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Treatment For Fluid Retention In Stomach, Weight Loss, Gallbladder Stones, Inguinal Hernia And Blurred Vision?
Question: Dear Doctor,
I am a 58 year old Male. I am 1.88M tall and normally healthy up until 18 months ago. For the past 18 months I have been suffering from some retention of mainly fluids in my stomach/gut, meaning if I drink a lot, not too much urine comes out, the pressure is low and i hae to strain at the end of my pee. - I had a few ultrasound tests, which showed bladder normal with only minor urine retention. Also I have difficulty in passing stools - I always have to push so hard. The stools are quite hard. I have gall stones (no pain), mild diverticulus and a small very low down (appendix area) hernia, although this now getting bigger and I have to hold it in when I am using the toilet. I have a very poor appetite. I always feel quite full and more recently my stomach is always and further bloated, with intermittent dull pain in both sides. Also my vision has started to become more blurred with some minor hearing loss (this may not be related), this maybe stress related?. In the first 3 months my weight changed from 103kg to 74kg, for the past 15 months it has stayed about the same.
In the past I have had colonoscopy, US, CT scan (3 times), which showed minor gall stones and minor diverticulitus with no cancer or blockages.
The bloated feeling and intermittent dull both side pains caused me to overly worry and I lost my job. My sleep is always bad with an average of only 4/5 hours per night. I am afraid to eat and drink too much. I used to enjoy drinking, but now am afraid to drink alcohol because I fear the beer will cause more bloated and will be dificult to pass through my body.
PLEASE HELP ME, I am so unhappy and depressed, sometimes I feel suicidal.
Please kindly respond today
XXXXXXX
I am a 58 year old Male. I am 1.88M tall and normally healthy up until 18 months ago. For the past 18 months I have been suffering from some retention of mainly fluids in my stomach/gut, meaning if I drink a lot, not too much urine comes out, the pressure is low and i hae to strain at the end of my pee. - I had a few ultrasound tests, which showed bladder normal with only minor urine retention. Also I have difficulty in passing stools - I always have to push so hard. The stools are quite hard. I have gall stones (no pain), mild diverticulus and a small very low down (appendix area) hernia, although this now getting bigger and I have to hold it in when I am using the toilet. I have a very poor appetite. I always feel quite full and more recently my stomach is always and further bloated, with intermittent dull pain in both sides. Also my vision has started to become more blurred with some minor hearing loss (this may not be related), this maybe stress related?. In the first 3 months my weight changed from 103kg to 74kg, for the past 15 months it has stayed about the same.
In the past I have had colonoscopy, US, CT scan (3 times), which showed minor gall stones and minor diverticulitus with no cancer or blockages.
The bloated feeling and intermittent dull both side pains caused me to overly worry and I lost my job. My sleep is always bad with an average of only 4/5 hours per night. I am afraid to eat and drink too much. I used to enjoy drinking, but now am afraid to drink alcohol because I fear the beer will cause more bloated and will be dificult to pass through my body.
PLEASE HELP ME, I am so unhappy and depressed, sometimes I feel suicidal.
Please kindly respond today
XXXXXXX
Hello,
Thanks for writing to us.
I have noted all your problems. The listed problems are retension of fluids; straining during micturating; constipation; gallbladder stones; right inguinal hernia; blurred vision; decrease in weight from 130 to 74kg and finally poor appetite, feeling full and bloated and pain abdomen. It was good to know that some of relevant investigations such as CT scan, Colonoscopy and ultra sound which can provide some clue to your problems, have been done. Based on these details, I will try to address your problem one by one.
1. A diverticula was found on colonoscopy. Though minor, it can pose some abdominal problems such as constipation, occasional abdominal pain and fullness.
2. Residual urine in bladder can be secondary to enlarged prostate. And enlarged prostate can present as straining during micturation and passing thin stream / low pressure urine.
3. Gall bladder stone and hernia are 2 surgical problems. They together can be responsible for abdominal pain, abdominal fullness and other indigestion symptoms. It may need to be addressed by surgical means.
4. Retension of fluids in the body needs further investigation like kidney function test and CBC.
5. Stress, strain, depression and other pscyhological factors can very well influence digestion and bowel movements. It needs to be addressed by destressing measures. Regular sleep, physical exercise, yoga and transcendental mediation are few destressing measures which I rely on.
