Ask a doctor on the topic of Internal medicine

Chronic abdominal pain

February 1, 2012 | 15,00 EUR | answered by Dr. med. Ralf Berg

I have been experiencing pain in the right abdominal area for about 2 months. The pain is present in both the lower and upper abdomen, as well as on the side under the ribs (only on the right side).

It is a constant, bearable pain that worsens with pressure. Additionally, I occasionally feel a sensation of heat in the specified area.

Other symptoms include a feeling of a lump in the throat at times, as well as cold feet (internal coldness that does not go away even with 3,4,5 pairs of socks).

I am not sure if the symptoms are related, but my personal assessment is that there is a connection (just my gut feeling).

The following examinations have already been conducted:

Multiple blood tests (including kidney function)
Urinalysis
Endoscopy
Colonoscopy
Abdominal MRI
Laparoscopy (with removal of the appendix)
Stress ECG

All examinations yielded no significant findings (the appendix was apparently inflamed in the past according to laboratory results).

No doctor has any idea where the symptoms may be coming from, so it appears to be attributed to psychological causes. Upon the doctor's advice, I now have an appointment for psychotherapy. However, my personal assessment does not lean towards a psychological cause as I do not have stress or major concerns. My only worry is my severely diminished quality of life due to the constant abdominal pain. Furthermore, I am unsure if a psychologically induced pain can be worsened by pressure on the area. But I will follow the recommendation and be open to it.

It may be difficult to answer my question, as apparently all necessary examinations (and more) have already been conducted.

With my question, I am seeking possibilities that may have a simple cause and have been overlooked. For example, I wonder if a stool test could provide clues to conditions that were not detected in the other examinations?

Additionally, up until the onset of the symptoms, I took a lot of ibuprofen for back pain (examined by an orthopedist due to the abdominal pain). In hindsight, I learned that ibuprofen can be very damaging to the stomach. However, I am not sure if damage would not have been seen during the colonoscopy or endoscopy?

As a non-medical professional, I have also considered the possibility of a fungal infection in the intestine that was not detected, but I am unsure if it can cause such persistent and pronounced symptoms?

I would appreciate if there are still realistic possibilities to localize and treat these symptoms. My daily life is currently heavily burdened by pain and worries.

Dr. med. Ralf Berg

Dear seeker of advice,

I understand that you are in an unsatisfactory life situation. After all, these complaints do not seem to go away. I can at least reassure you regarding the Ibuprofen, as damage to the stomach from this medication would have been visible by now. Also, since your complaints seem to originate more from the intestine, as they are not only in the upper abdomen. Since you have already had a laparoscopy done, where anomalies of the right side of the intestine/Colon Ascendens can be seen, it is difficult to give good advice. The idea of a fungal infection in the intestine is correct, as they usually do not cause such severe persistent pain. You have not mentioned if your pain is also accompanied by diarrhea, vomiting, weight loss, or loss of appetite. Nor have you mentioned any changes in the color or consistency of your stool. If you can answer all these questions with yes, then I don't see how a stool test could help us.
Even after a second look at your complaints, unfortunately, I cannot find a simple cause that could have been overlooked. I appreciate that you are also undergoing a psychological examination. From my practice, I can assure you that practically every complaint can also be triggered by the mind. Unlike a pathological somatic event, the nature of psychological complaints is that they cannot be localized. I hope that the methods of psychotherapy can help you alleviate or control your complaints.

P.S.:
One last thing: I assume that you are already fully grown/adult (over 21 years old). I have seen this type of complaints often in adolescents as growing pains, which are completely harmless and go away without treatment. This would be a simple cause, but I fear it does not apply to you due to your age.

Best regards, [Name]