Possible Sphincter of Oddi?

[Anjalena]

I'm 38 years old, female, with IBS (constipation) and chronic pain due to Fibromyalgia. I also have Type 2 Diabetes which is very well under control (a1c has been 6.0 or below for the last couple of years). I have high cholesterol which is now under control with simvastatin and lopid. I take Lyrica for Fibro and Metformin for diabetes. I take acidophilus, fiber (Benefiber), and stool softeners with laxatives every single day for my constipation. (my other meds are: flexeril due to chronic very tense muscles in my upper back, shoulders, and neck; meclizine for vertigo; requip for restless leg syndrome; Imitrex for migraines; ativan for anxiety and luvox for OCD/skin picking. I was on amitriptiline for headaches but stopped that a few days ago to limit exacerbation of constipation. I also have asthma but don't have very much trouble with it... i have a Pro-Air inhaler if needed)

A few months ago (in April), I started having severe abdominal pain. Through April, May, and until early June, I went to the emergency room 4 or 5 times due to severe pain. Towards the end of things, the pain was a level 9+. Well, I have Irritable Bowel Syndrome with constipation. I also have chronic pain due to Fibromyalgia and several other conditions (including plantar fasciitis and bursitis and severe lower back pain). My Fibromyalgia doctor prescribed Vicodin for me to use for my pain. Well, unbeknownst to me, Vicodin compounds constipation. I started having severe abdominal pain and so I would take more vicodin. It would ease the pain until it wore off, then it would come right back and I'd take vicodin again. This would last about 10 to 14 days until even the vicodin couldn't ease my pain and I'd have to go to the E.R. I would get a diagnosis of constipation, be given an enema and magnesium citrate and sent home. I was stubborn and wouldn't believe that constipation could cause such extreme pain so I kept using the vicodin and consequently kept ending up back in the E.R. Finally, after my June 10th visit to the E.R., I grew a brain and stopped using the vicodin. I started taking Acidophilus, Benefiber, and Stool Softeners with Laxatives every day. Because I didn't have anything for the pain, I went through HORRIBLE pain for about 6 days before the pain finally eased. I continue to take the meds for constipation every day and my tummy doesn't feel nearly as bloated or full and I'm a little more regular than I was.

Here's the thing, when I was going to the E.R. all those times, I had some general all over pain, but the MAJORITY of my pain was in my upper abdomen... like between my ribs in that place where you'd get the wind knocked out of you or someone would do the heimlich... in that area or just below it. Pushing on that place hurts... and I've discovered that pushing on the upper right area hurts too. Where the constipation pain seems to be mostly gone, this upper abdominal pain continues, though it's more moderate than severe. Over the past several years, I've had slightly elevated liver enzymes on and off. Testing showed nothing wrong with my liver so because I'm obese (around 225 lbs... down from 260 lbs the end of last year), she said it was probably just "fatty liver". Well, one of the times I was in the E.R. (back in April), my blood test for my pancreas levels came back a little elevated. They admitted me to the hospital just in case it was pancreatitis and did an ultrasound which came back negative. I've had ultrasounds a couple of times on my gallbladder and no stones were found. I have looked all over the internet for the past couple of months trying to find something that was close enough to my symptoms but didn't find anything. Well today I found something called "Sphincter of Oddi"... which an online doctor mentioned a month ago but I didn't know what it was and thought it was just a typo or difficulty with English. Well, it turns out that I have several symptoms that track with SOD. Here's a list:

-- pain is (postprandial?) worse after eating (seems to ease during times of clear liquid diet)
-- consistent pain and tenderness in upper abdomen, middle and to the right.
-- have had occasional slightly elevated liver enzymes
-- have had one blood test return a mildly elevated pancreatic level
-- ultrasound for gallstones negative
-- return of acid reflux (approx 3 mos ago) after being "cured" approx 5 or 6 years ago after a period of taking Cimetidine
-- daily mild to moderate nausea that strongly interferes with my eating habits (I usually only eat once a day due to nausea)... have lost around 30 lbs or more since the end of last year (Nov/Dec 2008) with no change in activity level... just lack of eating regularly.
-- Only 1 episode of vomiting. Woke up one morning, sat up on the bed for a few minutes, then started vomiting. But I've had MANY episodes of very overwhelming nausea, however I have a very strong control of my gag reflex... can stick my fingers WAY down my throat and not even begin to gag. So I don't know if that's why I haven't been vomiting.
-- very tired, can't get enough sleep

So I'm wondering could it be SOD? Obviously it's not a severe case... my pain lately is mild to moderate, but pretty much constant every day. Does anyone have any ideas or suggestions or questions? If you need more info, just ask. I don't get offended and am not easily embarrassed. I'm an open-book. I just want some ideas. I've had abdominal problems since I was a pre-teen... I used to have problems with gas getting locked up inside and couldn't release it and it caused excruciating pain. Those phases would last for HOURS, and usually happened at night. That lasted til I was in my mid 20's. My primary doctor is now finally trying to get me in to a GI doctor, but apparently there's only 1 in this area so he's booked I guess.

