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Forum Name: Gastroenterology Topics

Question: abdominal distention caused by excessive fluids?


 nadia - Mon Jan 17, 2005 4:40 am

I've been diagnosed with IBS-C some 15 yrs ago; symptoms were constipation, gradual abdominal distention and abdominal pain;
A month ago my symptoms worsened, after a 5-day constipation period; especially the abdominal distention isn't gradual anymore (doesn't diminish anymore) and the pain, naturally.
I've been treating the constipation succesfully with Miralax and some MagOx tabs, drink about 3-4 liters of water daily, exercise a lot and eat good fibers (no extra bulking fibers, as they give adversary results).
What bothers me most currently is the distention; it started just before the 5-day constipation, and won't diminish, and this was even before starting the use of osmotics.
As excessive gas doens't seem to bother me much (only in the beginning, not anymore) and you can see the actual distention taking please after just consuming water, I just start wondering if what every doctor just assumes is true: excessive gas causes distention.
I'm just not so sure anymore; however, urine amount has increased: I just have to go every 15 min.
I can't get the idea out off my mind that somehow the small intestine isn't working quite well dealing with intestinal fluids or maybe my low blood pressure has got something to do with ineffective fluids transfer.
Eating doesn't seem to do the greatest damage in my case, some days I just drink a lot and eat less, and the distention just stays the same. You can even see the vains in the lower abdomen down through the pubic zone. This visible distention of the pubic zone (utmost lower part of the abdomen) and the fact that lying down causes the distention to spread over the whole abdomen give me the impression not excessive gas but excessive fluids are the cause.
Is this possible, and if it it, can this be tested somehow? I have a Belgian gastroenterologist, who has only done some general testing (palpitation, rectal exam) and complete blood test (results due today) and can only partially do something about the constipation (and pain) but not the distention.
Can you give me some suggestions for what to ask for next time to exclude gas or fluids?
thank you so much
 Dr. Yasser Mokhtar - Mon Jan 17, 2005 3:23 pm

User avatar Dear Nadia,

The distention that you have is caused by the constipation. i would suggest using other alternatives such as suppositories. Don't let yourself have a constpation beyond 3 days period and then start using other alternatives besides your usual medications.

The frequency of urination could be caused by the fact that you drink a lot of fluids, it is cold and your pelvis is already filled with stools, so there is no place for your bladder to distend with fluids.

It is very important to rule out the presence of intestinal obstruction, but you did not mention any symptoms that would suggest that you have intestinal obstruction. So, i think that this is just constipation.

There is a measure that i usually don't patients to do unless they are examined by their physician first to make sure that there is nothing wrong and that is to have an enema if all other measures don't work.

Fluid in the abdomen causes distention but you have to have a disease that causes the fluid to accumulate in the abdomen. There are many diseases that can cause fluid accumulation in the abdomen including but not limited to liver disease, inflammation or infection of abdominal organs such as pancreas and cancer of any of the abdominal organs.

Fluid in the abdomen can be detected clinically if it is of certain amount. And if the doctor suspects that there is fluid but the amount is less than that could be detected clinically, an ultrasound or a ct scan of the abdomen are very good tests to do.

i am not a gastro-entrologist but i am not aware of any disease of the small intestines that makes the smell intestines not able to handle fluid absorption and make the fluid go into the abdomen causing distention.

Please, call your doctor if the constipation does not resolve within another 2 days period.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.
 nadia - Tue Jan 18, 2005 2:25 am

Dear doctor,

I'm afraid the distention is permanent, not fluctuating, like in the case of constipation. As the constipation is already taken care of by the Miralax, this can't cause the distention.

Yesterday I got the blood results back, and they show malfunction of the kidney. High creatine level indicating that I don't drink enough, yet I drink 3-4 liters of water dayly, and then some.

As you can clearly see swollen veins on the abdomen, neck, and I do have a puffy face and swollen legs (none of my clothes fit anymore) I'm still considering the abdominal fluids.

Thank you for your quick reply, maybe I should have the ultrasound soon.
 Dr. Yasser Mokhtar - Tue Jan 18, 2005 8:16 am

User avatar Dear Nadia,

Thank you very much for the update.

By permanent distention, how long do you mean it has been there? How long have you had the swelling in your legs and puffiness in your eyes? Are they getting worse and at what rate you think?

If your creatinine is high, this does not necessarily mean that you don't drink enough. Is this the first time that you discover that you have a kidney problem?

How high was the creatinine, and if you don't mind, would you please tell me what are the results of the other blood tests that were done.

If you have kidney problems, an ultrasound of the abdomen, would show, not only the fluid in your abdomen if any, but will also show the kidneys, their size, whether there is any abnormality in their shape, whether one is bigger than the other, whether there are any cysts there, whethe any of them is obstructed, etc...It is non-invasive and yields helpful information.

If this kidney problem is new, my advice for you is to see a kidney specialist to take care of the problem right away.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.
 nadia - Wed Jan 19, 2005 7:51 am

Dear doctor,

I'm still waiting for the blood results to come in, any day now.
What I do know is that they show I don't drink enough yet I drink 3-4 liters daily. So that is a indicator of a malfunction. I'm not sure if I mentioned strong activity of antibodies in blood.
I live a healthy lifestyle with daily aerobic exercise, low-fat diet (<= 20grms daily) and there's no genetic high cholesterol in my family, yet my cholesterol level total >240.
These seem to me strong indicators that something is wrong, compared to my lifestyle, diet and build (1mtr67 and only about 50 kgs.).
I also have increased joint and muscle pains and cramps. Faintness, low blood pressure (90/60), diminished coordination, always cold, quick bruising.
By permanent distention I mean that since it started last December the abdominal girth doesn't shrink anymore like in the IBS case, which always gives an "overstretched" sensation, difficulty breathing in deeply. It's like someone very heavy is constantly sitting on my upper body.
Around the same time I experienced significantly more hair loss and nails splitting in several layers up to halfway nail bed.
So I'm experiencing an array of vague symptoms which I didn't have before december 2004 and which has strongly diminished my quality of life up to the point that I had to stop working and quit my social life, waiting for the right diagnosis and to be able to pick up my life again.
 Dr. Yasser Mokhtar - Wed Jan 19, 2005 10:31 am

User avatar Dear Nadia,

Thank you very much for the update.

i don't think that there is a blood test that can tell whether or not you drink enough.

If you have a kidney problem, it can account for most of your symptoms. The question is now what is causing the kidney problem.

There is another disease that might fit most of your symptoms and that is hypo-activity of the adrenal gland.

i have to know the actual blood tests' results to be able to think what could be the differential diagnosis.

Please, be advised that blood tests never make a diagnosis, it is the history of the patient (the symptoms that the patient is complaining from) and the examination that point to a certain disease(s) and then blood tests and x-rays of various types are used as helpers to the diagnosis.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.

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