Lower left quadrant pain

[Kathy5878]

I am a 42 year old woman with frequent lower left quandrant pain.  I've had this pain for the past 2 years, off and on.  I've been checked by my obgyn as I have a history of complex and simple cysts of both ovaries as well as cervix; I had a partial hysterectomy 4 years ago.  This most recent bout of pain has lasted 2 weeks; it is more pronounced in the morning and after exercise.  My abdomen seems to be slightly swollen only on the left side and is tender to the touch.  I do have occasional sharp pain, but for the most part, it's a dull aching pain; almost like a cramp.  I do have bouts of constipation as well as bouts of diarrhea, as well as frequent heartburn and vomiting, especially when the pain is present.  I have been treated in the past for GERD, but for the most part, that is under control.  I've had Upper GI series exams as well as a scope and all is negative.  Can you recommend my next course of action?

[Dean09]

Thank you for your post back you have given me more data than any other Doctor.
The slipping feeling I describe feels like if I do not "adjust myself" when laying down or twisting I may receive a "stabbing pain" in my back however I have prevented feeling pain directly by "adjusting" my body movements. The pain in my abdomen is prominant after lifting bending and moving (we moved recently & I lifted a great deal as I am in very good shape the next fews days I had no back pain but severe abdominal muscle aches where I can palpate & it hurts to the touch). After intercourse (the next day), I have this same "muscular" like pain in my abdomen. I do feel this rope like mass that seems to be from to the left of my hip bone down to my pubis.( I thought it may be my descending colon/sigma, but I do not feel this on my right side equally at all, no pain no "rope like" thickness).  I had the MRI 10 days after I bent down to turn the TV off, it has been 2 years since then, they said I was a little constipated but there was no inflammation (they mentioned they could not even see my appendix). The mentioned everything looking amazingly healthy except my cervical vertebrae. They wanted me to come back the next day to check my bowels but after 16 hours in an ER, I never went back. (it took 4 dosages of IV MOrhine and 4 shots of adavan to relive some discomfort, I was like trying to sedate an elephant!).  I do not have any female issues that you mention although I had a cross section to remove my son & am wondering if this is relative moreover, you mentioned hernia, my fathers brother is suseptible & I never had an ultra sound. Could I have damaged a nerve root that would not show up on a scan? DO you suggest an ultra sound?  Do you know if a thermal imaging scan would help at all? I feel like my bowel is "tied in some how", like the motility is slowed as a side effect, is this possible? Thank you Boron for you responses, you have made me feel better just speaking to me.

[boron]

We can try to rule out some causes and see what lefts.

1. Negative MRI (even without contrast) of the spine speaks against pinched nerve but I can't say it isn't pinched nerve without reading doctor's (radiologists's) comments on MRI. Pinched nerve(s) in the thoracic spine would cause band-like burning, pain, tingling or numbness occuring somewhere between the spine and middle line in the front. You would probably know it radiates from the back to the front. If you have never had this tigling, numb feeling in abdominal *skin* on the left, it's not likely pinched nerve. Pain to touch would be a dull deep pain. I'm talking about sciatica like symptoms appearing in abdominal wall instead of the leg. Rope like feeling, to me, also doesn't sound related to pinched nerve. I understood that with "slipping feelig" you mean like your feel your vertebra slipping. Can you explain this a bit?

Pinched nerve in thoracic spine would not affect the bowel.

2. Pain in colonic (sigmoid) disorders limited to the inner layer or the intestinal muscles (which means most of disorders including diverticula/itis, Crohn's disease, etc.) would be not likely affected by moving or certain body positions. It's just possible you have diverticula - they cause constipation - but they are not likely the cause of symptoms you are describing. It's not likely you have diverticulitis (obvious pain, fever and diarrhea are common). Barium investigation includes X-ray...It could be adhesion pulling your colon but this can't be seen by barium investigation or sigmo/colonoscopy.

--------

What lefts?

