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Gastroenterology (Expert Forum)
IBS Diagnosis/Diverticulitis and Mysterious Pelvic Pain
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
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.
IBS Diagnosis/Diverticulitis and Mysterious Pelvic Pain
by weasel1, Nov 10, 2005 12:00AM
35 year old male.
I have had 2 bouts of diverticulitis over the last two years (with two CT scans). The most recent confirmed attacke was in May of this year. Ever since then I have problems with persistent abdominal pain. During a recent episode of pain a sigmoidscopy was done which showed no infection/inflammation but did show some feces in the diverticuli.
Blood tests were done early on ruling out malabsorption/liver and celiac. My GI has also ruled out Meckels(sp?) and is planning a imaging test where I swallow a capsule and it takes pictures.
I have since had 2 surgical consults which reviewed the CT scans and suggested surgery would potentially be the thing to do. My GI and GP both seem to think it is IBS. I have been taking clonazepam for anxiety (.5 MG a day) and nortriptylene for pain management (25 mg a day).
The Nortrip had been helping somewhat but this morning I was awoken from sleep by severe abdominal pain (I had been constipated the previous week and had been having much thicker than normal BM's) that lasted for about 1/2 hour. I could not move my bowels during this time. I took a Levsin and then began having explosive diarrhea that lasted for another 2 hours or so intermittently. The rest of the day I had what I would describe as rectal pain (sphincter maybe) and tenderness in the pelvic area right above my penis. The tenderness does not seem to change with coughing, but is persistent. Not a skin sensation, but just a little further in.
QUESTIONS:
1. I had read that this type of severe pain I described (where it wakes you up) is not consistent with IBS. Your thoughts on this?
2. Any idea on the pain/tenderness in the pelvic/lower abdominal front wall area?
3. Any other thoughts or ideas given what I've described would be appreciated.
I have had 2 bouts of diverticulitis over the last two years (with two CT scans). The most recent confirmed attacke was in May of this year. Ever since then I have problems with persistent abdominal pain. During a recent episode of pain a sigmoidscopy was done which showed no infection/inflammation but did show some feces in the diverticuli.
Blood tests were done early on ruling out malabsorption/liver and celiac. My GI has also ruled out Meckels(sp?) and is planning a imaging test where I swallow a capsule and it takes pictures.
I have since had 2 surgical consults which reviewed the CT scans and suggested surgery would potentially be the thing to do. My GI and GP both seem to think it is IBS. I have been taking clonazepam for anxiety (.5 MG a day) and nortriptylene for pain management (25 mg a day).
The Nortrip had been helping somewhat but this morning I was awoken from sleep by severe abdominal pain (I had been constipated the previous week and had been having much thicker than normal BM's) that lasted for about 1/2 hour. I could not move my bowels during this time. I took a Levsin and then began having explosive diarrhea that lasted for another 2 hours or so intermittently. The rest of the day I had what I would describe as rectal pain (sphincter maybe) and tenderness in the pelvic area right above my penis. The tenderness does not seem to change with coughing, but is persistent. Not a skin sensation, but just a little further in.
QUESTIONS:
1. I had read that this type of severe pain I described (where it wakes you up) is not consistent with IBS. Your thoughts on this?
2. Any idea on the pain/tenderness in the pelvic/lower abdominal front wall area?
3. Any other thoughts or ideas given what I've described would be appreciated.
Doctor's Answer
by Kevin Pho, MD, Nov 10, 2005 12:00AM
, Nov 10, 2005 12:00AM
To answer your questions:
1) If the CT scans show diverticulitis, then I would address that first before attributing it to IBS. You can consider another opinion if the diagnosis continues to be in question.
2/3) Other possible causes can include inflammatory bowel disease, colitis, malabsorption, or a colon mass or polyp. You can consider sending off the stool for culture and analysis, as well as a colonoscopy - which is more comprehensive than a sigmoidoscop - for further 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.
http://www.straightfromthedoc.com
1) If the CT scans show diverticulitis, then I would address that first before attributing it to IBS. You can consider another opinion if the diagnosis continues to be in question.
2/3) Other possible causes can include inflammatory bowel disease, colitis, malabsorption, or a colon mass or polyp. You can consider sending off the stool for culture and analysis, as well as a colonoscopy - which is more comprehensive than a sigmoidoscop - for further 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.
http://www.straightfromthedoc.com
