Discussions By Condition: I cannot get a diagnosis.

Any ideas to GI related...abdominal distention?

Posted In: I cannot get a diagnosis. 5 Replies
  • Posted By: concernedformywife
  • September 20, 2009
  • 00:12 AM

My wife started to bloat in March of this year, led to abdominal pains on lower right, which shifted to lower and upper left. She has continued to grow in her abdominal distention. We have seen GI doc, urologist, and two Obgyns. GI doc scoped from both ends, did barium tests and did biopsies of all organs - nothing found. They said she had "symptoms" of IBS, but couldn't confirm that. Urologist also scoped and didn't see anything - did biopsy and also found nothing - suggested IC as probable cause. First obgyn did a ultrasound and found nothing, said come back in 12 weeks. Next obgyn also was concerned as me and my wife about Ovarian Cancer - did laparoscopy and biopsied uterus - nothing found all clean.

So this started in March, bloating would come and go to May/June where bloating stays, to now, Sepetmber, where it has gotten larger. It has been determined to be GI bloat or gas, not fluid. Pain is less but still present and dull. In the meantime we also had 2 CT scans which yeilded nothing, 2 CA-125 tests which yielded nothing, and bloodwork that hasn't shown anything unusual.

While we have felt docs seemingly pushing the IC and IBS diagnosis on us, we don't feel after reading symptoms that either of these are correct. She doesn't ever have diarreha, more constipated. She does have an urgency to urinate at times, but not usually a bladder infection when tested...we feel maybe just from pressure of abdomen on bladder. Also - no correlation to any food or eating. While she used to wake up okay - then bloat - she now is bloated and most pain on left side, and has trouble sleeping.

One more thing - around her period the bloating seems to go down for a few days, and in this same period she has had abdominal spasms - which subside with period end and bloat returns...which made us really think gyno for awhile...

So -in the interim, she has decided to try taking the depression drugs they (noratriptalyne....) want her to.

We're not sure, after laparoscopy last week and OVAC ruled out...should we progress to another GI doc??? Any suggestions???