6. Loss of weight and appetite is concerning. Perhaps it could be related to all the aforementioned factors. However we could investigate further to exclude all other pathologies. Complete hemogram, upper gastrointestinal endoscopy and stool test are few test that can be considered to start with. Your current treating doctor can help you in getting these tests. Discuss with him/her.
7. Blurring in vision could be due to local eye condition such as cataract formation or refractory error. It may not be related to your other symptoms.
Hope I answered your question. Let me know if you have any more queries.
Regards
Dr Sadiq
Thanks for writing to us.
I have noted all your problems. The listed problems are retension of fluids; straining during micturating; constipation; gallbladder stones; right inguinal hernia; blurred vision; decrease in weight from 130 to 74kg and finally poor appetite, feeling full and bloated and pain abdomen. It was good to know that some of relevant investigations such as CT scan, Colonoscopy and ultra sound which can provide some clue to your problems, have been done. Based on these details, I will try to address your problem one by one.
1. A diverticula was found on colonoscopy. Though minor, it can pose some abdominal problems such as constipation, occasional abdominal pain and fullness.
2. Residual urine in bladder can be secondary to enlarged prostate. And enlarged prostate can present as straining during micturation and passing thin stream / low pressure urine.
3. Gall bladder stone and hernia are 2 surgical problems. They together can be responsible for abdominal pain, abdominal fullness and other indigestion symptoms. It may need to be addressed by surgical means.
4. Retension of fluids in the body needs further investigation like kidney function test and CBC.
5. Stress, strain, depression and other pscyhological factors can very well influence digestion and bowel movements. It needs to be addressed by destressing measures. Regular sleep, physical exercise, yoga and transcendental mediation are few destressing measures which I rely on.
6. Loss of weight and appetite is concerning. Perhaps it could be related to all the aforementioned factors. However we could investigate further to exclude all other pathologies. Complete hemogram, upper gastrointestinal endoscopy and stool test are few test that can be considered to start with. Your current treating doctor can help you in getting these tests. Discuss with him/her.
7. Blurring in vision could be due to local eye condition such as cataract formation or refractory error. It may not be related to your other symptoms.
Hope I answered your question. Let me know if you have any more queries.
Regards
Dr Sadiq
Above answer was peer-reviewed by :
Dr. Prasad
Dear Dr. XXXXXXX Mughal,
Thank you for your 7 point reply to my questions. I have a few comments and more questions:
1. My prostate is normal size and my gall stones are small and few, surgery is not required at this stage.
2. What is "CBC" and "Hemogram"?
3. What other reasons could be the cause of my stomach bloatedness (it is physically larger) and what are the dull pains on both sides?
4. Apart from fluids entering the bladder, is it possible for fluids to go to other parts of the stomach/gut area? When I push my hernia lump, there is a fluid noise, is this normal, as my hernia is very low down (not close to my bladder).
5. Apart from meditation, etc. is there anything else I can do to solve this problem?
6. As my prostate is normal, what else could be causing the small amount of urine with low pressure during release?
7. Can such problems be cured without surgery?
8. Should I take a chance and drink large quantities of liquis and eat normal size ,meals - I have only been eating and drinking a little?
9. What is the worst case scenario?
Kind regards
XXXXXXX
Thank you for your 7 point reply to my questions. I have a few comments and more questions:
1. My prostate is normal size and my gall stones are small and few, surgery is not required at this stage.
2. What is "CBC" and "Hemogram"?
3. What other reasons could be the cause of my stomach bloatedness (it is physically larger) and what are the dull pains on both sides?
4. Apart from fluids entering the bladder, is it possible for fluids to go to other parts of the stomach/gut area? When I push my hernia lump, there is a fluid noise, is this normal, as my hernia is very low down (not close to my bladder).
5. Apart from meditation, etc. is there anything else I can do to solve this problem?
6. As my prostate is normal, what else could be causing the small amount of urine with low pressure during release?
7. Can such problems be cured without surgery?
8. Should I take a chance and drink large quantities of liquis and eat normal size ,meals - I have only been eating and drinking a little?
9. What is the worst case scenario?
Kind regards
XXXXXXX
Dear XXXXXXX
Here are my answers to your other queries.
