[52M] With chronic sharp abdominal pain and changes in stool

Patient Description

A 52-year-old male reports experiencing sharp pain from the right side groin area up to the stomach. This pain has been a lifelong issue but has significantly worsened over the past 2-3 months. The pain is rated as a 6 out of 10 in severity and occurs once or twice a week, lasting a couple of days each time. It is exacerbated after eating and is not relieved by any known methods. The patient also reports changes in stool, including dark green or black coloration and constipation, along with occasional black, tarry stools. There are no additional symptoms such as weight loss, changes in appetite, dizziness, lightheadedness, heartburn, acid reflux, or difficulty swallowing. The patient has no family history of gastrointestinal diseases and has not traveled recently. The patient is not currently taking any medications other than Pepcid AC once or twice a week.

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Arora's Assessment

What might be happening

It sounds like you are experiencing a complex set of symptoms that could be related to multiple underlying issues. Here are some possibilities:

1. Gastrointestinal Bleeding

  • Rationale: The presence of dark green or black stools, especially when associated with constipation and occasional blood in the stool, suggests gastrointestinal bleeding. This could be due to a variety of causes, including peptic ulcers, gastritis, or even more serious conditions like colorectal cancer.
  • Typical Treatments/Testing: Your doctor may recommend a stool test to check for hidden blood, blood tests to check for anemia, and imaging studies like an endoscopy or colonoscopy to identify the source of the bleeding.

2. Irritable Bowel Syndrome (IBS) or Inflammatory Bowel Disease (IBD)

  • Rationale: The combination of sharp abdominal pain, constipation, and bloating could be indicative of IBS or IBD. These conditions often cause chronic abdominal pain and changes in bowel habits.
  • Typical Treatments/Testing: Diagnosis may involve a combination of blood tests, stool tests, and imaging studies. Treatment often includes dietary changes, medications to manage symptoms, and sometimes lifestyle modifications.

3. Diverticulitis

  • Rationale: Sharp, cramping abdominal pain that worsens after eating and is associated with changes in stool could be due to diverticulitis, an inflammation or infection of small pouches in the digestive tract.
  • Typical Treatments/Testing: Diagnosis is usually confirmed with a CT scan. Treatment often involves antibiotics, a liquid diet to allow the colon to heal, and in severe cases, surgery.

What you can do

Gastrointestinal Bleeding

  • Seek Immediate Medical Attention: Given the presence of black or dark green stools and occasional blood, it's important to see a doctor as soon as possible. These symptoms could indicate a serious condition that requires prompt evaluation.
  • Avoid NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can exacerbate gastrointestinal bleeding. Stick to medications like acetaminophen for pain relief unless otherwise directed by your doctor.

Abdominal Pain and Constipation

  • Dietary Changes: Increase your intake of fiber-rich foods like fruits, vegetables, and whole grains to help alleviate constipation. Drink plenty of water to stay hydrated.
  • Over-the-Counter Remedies: Consider using over-the-counter stool softeners or laxatives to help with constipation, but consult your doctor before starting any new medication.
  • Avoid Trigger Foods: Since your pain worsens after eating, try to identify and avoid foods that trigger your symptoms. Eating smaller, more frequent meals may also help.

General Health

  • Quit Smoking: Smoking can exacerbate gastrointestinal issues and increase the risk of serious conditions like colorectal cancer. Seek support to quit smoking.
  • Track Symptoms: Use MDandMe to journal your symptoms, track your progress, and share longitudinal medical notes with your healthcare provider. This can help in identifying patterns and making a more accurate diagnosis.

What you should look out for

Given the severity and duration of your symptoms, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • Severe Abdominal Pain: If the pain becomes unbearable or is accompanied by fever, vomiting, or signs of severe infection.
  • Significant Changes in Stool: If you notice a large amount of blood in your stool or if your stools become consistently black and tarry.
  • Unexplained Weight Loss: If you start losing weight without trying, this could be a sign of a more serious underlying condition.

Remember, while I can provide guidance based on your symptoms, it's crucial to consult a healthcare professional for a formal diagnosis and appropriate treatment.

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3 mo ago


People Also Ask


What could cause black or dark green stools?

Black or dark green stools can be caused by gastrointestinal bleeding, which may result from conditions like peptic ulcers, gastritis, or colorectal cancer. Certain foods, supplements, or medications can also cause changes in stool color.


How can gastrointestinal bleeding be diagnosed?

Gastrointestinal bleeding can be diagnosed through stool tests to detect hidden blood, blood tests to check for anemia, and imaging studies such as an endoscopy or colonoscopy to identify the source of the bleeding.


What are the common symptoms of diverticulitis?

Common symptoms of diverticulitis include sharp, cramping abdominal pain, especially after eating, changes in bowel habits like constipation or diarrhea, fever, and sometimes nausea or vomiting.


What lifestyle changes can help manage irritable bowel syndrome (IBS)?

Lifestyle changes to manage IBS include increasing fiber intake, staying hydrated, avoiding trigger foods, eating smaller, more frequent meals, managing stress, and regular physical activity. It's also important to work with a healthcare provider to tailor a plan specific to individual symptoms.

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