Ask a doctor on the topic of Internal medicine

Pain and gastrointestinal issues for 7 weeks.

February 3, 2017 | 50,00 EUR | answered by Dr. med. Frauke Gehring

Dear Sir or Madam,

for about 7 weeks now I have been experiencing the following symptoms:

For 7 weeks...
- Dull pressure pain under both rib cages. Sometimes radiating into the flanks and down to the groin area. Sharp pain when pressure is applied to certain spots directly on the rib.
- Several days of severe gastrointestinal complaints (cramps, diarrhea, heartburn)
- Initially also pain in the area of the thoracic vertebrae - at the level of the ribs.
- Initial examination by the general practitioner: Referral to an osteopath. Working diagnosis: tension in the back/diaphragm. Comprehensive blood test inconclusive.

For 5 weeks...
- New symptom: severe constipation - not relieved despite treatment with psyllium husk + plenty of fluids + exercise. Now using laxatives every 4 days.
- Foul-smelling flatulence with pain.
- Second examination by the general practitioner: Comprehensive blood test again inconclusive. Referral to radiology due to persistent constipation. Abdominal CT scan with findings of gallstones and chronic constipation. No other findings, no masses. Referral to gastroenterology for colonoscopy in four weeks.

For 2 weeks...
- Constipation slightly improved. Bowel movements still very hard and only possible with a lot of pressure.
- Flatulence slightly better. Possibly due to now following a low-sugar diet.
- Recently experiencing mild nausea, especially at night and upon waking up. Pressure sensation now also in the stomach area. Symptoms somewhat alleviated by Domperidone and Buscopan.

Additional information:
- I am 33 years old, male, tall with slight overweight.
- No family history of gastrointestinal diseases except for gallstones.
- An endoscopy was performed last year due to chest pain. No findings were detected, attributing it to postural issues related to my height. The issues resolved shortly after the examination.

My suffering is now quite significant and I am unsure if the planned examination (colonoscopy) is the next right step. A stool test, for example, has not been done. The problems are not improving at the moment, only changing. In this context, I feel that the diagnostics, guided by my general practitioner, are taking too long.

What course of action would you recommend? Should I seek a second opinion? What diagnostics would you suggest?

Kind regards

Dr. med. Frauke Gehring

Good day,

I suspect that the pressure and stabbing under the ribs 7 weeks ago were already due to intestinal problems; air in the intestines feels exactly the same. Almost all imaginable causes do not show up in the blood, so it is no wonder that these tests always remained inconspicuous.

A strong constipation that was not "always there" is a clear indication for a colonoscopy, so this should definitely be done. Tumors are rare at your age, but not excluded.

Alternatively, food intolerances could exist, which can also manifest only in flatulence (but if so, causing more diarrhea than constipation). If the colonoscopy remains inconclusive, gluten, wheat, fructose, lactose, and sorbitol intolerance should be ruled out.

Irritable bowel syndrome is also a possible explanation, especially if you are under stress. However, this diagnosis requires the exclusion of other diseases, including colonoscopy.

A stool examination is only done for parasites or blood; both would be noticeable in the colonoscopy, so you cannot save yourself from the stool test. This makes this test unnecessary.

You can take macrogol for any cause of constipation, which I would also do if there are still "balls", and then wait for the colonoscopy. Please refrain from chocolate, bananas, and white bread (they all cause constipation).

Sincerely, Dr. Höllering