Chronic and Constant Distention, Beyond Bloating!

[Paintmiller]

Thank you in advance for your help on this.  I hope that you have some insight.  About 9 months ago, my stomach changed.  I remember that my abdomen got very hard, and stayed this way for about one week. Then my stomach became bloated, and has remained this way every second of every day for the past nine months.  I have no stomach pain.  HOWEVER I do have a dull constant ache/pressure on my mid-right side, to the right of my navel just where my ribs end.  This diffuse pain is also felt in my back in the same place as the front side but in my back.   The distention reaches the point of 6-7 months pregnant.  It never ceases - it is there when I wake up but typically gets worse throughout the day.  The distention can get very bad then minimize without passing any gas.  I have noticed that I strain in bowel movements more often than I used to, but I still have a BM daily.  They are sometimes hard, sometimes not, but this has no effect on the distention.  I even did a colonscopy prep once and had nothing in me and was still distended.  I have a constant feeling of pressure in my entire mid/lower abdomen and in my back.  I think the bloating is in my intestines because it is so prominent under my navel, you could almost set a glass on where it starts.  I have tried to eliminate foods to pinpoint an allergy, to no avail.  Here is a list of tests that Ive had done:

1. Colonoscopy - normal. It took a long time for the prep to go through my system, I think 6 hrs before any BM
2. Ultrasound, Abdominal and Pelvic and Gall Bladder - Normal
3. CAT Scan Abdomen - normal
4. Basic Digestive Blood Workup- Normal
5. Sprue Test - Normal
6. Fluoroscopy, Upper GI Followthrough - "somewhat lenghty transit time, otherwise normal"
7.  Gastric Emptying Test - 90 minutes - normal?

My GI physician suspected slowed motility and put me on Reglan.  I had adverse reactions to this, and it seemed to help a little but not much.  I am now on erythomiacin with may or may not help. Bloating may be less, but still there all the time.  Conversations with my GI physician have led us suspect to a virus that caused the slowed motility.  However, I have these questions:

1.  What IS the dull right sided pain? I can "pop" something in and out all the time right where ribs end which makes bloating worse. Is this from the bloating?

2.  Bloating and pain get worse with activity,especially climbing stairs and hiking. Right side seems to bloat very slightly more than left.  
Could this bloating be structural and not digestive, in spite of normal tests?

3. Could this be IBS if I do not have any stomach pain or diarrhea? I took Zelnorm and the distention got so bad I thought I would split open.

4. If bloating is not fixed with Reglan and erythomiacin, is this not a motility problem?

I have made an appt (AGAIN) with a GI doc next week, and would appreciate input on what to ask for, look for, etc. Thank you SO MUCH for your thought and input.

Sincerely, Christine

[seven7]

First, let me say that I have just a suggestion.  I have no particular knowledge in this area, with the exception that my pancreas has enlarged after a mastectomy and chemo, so I am having cat scans every 6 months to see if it changes.  So far no change, and I have no pain there.
NOW, has any doctor considered your pancreas?   One can have Pancreitis>  I think  the pancreas may have something to do with digestion of food.

[Paintmiller]

How do I get tested for a fungal infection?

[yoshi]

if you can search this forum,i think several people have posted complaining pain on one side of the stomach.

[Kevin Pho, MD]

To answer your questions:
1) Bloating can cause the right-sided pain.  Typically we think about the liver or gallbladder on that side.  Irritable bowel syndrome as well.

2) With more normal tests, it is certainly possible that an anatomical reason can lead to the bloating.  

3) Although possible, IBS often leads to changes in bowel habits.  I would ensure there isn't any other issue going on before attributing it to IBS.

4) Reglan and e-mycin are typically used to treat gastroparesis.  Other, more invasive options, would include gastric pacing or surgery.

Other tests to consider would be an upper endoscopy (I did not see it mentioned) as well as esophageal motility/24-hr pH study.  The latter test is more specialized and can be discussed with your gastroenterologist.  

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

[yoshi]

are you still taking the simply digestion stuff??

[Paintmiller]

I take probiotics and prebiotics daily in a liquid supplement.  JUST AN FYI - I think that this stuff is great for regularity and digestion in general.  Product: Simply Digestion 2000 Plus available at www.herbalremedies.com.  It contains enzymes, fiber, pre/probiotics, aloe vera...and it is not that pricey. I recommend it for constipation and general gut health.  Not that mine is too healthy these days..:)