Teenage son’s unknown abdominal pain in lower left region

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My 14yo son has been experiencing localised pain in the lower left region of his abdomen for the last 4 years with different levels of severity. In 2016 he went into emergency 3x in 2 weeks and it took a month for the pain to dissipate. 

In 2016 the gastro specialists tested and scanned him for various ailments/ issues however the results were inconclusive. Blood tests and ultrasounds were normal, no constipation, no diarrhoea, no bleeding. Not an abdominal migraine. 

We’re back in hospital today with a similar issue, once again the tests are all clear! He’s on Tramadol however that has no effect on the pain which has escalated to 5/10 currently. 

Wondering if there’s anyone out there who’s been through something similar. Any thoughts on what this issue might be and alternate options for natural/ homeopathic medicines for his ongoing pain management plans?  

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  • Posted

    There is a condition called FAPS - functional abdominal pain syndrome.  This is different from IBS which causes bowel habit change.  Maybe ask your Gastro doctor about that.  You could ask doctor for an antispasmodic to manage the pain in the meantime. This may help combined with Tramadol.
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  • Posted

    The primary symptom of FAPS is abdominal pain. The pain can often be very severe and impact the quality of life of patients significantly. This can even disrupt their normal daily routine due to inability to take part in certain activities. It can also have a financial impact on their wellbeing and may increase levels of stress.

    The condition is not usually associated with gastrointestinal symptoms such as diarrhea or constipation, and the findings from imaging and laboratory tests are often unable to explain the cause of the pain.

    The pain is actually associated with changes in the sensitivity to nerve impulses between the gut and the brain. It is, therefore, a functional problem and not associated with abnormal intestinal motility.

    It is important to note that the symptoms of FAPS often appear or worsen after certain events, such as an infection, traumatic life events, or significant stress

    For people with FAPS, there is an alteration in the brain-gut axis and ability of the nervous system to regulate the pain signals for the gastrointestinal tract. As a result, even small stimuli that disturb the intestines can become amplified and lead to severe pain, known as central hypersensitivity.

    In some cases, repeated injury to the abdomen may be associated with causing FAPS, due to over-sensitization of the nerve receptors in the area. For example, people who have had multiple abdominal surgeries, recurrent infections or a history of physical or sexual abuse are more likely to be affected by the condition.

    The diagnosis of FAPS typically involves a series of diagnostic tests to identify the cause of the pain. This may include X-rays, ultrasound imaging, computed tomography (CT) scans, endoscopy, and blood tests. For patients with FAPS, these tests are not able to reveal a specific cause of the pain.

    It can be helpful to keep a pain diary to record symptoms and possible triggers that may have caused a flare-up of symptoms. Over time, this information can help to identify problematic time and causes of worsened symptoms, which can be helpful when developing management strategies.

    The role of the brain in the experience of pain is an important factor in the treatment of FAPS. Certain factors, such as anxiety, depression, focusing on the pain can lead to increased severity of the pain. In contrast, relaxation and diversion techniques can help reduce the severity.

    Non-pharmacological management techniques for FAPS include:

    Meditation or other relaxation techniques to manage stress

    Hypnosis or diversion therapy to refocus attention away from the pain

    Cognitive behavioral therapy (CBT) to change thoughts, perceptions, and behaviors related to symptoms of pain.

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    • Posted

      My child was labelled IBS and FAPS.... and they were soooo wrong.

      For us anything 'functional' was just an excuse label for 'go away, basic tests were normal, I don't believe you, I just believe you are nuts, I can't deal with you longer, just relax.'.

      The problem: as soon as one doc utters 'FAPS' or 'IBS', all the other docs, who his/her opinion get's sent to (and it is only an opinion), chime in happily and they don't take you seriously anymore either.

      The whole psychological explanation, that has a place! -yes true-,

      is nowadays too soon abused for an too easy to quick out explanation and stop looking.

      It's like with education models, once they are in complete utter drill, then they go into utter intiutive self learning mode instead of combining both to maximise best outcome.

      My girl's life will only be saved for good by very invasive surgery. No yoga, no meditation, no diet will ever help cure her.