- Skin...any rash or discoloration?
- Muscles in abdominal wall - it could be streched or ruptured muscle...which would not likely last for so long. Pressing on the affected spot would cause obvious sharp pain and you would likely know it's in abdominal wall, not deep inside..

- Adhesions or endometriosis. Laparoscopy. MRI might have missed them.

- Inguinal hernia. Possible visible or palpable bulging. Ultrasound.

---------------------------

1. Any visible or palpable bulge?
2. If you can trigger pain by pressing, where exactly is the pain and do you feel any mass?
3. Does pain appear when you bend forward, backward, left- or righward?
4. Can you furter explain "slipping feeling"?

[Dean09]

Thank you for getting back to me, you have given me more realistic data than anyone else in the medical field.  Would you suggest I do the Spinal MRI to rule out if I maybe I have a nerve root issue due to the correlation of body positioning upon pain onset? If I had an issue with my spine could it cause issues with the descending colon & sigma, meaning pain to touch or that "rope like legion" (may be inflammation now but it was there when I had the MRI & they saw nothing)?  I have had constipation off and on my whole life (i need more water than most people & fiber to eliminate) however, I do not have any other symtoms of diverticula/itis.  Never diarrhea, black stool, fever etc. Would the spinal MRI be done with contrast?  I had an MRI and suggested herniated disc 10 days after this happened & they told me no, is this becuase is was a regular MRI and one without contrast? OR should I just have the barium first to rule out the expense of the MRI? Your thoughts, thank you so much!

[boron]

In general, pain in disorders limited to colonic wall (diverticulitis and all diseases that affect inner layer of the colon) is not triggered by body movements or position.

Pain in the back while bending down and resulting pain in the left lower abdomen sounds like a herniated disc in the lower thoracic spine affecting the left spinal nerve that innervates abdominal wall muscles and skin. You would probably feel some numbness or tingling in the skin in affected area. "Slipping" feeling speaks for spondylolisthesis (search online), where a particular disc is so damaged that vertebra below and about it move back and forth...Could triggers the same symptoms as herniated disc. All this can be checked by spinal MRI.

Adhesions can be checked by laparoscopy - endoscopy of the abdominal cavity.

Diverticulosis - non-inflammed pouches in the sigmoid colon often cause some constipation. Diverticulitis - inflamed diverticles usually present with fever and diarrhea.

If you decide to check the colon (or only sigma), the first is barium examination, then sigmoidoscopy.  

[Dean09]

I was wondering, even though this feels muscular could it be the descending & sigmoid part of my colon.  Could it be it was too soon after ct/mri to see anything (10 days after episode)? What do I do?  Should I try a barium exam 1st because of where it is versus a colonoscopy? Does it sound like my bowels at all.  I had a C section with my son at age 37 could these be adhesions & if so why like a perfect rope in feeling?  How can I tell the difference with all of these questions?  Help!
Sincerely, Dean09

[Dean09]

I have pain in my lower left abdominal quandrant. I work out 2 hours per day 5 times per week, eat great and have mild constipation off and on despite clean habits & drinking alkalized water. 2 years ago I bent down to shut the tv off and I felt a vibrating pain in my abdomen and when I went to stand, pain in my back. I also became jittery & experienced a black out feeling. Ever since, I have had pain in my abdomen.  I had a ct & mri scans showed no imflammation. I can actully feel a "rope like" mass that goes from my hip to my pelvic bone (descending to sigmoid). It feels like muscle pain however.  I have been ruled out for vaginal issues/uterine etc. I do not have the common diverticulis symptoms. I have some mild back pain with it (more like a "slipping" feeling). I have a dull pain there off and on/after a bm I am sore/when I work abs/same feeling.

[boron]

If it is na mesenteric cyst, it is outside of the bowel and can't be seen with colonoscopy, but with laparoscopy.

[Kathy5878]

I got the results of my CT scan of Abdomen & pelvis.  It appears I have a 2.0 cm. cyst that could be a mesenteric cyst.  I am scheduled to have a colonoscopy 08/25/08.  Would this cyst be detected with a colonoscopy or will I have to have additional testing?  

