Smooth Muscle Spasms

[jenniwrenne]

I have smooth muscle spasms in my gut, mostly in the diaphragm area, though they often spread up my chest, and sometimes affect my lower abdomen.   A colonoscopy has shown no organic disease in the colon, and u/sound scans and MRI scans have ruled out any disease in other abdominal organs.

The spasms have a severe effect on my breathing, making me constantly breathless, and I am woken several times a night struggling to breathe.

I have been prescribed several drugs in the past, at different times, to treat the problem. None of them helped, partly because of the side effects I experienced .  The drugs were a small dose of  benzodiazipine, which made me too tired to do anything all day. Later I tried a very small dose of Amitryptiline, but it  made me too agitated to continue with it, and did little to relieve my symptoms.

I do not suffer from diarrhoea or constipation.  But when I tried taking one of the smooth muscle relaxant drugs (cannot remember the name of it) it gave me terrible constipation, which was a nightmare to resolve.   There is just no point in me taking a drug that makes my quality of life worse than it already is.  Can anyone recommend a drug that might relax the muscle spasms, without giving me constipation or other intolerable side effects?  

Thank you.  

[boron]

Do you ever have a shoulder pain - on any side?
These spasms are constant or are limited to certain time of the day..are they related to meals...?

[jenniwrenne]

Yes, I sometimes get pain at the back of my right shoulder, (i.e. in the shoulder blade).
The spasms in the diaphragm are more or less constant, though much less severe in the mornings after a night's sleep. But they start getting worse as soon as I am up and moving about.
They are related to meals in the sense they get much worse if I am hungry. I always feel better after a meal, particularly if I eat quite a big meal..  

Apart from hunger, there are 3 things that always make the spasms much worse:-

1) brisk exercise, lifting anything heavy, or bending/stretching -- these are all big triggers and cause a lot of pain.  The only exercise I can safely do is gentle walking.

2) I have a number of food intolerances, and if I occasionally eat something from the 'forbidden' list, (i.e. if I am eating out) then the spasms get much worse. The list includes gluten, dairy, soy etc.

3)  stress or excitement make the spasms worse.


I also have asthma, and the spasms in the diaphragm do often trigger bronchospasms, which can result in either an asthma attack, or
severe coughing fits to the point of almost choking, which is very embarrassing if it happens when I am with people.  

[boron]

When you have spasm does your abdominal wall becomes hard ? This can be easilly detected by fingers. I'm asking because I wonder why you say that you have spasms in *smooth* muscles. Stomach, gallbladder and intestines have a wall from smooth muscles. Diaphragm and abdominal wall have striate muscles. Bronchial walls have smooth muscles.

When did your symptoms start? Do you have exact diagnosis for food intolerances: celiac disease, soy allergy, fructose malabsorption, lactose intolerance? Which exact foods (do you have a list?) you are intolerant to?

Spasm in striat abdominal wall muscles appears during or after heavy exercise and in mineral imbalance (sodium, potassium, calcium, magnesium) or in dehydration. Small intestinal inflammation in celiac or other disease could cause deficiency of some minerals in your blood - this can be detected by blood test.

Food intolerances often result in gas built in transverse colon - the horisontal part running below diaphragm - this could possibly irritate diaphragm. Right shoulder pain typically appears in inflammed gallbladder (stones) but could be triggered by any process occuring below the right diaphragm (including distended horisontal part of the colon from gas from food intolerances. In this case you'd probably notice distended upper abdomen.

[jenniwrenne]

Many thanks for your helpful reply.  When I have the spasms in the diaphragm area my abdomen does not become hard.  I get a pain like a stitch in my left hand side, my sternum becomes very painful and sore, like the skin has been burnt, so sore
I cannot bear to touch it.

The spasms affect the secondary muscles of respiration, which is the cause of the breathlessness. Are not the secondary muscles of respiration smooth muscle?  As I understand it, the doctor seems to think the spasms in the smooth muscle (gut & respiration) have involved the striated muscle in the diaphragm area.  I do not understand the reasons why.

I was dxed with celiac disease 30 yrs ago, and have been on strict gluten-free diet since.  Dxed with lactose intolerance as a teenager, and have  been on dairy free diet since.  5 yrs ago I became very ill with gastritis, and was dxed with autoimmune thryoid disease. A year later I developed more intolerances ...to all cereals (except rice), soy, nuts, beans,  chocolate, tea, coffee,  and some vegetables. I also developed asthma, which is triggered by the food intolerances, heat, exercise, stress etc.

