If colonscopy negative, should I have pelvic lap

[Bellaciao]

I have had lower abdominal pain since June.  I have constipation unless I use colace and citrucel or fiber lax.  Even with these I have a lot of cramping and pain with bowel movements. A colonoscopy was totally negative.  One MRI showed a small ovarian cyst and adenomyosis although I am past menopause. A second MRI showed a small 2 cm growth off the liver.  The question is should I have a pelvic laparoscopy for diagnostic purposes as my doctor is suggesting.  I have a lot of bloating also and occasional nausea although I have not lost weight. It is difficult to plan my life since I never know when the pain will be severe.  Thank You

[Kevin Pho, MD]

Erin, PA has kindly answered your question in her comments below and I agree with her assessment.  

One other consideration would be tests for malabsorption.  You may want to consider tests for fecal fat or blood tests for celiac disease.  A GI consult would also be reasonable at this point as has been suggested below.

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.

[GI.PA]

Ok..first you have to look at this in pieces.  

First from a constipation standpoint (bloating, cramps, constipations), most colonoscopies are normal (suggesting no structural abnormality contributing to the constipation).  This usually is cause by a bowel that just slows down.  Miralax could be considered perhaps at twice daily doses in combination with the fiber.  You will find the results superior to your current regimen.  Zelnorm could also be considered.  Although a laporoscopy may elimate stuff going on outside the bowel (adhesions, GYN organ issues), it will most likely not give any more information on this aspect.

Secondly, from a GYN standpoint, a laporoscopy may be indicated.

From a liver growth issue, I simply do not have enough info.  If this showed a spot consistant with a hemangioma, sugery to fix this is not usually advised.  If it is something else on the outside or surface of the liver, biopsies may be able to be obtained during lap may be helpful.

It sounds as if you may have less than helpful GI support on this case.  If not already done, get a GI consult (not just a colonoscopy but a side down talk about your constipation and liver)..preferably before your lap.  

What I must caution you about is this:  The lap may not provide any info or cure to your consipation.  Your symtoms are very consistant with IBS with constipation and every study in the book will be negative/normal.  You need a doctor who will maximize medications available for this condition.  If a lap is indicated for GYN or liver issues, dont hesitate but go into this with reasonable expectations if you expect answers/cure with your constipation.

Just my 2 cents.

Erin
GI.PA