[boron]

CT results are available right after the scan.

Blood is red, either as red strings on the top of the stool, or mixed within the stool. A small amount of blood can't be seen, hence the name of the test: Hemoccult.
Blodd from the stomach or above would be black, since acid changes its color.

[Kathy5878]

I finally got to see my GI doctor on 8/7/08.  He asked me a lot of questions and felt my abdomen and tapped on the abdomen; he said the belly sounded pretty benign, but sent me for a CT scan of the abdomen and pelvis.  I had that 08/09/08.  He also said that he wanted me to have a colonoscopy, too.  My question is, how long should I wait to hear from him or his office regarding the CT results?  The left sided pain is still there, however not as severe, but never the less, still present; the diarrhea is still 3-4 times a day, which I can manage.  I have noticed that I am becoming tired, and am getting dark circles under my eyes.  I'm a fair skinned person, and when I get sick, I seem to get dark circles under my eyes.  I guess I just wanted some advice as what I should do.  Is it ok for me to wait a week or two, or should I be a pain in their butts and call and ask for the results?  Also, can you please describe to me what blood in the stool may look like?  I know what the bright red would look like, I have hemorrhoids sooo bad, so I know what that looks like, but the doctor had asked me if I had blood in my stools.  I'm not sure what it would look like to even being to know if I saw any or not.  It's kinda hard to see anything through all the diarrhea, but I was just wondering what I should be looking for.  Thanks for your time and help!

[boron]

Hm, normally, with the healing, diarrhea should go slowly down of course. If diarrhea will get worse, this can be from antibiotic itself. It is called antibiotic-associated diarrhea. In this case you should see the doctor promptly, have test for Clostridium difficile, and then eventually get other specific antibiotic.

[Kathy5878]

I went to my family doctor last Thursday; she examined me and spoke with me about my family history and my pain, diarrhea and nauseau.  She felt it is diverticulitis and prescribed Avelox 400 mg, 1 pill a day for 10 days and referred me to a GI doctor.  I've been taking the antibiotic since Thursday, and the pain is somewhat relieved, however, not the diahrrhea.  There is a lot of gurgling and noise in my abdomen and the diarrhea is less intense, but I have more episodes of it.  Is this normal while on the antibiotic?  

[met_tech]

Hello Boron,

I like your answers,
for the past 20yrs I have been having bowel problems I have lower abdominal pain and lower back pain with a clear jell like secreation from my rectum...

I have had numerous blood tests which all come back normal....
I had several scopes and was dianosed with IBS

BUT I am not happy with the diagianoses what can it be or what else can i be tested for????

[boron]

Colon problems do not cause heartburn. Heartburn is from stomach/duodenum problems.

All intestinal disorders your relatives have, indicate that a sort of connective tissue weaknness is running in your family. In my family many had discus hernia...

This is not some exact (or known) genetic disease, some of you are simply prone to get these weaknes problems. Diverticulitis is like a puch(es) protruding out from colonic wall. This is clearly seen on x-ray with barium.

[Kathy5878]

Than you so much for responding to my question.  I'm so tired of having this pain and am desperate for relief.  I'm going to my family doctor tomorrow and ask about getting checked for Crohn's, ulcerative colitis and diverticuliits.  My grandmother has diverticulitis.  Is this something that maybe could be family related?  My sister suffers from something called a twisted bowel.  Not sure what that is but she has pain if she eats a large meal.  I don't seem to have that problem.  I do not eat red meat, and do eat alot of vegetables, fruit, soups and pasta.  I do eat alot of hot peppers, black pepper and hot sauce.  It doesn't seem to give me heart burn; cucumbers and raw onions do, however cause heartburn for me.  

[boron]

Lower left abdominal pain, beside from ovaries, most often arise from the last part of the colon (Crohn's disease, ulcerative colitis or diverticulitis). X-ray with barium enema is usually the first investigation, then colonoscopy. Ovary surgery may leave adhesions, this would be seen during laparoscopy.