Had some blood tests 3 yrs ago for mineral/vitamin imbalances. I was low on zinc and all B vits. Have been taking supplements since. Magnesium levels were mid range normal, but nowadays I take Cal/Mag supplement + Vit D3 as I have Osteopenia.

Interesting you mention gas collecting in the transverse colon can result from food intolerances, as this has been mentioned to me in the past by a doctor.   However, as long as I keep to my exclusion diet (as above), I get very little gas, way less than anyone else in my family in fact!   The one off occasions when I go off the diet, then I do get some gas.  But I have the pain and the spasms whether I have gas or not.

Yesterday I went for a massage. My usual therapist is away, and I had a therapist who massaged with more force and pressure than I am used to. This was quite invigorating at the time, but afterwards I started getting bad spasms in my back, then they spread to my chest, and caused quite severe breathing problems involving my upper airway. It was horrible, and needless to say I won't be going back.  These were the same kind of spasms I get from other causes, such as exercise, lifting, food intolerances etc.

Do you think it is possible for part of the transverse colon to become permanently distended, even when there is no excess gas, and none of the culprit foods are being eaten?   It feels so much to me like something is out of place, resting on another organ, and causing a strong pulling, tugging sensation. My abdomen is not distended though.   Nothing unusual was seen on the MRI scan.  

[boron]

Secondary breathing muscles are striated muscles that connect ribs (so, they are part of the chest wall). They are like muscles in the abdominal wall. If spasms were occuring in either abdominal or chest wall muscles, you would be able (at least partially) control spasms with certain body movements like streching the trunk.

Spasms triggered by certain moves, exercise, and massage and spasms in the back strongly suggest that they affect striat muscles (including breath muscles).

If spasms are always limited to abdominal/back/chest area this sugessts a spinal disorder affecting nerves arising from certain segments of thoracic spine (several bulging discs or spinal arthritis - spondylitis)...or something other pressing on these nerves (spinal tumor), a neurological disorder including multiple sclerosis or other. MRI of the spine/spinal cord would be needed to find this.

If spasms also appear in the hands, fingers, feet, calfs..this speaks for metabolic disorder (iron, potassium, calcium, magnesium, natrium, vit B, folate..also...deficiency... ) or some rheumatic disease. Checking main vitamins and minerals, also morning glucose in the blood would be needed to find out this.

Hunger causing cramps may be due to hypoglycemia or because of anxiousness that increases muscle tone.

"I get a pain like a stitch in my left hand side, my sternum* becomes very painful and sore, like the skin has been burnt, so sore I cannot bear to touch it.

Skin in the sternum area is tender to touch?



  

[jenniwrenne]

Thank you for your helpful comments.  

I was seen by a neurologist a year ago, and, interesting what you say about spinal problems, as I was diagnosed with 'mild' spondylitis of the spine, in the upper back. The neurologist did not feel it was serious enough to warrant having me MRI scanned at that stage. Maybe I will go back and ask him to arrange an MRI for me....

The neurologist considered pain from the spine might travel round to the front chest wall, and cause pain, but did not think it could cause pain in the muscles of the diaphragm. He therefore dismissed the idea of my diaphragm pain/spasms being due to the spondylitis. My physical therapist also felt the same. Do you think they could be right?

The spasms are not limited to my back and chest -- mostly they are in the diaphragm muscles, located either side at the bottom of the ribcage. Sometimes the spasms spread to the back and chest,  usually after exercise or bending whilst doing chores, or gardening
or from rough massage. But the pain, spasms and soreness always originate in the diaphragm.    

There was one exception to this :-  when I had a colonoscopy. The radiologist has to pump the colon with air for the x-ray, and when he did so I experienced very painful muscle spasms up my back.   Apparently he never had a patient react this way before.

Ocasionally I get quite severe spasms (cramp) in my calves and feet, often in both feet at the same time.  You mention that this might indicate a metabolic disorder. As mentioned previously I have thyroid disease, which is a metabolic disorder. There is a causative link between low thyroid levels and fibromyalgia, though my rheumatologist has ruled out fibromyalgia. Blood tests have also ruled out any rheumatic disease.

Could the muscle spasms be caused by my thyroid, even though I have been on
thyroid replacement meds for 5 yrs and my levels have been optimised for the past 3 yrs?

I have not had Vit B12 levels tested recently. My iron and ferritin were mid range normal when they were last tested 4 yrs ago. I have had several fasting glucose tests in the past
5 years, the last one being about a year ago, and they were all normal.  I have not had potassium levels checked. My magnesium levels were mid range normal when tested a year ago.

