OpenHealth Q&A

Persistent Abdominal Discomfort: A Journey

This marks my initial post on Reddit, so I'd appreciate some gentle feedback. At 31 years old, I have been grappling with abdominal discomfort since my late teens. Initially, the pain resembles a mild cramp or ache in my stomach, but within about an hour, it escalates to an unbearable level. Over the years, I've noticed an increase in the severity of these episodes, which last somewhere between 6 to 8 hours. During these painful episodes, I often feel sweaty and overheated, and I find myself either curled up in a fetal position or pacing around the house. My bowel movements remain relatively unchanged; although I tend to feel the urge to use the bathroom, it rarely yields any significant relief. The sensation is distinct from constipation, even if that comparison might make sense. Typically, the discomfort begins in my lower abdomen (around the belly button area) but intensifies to involve my entire midsection—from my ribs to my hips and encompassing my back. Although I've never been pregnant, the pain feels similar to what one might imagine labor contractions would feel like, yet it's continuous. Over-the-counter medications such as Tylenol, Advil, or Aleve have proven ineffective against the pain. I have been prescribed tramadol, which doesn’t completely alleviate my discomfort; rather, I often find that it sedates me enough to eventually sleep through the episode. Afterward, I feel exhausted and somewhat lethargic, a sensation that predates my tramadol prescriptions. The frequency of these painful episodes appears completely erratic. There are times when I might experience several occurrences in a short period, only to go six months without any incidents. During my early encounters with this pain (around ages 19 or 20), I sought help at the Emergency Room. Initially, I was diagnosed with a bladder infection and prescribed antibiotics, but the pain would return a few months later. On one occasion, doctors administered Buscopan for what they believed was spasms associated with the bladder infection. Remarkably, this was before the era when we could check our lab results online, and during my ER visits, only a urine test was conducted—no blood tests. I spent a considerable amount of time believing the issues were due to bladder infections, which never fully added up in my mind. I was instructed by a doctor to practice proper hygiene after sexual activity, even though I hadn't been sexually active for over a year at that point. Eventually, I stopped visiting the ER because it became clear they weren't offering any real solutions, and I learned to endure the pain, knowing it would eventually subside on its own. Fast forward to 2019: the impact of these episodes had begun to interfere significantly with my work as a lifeguard—hard to oversee a pool while in extreme discomfort. Therefore, I sought meaningful answers from my family doctor, who ordered blood tests, stool samples, and an abdominal ultrasound. The results didn’t reveal anything alarming, aside from a diagnosis of fatty liver disease, which concerned me but didn’t explain my symptoms. At the time, I weighed 170 pounds at 5’3”, and while I wasn’t in optimal health, I wasn’t significantly overweight either. Later, I inquired about potential food allergies, specifically gluten and dairy. Testing indicated an abnormal reaction to gluten, leading me to eliminate it from my diet entirely. When I queried about undergoing a scope and biopsy for celiac disease, my doctor advised against it. Soon after, my doctor relocated, and I was assigned a new one. Despite adhering to a gluten-free regimen for nearly a year, I continued to experience these episodes. Interestingly, whenever I indulged in gluten, I didn’t seem to have any adverse reactions. My new doctor eventually referred me for a colonoscopy and endoscopy. At this point, I had abandoned the gluten-free lifestyle because it had become cumbersome without any discernible pain relief. Ironically, the day of my procedure coincided with the day after my 30th birthday. They discovered one small polyp, which was removed, but the biopsy for celiac disease returned negative. I was diagnosed with chronic gastritis, and although tested for H. pylori, the results were negative. Both my doctor and I hoped that this gastritis could explain my discomfort, and I was prescribed a PPI, which I took for about a year. Sadly, my painful episodes continued. If I ever forgot to take the medication, the gastritis would make itself known through upper abdominal pain. During this time, I also dealt with painful menstrual cramps and irregular cycles. A pelvic ultrasound revealed "Small peripheral follicles in the right ovary, indicative of a PCOS variant,” with the conclusion suggesting possible PCOS. In March 2024, I developed achy pain in my right flank and abdomen. I made an appointment with my family doctor, who suggested it was likely a kidney stone or urinary tract infection (UTI). I was placed on antibiotics, but shortly after completing the medication, I experienced one of my usual painful episodes, this time with increased discomfort on the right side. I suspected it was different from my typical stomach pain, leading me to seek ER assistance, where I was told I had a bladder infection based on leukocytes found in my urine. I requested a culture, which returned negative for bacteria. Blood test results showed some flagged values, but overall, nothing alarming. The ER doctor theorized gallstones and indicated that an ultrasound was necessary, advising me to avoid fatty foods until then. Eventually, the follow-up ultrasound revealed again a fatty liver and a "Friesian cap gallbladder," yet there were no other indications of stones or sources of my abdominal discomfort. My family doctor consulted a surgeon about the gallbladder's unusual shape, but they dismissed it as a potential cause for my pain. In due course, I was prescribed tramadol for pain management along with Accel-hyoscine, neither of which seemed to significantly relieve the extreme pain. I began to restrict my use of medications for when the discomfort became unbearable. During this time, I also made the decision to resume birth control (Depo), as I couldn’t recall whether the pain episodes reduced while I was taking it, possibly due to endometriosis. However, after a year of being on Depo, I continued experiencing episodes with no clear correlation to my menstrual cycle. In March this year, I again experienced severe abdominal pain, compounded by right-sided discomfort. This pain persisted for a few days, leaving me feeling fatigued and bedridden. My husband insisted I visit the ER on the third day, where a doctor expressed concern about possible appendicitis, but noted that being a woman meant it could also be related to reproductive health issues. I was referred for a CT scan, which I underwent that week. My blood tests revealed some high cell counts, which concerned doctors. The CT scan results indicated mild fatty infiltration of the liver but no acute issues in the abdomen. However, an unusual focus was noted in the iliopsoas muscle on the right, measuring 38 x 16.8 x 19.4 mm, warranting an MRI for further investigation. My family doctor was uncertain if this finding contributed to my pain, confessing he hadn’t encountered it before, only hearing about similar cases while practicing in Africa. Consequently, I was referred to a surgeon, who ordered an MRI and consultation with a gastroenterologist. The MRI findings revealed a benign thin-walled multiloculated cyst in the iliopsoas tendon, suggesting a long-standing condition, with differential diagnoses including iliopsoas bursitis or possible issues buttressing the labrum. Since February, however, I have been free from those painful attacks. My growing frustration mounts as I finally connected with the gastro doctor, who requested more stool and blood tests, along with yet another abdominal ultrasound despite a CT scan conducted recently. This time, the stool sample returned positive for Yersinia enterocolitica infection, an unknown factor as I had no symptoms. Still, following my insistence, I received antibiotics to treat it due to its potential to masquerade as appendicitis. My hope to resolve this experience was palpable, although the gastro doctor expressed skepticism about its relevance. While awaiting further ultrasound results, I met with the surgeon, who opined that I should not have been referred for the cyst since it likely wouldn’t cause abdominal discomfort. We reviewed the chronological issues I've encountered along with possible explanations, ultimately contemplating a HIDA scan as my next step. The week following this, my gastro doctor called with the ultrasound results revealing nothing new about my fatty liver and fixated on weight loss as a solution—something I was already aware of but took as somewhat condescending. The communication was challenging as the doctor was located six hours away and I had difficulty understanding through the heavy accent. While I tried to explain that these pains surfaced when I weighed as little as 150 pounds, the doctor demonstrated little regard for my historical context and opinions, dismissing the suggestion from the referring surgeon for a HIDA scan. Instead, he proposed another imaging test—a CT scan, despite my recent history with the same procedure. Currently, I have reached out to the surgeon's office for their input, and I'm scheduling an appointment with my family doctor to explore the possibility of seeking a different gastro doctor. As for diagnosis, my current doctor suspects irritable bowel syndrome (IBS), but I’m hesitant to accept this label. It feels too simplistic considering the complexity of my situation, and I want to ensure that all potential underlying causes are thoroughly investigated. He prescribed Librax to try as a remedy for the next time I experience an episode. At this stage, I feel uncertain about the next steps to take.