1. Prostate is commonly responsible for retension of urine in middle aged and elderly men. It is the portion of prostate which in the posterior lobe and directly over the urethra which needs to be assessed and not the prostate as a whole. Even small increase in posterior lobe can give rise to increase in amount of residual urine. Urodynamic studies done by qualified urologist can help us identify problems not picked on ultrasound scan. I would suggest consulting an urologist here.
2. The size of gall bladder doesn't matter too. Gall stone are the commonest cause of acid peptic disease. It is the usual cause of abdominal bloating, abdominal pain, nausea and other symptoms of indigestion. Larger stones cause obstructive jaundice, while small stones can slip into common bile duct leading to further problems.
3. Hemogram is a name given to hematology related blood tests and complete blood count (CBC) is one part of it.
4. Lump and fluid noise which your listening could be due to a loop of gut passing into hernial sac. Movement of fluid entrapped within the loop of the gut can the causing that sound.
5. Fluids which we take doesn't go any where else. Most of it is absorbed through stomach and intestine and latter excreted by your kidneys in the form of urine; rest is passed out with fecal matter.
6. Based on the details provided the aforementioned conditions are the causes I can think of as the causes. A detailed abdominal examination and other tests including endoscopy will provide more clues to include/exclude conditions. A gastroenterologist can be helpful here. He/she can also evaluate for loss of appetite and weight.
7. Apart from the destressing measures, medicines can take care of your problem. The medications needed can be listed following a physical consult. Surgical conditions however can be cured ony by surgical treatments. Presuming your kidney and heart are working well, I do not find any other reasons to restrict your fluid intake. You can take lot fluids and normal diet except you have to avoid fatty foods due to gall bladder stones.
8. Prognosis of all the above conditions is good and you don't have any disease for which I should give you a guarded prognosis. You may need a multidisciplinary approach (as specified earlier) in treating you. I am confident that your conditions can be treated with this approach.
Hope I answered all queries posted by you. Let me know if you have any more queries.
Please close this discussion if all your queries are answered.
Regards
Dr Sadiq
Here are my answers to your other queries.
1. Prostate is commonly responsible for retension of urine in middle aged and elderly men. It is the portion of prostate which in the posterior lobe and directly over the urethra which needs to be assessed and not the prostate as a whole. Even small increase in posterior lobe can give rise to increase in amount of residual urine. Urodynamic studies done by qualified urologist can help us identify problems not picked on ultrasound scan. I would suggest consulting an urologist here.
2. The size of gall bladder doesn't matter too. Gall stone are the commonest cause of acid peptic disease. It is the usual cause of abdominal bloating, abdominal pain, nausea and other symptoms of indigestion. Larger stones cause obstructive jaundice, while small stones can slip into common bile duct leading to further problems.
3. Hemogram is a name given to hematology related blood tests and complete blood count (CBC) is one part of it.
4. Lump and fluid noise which your listening could be due to a loop of gut passing into hernial sac. Movement of fluid entrapped within the loop of the gut can the causing that sound.
5. Fluids which we take doesn't go any where else. Most of it is absorbed through stomach and intestine and latter excreted by your kidneys in the form of urine; rest is passed out with fecal matter.
6. Based on the details provided the aforementioned conditions are the causes I can think of as the causes. A detailed abdominal examination and other tests including endoscopy will provide more clues to include/exclude conditions. A gastroenterologist can be helpful here. He/she can also evaluate for loss of appetite and weight.
7. Apart from the destressing measures, medicines can take care of your problem. The medications needed can be listed following a physical consult. Surgical conditions however can be cured ony by surgical treatments. Presuming your kidney and heart are working well, I do not find any other reasons to restrict your fluid intake. You can take lot fluids and normal diet except you have to avoid fatty foods due to gall bladder stones.
8. Prognosis of all the above conditions is good and you don't have any disease for which I should give you a guarded prognosis. You may need a multidisciplinary approach (as specified earlier) in treating you. I am confident that your conditions can be treated with this approach.
Hope I answered all queries posted by you. Let me know if you have any more queries.
Please close this discussion if all your queries are answered.
Regards
Dr Sadiq
Above answer was peer-reviewed by :
Dr. Prasad
Thanks Dr. XXXXXXX
Just a few more questions for now:
1. My question in item 3 above has not been answered - "What are other causes for stomach bloatedness and what are the dull intermittent pains at each side of my stomach?