When the muscles in my sternum get really sore, it feels like they are burning hot, and
it is as though the skin itself is sore too, maybe nerve endings in the skin? Or maybe just an impression because of the burning pain in the muscles.

[boron]

If your thyroid disease is well controlled, it is not likely a cause of muscular spasms. Having cramps in feet speaks for a systemic disorder rather then something specifically related to abdomen or diaphragm. With metabolic disorders I've mainly meant changed levels of potassium or sodium that are controlled by hormones aldosterone and cortisol...or changed levels of calcium that is controlled by parathormone and vitamin D.

It seems reasonable to have a metabolic panel test done (K, Ca, Mg, P...) and, if doctor decides, aldosterone, cortisol, parathormone, vitamin D and vitamins B.

Hypokalemia and hypocalcemia are known cause of painfull muscular cramps.

[kdsmom]

I began experiencing upper abdominal pain about 2 yrs ago. It was a squeezing pain that lasted for 2-3hrs. My dr ordered ultrasound-neg,
mri-clear, HidaScan-clear and full labs. She and I both were suspecting gallbladder but the pain "moves" around my upper ribcage. She sent me to a GI dr. I had been keeping a journal and his dx was IBS. I was skeptical at first because my good friend has IBS and her symptoms are very different but when I began to research IBS I realized the dr was correct. My spasms occur in the transverse colon/smooth muscle and are triggered by too much fat in my diet. They can be triggered by many things in different people. I also have GERD and migraines. I have had usual muscle pain and have been noting that also. It is not uncommon for a person to have IBS, migraines, and fibromyalgia. Don't know if this helps but it took several months for us to get to the bottom of my triggers. I kept a journal noting the foods I ate, meds I took, and anything else remarkable. I am currently taking Levsin extended release. When I have the "attacks" I have a pill that contains phenobarbital and 2 smooth muscle relaxants. It is somewhat effective but because the pain is excruciating I have to take Vicadin.

[betty_on_a_journey]

Check out the thread on this forum about the Vagus Nerve. Read all of it because there is lots of info. there. Also, you should see a specialist on dysautonomia a.k.a. dysautonomia. The autonomic nervous system controls many of the "problems" you've experienced. Have you tried a competent, knowledgeable chiropractor? I've had some of the issues you describe and I'm still looking for answers, but the dysautonomia doctor and chiropractor are on my medical team in this quest. I know how those spasms feel and I often wonder if I have a "real heart attack" how I'll know it because the spasms mimic those symptoms. Not good!

[jenniwrenne]

Thank you for your comments. It is reassuring to know there are others such as yourself suffering similar symptoms. I have gotten so depressed with this illness as it restricts my life so much, and being in constant nagging pain gets me down.  Unfortunately as I have asthma I am very allergic to codeine based meds such as Vicadin, and all opiate derivative painkillers.  Nor can I take NSAIDs as I have had gastritis. So am left with paracetomol, which I do not find very effective, especially against the agonising burning pain I get in my sternum and ribcage. I am grateful I don't have GERD on top of everything else.

3 yrs ago I was diagnosed with Chronic Intestinal Pseudo Obstruction (CIPO) as on the basis of my symptoms I was a clear cut case. However when I had all the x-ray investigations
there was no evidence of the disease, so the diagnosis was withdrawn and I was instead told I had IBS.  I have never thought IBS fits my symptoms as I don't have constipation or diarrhea.  However it is true to say  foods are a trigger for my attacks. Or I should say, were a trigger, but no longer as I worked with a nutritionist for over a year and identified all my triggers and now strictly avoid them. My diet consists of only fresh cooked organic meat (non red meat) fish, vegetables and a little fruit. Nothing else. All I drink is water.  

I have not heard of Levsin -- is it a painkiller?

Which smooth muscle relaxants do you find helpful?  Do any of them cause constipation?  That was my experience when I used them in the past.

[jenniwrenne]

Thank you for directing me to the Vagus Nerve posts -- they were very interesting to read, and helpful.   I think it could well be the case there is pressure in my diaphragm on my vagus nerve, and maybe it is this that is causing my chronic severe breathlessness.  Though there does not seem to be any treatment for vagus nerve problems....

I was also interested you mentioned dysautonomia, as that has been mentioned to me before by doctors, and to that end I was prescribed a small dose of tricyclic antidepressant a year ago but unfortunately I could not tolerate it as even 2.5.mls made me unbearably agitated and irritable. The drug does this to some people apparently.  

I am just about to start learning Tai Chi, as I have heard it can be very helpful for many things including dysautonomia.   I will post here to report how I get on with it..

