Lower Right Abdominal Pain

[korincob]

I was diagnosed with Irritable Bowel syndrome in 2004, and about 4 months ago I stated experiencing periods of severe pain in my lower right abdomen that seems to be nothing like the IBS pain that I was previously experiencing. I have been to the doctors and now a gastroenterologist several times  I have had two abdominal CT scans, a pelvic ultrasound, and a colonoscopy with biopsies, all of which have come back normal. My ESR came back one week at a value of 30 and the very next week at a value of 60, and tests have also shown mild anemia. I am at a dead end and the pain just seems to get worse with time. Any one have any ideas?

[boron]

I can't say from here you have Crohn's disease, but right lower abdominal pain with all circumstances as you describe them, is quite characteristic for Crohn's. Th most often affected part in Crohn's disease is "terminal ileum" - the part of small intestine just before it connects to colon- actually there where appendix is and a bit upper. Capsule endoscopy should show inflammation of that part of intestinal wall.

Treatment, if tests will be positive, is by anti-inflammatory drugs, but you will need to figure out the right diet by yourself. Something what doesn't stay a long time in the stomach (low-fat and low-protein diet, in short: less animal food) may help to relieve nausea (if this will be the problem). Probiotics don't help in this inflammation, just for info.

[korincob]

My symptoms seem to be completely different. Previously I could attribute my pain to stress, or certain foods that I ate, and the pain seem to be relieved with a bowel movement or when I took the medication dicyclomine that my doctor had prescribed me. The pain was also more centrally located. The past 4 months this has not been the case, this pain is centralized to my right lower abdomine, and is much more excruciating when it occurs. It seems to be related to nothing, and does not seem to get worse from stress and or certain foods, and is not relived with a bowel movement. I have also notice that the past 4 months I have lost my appetite and my weight seems to be fluctuating quiet a bit. I highly doubt that this is related to my IBS, unless the IBS can change this significantly. Thanks again for the input.

[boron]

4 years is a plenty of time for any inflammation (Crohn's, celiac...) to develop in the intestine. But do you want to tell, that you had the same symptoms then?

[korincob]

Thanks for the reply, I really appreciate any advice that I can get. I am 24 years old, and Crohn's is what my gastroenetologist is suspecting it may be, and he is actually in the process right now of approving a capsule endoscopy. The only thing that makes me skeptic is that I had apparently was scoped in 2004 on the left side of my small intestine, which came back completely normal as well. I am just concerned that this capsule endoscopy will come back normal, and then I will be stuck, but I suppose I should just be patient and wait it out. Thanks again for the input.

[boron]

Lower right abdominal pain + elevated ESR + anemia speak for inflammation, maybe Crohn's disease which, in your case, may predominantly affects the small intestine.

Small intestine may be checked with capsule endoscopy. Duodenum (the site of main iron absorption) may be checked by upper endoscopy, and then biopsy made.

How old are you?