Severe abdominal pain, does this sound like functional pain?

Posted , 7 users are following.

This discussion has been locked due to a period of inactivity. Start a new discussion

My daughter who is 8 years old has ongoing severe abdominal pain, but no one has been able to work out the cause.  The last visit to hospital the consultant in the day assessment unit suggested she had functional pain, after ruling out appendicitus.  But I am really struggling to see that there isn't an underlying cause, just because they haven't found it yet.   I wondered if any one had a similar story and it turned out to be functional pain or something different?

The pain she has is severe - she screams out in pain if someone touches her stomach.  The pain is located in the right hand side where her appendix is.  The pain never goes but she also has episodes which last several hours when the pain is more severe, where she will cry and roll around in pain.  She cries out if she jumps, goes up the stairs, laughs, coughs or yawns. The doctor made her cry and sob for insisting she laid down with her knees up.  She wakes from her sleep because of the pain.  I have had her in bed with me some nights and have seen her wince in pain in her sleep.   This has been going on for the past three months.  School time, weekend, school holidays do not make any difference. Distraction can help but she can forget about it sometimes and then wince in pain because of the movement she makes.  She has had blood tests, urine test and an ultra sound scan which were all found to be normal.  She has not had a fever and does not suffer from constipation or diarrhoea.  It seems we have been on a roundabout of is it or isn't appendicitis.  The only other suggestion has been colitis.   She does have a low pain threshold and I know she worries that the pain is something serious which does not help.  I would be grateful of any advice.  Should I be pushing for more tests? if so any idea what? Thank you for any help or advice.

1 like, 13 replies

Report

13 Replies

  • Posted

    Hi jo34531, have the doctors ruled out a muscle injury and has your daughter seen a Gastroenterologist?  It sounds quite possible that it's a functional disorder of the bowel and I know exactly how severe it can be.  Is your daughter a worrier with an anxious personality.  My first experience of IBS lasted two years, but I was mentally unwell at the time and the more I cried and got upset, the worse the pain got.  You are quite right in saying that distraction is a way of alleviating the severity, if only temporarily.  Other methods worth trying are listening to relaxation and or slow breathing Apps.  Probiotics also help, because she might have too many bad bacteria in her gut.  I have every sympathy with your daughter.  The calmer she can remain, the less pain she should feel.  The connection between the brain and gut is inextricably linked.  Hypnotherapy helps me.  If you are not happy with the Consultants diagnosis, ask the GP to be referred for a second opinion.  I hope things slowly improve for your daughter. 

    Report
  • Posted

    It may be worthwhile having a CT and colonoscopy. IBS typically causes change of bowel habit along with shifting stomach pain which be constant or come and go.  It is sometimes caused by stress and stress itself makes flare ups worse.  Does eating make the pain worse?  Perhaps try a food diary to see if any food is causing symptoms.  Sometimes you can get atypical IBS which means you have IBS but your symptoms are not typical of IBS.  Does her pain improve temporarily after a bowel movemement?  IBS can be caused by anxiety, surgery, or stomach infections.  How long has she had the pain?  
    Report
    • Posted

      Thank you for your reply. We will try keeping a food diary but to be honest the pain seems so constant I am not sure what it will show?  But she does have bouts of diarrhoea so maybe it might help to work out what causes it.  Her bowel movements don't seem to be connected to the pain, but I suppose a diary might to be sure?  Who  gastroenterologist organise a CT scan or an endoscopy? Or could she be referred via her GP?

       

      Report
    • Posted

      Speak to your GP to get referred to a gastroenterolgist who may do an endoscopy or colonoscopy. Your GP can also organise a CT scan.
      Report
  • Posted

    Hey.. Get mormodica (bitter melon) we use mormidica here in Africa to treat stomach pain... Use it twice a day for one week

    .. I bet you she will improve.. Hang on there!

    Report
  • Posted

    I would think it is from certain food she eats. So I would add probiotics to her diet. Try to stay away from Lactose first.. if that is not the cause, maybe gluten. 

    And give her Aloe Vera. That helps very much to calm the GI tract down. 

    Report
    • Posted

      Thank you for your reply. Good idea about the probiotics.  I have started her on some probiotic chocolate balls which she thinks taste great!
      Report
    • Posted

      Hi, one thing I would suggest is making a food diary. Write down when and what she eats and drinks.. 

      Report
  • Posted

    .. and make sure she drinks a lot of water... no juices, just flat water
    Report
  • Posted

    I feel very much for your daughter

    as her pain is very real and prior to jumping on anything like psychological, functional and the likes, all other components must be excluded.

    The problem:

    her age.

    As you see already she has a personality or due to being so young, taking every examination as "bad" and "what is wrong with me".

