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Dr. Phil, MD
Dr. Phil, MD, Medical Doctor
Category: Medical
Satisfied Customers: 55189
Experience:  Medical Doctor Trained at a Top Academic Institution
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I have a dull intermittent pain in my lower right abdomen diagonally

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I have a dull intermittent pain in my lower right abdomen diagonally between my navel and hip (closer to hip). It's like this for a week, sometimes moderately painful but never bad. I have regular bowel movents (once a day, sometimes twice), no blood, no unusual colors. Regular urine. Not dark, no problem or discomfort. No indigestion or reflux. No upper abdominal pain. However my lower abdomen noticeably distended between morning and evening (by maybe 3 to 4 cm). I am passing gas regularly but not unusually. I am male, 45, non smoker, light drinker, gym and swim 4 times a week, Caucasian, 174cm, 73kg ... Any ideas?
Submitted: 5 years ago.
Category: Medical
Expert:  Dr. Phil, MD replied 5 years ago.
Answers are for informational purposes only. You should always see a doctor when you have a medical question.

Have you ever had similar symptoms in the past?

Ever had alternating constipation and diarrhea?
Customer: replied 5 years ago.
Something similar around ten years ago. Had various tests including colonoscopy that did not reveal any specific problem. Situation resolved without treatment after a couple of months.

I have never suffered with constipation
Expert:  Dr. Phil, MD replied 5 years ago.
Any recent increased stress in your life?

Any pain with eating?
Customer: replied 5 years ago.
No problems with eating. No loss of appetite. No adverse reactions to eating and no intolerance to dairy etc. Diet is low on red meat, eat mostly chicken.

Stress, yes probably a little more than last year but (subjectively) not anything major, more busy stress than worry stress
Expert:  Dr. Phil, MD replied 5 years ago.
I think you have irritable bowel syndrome sir.

You seem to have a mild form that flares up intermittently over time.

I suggest a trial of a daily fiber supplement like metamucil.

If you have follow up questions, please ask prior to accepting.
Customer: replied 5 years ago.
Im happy to give the metamucil a try. I'm curious though why I should increase fiber intake when I already have regular bowel movements (for me at least once a day), and I'm not constipated.

Are you of the opinion that it is not likely to be a problem with the illiocecal valve not closing properly?

Also, the reason for this online consultancy is because I am working in the middle east and I plan to see a local doctor just to be on the safe side. What tests (if any) would you suggest to affirm your preliminary diagnosis or rule out anything potentially more serious?

Thank you
Expert:  Dr. Phil, MD replied 5 years ago.
The mainstay of treatment for IBS is extra fiber. It works even in patients that have diarrhea predominant IBS. The exact mechanism of which is unknown.

I doubt it's the ileocecal valve. Very uncommon.

You may want to get screened for celiac (yes, possible even without diarrhea) and make sure your standard blood work is in order. Finally stool cultures and parasite tests should be done

If you have follow up questions, please ask prior to accepting.
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