What Causes Abdominal Discomfort In The Evenings That Gets Relieved After Passing Stool?
My GI woes continued and I felt like I was emptying too much from my bowels whenever I went in the morning. The stools would often stick to the toilet bowl. I also continued to have incomplete evacuation. This continued on and off for months. In April and May, I had two days where my stomach felt so bloated and full that I had to throw up to relieve the pressure. In May, I ran the Broad Street run and had stomach pain the entire race. All throughout the summer, I still had problems with emptying my bowels and emptying what looked like too much.
In August, I took my migraine meds (Immitrex, which always gave me abdominal pain, but I continued to take it as it took away my migraines) one night and went for a 16 mile run the next day. When I finished, I had bad pain under my right ribcage and the pain descended down to my stomach. I ate chili that night and this worsened my pain to the point where I considered going to the ER. This triggered two months of my stomach feeling unsettled and my stools looked like sludge (again, I was emptying too much and still could not completely empty my bowel). After this “GI attack” I lost 7 pounds. I finally went to a GI doctor in October who discovered after doing an endoscopy that I had severe esophogitis (even though I never had any symptoms of GERD—no acid reflux, esophageal burning, etc). There was also a small, benign nodule that had formed under my right rib cage (where I had the pain). After this diagnosis, I changed my diet (I eliminated acidic foods) and my stomach settled down, even though I still had stomach discomfort off and on. I also continued to have pressure under my right rib cage.
In December of 2014, I had a hysterectomy (I had multiple issues with my uterus). I recovered well and I felt like my GI tract was “back on track.” I was on a good routine where my system emptied at the same time every day and it was emptying what seemed to be a normal amount and it looked like “healthy” stool. I had also put on the weight I had lost from the previous GI attack.
In February of 2015, after reading about the dangers of esophogitis, I decided to take the PPI my doctor prescribed in October of 2014. I then started having acid reflux—burning in my esophagus, burps that were stuck in my throat, etc. So, I returned to my GI doc who then told me to take 60 mg of Dexilant. I did so for a week and 4 days and then I developed severe abdominal pain. I immediately went off of the Dexilant and what ensued was two months of GI hell—I had cramping pain in stomach that was relieved somewhat with taking different laxatives to empty my system. I also was not able to eat most evenings because of the pain in my stomach. As a result, I lost 9 pounds. One doctor said that stopping the acid production in my stomach caused bad bacteria to grow/caused a leaky gut and this seems like a likely theory as different foods that I ate seemed to worsen the pain.
Mid April I also ate salmon and asparagus one day and this resulted in awful pain in my stomach in the middle of the night and into the next day. I had to throw up to try and relieve the pain—what came out was full pieces of the asparagus that I had eaten. I had an abdominal MRI to rule out anything going on in my stomach. It came back negative.
Now in May, the abdominal pain has stopped, but I have abdominal discomfort most evenings—my stomach feels full and bloated and my gas feels trapped. The pressure is not relieved until I go to the bathroom the next day. I am back to not being able to completely empty my bowels—there seems to always be a little more that I need to strain to get out (what comes out is normally flat and/or thin or a small “nugget” when the “extra” does come out).
To rule out anything serious going on with my colon, I had a colonoscopy on May 4; I also had a repeat endoscopy. My colon looked great, but I still have a little scarring on my esophagus.
I don’t know if the PPI incident reveals that I may have low stomach acid and not high stomach acidity. Or, did it exacerbate an existing condition with SIBO. Do I have motility issues where food is either moving too quickly or not quickly enough through my system? If so, what creates this problem? Is it possible my gallbladder is not working correctly and breaking down my food even though the abdominal MRI did not show anything?
If you are able to lend any insight as to what my going on with my GI track, I would greatly appreciate it!
To restrart PPI along with probiotics
Detailed Answer:
Hi,
I went through the details posted with diligence. From what I understand, you are currently suffering with enormous abdominal discomfort which usually occurs in the evening and gets relieved after passing stool. You developed or rather the pain evolved gradually over years. During the course of years, the pain was investigated - only significant result of investigations was that you had esophagitis and incidental nodule on the right upper abdomen. The symptoms were under control briefly with use of acid lowering drug.
It could have been better if you had specified the precise region where you currently have this discomfort. However I assume the discomfort is in lower abdomen region and lead to the following discussion.
Well at this instance my first consideration is hyperacidity. Esophagitis is commonly found secondary to hyper acidity / reflux condition. The other causes is related to infection and drugs and you have no significant history of infections / pain medication use. Therefore I don't believe you had low acid condition.
Bacterial overgrowth is a possibility which can be debated as we do not have a diagnositic tool to exclude/confirm bacterial overgrowth. Nevertheless, you can ask your GP/gastroenterologist to check if you have features of malabsorption. Perhaps they can check for presence of fats, xylose and infection in the stool sample to acknowledge malabsorption.
The last consideration is irritable bowel. Your doctor can arrive at this disorder only after all other parameters are checked.
Based on these criteria my suggestions would be:
1. To start probiotics - either as supplements or dietary probiotics.
2. To start proton pump inhibitors under cover of probiotics.
3. To increase fibre rich diet
4. To start physical exercise
While the suggestions are initiated, discuss about stool tests, liver function test and thyroid hormone test in the next gastro visit. And yes gall bladder can also be looked into through HIDA scans.
I hope my suggestions help you. Let me know if you need clarifications.
Regards