      It is good to support though!, but it won't touch the root cause.

      I think it highly depends on the

      nature of pain,

      how much,

      how often

      if one can have the nerve to live with IBS or FAPS diagnosis.

      One can trial diets and meditation, of course. Why  not? Nothing to loose.

      We couldn't find any relief though, not with supplements, meditation, psychologist (who made us more angry), acupuncture, hydro pools and the likes, financially it did relief us quite well. ;-) 

      My child's life is disabled 24/7 due to localised pain and vomiting her heart out. All happened in teenage-hood and no, not because of hormones, because the hips grew wide pulling diaphram and spine into a different position (lordosis), having weak connective tissue was the tipping point.

      My experience

      and urging anyone to be careful with any FAPS diagnosis as it hinders any further investigation.

      Be vigilant no imaging is a 100% proof of anything, it is a puzzle piece.

      - We had imaging and the issue overlooked as it was not the focus of imaging.

      - We got THREE times the same plain basic unhelpful pelvic ultrasound to measure uterus and ovaries. And what do they write into report 'FURTHER imaging could not reveal pathologies', further?, doing the same normal examination again and again, might exclude that something basic was overlooked as they always hope to find a cyst being the trouble for women, because nothing else could be it, duh, but it is not 'FURTHER', it is repeated SAME imaging.

      - Another example, my girl had 11Mio red blood cells/ Liter urine. The so called 'normal range' is 12Mio/L. BUT it does not consider, that someone in a wheel chair, should have zero red blood cells.

      Again, docs didn't know, they look even at blood parameters black and white as if they didn't know better or get suspicious, that a reference range is just a helping 95% 'of normal pain free people' have that value. Anything above or below could be normal, anything within could be pathological. There is no absolut measure in anything. Normal people do sport or have sex and that's why they have ery in urine.

      It needs a darn good clinician to know how to put pieces together and where to go from there to be sure, that no overhasty functional diagnosis was made.

      Unfortunately I have never come across such a clinician....

      Trust your gut feeling,

      if IBS and FAPS sounds right and you find relief with some tools, very good.

      But if not, don't give up fighting.

      That's my essence under the line.

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    • Posted

      Unfortunately your daughter has very complicated conditions but is lucky to have a mum with such a wealth of medical knowledge and experience who is able to push for all possible answers. 

      My dad,had to research hard and fight to get my mum's hypothyroidism treated properly and combat the string of misdiagnoses she got.  Unfortunately, the condition went too far and progressed to hypothyroid dementia which she died from last year.  Many doctors don't recognise it even though it is mentioned in research material

      With me, I was correctly diagnosed with IBS after eight visits to the doctor.  Each time I saw someone different who was just as confused as the others.   My tests showed nothing and in the end a very thorough doctor recognised stress related IBS. I have always been hyper anxious and it was after a relentless bout of stress that my IBS appeared.  Diagnoisis eliminated my health anxiety and my IBS got so much better.

      I do appreciate though that not everyone is lucky as me and that you must be going through unimaginable stress to see your daughter suffer.

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  • Posted

    Just 3 rare ideas if checked:

    A) Abdominal HAE (heriditary angoedema) - easy to test with serum C1 esterase inhibitor, which is NOT included in basic usual ER bloods!

    B) ask specifically for nutcracker syndrome of the left renal vein. Blood is dammed , collaterals form, but often insufficient, dammed blood can cause pelvic congestion in girls and boys. It s not included in a normal abdominal ultrasound.

    C) very far fetched and in case fever involved: FMF (familiar Mediterranean Fever), always has abdominal pain.

    D) porphyria with only abdominal symptom (not the skin blister one)

    We had a long run and all imaging overlooked my girl's problem until I saw it in an MRE and found the right doc to check do vascular compressions like nutcracker.

    Hence my list of rarer diagnosis before being put into the IBS draw.

    Best of luck!

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    • Posted

      Typing from mobile and hard to review:....

      "4" possibilities if checked and

      It is spelled abdominal "angioedema".(they have no face swelling)

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  • Posted

    Google Anterior Cutaneous Nerve entrapment Syndrome.