2. Regarding retention of fluid/urine, does that mean liquid could only be retained in the stomach or bladder?
3. My stomach is very noisy at times, is this normal?
4. In the short term is there anything I can do to help alleviate the condition/discmfort?
Thanks
XXXXXXX
Just a few more questions for now:
1. My question in item 3 above has not been answered - "What are other causes for stomach bloatedness and what are the dull intermittent pains at each side of my stomach?
2. Regarding retention of fluid/urine, does that mean liquid could only be retained in the stomach or bladder?
3. My stomach is very noisy at times, is this normal?
4. In the short term is there anything I can do to help alleviate the condition/discmfort?
Thanks
XXXXXXX
Hello Dear XXXXXXX
Please read the answer carefully, I have already answered the commonest cause for bloating and pain abdomen that is Cholilithiasis. Additionally, other cause could be: Gastritis (inflammation of stomach) due to infection of stomach by a bacteria called as H Pylori, which can be diagnosed by upper G I endocopy. Dragging of the gut loop entrapped in hernial sac could also give rise to pain on both side of abdomen.
Increased peristalsis due to partial obstruction of gut loop entrapped in hernial sac could be responsible for noisy stomach.
Liquids are not retained by stomach or bladder. Some amount of liquid is absorbed from stomach and some is pushed towards intestine from where, a part is absorbed and a part pass out with fecal matter.
Urinary bladder only store urine for sometime till one pass it out.
If your heart and kidneys are working properly body always maintain fluid balance and no excessive fluid is retained by body, but passed by kidneys in form of urine.
You can alleviate your problems due to gall bladder stone by avoiding fatty foods as mentioned earlier. Stomach pain can be taken care by proton pump blocker like pantoprazole,with some antispasmodics.
As I mentioned earlier, your problem needs multidisciplinary approach. Consultation with a gastroenterologist and urologist are essential in the management of your problems.
Hope I answered your all queries.
If you don't have any more queries you can close the discussion, accept the answer and rate the answer.
Take care
Regards.
Dr Sadiq
Please read the answer carefully, I have already answered the commonest cause for bloating and pain abdomen that is Cholilithiasis. Additionally, other cause could be: Gastritis (inflammation of stomach) due to infection of stomach by a bacteria called as H Pylori, which can be diagnosed by upper G I endocopy. Dragging of the gut loop entrapped in hernial sac could also give rise to pain on both side of abdomen.
Increased peristalsis due to partial obstruction of gut loop entrapped in hernial sac could be responsible for noisy stomach.
Liquids are not retained by stomach or bladder. Some amount of liquid is absorbed from stomach and some is pushed towards intestine from where, a part is absorbed and a part pass out with fecal matter.
Urinary bladder only store urine for sometime till one pass it out.
If your heart and kidneys are working properly body always maintain fluid balance and no excessive fluid is retained by body, but passed by kidneys in form of urine.
You can alleviate your problems due to gall bladder stone by avoiding fatty foods as mentioned earlier. Stomach pain can be taken care by proton pump blocker like pantoprazole,with some antispasmodics.
As I mentioned earlier, your problem needs multidisciplinary approach. Consultation with a gastroenterologist and urologist are essential in the management of your problems.
Hope I answered your all queries.
If you don't have any more queries you can close the discussion, accept the answer and rate the answer.
Take care
Regards.
Dr Sadiq
Above answer was peer-reviewed by :
Dr. Mohammed Kappan
Follow up REF: hcmg0000
Dear Dr. XXXXXXX
Thank you for your comprehensive answers, however I still have a few more points.
1. Are my symptoms common? Have you dealt with many similar cases? How were the problems solved and did the patients return to a normal life?
2. If the posterior lobe is the cause of some urine retention, how to solve the problem, preferably without surgery?
3. Why does my stomach seem to retaiin the contents longer than normal? After eating or drinking a relatively small amount, it physically becomes swollen with bad bloated feeling - could there be a partial obstruction/blockage?
4. If I take no action, is it likely my condition will worsen?
5. How long would it typically take to solve all the problems?
6. I noticed when I sleep, I wake up several times each night feeling hot, with heavy breathing and most times an erection -which is strange as I have no physical desires. I can hear my heart beating in my ears. Why is this?
