Persistent, chronic right abdominal issues

[veridian]

For many years felt my right abdominal area to be quite tight. If asked to twirl I would turn to my left naturally since that felt more comfortable. I am increasingly more active but abdominal issues have got worse along with it. If running I would get what I thought was a stitch but really was a spasm of the right upper quadrant localized to the epigastric region.

Last year training for rowing went up and worked through the discomfort. Developed tear on outer part of upper quadrant muscle. Sent to GP. Initially diagnosed chronic strain and ordered anti-inflammatories and rest for a few months. This worked but the original issue persists. Also took bloodtests and found my TSH to be c. 5 and creatinine was slightly high also. With rest my TSH is back down to 4-4.5  but the creatinine level is still the same (118 I think). All other readings excellent. Kidney ultrasound looked fine. Just had an MRI scan but I suspect will prove inconclusive and my GP will forward me on.

When at rest the pain feels deep down i.e. not in the muscle and moves about the inner side of the right upper quadrant and right epigastric region. Delayed urination standing at a urinal but not when sitting down. Running turns the discomfort into pain and spasm in the inner right upper quadrant. Cycling and light rowing are ok but don't help anything. Pounding activitie on the abdominals cause distress. Hard rowing results right lower back feeling uncomfortable.

All right abdominal region is sensitive to being pressed with flat hand. When this occurs the upper quadrant feels very uncomfortable for a long time afterwards. This discomfort feels quite deep with some bowel movement but not neccessarily. Feelings of gagging occur when the right abdominal region is pressed or am nervous. Squatting with weights not good also.

So, what could cause this persistent discomfort in the right abdominal region?
P.S. When less fit had a tendency to hold in my stomach but not anymore.

[Kevin Pho, MD]

The MRI would rule out many of the major RUQ disorders, including gallbladder or liver disease.  

You can consider an MRCP or ERCP can be considered to look at the biliary ducts.  A Sphincter of Oddi manometry can be considered (with the ERCP) can be done to evaluate for Sphincter of Oddi dysfunction - which can lead to the symptoms you are describing.  

Another specialized test would be a HIDA scan with CCK stimulation.  A low gallbladder ejection fraction can lead to some RUQ pain that may not have shown up on the MRI you had.  

Other causes would be various forms of dyspepsia caused by GERD, an ulcer or inflammation of the upper digestive tract.

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.
kevinmd_

[veridian]

Just following up on my previous post for those who are interested...

I went to my GP to discuss MRI and plan of action. As suspected the MRI showed nothing unusual. No evidence of a tear or gallbladder/liver problems.

We discussed further the source of the pain. It is worse in stessful situations such as public speaking, a big exam or the start of a race. Doctor now suspects it is IBS. Now that I think about it I think he may be right. I don't show all the symptoms of IBS just really spasm of the colon and sometimes the oesophagus. I don't have constipation or diarrhea though I can have it now and again but really very rarely.

I do fit the bill as the sort of person who might get IBS. I am highly strung and can be pretty emotional but I do thrive on adrenaline. If only my colon would also.

The main reason I think he is right is the nature of the pain. It is deep and it moves around. Sometimes the discomfort could be just below your sternum other times it is in the lower inner part of the right quadrant. I cannot imagine a gallstone causing pain in such a fashion.

So now I'm going for a breath test to test for H.pylori and then I will try an anti-spasmodic called colofac. I think/hope that the anti-spasmodic will work.

I have resumed training after a break of 6 months with the hope of returning back to the rowing team next September.

I am keeping everyone informed because I know how this sort of pain can ruin your life. I don't want anyone to experience what I have gone through for longer than they have to.

I will keep everyone posted on further developments.

[veridian]

Following up, as I said I would, it turns out that the problem is musculo-skeletal after all. There is a certain degree of psycho-somatic influence as well. I just focussed my mind on trying to relax the colon for a few days and I noticed a great improvement. It tended to still want to knot up but this has stopped now that it has found a new natural position. My right glute and lower back still tended to tense up. I have gone to a physical therapist (not a physio therapist) to lossen these up. Seems that the fascia have become very tense over time in that region. A series of treatments should help aleviate the situation.

Frankie says relax!,
Veridian