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Digestive Disorders / Gastroenterology Forum
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Avatar universal

IBS Diagnosis

My wife was recently diagnosed with irritable bowl syndrome.  She has recurrent night pain in her right side which can be predicted almost to the hour.  Occasionally the pain will occur during the day but not often.  The pain radiates around to the right side of her back on occasion.  We both are former runners and she describes the pain as very much like a "side stitch".  Our family doctor ordered ultrasounds of the upper and lower abdomen as well as a trans-vaginal ultrasound.  All results came back unremarkable.  The pain continued and he (after my wife insisted) ordered a CAT scan of the abdominal area.  At first, they thought that a small cyst was spotted on her kidney. Our doctor ordered a second ultrasound, specifically focusing on the kidneys and they could find nothing.  Our doctor also had my wife examined by her OB/GYN who reviewed the lower abdomen and transvaginal ultrasounds and gave her a pelvic exam and PAP smear.  His only comment was, "I hope you and Dr. Samitt get to the bottom of this but I can see nothing amiss."  Of course, stool samples and blood samples were taken.  These also were negative.  Finally, my wife insisted on seeing a gastroenterologist.  He reviewed the results from the tests that had been conducted, reviewed her symptoms and finally did an abdominal check, concluding with the diagnosis of IBS. He prescribed an anti-spasmodic medication and sent her home.  The anti-spasmodics don't seem to have any effect.  Occasionally, the pain will disappear for days or even weeks, only to return.  Some foods, especially nuts seem to make it worse, but there isn't a real "rhyme or reason" to it.  (Actually, when my wife was going through the testing I submitted her symptoms to your site and you mentioned IBS as a possibility if the tests were negative.)  No gallstones were located but I have read about the possibility of an underfunctioning gallbladder.  Is this a possibility?  The pain symptoms seem to match gallbladder so closely. I trust our family doctor implicitly, but have nagging questions if he or the gastroenterologist could be missing something.  I feel so sorry for my wife.  The symptoms have been going on for almost two years now.  They do not worsen but also do not get any better.  Do you have any further ideas?  Is there a good source of information on IBS control?  Your service is wonderful!  Thanks for taking my question!!
5 Responses
233190 tn?1278553401
MEDICAL PROFESSIONAL
Irritable bowel syndrome is normally a diagnosis of exclusion - meaning that if all the other tests come up negative, IBS is possible.  There are a few other things to consider.  One would be either an upper or lower endoscopy.  These tests can show diseases that may not be able to be seen during the CT scans and ultrasounds - for instance, masses, inflammation or ulcers.

Another consideration is the possibility you brought up - an underfunctioning gallbladder.  This typically causes gallbladder-like pain in those without gallstones.  A HIDA scan with CCK stimulation can be considered to further evaluate this possibility.

Regarding IBS, the initial treatment is usually anti-spasmodic agents along with increasing the amount of fiber intake.  If there continues to be symptoms, the medication Zelnorm can be considered if there is also evidence of constipation.

More information can be found here:
http://digestive.niddk.nih.gov/ddiseases/pubs/ibs/

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.
Medical Weblog:
kevinmd_b
Avatar universal
Did she have a colonoscopy, upper or lower? If nuts make her feel worse, she could have diverticulitis problems....which basically means that there are small pockets inside the intestines that food, mainly nuts, seeds, popcorn, etc. get hung up on and cause pain. The ultrasound - upper and lower - would probably find any abnormalities with the gallbladder and liver.
Avatar universal
That type of pain sure does sound like the gallbladder.  Even though no stones were found on the ultrasound, she could have an underfunctioning gallbladder.  The test that would rule this out is a Hida scan with CCK injection.  I had this test done after two normal ultrasounds and my gallbladder was found to be only functioning at 20% (normal is above 35%).  If you question the diagnosis, which I would because it does not sound like IBS, then I would ask your gastroenterologist to run this test.  I personally hate the "IBS" diagnosis because I think it is relied upon too much when tests come back normal.  Keep searching, the answer will be found.  Good luck!
Avatar universal
Is the pain in the lower right side in the pelvic region almost. I wake up crying in pain it hurts so bad. I too used to be a runner and very active , a tumor on the knee took care of that.
I have had all the work-ups Colonoscopy found polyps, 5yrs ago, diagnosed with the dreaded IBS many years ago and now if I eat chicken which I have never had a problem with before I am "sick" within 10 minutes. I do have bleeding problems and will go for another Colonoscopy in about 6 months, I am 43 now.
I think the pain is the worst not knowing why you hurt. I do know that my appendix is not where it should be and drs always want to know if I had it removed. I assure them it's still there and they search for it and find it over in a different location.Could be the root of all my problems.
Avatar universal
Hi there,
I have been having RLQ pain every single day for the past 4 months. I've had every test imaginable, except an MRI, and everything is negative except I have two very small 1.5 cm fibroids which the dr.s tell me is not causing the pain. I keep being sent from one specialty to another and get no answers. At first my GI said "maybe IBS" but it's very rare to have IBS give pain in one specific location and  not be more diffuse.  I then went to Mayo Clinic, and they said it's not IBS because of this same reason.  I'm now back to my local dr.s continuing on the path to hopefully finding a reason for my pain.  On my next visit I'm going to ask for a lower abdominal MRI and then a referral to a surgeon to see if they will do an exploratory laparotomy with elective appendectomy.  I had my gallbladder removed in May and my GYN dr. took a look around too to see if he could find anything but couldn't find anything abnormal.  The pain can come and go throughout the day with no rhyme or reason, but it is becoming debilitating.  I can't even touch my RLQ without having pain and also putting on jeans that are a little snug hurts it and so does even leaning against the counter.  I hope you have better luck with the medical system than I seem to be having!!!
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