Thanks for reading my long, novel-sized post.  =)

Holly

[elie7777]

Hi I was diagnosed with SOD my symptoms I had for years since 1993.  I had about 10 ERCP at UCSF with a sphincterectomy, which is a cut of the sphincter to allow the flow of bile to the duodenum.  My pain can be severe to moderate on my right upper quadrant.  The pain radiates to my back and up the shoulder.  Very painful.  I cannot eat very much, and  I feel nauseated often .  When I have an acute attack of the bile ducts not allowing the flow of bile I can be sick to my stomach for weeks at the time.  Currently I have a  band around my  upper abdomen that is about 3 inches in width and goes all around my body, front and back.   Sometimes it takes my breath away, because is so constricting.  I feel this band under my breast to my  belly button.  It is there all the time.  Just sometimes is worse than other times.  I am having a surgery this coming week to correct this problem.  I am so excited, the doctor who is doing the surgery is a Liver Transplant Surgeon.   I am a little scare, but most of all, I really look forward to feeling better.  I hope this helps,  Good luck to you.  Hope you get diagnosed soon.  

[esrakizzit]

i have had a scan on my stomech...all the women said was, oh you are full of wind on the right side, it is irritable bowel..., she said everything looks normal in scan otherwise,.but i have never had tests on my liver or pancris, i had the barium meal drink too, nothing!.. all seemed normal, also had the camera into gut, dr said i produce too much acid...but i have met ppl b 4 who has had these feelings, but nothing shows up, all seems like too much wind and constipation, which is very painful, sometimes hard to get your breath. but i must say, i try not to take laxatives, as in the long run, they do more harm then good, i find bran flakes help very much for constipation, but i do understand your frustration, i am in discomfort everytime i eat a meal.
take care carole x
..

[Anjalena]

Hi Carole!  Thank you so much for replying. I appreciate your thoughts and help. I don't think it's as simple as that, though. I'll explain why I think that.

I had 1 test.. 10 years ago. A barium enema to check for pollips. The doc saw no pollips and said IBS! This is the same doctor who said I didn't have asthma, which I've had since I was a baby... and I came in 3 or 4 weeks later with severe bronchitis which was giving me asthma attacks so bad I couldn't MOVE without going into an attack. I mean if I moved an arm or shoulder, anything. Thankfully his P.A. was there and took care of me. I have a different doctor now. But she's not listening to me.

I've had abdominal problems since I was a pre-teen. I used to have trapped gas so bad that I would actually see things. That, and the constipation, are probably IBS. But the elevated liver enzymes that show up on and off, and the elevated pancreatic level when I was in an acute attack at the E.R., plus the epigastric pain that is postprandial (after eating) and tender to touch... also my upper right quadrant is tender when pressed on.. the nausea that started around the end of last year and I've lost 30+ lbs since then from not being able to eat more than once a day or less because of it... these symptoms are all new. And no matter how much I clean out my system with enemas and laxatives, I still have this pain in my upper abdomen.

All of those new symptoms are common with SOD and Biliary Colic and things of that nature. To quote from merck.com:

"Elevated liver enzymes suggest sphincter of Oddi dysfunction; elevated amylase and lipase suggest dysfunction of the sphincter's pancreatic portion." and "Diagnosis of papillary stenosis is based on a clear-cut history of recurrent episodes of biliary pain and abnormal liver (or pancreatic) enzyme tests."

A dysfunction in that system, somewhere, seems most likely according to all the different medical websites I've been to. Along with searching, online, for months trying to find something that matched my symptoms. Constipation alone just doesn't seem to cover it. Especially when all my bowel movements over the last week or so have been soft and plentiful.

Thanks again, Carole. I hope you get to feeling better. I do know how unfun pain is, how frustrating and tiring and depressing even. It really wears on you. *hugs* Take care.

[esrakizzit]

hi anjalena, i have the same problem as you, had tests= irritable bowel syndrome, i have very bad pain, pressure, fullness in my ribs, as if everything has been pushed up, pains in back, it is constipation=bad wind.......very uncomfy after eating, bad acid as well, which can cause the stomech lining to be inflamed, so discomfort too...irritable bowel is not a nice thing to have, very uncomfortable and painful
all the best carole

[Anjalena]

Nobody ever replied to this. I'm hoping someone will read and reply with some sort of response.

I do have a question to add. Lately my stool has been BRIGHT green. I've been taking Acidophilus, Benefiber (two teaspoons once daily), and a stool softener with a stimulant laxative in it (just 1 pill per day). I know that the bright green color can mean that the stool is going through my digestional tract too quickly. So the stimulant laxative might be the cause.

BUT, since it's bile that causes the stool to be green to begin with, could this be another symptom related to possible SOD? (also, my stool has been very soft and comes out in thin broken pieces, but it has form.. so, can I still be constipated?)

Please, someone help me out here. My doctor tends to be one-track minded and she's still thinking all my pain is caused by constipation and has even said to not make another appointment with her until I have started a diary and adhered to a strict regiment for a full month and still have problems. I need more information to present to her. (and my appointment with the GI doctor is still pending)