Lower left side (flank) back pain every 5-7 days

[michaelh]

I am a 22-year-old male, 6'2", 128 pounds. In June of 2001, I started experiencing pain in my lower left back (off to the left side). The pain is best described as very similar to a stomach ache (cramping, dull yet intense pain unwavering in intensity). Each pain episode lasts 12-18 hours.  The pain disappears at hour 12-18 if I lie on my side with my knees bent, such that my left hip bears the weight.  If so, I experience a gurgling noise (which sounds like stomach rumbling), except the sound originates from the lower left back/side, along with a spasmic/pulsating sensation. 15 seconds and the pain is completely gone, with no remaining symptoms. The pain occurs every 5-7 days, but has not been continuous since 2001. I experienced the pain every 5-7 days in June 2001, May-June 2002, March-July 2004, and July 2005-present. Within these periods, I haven’t gone over seven days without a pain episode, but the pain episode never occurs if it has been less than five days. Additionally, outside of the above-mentioned periods, I did not experience even one episode of pain. An interesting occurrence marked the end of the March-July of 2004 pain sequence. I was traveling and thus unable to lie on my left side as I usually do to mitigate the pain.  The pain increased to a nearly unbearable intensity.  Then, I felt an extremely hot sensation on my lower left back/side, along with a clearly audible liquidy/gurgling sound.  This lasted 15 seconds, and then the pain was completely gone.  That was the last pain until July 2005. The pain episodes were most intense during the 2004 sequence. Each pain episode was usually so intense that I couldn’t ingest foods or liquids.  Any attempts lead to vomiting. In July 2004, I introduced certain benchmarks in my diet. I increased my daily water intake to 8 glasses a day. I ingest multiple servings of high-fiber vegetables every day. I cut out all curries, fermented sauces, rice, and pastas. I take 400 IU of Vitamin E every evening.   However, the 2005 pain episode now occurs even in light of following these dietary habits.  Yet, I find that wavering from these habits leads to more intense pain episodes than otherwise. My normal bowel patterns are two large movements every morning. Throughout this current 2005 pain episode, I have maintained unbroken regularity. I observe nothing unusual about my stools and am able to have bowel movements even during the pain episodes. During the pain, I do sometimes (but not always) notice a foul taste and smell emanating from my mouth that otherwise is never present.  I do not drink alcohol whatsoever, nor do I smoke.  My beverage intake consists solely of water, except for a glass of cranberry juice every evening and a glass of orange juice every morning.  I eat three full meals a day. CT urinalysis showed a slightly enlarged left kidney (have had this since birth), but no blockage whatsoever in flow was detected.  MRI of spine- no abnormalities. Blood - no elevated WBC. No fever.

[Kevin Pho, MD]

GI causes for pain in the left side can include various causes of dyspepsia (i.e. ulcer, inflammation of the upper digestive tract, GERD), pancreas disorders, or irritable bowel syndrome.  If the pain is lower down on the left side, diverticulitis can be considered.  

The CT showed an enlarged left kidney - but would also evaluate for kidney stones (which can also cause the pain).

You can consider further evaluation with an upper endoscopy to evaluate the upper digestive tract, or a CT scan of the abdomen to evaluate the pancreas.  Blood tests looking at the pancreatic enzymes can also be considered.

If there is a foul taste in the mouth, GERD can be considered.  If the upper endoscopy is non-revealing, you can consider a 24-hr pH study to definitively rule in or out GERD.

These options can be discussed with your personal physician.

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

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