pain under ribs

[Skyline4]

I have been now been told my discomfort is ibs constipation and not hiatus hernia or acid reflux. Symptoms started 8 years ago and steadily deteriorated so I’m now finding it difficult to eat/drink. Domperidone did help (half tab not every day) but GE said not to take it as advice re impact on heart (my heart is fine , I’m 77 F. ) So it’s cosmocol (prefer half measure) , or docusate, or mebeverine. These do work but I still have awful pain under ribs (nurse said it’s bloating). Meals are a nightmare now - tried gf, low fibre, … I’m concerned now I’m missing nutrients. I’m caring for my husband - stroke and prostrate cancer - but GPs not helpful. Had endoscopies which not indicating anything wrong though mixed opinions re hiatus hernia . I saw one private GE but when my husband became ill I asked to be referred back to NHS as it was difficult to see him and I certainly didn’t want surgery

I would appreciate if anyone can comment on the rib pain being part of the bloating issue and if you have resolved this My pain goes when I lie down at night- thank goodness!

Any comments on docusate (GE said it’s gentle!) or mebeverine? Or even the Domperidone. I would much prefer to manage with natural products and adjusting my diet, again. I was also recommended buscopan but yet to try it.

I should say I am generally active and healthy despite this. People only see me when I’m feeling stronger so they have no idea how difficult it is and I try not to explain - in my age group we have many health issues and it’s v negative conversation. We like to be positive and active.

Thank you for reading this.

[Luisa22]

Maybe the pain on left, and to a smaller extent on the right is trapped wind or spasms in the colon. There are two sharp flexures in the colon, one the "Splenic flexure" just under the ribs on the left. That comes up higher than I used to think it did! Then two, the "Hepatic flexure" on the right. It is typical for wind to get trapped on these bends, and that could maybe cause sensitivity or some spasms in those ares. It's interesting that you feel okay when you lie down and relax to go to sleep. That's a blessing too.

I often find when I get any pains similar, lying down flat eases them and can even make them go away.

I'm not telling you what to do, this is just a suggestion, but if you feel you aren't getting enough nutrition, maybe you could consider taking a multivitamin and mineral complex, as a kind of safety net. Try to find a good one though without the usual fillers and possibly irritating additives.

[Skyline4 in reply to Luisa22]

Thank you so much Luisa. To know you have taken the time to read my post and make such a helpful response means so much to me. Coincidently I have managed to get an appt with a GP on thurs and I will discuss meds and I hope that will reassure me. I also heard from the hospital who have booked me in for another breath test in Dec (glucose this time not lactose, which was “inconclusive”) and magically the awful bloating actually disappeared in the evening! I know stress is a factor for me but I also think certain foods have an enormous impact. I’ve managed to get a space with a local Tai Chi group which should help…

I never give up trying and I am now feeling I can continue to resolve this - or manage it much better.

I wish you well.

[225AEDWARD05 in reply to Skyline4]

As a fellow sufferer,not anywhere near as bad as you by the sound of it,it's so reassuring hearing the reply given to you and that it gives you a glimmer of hope aswell. I wish you well and hope it works out well on your GP's visit. 👍

[JulieB5200 in reply to Luisa22]

Your explanation has really helped me understand what’s probably causing my pain! Thank you x

[Gold22]

Totally understand how you feel. I have begun to understand my bowel issues after suffering for many years. I have gallstones and IBS also rectocele which makes opening my bowels difficult. I get pain high up and near my ribs when my bowels are full, it’s the transverse colon pushing up against the diaphragm. I have tried many things, reducing carbs helps and flax. I recently started using Juvia and it had transformed my bowel habit I am now regular and very rarely have pain. If I do like today I know I have eaten too much carbs or Dodds that upset my gallstones. Constipation is a nightmare problem and causes so much discomfort, more than we recognise. Stress is a big factor, I care for my 94yr old mother in law and my husband is about to have prostate surgery, my stomach tightens when I am stressed, don’t want to eat, get lots of acid etc. all the best.

[Skyline4 in reply to Gold22]

Thank you for this. I shall follow up you suggestions. I wish you and also your mother all the very best.

[Ellie-Louise in reply to Gold22]

I would like to send good wishes to your husband. My own husband and also my brother in the last few years have both had prostate surgery.

My husband had his removed robotically and my brothers surgery shortly before and in another part of the country was through the normal surgical procedure.

Both are fine now and their PSI blood tests always come up good.

[JulieB5200 in reply to Gold22]

I’m so pleased I read your response to the above question as what you have explained as really helped me understand what is possibly causing my own pain/discomfort. Thank you x

[xjrs]

Sorry to hear what you are going through.