7. Is it possible to live with this condition and have a better quality of life?
Kind regards
Dear Dr. XXXXXXX
Thank you for your comprehensive answers, however I still have a few more points.
1. Are my symptoms common? Have you dealt with many similar cases? How were the problems solved and did the patients return to a normal life?
2. If the posterior lobe is the cause of some urine retention, how to solve the problem, preferably without surgery?
3. Why does my stomach seem to retaiin the contents longer than normal? After eating or drinking a relatively small amount, it physically becomes swollen with bad bloated feeling - could there be a partial obstruction/blockage?
4. If I take no action, is it likely my condition will worsen?
5. How long would it typically take to solve all the problems?
6. I noticed when I sleep, I wake up several times each night feeling hot, with heavy breathing and most times an erection -which is strange as I have no physical desires. I can hear my heart beating in my ears. Why is this?
7. Is it possible to live with this condition and have a better quality of life?
Kind regards
Hello Dear XXXXXXX
Here are my answers to your new queries.
Yes, many people have symptoms complex similar to yours. Yes, I have dealt with patients with symptoms and diseases much serious than yours, all are well and back to their normal work.
Treatment modalities vary from patient to patient and from disease to disease, but basic principles remain same.
There are drugs, which can shrink the prostate, including posterior lobe without surgery.
As I have already suggested you to go for upper G I endoscopy to sort out the cause for your stomach problem.
As I have mentioned earlier gastritis can produce this kind of symptoms. The other condition which can produce these symptoms could be a healed duodenal ulcer producing scaring leading to partial pyloric (outlet portion of stomach) obstruction.
Any other condition, which will cause obstruction of pylorus, can produce symptoms of fluid retention in stomach like duodenal edema due to cholilithesis and any tumor in stomach.
Fall out in case of no treatment;
Hernia can lead to gut obstruction with gangrene of loop entrapped in hernial sac, which may eventually need resection anastomosis of intestine, if still no treatment done septicemia and its fall out which everybody knows.
Cholilithesis, can lead to obstructive jaundice and its consquence liver failure.Secondly gall bladder rupture leading to biliary peritonitis with high mortality. Cholilithesis can also cause pancreatitis with very high mortality.
Retention of urine, back pressure, leading to hydro ureter and hydronephrosis (enlargement of kidney) and finally kidneys failure.
Awaking during night with so many problems is normal and understandable. Palpitation and erection after sudden awaking from sleep is normal physiological process and nothing to worry for.
You can live with these conditions but surely not with better quality of life.
Hope I answered all your queries.
Close the discussion. Rate the answer and write the review if you like.
Take care.
Regards.
Dr Sadiq.
Here are my answers to your new queries.
Yes, many people have symptoms complex similar to yours. Yes, I have dealt with patients with symptoms and diseases much serious than yours, all are well and back to their normal work.
Treatment modalities vary from patient to patient and from disease to disease, but basic principles remain same.
There are drugs, which can shrink the prostate, including posterior lobe without surgery.
As I have already suggested you to go for upper G I endoscopy to sort out the cause for your stomach problem.
As I have mentioned earlier gastritis can produce this kind of symptoms. The other condition which can produce these symptoms could be a healed duodenal ulcer producing scaring leading to partial pyloric (outlet portion of stomach) obstruction.
Any other condition, which will cause obstruction of pylorus, can produce symptoms of fluid retention in stomach like duodenal edema due to cholilithesis and any tumor in stomach.
Fall out in case of no treatment;
Hernia can lead to gut obstruction with gangrene of loop entrapped in hernial sac, which may eventually need resection anastomosis of intestine, if still no treatment done septicemia and its fall out which everybody knows.
Cholilithesis, can lead to obstructive jaundice and its consquence liver failure.Secondly gall bladder rupture leading to biliary peritonitis with high mortality. Cholilithesis can also cause pancreatitis with very high mortality.
Retention of urine, back pressure, leading to hydro ureter and hydronephrosis (enlargement of kidney) and finally kidneys failure.
Awaking during night with so many problems is normal and understandable. Palpitation and erection after sudden awaking from sleep is normal physiological process and nothing to worry for.
You can live with these conditions but surely not with better quality of life.
Hope I answered all your queries.
Close the discussion. Rate the answer and write the review if you like.
Take care.
Regards.
Dr Sadiq.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Shanthi.E
Answered by
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