    Learn how to do the Carnett's test - you can do it yourself.

    Lie your son down. Find the pain spot. Put your finger tip on the spot and press in.

    Does it hurt. How much?

    Release pressure off finger but keep it on same spot.

    Get your son to raise his head, thus tensing his abdominal muscles.

    Press in again. Does it hurt. How much?

    If the pain is very localised and it hurts more when you press against tensed abdominal muscles suspect ACNES, or possibly a hernia, though they should have spotted that by now.

    The difficult thing will be finding a doctor to treat it, but it is a lot easier the closer you are to adult - i.e. over 15

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    • Posted

      How is it treated please?

      My girl is despite vascular and duodenal compressions also Carnett's sign positive.

      Got a Lidocaine injection (m.rectus abdominis) succuessfully. Pain down 2 points (totalling in 4.5/10 first time in a while), but only lasting for 12 hours.

      Next injection double amount of Lidocaine and steroids.

      Pain down 2 points (totalling again in 4.5/10), lasting again only for 12 hours.

      You can't inject every 12 hours...

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  • Posted

    Hi Audrey.

    If Lidocaine reduced the pain for 12 hours that is generally a sign of ACNES. It can be treated with a neurectomy. They usually give 3 steroid/lidocaine injectionss before trying neurectomy though, and . But by the sound of it your daughter may have other problems. The compression you described sounds like MALS/Nutcracker etc. Vomiting? Also not typically an abdominal wall problem.

    However you seem to be being treated by experts in these conditions - just never forget that you can have both syndromes - it is not impossible even though both are rare.

    On the other hand you say that your daughter's pain occurred because her hips grew. Could be correct. Consider another possibility or factor. At certain ages of development adolescents and girls especially are susceptible to something called central sensitisation. This is a fairly new but pretty solid science (experiments on mice, human volunteers, clinical experience) but seems to be only really understood by anaesthetists/pain doctors.

    Central Sensitisation ramps up the 'volume' control in the spinal cord, amplifying what used to be minor pains, or minor conditions that happened before or during this period of development. This means that if your daughter was susceptible to anything hurting then the pains could have appeared from multiple conditions all at the same time. CS can also be triggered by even short bursts of stress, and probably other stuff that we don't know about yet.

    You seem to be in good hands if you know about compression syndromes and abdominal wall pain.

    Good luck with your search and remember that science is advancing all the time, even if knowledge takes time to spread.

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  • Posted

    Thank you adrian!

    The problem is, 

    that this 

    'central sensitisation' 

    word is used to accuse anything and explain everything very quickly, prematurely.

    This, what you mentioned in your post about central sensitisation, went through my heart like a knife:

    "sensitisation disorder' was the FIRST LINE diagnosis by paediatrician and pain specialist prior any ANY imaging for my hugely suffering teenaged child,

    and we had to go to ......


    try antidepressants and physio. 

    Try neuropathic pain meds to no end (Lyrica, Neurontin, Amitryptilin, Sandomigrain,...you name it)

    All to no help (other than unburden our budget from immense amount of dollars!).

    We also did try acupuncture and naturopathic GP, who get's you do 1000s USD of tests and supplements. It helped nothing. plain and simple, because it is not a nerve amplification or general heavy metal intoxication.

    You might understand from this, my personal experience years ago and still hanging in there, 

    that I got 

    my personal 'sensitisation' 

    to this blanket term 

    of anything, that can't be explained with basic tests 

    to be called 'central sensitisation', 'pain disorder' too easily.

    It is often not the case at all. 

    It is just 'not found yet' or 'rare' or 'too small and overlooked'.

    (often IBS is too)

    I had to discover the vascular issues in old MRE, no radiologist did (it was not the indication I have to admit, to look for nutcracker or pelvic congestion or coeliac artery - for coeliac artery we would need a special exhaling protocol, otherwise images will almost always come back 'normal'. The problem is not only the knowledge of referrer - who needs to name the issue to look for- but also radiologists and technicians involved. A 'normal' result is by no means a 'nothing up' result.