This is how I deal with IBS-C (constipation) and IBS pain from food intolerances:

What is your fibre intake like? To improve constipation in the short term you can try ground flaxseed on your breakfast, starting at 1 teaspoon and increasing at 1 teaspoon every 2-3 days - you'll need to consume extra water with it.

All foods I mention are down to tolerance e.g. you may not tolerate wheat, so it is best to keep a food diary (I do this on a spreadsheet) recording symptoms for up to 2-3 days after each change.

There are also medications that help IBS-C. I have been prescribed Linaclotide for it, this helps to calm intestinal nerves assisting pain and motility. I don't like taking medication, but I did a lot of research into this and it only acts locally in the gut, increases cGMP in the gut which has a calming effect (which also I think helps guard against cancer in the gut) and degrades into natural peptides then eliminated from the system.

I also take Alflorex probiotic which has made me more tolerant to taking in the extra fibre I need for a BM - this also helped me greatly with the pain, since many people's IBS is due to a gut bacterial imbalance. The Bifdobacterium in it reduces gas causing bacteria, helps to digest complex carbs and helps to control any bad bugs resulting in food intolerances and pain.

In terms of stress reduction, I can highly recommend the Nerva gut directed hypnotherapy app, which is very relaxing. Any type of meditative practice also helps to switch of the pain response.

These foods are also high fibre:

8-9 Prunes

2 tablespoon chia seeds (soaked for 10-15 mins in milk or non dairy milk with cereal or water)

Shredded wheat (or if GF: Nutribrex)

60g Quinoa

Wholewheat bread

75g Whole grain pastas (if GF: Buckwheat)

2 Hard pears

5 Dried apricots

90g Raspberries

1 orange (contain a natural laxative)

2 kiwi.

I find that I need to have 1 orange or 2 kiwi a day and then another high fibre fruit later in the day to help with BMs. Introduce new foods and any fibre increases slowly, starting with one new thing at a time, waiting for 2-3 days for a response and keep a food diary. You may not need to consume as much fibre as I do.

For breakfast I make a porridge of 4 tablespoon of oat bran and 4 tablespoon all bran (wheat bran), 2.5 small cups of water and microwave for 10 mins. I then mix in 2 tablespoon of chia seeds and 1 tablespoon ground flaxseed and leave to stand for 15-20 mins since the chia seeds need to form a gel. On top of that I place 8 prunes and eat. The best thing to do is to start with normal oats in similar quantities and, if needed, replace one of the tablespoons of oats with oat bran for a couple of days, carrying on doing this every couple of days until you get to 4 tablespoon of oat bran and 4 tablespoon of oats. Then start replacing with wheat bran in the same manner. You can then add the other ingredients one at a time. You might find you do not need the complete 'recipe' to have a BM.

I also take 30 drops of ginger extract before bedtime to aid motility. You may need to work up the dose to say 7 drop increments each night.

Exercise can help with BMs. The government recommends 150 mins of moderate exercise (e.g. walking as if you are late for an appointment) or 75 of intense exercise (e.g. jogging) per week. I also have a bit of a walk around straight after breakfast to get things moving.

You need to ensure that you are drinking enough fluids (2 litres of fluid per day).

There is some good advice about constipation here:

theibsnetwork.org/constipat...

theibsnetwork.org/constipat...

Failing dietary measures, you can try Optifibre, which needs to be worked up to a dose according to instructions. You may not need the full dose - watch out for gas and increment to a level that is acceptable for you.

Some people are more prone to constipation due to their intestinal anatomy. Through colonoscopies I have been told that I have a long loopy (redundant) colon. This means that food takes longer to pass through and in the mean time the intestines have more time to suck out water from the stool, drying them out and causing constipation. I have found that I need to consume much more fibre than other people to have regular BMs.

I have also found useful having most of my food at meal times, leaving 4-5 hours of not eating between meals, eating my fruit snack before a meal. This means that your digestive system has time to process each meal. It also allows something called the MMC (migrating motor complex) to run which sweeps food waste from your small intestine into your large intestine. This only happens when you have an empty stomach. When people snack regularly, it prevents the MMC from working properly. I also find the larger meals help to push things along better than drip feeding through snacking.

[Skyline4 in reply to xjrs]

Thank you so much for your detailed reply. I am taking my time to read it properly and note all your information and suggestions. It is enlightening and helpful.

[xjrs]

Here is also some research I did into bloating:

In studies, when healthy individuals are continuously fed gas into the intestines, they normally evacuate all gas without discomfort, passing more easily when a person is standing than laying down. They can tolerate 1.8 litres per hour and distension is related to the amount of gas within the gut. There is a better tolerance to gas when the gut is relaxed and if it is in the large bowel rather than the small bowel. (3)

Daily evacuation of gas in healthy people is around twenty times, depending on diet. Some foods are fermented in the large intestine producing gases, since they are not completely absorbed in the small intestine. This includes some dietary fibres, starches, complex carbohydrates such as beans and sorbitol and fructose sugars. Beans contain a compound that blocks the intestinal enzyme that helps to digest starches in the small intestine meaning more enters the large intestine thus increasing gas production through fermentation. (3)

Many IBS sufferers complain of excessive gas production, but studies have shown that the volume of gas produced by IBS sufferers is normal (1) (3) (7).

