Constant Abdominal Pain

by Dan

Hello Doctor,

I am 50 years old male. About five weeks back it started.

Pain in left lower abdomen and bladder area.

Stool is inconsistent but no constipation or diarrhea but pellets. Bladder area also a constant dull pain especially when I sit. Gassy or cramping above the belly button. Since I was going through a stressful time when it started, I attribute it to IBS.

I had a colonosopy 2 weeks ago. All good there. Appetite good. No blood in stool or urine both tested. Other symptoms;
  • Tiredness
  • Difficulty sleeping
  • Urination at night more often (3 times)
  • Gassy pains up and down abdomen

No medicines or allergies.

I have been diagnosed with Impaired Glucose Intolerance. Been monitoring my levels. Just when symptoms started, I slipped in to HYPO at level of 50. I was not eating due to stress. Not sure if this provoked my abdominal pains but worth mentioning.
Any input?

Dear Dan,

The following may be the cause of your symptoms.

Irritable bowel syndrome. The constant abdominal pain you've described on your left lower abdomen may be due to irritable bowel syndrome. But The diagnosis of irritable bowel syndrome is not one to be made lightly. You must have other potential causes of chronic abdominal pain on your left lower abdomen excluded first.

Irritable bowel syndrome or ibs is a chronic or long lasting medical condition that is characterized by the presence of symptoms of abdominal pain or discomfort which is associated with defecation, abdominal distension ( or bloating) and a change in bowel habit - this could be constipation leading to the passage of small pellet stools, or diarrhea, occurring for at least six months.

Other symptoms that could occur in irritable bowel syndrome include:
  • Feeling tired or lethargic most of the time
  • Feeling nauseated
  • Lower back ache
  • Bladder symptoms like feelings of incomplete emptying of the bladder, waking up to pass urine several times at night, and increase in the frequency of passing urine.
  • Pain during sexual intercourse in some women

Do you have unexplained weight loss in the recent weeks or months? Has there been any change in the color of your stool - passing dark colored stools or perhaps blood in your stool? Is there anyone in your family with history of bowel or colon cancer?

If you answer yes to any of these questions, then you will need to go back to see your doctor ASAP. I am sure your answer is no to all of the last three questions.

If your answer is in the negative to the above questions, then I believe that irritable bowel syndrome or IBS is most likely responsible for most of your symptoms, as you have nearly all of the above symptoms we commonly see in IBS.

Your primary care physician or family doctor must nevertheless, make sure that you have at least some basic blood tests (like full blood count or complete blood count; CRP or ESR and celiac disease screening) to exclude any other condition (like celiac disease or bowel tumour) that could mimic ibs.

Borderline Diabetes. Given the fact that you have been diagnosed with Impaired Glucose Intolerance, and has had an episode of hypo (hypoglycaemic attack), it is likely that your symptoms of tiredness and waking up to pass urine at night may be due to your being a borderline diabetic.

Waking up to pass urine up to 3 times at night as well as not sleeping well could also make you feel tired.

Stress / Insomnia. You clearly placed the trigger of your possible ibs on a recent stressful experience. This could also be the cause of your not sleeping well. Have you had problems with sleep for a long time? What are you taking for this if you answered yes?

What I think you could do for each of the above symptoms and conditions are:

  1. For IBS. Dietary modification. keep a diary of foods that tend to worsen your ibs and avoid them. Go for oats and other soluble dietary fibre rich meals. Avoid food rich in insoluble dietary fibre. Try Mebeverine hydrochloride tablets (Colofac), 200mg to be taken Twice Daily, as well as Amitriptylline, 10mg Tablet to be taken Once Daily. Since it appears that your IBS is a constipation dominant type, you may benefit from taking regular Fybogel sachets, once daily to help with constipation. Some Paracetamol or Tylenol , taking Two 500mg tablet up to Four Times Daily might also help in combination with the above medications. Please discuss the suitability of these medications with your doctor before using them.

  2. Impaired Glucose Tolerance or Borderline Diabetes. Dietary control is the best approach here. You can consult a dietician to advice you on the best dietary measure to adopt to help with your sugar control. You can also look for a list of food with low glycaemic index that will be perfect to help control your blood sugar level.

  3. Stress. The amitriptylline suggested above should also be able to help with stress control as well as improve your sleep.
    I sincerely hope this helps answer your question.
    Please do not hesitate to come back to us, should you have any further question, or if there is any other way we could be of help.

Thank you for contacting us and using our free online medical doctor consultation services.

Your Partner Towards Good Health

Dr O Edema

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