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  • What your wife is going through sounds a lot like my story. Mine turned out to be Celiac disease. I wish I could have been diagnosed sooner. One problem was that, like your wife, I had severe constipation rather than diarrhea. Apparently that's due to another problem I have of a tortuous colon. But celiac patients can have many different symptoms. I had the skin problems, depression, anxiety (when I was younger), foggy thinking, eventually my gallbladder failed and I had to have that out. Periods were affected by how bad the constipation was. When I could get rid of that early enough, the period was much better. Other weird possible symptoms could be seizures, alopecia, problems with nails, severe itching, gallbladder stones, infertility, miscarriages, and more. Several lab tests should be done. If she has it and stops eating gluten, everything can improve for her. It's not as hard to follow as it used to be. Good luck. My wife started to bloat in March of this year, led to abdominal pains on lower right, which shifted to lower and upper left. She has continued to grow in her abdominal distention. We have seen GI doc, urologist, and two Obgyns. GI doc scoped from both ends, did barium tests and did biopsies of all organs - nothing found. They said she had "symptoms" of IBS, but couldn't confirm that. Urologist also scoped and didn't see anything - did biopsy and also found nothing - suggested IC as probable cause. First obgyn did a ultrasound and found nothing, said come back in 12 weeks. Next obgyn also was concerned as me and my wife about Ovarian Cancer - did laparoscopy and biopsied uterus - nothing found all clean. So this started in March, bloating would come and go to May/June where bloating stays, to now, Sepetmber, where it has gotten larger. It has been determined to be GI bloat or gas, not fluid. Pain is less but still present and dull. In the meantime we also had 2 CT scans which yeilded nothing, 2 CA-125 tests which yielded nothing, and bloodwork that hasn't shown anything unusual. While we have felt docs seemingly pushing the IC and IBS diagnosis on us, we don't feel after reading symptoms that either of these are correct. She doesn't ever have diarreha, more constipated. She does have an urgency to urinate at times, but not usually a bladder infection when tested...we feel maybe just from pressure of abdomen on bladder. Also - no correlation to any food or eating. While she used to wake up okay - then bloat - she now is bloated and most pain on left side, and has trouble sleeping. One more thing - around her period the bloating seems to go down for a few days, and in this same period she has had abdominal spasms - which subside with period end and bloat returns...which made us really think gyno for awhile... So -in the interim, she has decided to try taking the depression drugs they (noratriptalyne....) want her to. We're not sure, after laparoscopy last week and OVAC ruled out...should we progress to another GI doc??? Any suggestions???
    Caryopteris 1 Replies
    • September 20, 2009
    • 05:46 AM
    • 0
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  • Okay, a few points of clarification here. First, Irritable Bowel Syndrome is purely a diagnosis of exclusion. This means that when all tests for organic disease prove negative, then IBS is the likely underlying cause. I would also tell you here that GI function is for the most part, a very straight-forward process. In light of all the various tests that your wife has undergone, this would certainly suggest the presence of a functional disorder such as IBS. Secondly, diarrhea is but one common form of the disorder, which is categorized as IBS-D for diarrhea predominant, IBS-C for constipation predominant, and IBS-mixed wherein the patient obviously experiences transition between the two variations. The urinary urgency would indeed most likely be associated with the intestinal bloating due to the fact that the bladder responds promptly to action on pressure sensors in the bladder wall. The fact that her symptoms seem to subside during menstruation would also suggest that the underlying cause may indeed be functional in nature. Realize that changes to the parasympathetic nervous system can be dominated by the menstrual cycle, by contrast to factors relating to stress or anxiety that tend to be associated with IBS, wherein studies have determined that certain serotonin transmitters are dysregulated during IBS episodes. Therefore, patients often claim that their GI symptoms tend to disappear or become less severe during their cycle, which is predominated by hormonal activity. It's also important to note that sufficient pressure against the retroperitoneal section of the duodenum can result in its dysfunction, with fairly intense pain and bloating occuring as a consequence. Gastric emptying studies, if not previously considered, may shed some light on this aspect of her difficulty, but would not likely change any treatment considerations. Also be aware that constipation, unlike diarrhea, causes a great deal more bloating and pressure. Extended fermentation of fecal material also exacerbates these symptoms as well. In the presence of a multitude of tests that all point away from organic disease, you may wish to speak with your doctors about a trial of a mild anxiolytic to determine whether positive change is noted. Tranxene, or clorazopate dipotassium, tends to work well for persons suffering from functional GI symptoms. They can also try dispensing a dose of liquid Donnatal elixir, a belladonna alkaloid, to determine if relaxation of the smooth muscle of the GI tract provides symptomatic relief. I would not recommend use of the Tranxene for more than about 8 weeks or so at most and the drug should be tapered slowly to termination entirely, during which evaluation of her symptomatology should be made to determine change. It is also a good sign that the abdominal distention is not related to ascites, but rather intra-abdominal air or gas, which would tend to rule out the more serious concerns as well. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • September 20, 2009
    • 10:20 PM
    • 0