Answers (1)

6/26/2025, 5:41:15 AM

OpenHealth AI

It sounds like you have been through a challenging and painful journey with your abdominal discomfort, and it's understandable to seek clarity and relief. Given the complexity of your symptoms and the numerous tests you've undergone, it’s crucial to take a structured and exploratory approach moving forward.

Key Points:

1. Persistent and Severe Pain: Your episodes of severe abdominal pain, along with the erratic pattern and associated symptoms (sweating, positional relief), are significant and warrant thorough investigation.
2. Potential IBS Diagnosis: While your doctor has suggested IBS, it's important to ensure all potential underlying causes are adequately explored before accepting this as a final diagnosis.
3. Recent Findings: Your testing revealed a Yersinia enterocolitica infection, which can sometimes cause abdominal pain, and the benign cyst might not be related to your discomfort.

Explanation:

Abdominal pain can stem from numerous sources, including gastrointestinal issues, infections, and even gynecological conditions. Given your symptoms, past diagnoses, and negative tests for conditions like celiac disease and H. pylori, it's essential to remain proactive. Your experience with frustrating medical consultations highlights the need for persistence in seeking a resolution.

Next Steps:

1. Consultations and Follow-ups: Ensure you follow up with both your current family doctor and surgeon to discuss the next steps in your treatment plan and advocate for a second opinion regarding your gastroenterology care. This is key since the current doctor seems dismissive of your concerns.

2. Consider Detailed Lifestyle & Dietary Review: Track your food intake and symptoms closely. This may help identify potential triggers and assist healthcare providers in better understanding your condition. Focus on noting any patterns with specific foods, stress levels, menstrual cycles, etc.

3. Medication Review: Discuss with your doctor the possibility of adjusting or changing your medications if Librax or any treatment prescribed is not yielding relief. Pain management should also consider medications that directly address your symptoms during episodes.

4. Further Testing: Push for a HIDA scan if this hasn't been scheduled yet, as it can provide information about your gallbladder function and help clarify any associated pain patterns.

5. Seek Support Groups or Counseling: Chronic pain can be emotionally draining. Connecting with support groups or a mental health professional specializing in chronic illness can provide emotional support and coping strategies.

6. Educate Yourself About IBS: While understanding IBS can be valuable, do not let it overshadow the investigation into your pain. Learn about its management so you can discuss all possible options thoroughly with your doctor.

Reassurance:

It’s commendable that you are seeking further answers amidst this ongoing pain and confusion. Remember that you're not alone in this journey, and advocating for your needs is vital in finding an effective solution. Take one step at a time, and keep detailed records of your symptoms to empower your discussions with any healthcare provider you consult.