Question
QUESTION: Hello, I am a 19 year old female. I have been having pain off and on in my right side for the past five years. I've been to the doctor, but they can't figure out what's wrong. It is all over in my right, front and back, ranging from top of my ribs to just above my groin, from the navel over. It's not severe, but noticable. I guess I'm more scared than anything. Sometimes it hurts when I move certain ways or cough or run. Other times it hurts on it's own. It's tolerable as of yet, but nerve-wracking. Thank you for your time!

ANSWER: Jamie,
Five years is a long time for this kind of pain. I wonder, what kind of tests have you had? Any xrays, CTs, MRIs? NOTHING FOUND? Since I can't examine you personally, and have no medical history available, I can only throw out a few ideas. One, is a herniation in the abdominal wall, called the 'omentum'. Another, is possible ovarian cyst which only will hurt at the same time each month, about 14 days before your period. Does this seem to happen? You need further workup, but more than that you need your fears alleviated. If you want to send me more info I can try to help you further. If not, you can speak to a gynecologist about the pain. A simple pelvic exam, maybe along with an ultrasound would rule out ovarian cysts. In the case of a herniation of the omentum it would be a little harder to diagnose. That's why I thought of it first.
Get back to me if you wish.


---------- FOLLOW-UP ----------

QUESTION: The only tests I have had were blood tests and ultra sound about two years ago. They couldn't find anything, and the pain is just getting worse. It's troubling me right now, with sharp stabs of pain. Other wise, it mostly hurts when I walk or twist. It's only in my lower right back right now.

The pain doesn't have a pattern. I finished my most recent period about a week ago. No pain during my period, but some before, but that wasn't as bad as what I have now, and it was in the front, above my belly button, where I sometimes get the pain. I had wondered if it was my appendix, but it has been five years already. My uncle had appendicitis for two years, which is shocking enough, but five would be astounding.

I had worried about kidney stones, but as I said, it's usually fairly mild pain, save for the occasional sharp stab, which only happens with some of the episodes.

I have also been worrying, because this past year my periods have been very irregular. I didn't have one in April or May, had two in June, and skipped both July and August. I've never missed a period before this year. I don't know if it's related to the pain or not.

Also, besides the irregular periods, I have no other symptoms with the pain. I don't vomit, and my apatite is fine. Although, sometimes I do not eat while having this pain, simply because I'm too scared to think about food.

The pain usually lasts from anywhere to a day, to a week, and comes at random times, sometimes missing a few months. This year I have not had as much pain as usual, certainly not enough to mention. But this morning when I woke up a 4:30, I had it pretty bad. It's only getting worse as the progresses. Still not anything severe, but a lot of discomfort.

Oh, yes! Before I forget, there is one other symptom that may be related. I typically have at least three bowel movements per day. This morning I have already had four. It's not unusual for me to have four or five in a day. I always assumed that it was because I drink a lot of water, but I hear it might be IBS. However, the pain does not subside with bowel movements.

Thank you for your time. I really appreciate it!

Answer
Jamie,
Yours is a very difficult case, this is true. When you mentioned the possibility of IBS that hit a nerve with me. It could well be that. Often a person will vacillate between diarrhea and constipation, with relief after a bowel movement. However, sometimes a BM doesn't bring relief, but becomes part of a vicious cycle.

I had a few other thoughts. You could have endometriosis. With this disorder the cells from the uterus and reproductive system begin to implant themselves on nearby organs, such as the colon and intestines. Sounds scary, kind of like cancer, but it is not. It may interfere with fertility, but mostly the symptom is pain- pain with menstrual periods and/or intercourse. When a woman has endometriosis often she may also have IBS, or it may copy the symptoms, because emptying your bowels before a period can greatly reduce the cramps during the menses. There is little treatment for endometriosis except for some hormone injections which cause the implants to shrink, and then ultimately surgery (hysterectomy).

Kidney stones are a possibility, but mostly kidney stone pain is more severe. You would notice pain that is not relieved by change in position, but a telltale sign of stones is the presence of blood in the urine. Sometimes the pain is so severe it causes nausea and a person must seek emergency help.

From your symptoms, I am inclined to feel you could have IBS with or without endometriosis. Your primary physician can diagnose and treat IBS. You wouldn't need a lot of tests that would run into a lot of expenses UNLESS you pass blood through the stools or experience fever along with the pain. There isn't a lot of treatment for IBS, but it is aimed at symptomatic relief of pain and cramping. You could be lactose intolerant; that is certainly worth looking into. That can contribute to IBS as well.

I am sending you a link to click on from the National Institute of Health on IBS. It is very comprehensive and offers a lot of information. One thing I do disagree on is where they say IBS usually occurs in people over 30. I've found young people in their teens and twenties with IBS. However, otherwise it is a good place to start. It is written for a layman in easy to understand terms.

I'm trying to offer you information without simply saying "See your doctor" which would lead you to a large bill. It would also give you no answers! So, click or go to that site and see what you think. Then discuss it with your primary doctor, or even a gynecologist. You don't have to get a lot of extensive testing done unless they rule out IBS. I hope you do have insurance. Your five-year history of pain is serious enough for you to pursue seriously.

I hope I have helped direct you properly. Click or go to the site below. Good luck to you. I'd be happy to hear from you to see how all this turns out.


CLICK HERE:  http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001292/