Splenic flexure or constipation?

[alexandria]

I am a 36 year old female with a history of severe IBS and chronic constipation. The severe constipation seemed to be kicked off by a combination of fertility treatment, stress and numerous drugs going in and out of my system. Over the past year, I have had the following tests: blood work, thyroid levels, abdominal x-ray, Abdominal CAT scan, upper GI, lower GI, small bowel follow-through, colonoscopy and colon transit marker study. All tests were normal (plan x-ray showed constipation). Have used the following to treat the constipation: fiber, Equalactin, Phazyme, Zelnorm, Miralax, Lactulose and Senakot S. Currently, I'm taking 1 Senakot S per day and this is the only thing that works.

My immediate concern is as follows: About 10 weeks ago, I began experiencing a feeling of abdominal fullness after eating small meals and my upper belly (just below the left rib cage) distends after eating.It's extremely uncomfortable. My doctor has told me that this area is actually my colon and not my stomach. Over the past week, this has gotten worse and is painful when bending over. When I bend over, I get a gripping, cramping pain. The mild distension seems to last through the day now and is only relieved by a BM (and only temporarily). As soon as I eat, it begins again.

I went to a doctor the other day and was give an plain abdominal x-ray. He mentioned that there was nothing noticeable aside for constipation. I took one dose of Milk of Magnesia that night which threw me into severe spastic colon for about 2 days and irritated the area under by rib more after each trip to the bathroom. Now, after 2 days I'm back to the mild distension and fullness after eating a small meal. Here are my questions: Am I experiencing this splenic flexure syndrome? What is the difference between typical splenic flexure syndrome and splenic flexure distension? Should I be concerned that there is a major problem? Or could this be from disfunctional contractions of the colon and constipation? If due to disfunctional colonic contractions, how can I get things to work normally again? Also, any possibility of stomach inflammation or infection? Is there anything else I should ask my doctor to check for? I have a follow-up on Monday and am scared that this is getting worse. Note: Doctor has told me that stomach is emptying fine due to normal upper GI.

[Kevin Pho, MD]

Splenic flexure syndrome refers to the trapping of gas at the splenic flexure causing distension and bloating.  To answer your questions:

1) It is possible that the increased gas can lead to splenic flexure syndrome.  IBS is one of the more common causes of increased gas.

2) I believe that both splenic flexure syndrome and distension refer to the same condition.  

3) You have been through a comprehensive variety of tests and with them coming back normal, it would be unlikely that a serious GI condition would be missed.  

4) Certainly irritable bowel syndrome can cause the dysfunctional contractions.  This can lead to increased gas and bloating.  

5) Zelnorm has been shown in studies to help with constipation-predominant IBS.  Unfortunately, you have already tried this.  There are some studies that also show that tricyclic antidepressants have some efficacy in the treatment of IBS.  

6) An upper endoscopy (to look for stomach inflammation and biopsy for H pylori) is the most reasonable test to look for stomach inflammation or infection.  

If you continue to have constipation despite all available medications, you may want to consider behavioral approaches such as biofeedback or surgical approaches that have been shown to help with chronic constipation.  These options should 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.

Thanks,
Kevin, M.D.

[neli]

hi, i have been experiencing the same symptoms you have with severe constipation and pain on my left side arm and always feel full and i only eat small meals cause if i eat large meals i feel sick and i also have chest pains and feel this heavyness and kinda short of breath from the stomach area...i have had numerous scans and test like you with nothing found...endoscopy, stomach xray, colonoscopy you name it and nothing....i feel with you and i would like to know if you find anything helful....i notice that if i watch what i eat it's ok at times or if i eat fiber it is worse...what i think is lots of gas trapped in the upper stomach which causes all this pain...try taking gas-x for gas and bloating and see if it helps when you feel bad....do you have history of anxiety or panic attacks? cause sometimes when you;re stressed the stomach kinda comes up in your esophagus causing same sensations you mentioned....anyways what exactly is spenic flexure? i never heard of it.....let me know if i was helpful in anyways...you can email me at ***@****

[alexandria]

Thanks for your response! On one of my trips to my regular doctor, he mentioned splenic flexure syndrome. The splenic flexure is where large amounts of gas gets trapped in the bends of your colon. The splenic flexure is one the left side under the rib and there is another flexure under the right rib. Right now, not much helps. Sometimes, taking 1-2 Phazyme before meals helps as well as eating 6 very small meals instead of large ones. I'm hoping to find some answers in January as I've been referred to an IBS specialist in NYC.

As for the chronic constipation, have you found anything that has worked? I think part of my problem is a combination of too many medications and stress. Over the past year, I've been put on many medications to the point where nothing is working correctly (things to speed things up and things to slow things down). Second, I was diagnosed with generalized anxiety last March. This is due to a very high stressful job (chronic stress for the past 3 years) and ongoing worry about the colon disfunction. Much of the concern stems from the fact that none of the doctors can tell me what the problem is and how to fix it. And, of course, stress makes everything worse. I've consulted with two colon surgeons who do not feel that colon surgery is appropriate. From what I've been told, most people with severe chronic constipation and who also have another functional disorder (such as IBS) are not good candidates for the surgery. Thesurgery is typical reserved for those with colonic inertia with no other functional problems.

Any other thoughts, comments would be greatly appreciated.

[cowley]

I to have the pain under my left rib and it is a frighting pain as you alwaya think it is to do with your heart. I have also had it under my right rib to the extent that i was rushed in to hospital as they thought it could of be a blood clot, but after lots of test and neddles they came up with the idea that it could be Splenic Flexure. I do not sufer from constipation but still have this problem. I am a full time student at the moment and i realy belive that stress has a lot to do with it. When i am over working or an exam is near it always seems to get worse. I also suffer from panic attacks and was put on medication ( amitriptyline) which helped a great deal and i did not suffer with it hardly at all. I have been off it now for 7 weeks after being on 7 months and now the past 3 weeks my pain has arrived back. I will not go back on medication as it made my hair go thin and at 32 years of age that is the last thing that i wanted. I am now going to try stress classes and see if this helps the pain. Its very painfull and can happen at anytime, worse after food, sometimes i wake up at night with it hardly being able to move.

[Lovesmms]

A related discussion, Pain in left side was started.

[lenawalt]

A related discussion, stomach pain was started.