[kdsmom]

Levsin is hyoscyamine, a smooth muscle relaxer. I use an extended release form.
I also have used Belladonna alkaloid which is a combination of phenobarbital, with the following anti-spasmodics: atropine, hyoscyamine, and scopolamine. I use the Belladonna  when I am having an "attack" of pain. One of my additional problems is that my body becomes accustomed to pain type meds or muscle relaxers quickly and I have to up the the dose to achieve the same results. So the Belladonna worked well when I first used it but now I have to increase the amount. A good resource for medical info including medications is medlineplus.gov  

[kdsmom]

About the constipation, yes these meds usually slow you down so I try to balance that in my diet. I have to be careful with insoluble fiber because of the IBS so it balances out
most of the time. Fat is really my enemy with IBS and is my number one trigger.

[jenniwrenne]

My GP has just prescribed Hyoscine butylbromide for me,  which is a derivative of Hyoscyamine.  I am hoping I can tolerate it and it will help, as I have not got on with other smooth muscle relaxants in the past..
An extended release form sounds convenient. If  I am going to be taking it longterrm I will ask the GP about it.  Many thanks.

[jenniwrenne]

I had the results of all the blood tests I had recently.  Everything was within normal range. I do not have hypokalemia, or hypocalcemia. My B12 is normal, as is my ferritin. There were no inflammatory markers.  Nothing the least bit suspicious.

So my GP decided it is IBS causing the pain under my ribcage,  and he prescribed hyoscine butylbromide, a smooth muscle relaxant. I  took 40 mg for 4 days and it was a disaster.  It messed up my BMs, which are usually normal, and gave me terrible griping pain in my abdomen that kept me awake at night. Also it gave me severe eye pain, visual disturbance,  dizziness, copious sweating, itching,  breathlessness and horrible fatigue.
It also triggered several asthma attacks.  The area under my ribcage became stiff, so that kind of numbed the pain a little bit for a while.  

I felt too taking the hyoscine to continue. Have felt much better since stopping it, but of course I have the pain under the ribcage back again in full.  I cannot see how my pain can be due to IBS if I get such a bad reaction to a medicine that helps many people who have IBS.

One doctor in the past suggested I might have an adhesion (from the stomach to the transverse colon) as this could account for the painful pulling, stretched feeling I have. However, as I have never had abdominal surgery it was unlikely.... do you agree?

Another thing mentioned in the past was possibility of a small hernia not visible on the xray. However, usually there would be acid reflux with this (which I do not have), and PPIs would help, whereas they did not help me with the pain.

Although I have mild diverticular disease in the sigmoid colon, the docs are sure I have none in my transverse colon, as they say it would have shown on the xray. Or at least some narrowing or widening would have shown up.

So it continues to be a mystery.

[ggreg]

Hey Jenni,
I read your thread here, I have thoracic spine issues, so I think you do indeed need to have either CAT scan or MRI of your spine.  When I broke my back in three places in the T-spine, those nerves go around the chest, and at the time made it very hard for me to breathe.  Also, I've had thyroid problems, and keeping the dose right is challenging for docs, so of course keep up with the visits to the endocrinologist.  While they're figuring your spasms out, I have a few suggestions to sort of help you relax your abdomen.

Lay down in a quiet low-lit room, flat on the floor with your legs bent, and do some deep breathing.  Rub your tummy with a flat hand, soft but firm, in a clockwise motion at the same time.  Also, focus on an object in the room that catches a light, just stay with it and empty your brain of all thoughts.  Do this for ten minutes a couple times a day.  

Another thing is, they ought to put you on better spasm type drugs, in the category of the barbituates as epilepsy medicine, the doc needs to find one that will not dry you out and constipate you.  Lastly, even tho your bloodwork says all is well, I think you should take extra B vitamins, extra calcium and vitamin D, keep protein going especially eggs for the omega3s, and consume probiotics once a week just to keep you digestion completely straight since it's a disaster when it goofs up.  These are just my suggestions, take what you want and leave the rest.

[jenniwrenne]

Hi, thank you for your comments.  The spasms and tightness in my chest emanate from the spasms in my left side under my ribcage, and the burning pain in my sternum also comes on when the pain in my diaphragm is bad. My neurologist is certain the mild deterioration in my spine cannot be the cause of the pain in my lower left side. He does not want to refer me for an MRI at present. I have no problems bending, stretching etc.

Thank you for your suggestion for relaxation -- I tried it and it's a great idea.  

I agree it is a good idea to take supplements. I have osteopenia, so I have to take calc/mag & Vit D and Boron. I also take all the B vits, CoQ10, Vit C, Selenium, Zinc, and Omega 3.

Thanks again.