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  • Thanks for your information. I was not aware of -d, or -c or -mixed for IBS. In light of what you told me below about the medications, should I ask about this to another GI doctor or her regular family doctor? It isn't easy to find any doctor familiar with IBS. As you mentioned, it has been the end result after tests have ruled out other things. I guess what bugs us is that the abdominal distention doesn't subside...it just has seemingly continued to grow - like she isn't getting rid of the gas - a bm has no effect on the pain or distention. Any though on the probiotics type of thing? Okay, a few points of clarification here. First, Irritable Bowel Syndrome is purely a diagnosis of exclusion. This means that when all tests for organic disease prove negative, then IBS is the likely underlying cause. I would also tell you here that GI function is for the most part, a very straight-forward process. In light of all the various tests that your wife has undergone, this would certainly suggest the presence of a functional disorder such as IBS. Secondly, diarrhea is but one common form of the disorder, which is categorized as IBS-D for diarrhea predominant, IBS-C for constipation predominant, and IBS-mixed wherein the patient obviously experiences transition between the two variations. The urinary urgency would indeed most likely be associated with the intestinal bloating due to the fact that the bladder responds promptly to action on pressure sensors in the bladder wall. The fact that her symptoms seem to subside during menstruation would also suggest that the underlying cause may indeed be functional in nature. Realize that changes to the parasympathetic nervous system can be dominated by the menstrual cycle, by contrast to factors relating to stress or anxiety that tend to be associated with IBS, wherein studies have determined that certain serotonin transmitters are dysregulated during IBS episodes. Therefore, patients often claim that their GI symptoms tend to disappear or become less severe during their cycle, which is predominated by hormonal activity. It's also important to note that sufficient pressure against the retroperitoneal section of the duodenum can result in its dysfunction, with fairly intense pain and bloating occuring as a consequence. Gastric emptying studies, if not previously considered, may shed some light on this aspect of her difficulty, but would not likely change any treatment considerations. Also be aware that constipation, unlike diarrhea, causes a great deal more bloating and pressure. Extended fermentation of fecal material also exacerbates these symptoms as well. In the presence of a multitude of tests that all point away from organic disease, you may wish to speak with your doctors about a trial of a mild anxiolytic to determine whether positive change is noted. Tranxene, or clorazopate dipotassium, tends to work well for persons suffering from functional GI symptoms. They can also try dispensing a dose of liquid Donnatal elixir, a belladonna alkaloid, to determine if relaxation of the smooth muscle of the GI tract provides symptomatic relief. I would not recommend use of the Tranxene for more than about 8 weeks or so at most and the drug should be tapered slowly to termination entirely, during which evaluation of her symptomatology should be made to determine change. It is also a good sign that the abdominal distention is not related to ascites, but rather intra-abdominal air or gas, which would tend to rule out the more serious concerns as well. Best regards, J Cottle, MD
    concernedformywife 2 Replies
    • September 21, 2009
    • 00:16 AM
    • 0
    Flag this Response
  • Hi -I know this is an older post, but I am taking the chance that you may still see my reply. Now that 2 years have passed, I hope that you have found an answer? I am a 38 year old female experiencing exactly the same symptoms. I have the doctors stumped, which is not consoling when I am constantly uncomfortable. Eating makes it worse, but regardless, it has progressed into a permanent distention. I am so frustrated! I've had a ridiculous # tests -- including ruling out celiac, CT scan, U/S, bloodwork...Please help! I've enlisted a new Internist today who is working on this, but it will take time with no guarantees.Thanks for your information. I was not aware of -d, or -c or -mixed for IBS. In light of what you told me below about the medications, should I ask about this to another GI doctor or her regular family doctor? It isn't easy to find any doctor familiar with IBS. As you mentioned, it has been the end result after tests have ruled out other things. I guess what bugs us is that the abdominal distention doesn't subside...it just has seemingly continued to grow - like she isn't getting rid of the gas - a bm has no effect on the pain or distention. Any though on the probiotics type of thing?
    Anonymous 42789 Replies Flag this Response
  • I thought I left a reply - so if 2 show up...my fault, if not:My wife has done remarkably better since my post in Sept 2009. Quite frankly, we also spent a lot of $ trying to figure out what the issue was. Our last doctor we saw may have nailed it on the head. When my wife visited him, he made mention that "this sort of thing" he has seen appear with women who grew up with a male dominant figure (father) that was possibly abusive, over-bearing, and maybe had an addiction - thus leading to turmoil and stress in their lives growing up, that this seemingly would manifest itself later at another point of stress or middle-age. My wife came home and felt as if she had just visited a psychic, and had not seen this doctor before, but yet he described her childhood and relationship with her father and she was blown away by that. September was also the month she was turning 40, and that was an great underlying factor with the issues she was having. Hands down, we now look back and realized this may have truly been stress/psycho-somatic in nature as she has had only a very mild return of this for a day or two, and to a much, much lesser extent, since. If you are going down the same path above...step back and examine your life and diet. Dairy was something that my wife found to be problematic in the above, along with her past and the worry she was having. I have learned that looking for a reason isn't the route to go. If they can't find a reason...that's okay and a good sign it is diet/stress. We always hear how stress causes health issues...this just may be the evidence. Log what you eat, examine the log, reduce the triggers. If you know your stress creators - eliminate them.;)Hi -I know this is an older post, but I am taking the chance that you may still see my reply. Now that 2 years have passed, I hope that you have found an answer? I am a 38 year old female experiencing exactly the same symptoms. I have the doctors stumped, which is not consoling when I am constantly uncomfortable. Eating makes it worse, but regardless, it has progressed into a permanent distention. I am so frustrated! I've had a ridiculous # tests -- including ruling out celiac, CT scan, U/S, bloodwork...Please help! I've enlisted a new Internist today who is working on this, but it will take time with no guarantees.
    concernedformywife 2 Replies Flag this Response
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