized testing for your constipation.  Colonic transit studies are most useful in the evaluation of patients whose major complaint is infrequent defecation.  Radiopaque markers are swallowed, and their passage through the colon is monitored by abdominal radiographs. Markers are counted in the right, left, and rectosigmoid colons (defined by certain anatomical landmarks), and are followed as they move distally until expelled.  Disease such as colonic inertia could be seen with these studies.

Defecography or anorectal manometry can also be considered to test the pelvic floor which may contribute to your constipation.

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.

Thanks,
Kevin, M.D.

[surgeon]

full colonoscopy would be one consideration, to check the whole colon. Another, perhaps more useful test, would be abdominal/pelvic CT scan with contrast in your bowel: that could show whether there's anything going on outside the bowel, as well as assesing the general anatomy of your small and large bowel. A modification of that is called CT enteroclysis where you drink a special type of contrast material that can outline the small bowel anatomy quite well.