    It can backlash in severity feeling to be sicker than being actually, if examinations are not experienced as helpful to get closer to a diagnosis or knowing, that exclusions are actually good too.

    You might be able to pre explain what was happening and as to why it was important.

    There is a lot missing in your girl's list of exclusions and tests, yet as said, it is difficult due to her age.

    So it is your gut feeling, that is asked.

    (my girl was 13 when starting with severe abdominal pains in right pelvis, unable to go to school and vomiting her heart out and was the other way round: being talked down as IBS or psychological issues after a negative abdominal x-ray for obstruction like a first line diagnosis, was the worst; any examination and if it was 20vials of blood taking or vein access during imaging, was welcomed. For small patients examinations, that could frighten, can be done sedated....)

    None invasive:

    calprotectin in stool test - has this been done?

    It's really simple to take a sample of her poop (by you) and have it sent off to see if leucocytes were too many in guts granting an inflammatory issue in guts. This will not show up in a blood test.

    Be aware that a "normal" ultrasound does

    a) not look at everything and

    b) does not exclude everything

    c) can't see a grumbling appendix. BUT good to know, the appendix didn't look blown up and inflamed.

    She has not been in an MRI, has she?

    There is a condition called :

    mobile caecum as you mentioned activity to hurt more.

    It's worth looking into it. 

    Did she ever have a plain quick abdo x-ray when her pain was the worst? This would pretty much include or exclude mobile caecum, a twist, that often resolves on its own (luckily), but will come again and again. Hence a plain abdo x-ray in acute abdo pain has a good indication and is peace of mind.

    There is also a condition called:

    abdominal migraine. Helpful is to trial medication to treat it. If it doesn't help, it most likely was not abdo migraine.

    Yet it doesn't sound much like it.

    Other thing, yes, muscular structures, that could be upset. No hernia, right?

    Is it very localised pain?

    Has she been tested with the Carnett's sign test

    (very easy, not invasive. Spot is touched, ouch, but patient lifts head and legs = contracts belly muscles, if it hurts more, a nerve in abdo wall is upset. My girl had referred pain into belly muscle and a lidocaine injection into that muscle helped instantly....for 12 hours. A steriod injection additionally should help if it was that nerve only. It did nothing in our case, as it was not an inflammed abdo nerve, just referring pain. As said, my girl doesn't mind examinations and even treatments with needles. So that might be not easy for your girl if she was positive for Carnett's sign. It needs the patient to guide the needle to the area of pain. But then again, maybe your girl is Carnett sign negative and not the case. Just giving examples.)

    All the best!

    There is nothing out there, that is not possible and a "don"t know, functional" is the last resort diagnosis. You can have a food diary in the meantime to see, if it was connected with food.

    Could well be too, but having very localised, not general or spot changing pains, is odd.

     

    Report
    • Posted

      Thank you so much for your reply.  She has had a stool sample sent off to check for levels of calprotectin and have been waiting for nearly two weeks for the results.  Hopefully that should be back soon. 

      Its a bit confusing as I thought she had been referred to see a paediatrician but now a choose and book appointment has come for a gastroenterologist?

      Out of desperation I took her to an Osteopath. He thinks it is possible the pain is to do with her hip? so she is going to have some treatment.

      The pain continues although she is generally calmer about it.  I think being told that the cause might be her hip has really reassured her.  

      I will ask about the other tests you mention.  I have taught her some relaxation techniques and she tries to distract herself, which is all helping.

       

      Report
    • Posted

      Awesome that Calprotectin is on the way!

      There are paediatric gastroenterologists, maybe that's who she is going to see?

      They are fully trained paediatricians (3 years or so) plus additionally gastroenterology (3-4 years) trained.

      So you would get even more (hopefully). ;-)

      Strangely my daughter had severe right sided hip pain upon every step walking with all the abdo pains and nausea/vomiting.

      After 'labra tear' diagnosis I refused a lidocain and steriod capsule diagnostic injection as too invasive as hip pain was the lesser problem of all her problems, but went for 12x low level laser therapy.

      I don't know if that was it or just simply time, but after half a year she was out of the wheel chair.

      Physio made it worse.

      We don't know if that was due to labra tear healing or if it was all to do with her pelvic congestion, that she still suffers, but collaterals do form and maybe have freed the hip?

      Relaxation, meditation apps did not help us, so it might be a very different issue.

      My girl scratched herself open in pain, and there was no ovarian cyst or the usual easy out diagnosis.

      All all the best!

       

      Report

Join this discussion or start a new one?

New discussion

Report as inappropriate

Thanks for your help!

We want the forums to be a useful resource for our users but it is important to remember that the forums are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the forums is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.

newnav-down newnav-up