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Dr. Saha
Dr. Saha, Doctor (MD)
Category: Health
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Experience:  35 years of experience
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JA Health team, I have had bad (ie. 'able to wake me up at

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Hi JA Health team,
I have had bad (ie. 'able to wake me up at night' bad) lower right abdominal pain for about two or three weeks. I've been cleared for (acute) appendicitis and ovarian cysts, checked for inguinal hernias, and had a lower abdominal x-ray with no conclusive diagnosis. An external ultrasound found that the painful lymph node was slightly enlarged. A very thorough internal ultrasound showed everything it could see (ovaries, uterus, kidneys, bladder) as being normal. I'm about at my wit's end as to what might be the matter.
My only identifiable symptoms are sharp Lower Right Quadrant pain which is temporarily eased by passing wind or going to the bathroom; constipation, and radiating pain down into the groin. I often have painful inguinal lymph nodes on that side. I had leukocytes in my urine when I was tested at the hospital, and they concluded I had some kind of infection: however, antibiotics had no effect. When I can go at all, my stools have been loose, oily, small and frequent. I've been very gassy and bloated.
Are there common conditions which cause these symptoms? I'm only 28 :(
Dr. Saha :

Hello,

Dr. Saha :

Thank you for your question,

Dr. Saha :

I’m Dr. Saha and I’ll try to help you.

Dr. Saha :

Where is the painful lymph node exactly?

Customer:

Hi, Dr. Saha. Thanks :)

Dr. Saha :

Is it inside abdomen or in the groin?

Customer:

So yes... I tried to recount as much of the information I was given over the last several months into the original question, but any advice would be appreciated.

The pain moves a bit: it is centered in the abdomen just above the pubis to the right hand side, near the point of my pelvic bone there.

Customer:

But it radiates down into the inside of my thigh, and sometimes more centrally.

Dr. Saha :

Did you have urine culture?

Customer:

Yes. They found leukocytes in both samples. The first one, they were concerned it was contaminated, so we did a second one. That came up positive, as well.

Dr. Saha :

Was it a routine urine test? or a culture of urine?

Customer:

I'm not sure. At the ER, they told me I likely had a bladder infection, and gave me Keflex, but the course made no difference to the pain.

Dr. Saha :

When did you finish the antibiotic?

Customer:

About a week and a half ago.

Dr. Saha :

How is your urine now?

Customer:

I have to go a lot. I've had to travel in the interim, and haven't had a urine test since then: just the internal ultrasound.

Dr. Saha :

You wrote they found painful node. Where is the painful lymph node exactly?

Customer:

Right inguinal node: right in my groin, just under the spot where the pain is worst.

Customer:

It's only on that side.

Customer:

That node has hurt on an off for a number of years, but each time, it's just been put down to an infection, even though antibiotics never made a difference to it.

Customer:

It is often too painful to touch.

Dr. Saha :

Pain radiating from lower abdomen to inside of the thighs can be due to a few causes.

Dr. Saha :

Urine infection, stone are common causes.

Dr. Saha :

As you had ultrasound, there is likely no stone.

Customer:

I was checked for stones. Gallstones and kidney stones.

Dr. Saha :

Urine infection is a possibility as there is leukocyte in urine.

Customer:

But neither were found.

Dr. Saha :

Yes they are not there as ultrasound was normal.

Customer:

I have had the bowel problems in conjunction with the pain, as well. Bad constipation, and oily, loose stools when I do go.

Dr. Saha :

You can take a repeat urine analysis & urine culture.

Dr. Saha :

Did stool test show any problem?

Customer:

The sample they took at the hospital showed no problems, but it was before the LRQ pain started. I had URQ pain for a good five months, which responded to treatment for an ulcer (antibiotics and Nexium).

My concern is that I may have an ulcer. I'm a medical journalist (which is which I am fairly comfortable with 'leukocytes' and other terms), but I don't know enough about the GI tract to understand what might be wrong :(

Customer:

It is quite a severe pain.

Customer:

Is it possible to get ulcers in that part of the colon?

Dr. Saha :

Ulcer pain is unlikely to be felt so lower in RLQ. The URQ pain can be due to gastritis, reflux, ulcer.

Customer:

Okay, I see.

Dr. Saha :

Constipation is a frequent cause of lower abdomen pain.

Dr. Saha :

This can cause mucus in stool.

Dr. Saha :

Please try to take plenty of fresh fruits, vegetables & fluid.

Dr. Saha :

Did you consult any specialist like gastroenterologist?

Customer:

I haven't had the chance yet, since this pain began. I saw one at the hospital when the pain was higher in my abdomen, but that was only about the ulcer.

Customer:

About the only test I haven't yet had is a colonoscopy, but that is on the agenda in the next few months.

Dr. Saha :

Yes, that is necessary if the pain persists.

Dr. Saha :

. Inflammatory bowel disease needs to be ruled out.

Dr. Saha :

Irritable bowel syndrome is another possibility.

Customer:

Can IBS cause that kind of persistent, often quite intense pain in one spot?

Dr. Saha :

Usually the pain is more diffuse. But sometimes, it can be prominent in one quadrant.

Dr. Saha :

If you have any further query, please feel free to ask.

Customer:

As remote as the possibility is, can these symptoms be associated with bowel cancer? I'm only 28, but my father died from bowel cancer at 52, and it has been a passing concern of mine.

Customer:

I am more worried about IBD, Crohn's, etc... but nervous minds often wander to worst-case possibilities.

Dr. Saha :

In young age IBD, IBS etc. are more common. Nervous or anxiety states are more associated with IBS, as you are aware.

Dr. Saha :

Colon cancer is more common in older age group.

Customer:

Yes. I have chronic depression and anxiety.

Dr. Saha :

Please do not worry much.

Dr. Saha :

This will aggravate your symptoms.

Customer:

I'll do my best. Last query: assuming it is IBS/IBD, is there anything that can be done to help it in the period before I can afford a GI specialist?

Dr. Saha :

Please try to take plenty of fresh fruits, vegetables & fluid. Those will keep the stool regular, soft & would prevent symptoms.

Customer:

Unfortunately, they don't seem to have a great deal of effect on the pain. Still, the advice is appreciated. Thanks for your time :)

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