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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 34354
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Hi. I have a swollen abdomen, intense lower back pain, and

Resolved Question:

Hi. I have a swollen abdomen, intense lower back pain, and constipation. I am 31 years old, and I have been having this problem for the past five years. I have been poked and prodded, and I have seen all kinds of doctors. No one seems to have any clue as to what is wrong with me, or how I can get rid of it. My back pain is so intense that it becomes difficult to walk. It usually lasts for a few days, but sometimes longer.
Submitted: 6 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 6 years ago.



What did your investigations like blood work, colonoscopy, barium meal with follow through, CT scan and ultrasound show?


Dr. Arun

Customer: replied 6 years ago.
I have had a colonoscopy, I have been to a gastrologist, and I have had blood work done. All tests came back clear. A regular Doctor prescribed ibuprofin,which didn't help. I have also been to a hernia specialist, and I have had physicla therapy. No one has any clue as to what it is. The pain in my back is definitely being caused by my gut. I am only 31 years old, I eat healthy and I exercise regularly. I have been to all sorts of specialists and no one can figure out what it is. I have abdominal distension, which is causing sharp pain in my lower back down to my rear. I have difficulty walking. There is no pain in my gut. I wake up almost every morning with some sort of back or stomach pain, just below my solar plexes. It seems like once a month it gets really serious, and I experience the symptoms described above
Expert:  Dr. Arun Phophalia replied 6 years ago.



I agree that your back pain can be due to gut. The large intestine (whole of the colon) lies on the inner portion of the back (retroperitoneum). The movement disorder of the large bowel can be responsible for your symptoms. You should get the following investigations which are the mainstay of the evaluation for your symptoms;


1) Blood investigations do give the clue. A complete blood count, biochemical profile, serum calcium, blood glucose, and thyroid function tests are routinely recommended in the evaluation of patients with these symptoms swollen abdomen (bloating / distension), intense lower back pain and constipation.


2) Depending on these blood results further blood work is done; serum protein electrophoresis, urine porphyrins, serum parathyroid hormone, and serum cortisol levels, may be done to identify or rule out myeloma, porphyria, hyperparathyroidism, and Addison's disease. These causes are not common causes so clinical manifestation and physical examination clues are important.


3) Barium enema or barium meal with follow through study


4) CT scan


5) Ultrasound


6) Colonic transit time; it can provide a better understanding of the rate of stool movement through the colon.


7) Other investigations like Anorectal manometry, balloon expulsion test, Defecography etc.


8) Colonoscopy / sigmoidoscopy


9) Laparoscopy; camera exam of inside of the abdomen.


Your symptoms can be due to;


1) Intestinal motility disorder

2) Irritable bowel syndrome

3) Congenital band or internal hernia of the gut


Please feel free for your follow up questions.


Dr. Arun

Customer: replied 6 years ago.

Thank you for your reply. I've had bloodwork, a barium enema, and a colonoscopy, and everything came back normal. It's been about 4 years since I've had these tests done. If I go back to the doctor, what would the next step be? Should I ask for a CT scan or ultrasound? Also, could you tell me more about intestinal motility disorder?



Expert:  Dr. Arun Phophalia replied 6 years ago.

You are welcome.


A CT scan with intravenous and oral contrast would be the better. Intestinal motility disorders may manifest in a variety of ways, including abdominal distension and recurrent obstruction; severe abdominal colicky pain; severe constipation etc. This can be due to;


a) abnormal intestinal contractions, such as spasms and intestinal paralysis.

b) gut looses its ability to coordinate muscular activity because of endogenous or exogenous causes.


So there is an abnormal transition of the food and digestive juices. One of the commonest cause is called as Chronic intestinal pseudo-obstruction. Defecography offers some information about the rectal emptying, though, scintigraphic study of the small bowel or colonic transit time is preferred. Diagnostic laparoscopy or laparotomy, with full-thickness biopsy or resection of the intestine tells about the muscle and nerve problems of the gut. Following medications can be helpful;


1) Bethanechol

2) Neostigmine

3) Metoclopramide

4) Tegaserod


It is pleasure and privilege assisting you.


I hope this was helpful to you. If it was, please remember to ACCEPT the answer so I can get compensated for my work. If you have any more questions, please feel free to ask. I am truly privileged to help you, and I want to make sure that you are satisfied with the answer. Good luck!


Dr. Arun

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