However, gas related pain and bloating in IBS sufferers may be connected to impaired transit of gas (3), resulting in gas retention and distension. However, a study using sophisticated measuring techniques didn’t find excessive retention of gas in IBS subjects (3). In contrast, the transit of solids and liquids didn’t experience significant abnormalities (3). IBS patients demonstrate symptoms such as intestinal gas retention, abdominal distension, and/or abdominal symptoms from an intolerance to intestinal gas loads that would normally be well tolerated by healthy subjects (1) (2) (3) (5) (6). Studies that involved the infusion of gas into the intestines of IBS patients showed impaired gas clearance due to abnormal gut reflexes which lead to delayed gas transit and retention (3).

It is often thought that gas is retained in the large intestine. However, a study of those complaining of bloating had the movement of infused gas tracked through different areas of the intestines using radioactive isotope. It was found that the small intestine was responsible for the impaired gas transit. Other studies found that gas infused into the first part of the small intestine, stayed there, since it was not propelled into further parts of the intestine. However when infused into more distant parts of the intestine, it cleared normally. This means that in IBS patients, the total volume of gas is not increased, but it tends to pool in specific areas resulting in a perception of distension and bloating due to IBS patients being hypersensitive (responsive to stimulation) to the presence of excess gas in these areas. Bloating relates to a feeling that can result from fullness after eating, constipation, functional dyspepsia or IBS (8). Whereas, distension relates to the increase in abdominal girth. Often this perception of distension evolves during the day and resolves overnight. Measuring techniques have found that this distension, that is a wider girth, is real and not just perceived. (3)

In healthy subjects, electromyography, which highlights electrical impulses in the muscles, has shown that there is abdominal muscle contraction in reaction to the volume of infused gas in specific areas, that is, the body adapts to the handling of the excess gas. However, in those complaining of bloating, this reflex contraction does not happen which leads to abdominal protrusion, even though there isn’t a true increase in the overall volume of gas. Subsequently, it is the abnormal control of abdominal muscles that causes the bloating and not necessarily gas in itself. (3)

The Rome Foundation explains the mechanics of bloating and distension (8):

Meals stretch the stomach or intestines causing the bloating sensation.

A brain reflex response to the sensation is to move the diaphragm down into the abdomen and relax the abdominal wall muscles.

Due to the increase in pressure, the abdominal cavity pushes out through the abdominal wall leading to distension (abdomino-phrenic dyssynergia).

Bloating and distension are independent. Some experience bloating and no distension and others have distension without a bloating sensation. The Rome Foundation may treat this with rebreathing techniques, central neuromodulators (drugs to reduce hypersensitivity improving brain regulation of the sensation to raise thresholds for bloating and pain), and less commonly biofeedback with esophageal probes. By treating the brain/gut communication bloating sensation may be reduced thus decreasing the possibility of distension occurring as a reflex to the bloating. (8)

10%-30% of healthy individuals experience bloating often, frequently or greater than 25% of the time meaning that bloating is not just limited to IBS sufferers. Some people who have gained weight might complain of bloating perhaps due to a reduction in volume into which abdominal contents can expand due to abdominal fat stores. As mentioned, weakness in abdominal muscles may also play a part. A third of patients complaining of bloating are unable to do one sit up. In addition to abdominal exercises, physical activity generally may help bloaters. (16) Theoretically, if part of the issue is connected with abnormalities in the gut/brain connection, gut directed hypnotherapy apps such as Nerva may help.

Latterly it has been suggested by scientists that gut microbiota hydrogen and carbohydrate metabolism may be altered in patients with IBS, which contributes to gas formation and abdominal pain (19).

[Jackie1612 in reply to xjrs]

Thanks for this xjrs

[JulieB5200]

Hi

I too often suffer with pain under my left ribs.My gp said it was gastritis but my endoscopy showed nothing wrong.So the consultant at the hospital said it was ibs related due to being constipated.Very similar to what you suffering.Also recently as well as pain I have been experiencing an awful sensation like my guts are being pushed up into my chest.However after reading some of your replies I now have some idea as to what might be causing it. I think when we understand what is causing our pain it becomes easier to cope with.x

[Skyline4 in reply to JulieB5200]

I agree Julie and this is why these posts are so helpful. I appreciate all the replies.

[modbury]

Buscopan does help with spasms , I take windeze gel caps for bloating