    We never ever had any vascular MRIs or CTs still as docs are in denial and easy brush offs or ignorance even if obvious to the blind in MRE or ultrasound. 

    Tricky conditions are not as easy as an ovary or liver or tumor diameter measurement.

    That's how good the hands are we are in. Unfortunately.

    A physical issue is quickly denied, far too quickly,

    because as a teenager 

    everything must be just hormones, growth spurt or a difficult stressful time.


    I had to ask for Carnett's sign re-test and trial of Lidocaine. 

    No hands, no docs would have just come up by themselves for it! 

    Yet shoulders are shrugged what to do now, as Lidocaine helped (steroid did not), but not completely. 

    It might well be, that culprit to be lower down inside than that superficial rectus abdo muscle nerve.

    Ureters can cramp for example. Do docs know about it? Do they know a loin pain haematuria syndrome does not always have to have blood in urine, even if 80% have, it means, 20% don't!?

    We are stranded. 

    Also vomiting and nausea is a big issue for us, 

    both triggered for the worse when lying down or after drink/food. 

    Hence very physical! This is not sensitisation.

    It has nothing to do with a weekday, Sunday or holiday, sleep in (which is impossible due to pain and vomiting) days or not, test days or not. So it is not psychological, stress.

    It does get better a bit with more weight and that alone says much.

    We try weight gain to gain more fat pad around the aorta to get the AA/SMA angle wider and relieve more of duodenum and LRV. 

    It is not always successful but sure worth a conservative trial. Yet my girl has to go overweight as she has those physical signs being normal weight (not underweight at all).

    The pain came on together with vomiting and nausea, headache is very frequent too,

    after walking home from bus station, feeling odd and eating something. There was no gastroinfection, no diarrhoea, always a GI standstill and by now proven slow gastric emptying and slow colonic transit.

    But this GI slowness is like measuring fever.  

    We know GI is slow, but not as to why.

    There was no insult that could simply 'continue'.

    I have asked about AAG (autoimmune autonomic gaglionopathy), but even the test for ganglionic AChR antibody doesn't exist in the continent I live in! That's how good  the hands are. 

    Our pain started in the most active year, with a lot of intraabdominal pressure paired with weak connective tissue (call it HSD or hEDS).

    Yet we are accused that the abdominal one spot, lidocaine partially responding spot was due to 'poor posture' and a RESULT of years of becoming weak. ......???

    Docs totally ignoring, that the abdominal pain was the same from the very start, when she was active and fit, when she was already Carnett's sign positive and hence gyn said to see pain specialist, who did not want to inject anything as it was as so often considered 'too invasive'.

    Docs often twist the time line of events around so that it makes sense to them.

    There are also things like "obturator hernias" in YOUNG people (study of a 12 year old is available online) WITHOUT gut involvement. 

    6mm small so that imaging misses it, especially if no gut is pushed through pelvic floor which anyone can diagnose, any blind one can.

    This 12 year olds obturator hernia was seen in laparoscopy due to luckily the ovary being stuck there and ..... NOT closed, because again arrogance of surgeons assuming, this tiny thing couldn't cause pain. 

    BUT IT WAS. 

    Only months later, in a second, totally avoidable surgery, it was closed with two stitches and the pain: gone.

    So for example this possibility of obturator hernia get's dismissed instantly as 'old women disease' and 'can't be' and 'MRE didn't show' and it does exist and is invisible to any imaging if so small and no gut pushing through pelvic floor. It is rare, but no one should just dismiss it as a possibility.

    It could only be seen in laparoscopy AND if surgeon was looking for it. 

    Also in laparoscopy it is often enough coincidental, if one and the same reason for pain was found or not, if it was small enough to be overlooked, but big enough to cause an issue (see subtle endometriosis, frequently overlooked).

    Such patients then get into the sensitisation draw and actually have a physical, but tiny, rare ailment.

    It is not sensitisation then, it is normal reaction of the nerve rightfully sending 'pain'.

    I have to fight windmills! 

    We are not in good hands unfortunately! 

    But I will keep on fighting, that's for sure! ;-) 

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