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Dr. Chip
Dr. Chip, Board Certified Physician
Category: Medical
Satisfied Customers: 35600
Experience:  20 yrs. in practice, includinge surgery, general medicine, addiction medicine and pain.
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I have abdominal bloating on and off throughout the day. Sometimes

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I have abdominal bloating on and off throughout the day. Sometimes after eating, sometimes just seems to happen. Stools are usually normal but have had inexplicable cases of loose stools or bad gas. Some days I also feel quite unwell and have a general tingling in the lower abdomen. I often have an ache in the perineum area and a slight feeling of wanting to pee more often. I cannot work out of this ache/tingle sensation is in the area of urethra, bladder, prostate, testicles or rectum. I have a stiffness in my lower back that is noticeable when I flex my lower back and which is sometimes more or less pronounced. It feels like tenderness / inflammation which is also apparent on the surface when I push; it is not a persistent 'pain'). I have had the bloating and ache on and off for six months and the lower back stiffness for four months. Over four months of medical involvement I have had colonoscopy and gastroscopy and nothing unusual found including negative for colitis, h pylori and inflammatory bowel. The full spine MRI showed nothing untoward in lower back. All the blood tests I have had show all is normal/healthy. I have never seen blood in my stools or pee (two occasions of very dark stool but not tarry) - except small red streaks if I over-wipe. I am aged 40, white male, good BMI and in otherwise excellent health. Small intestine, bladder and prostate have not yet been scanned although rectal exam of prostate was normal with PSA of 1.1. The main problem I have is engaging the medical profession in tests because they do not seem to see these symptoms as specific enough. But I am concerned that the general nature is confusing the doctors and something long-term or nasty is being left to get worse. My quality of life is diminishing as I feel unwell.

Hi. Have you been tested for celiac disorder and for pancreatic insufficiency? Have you had an autoimmune disorder screening? I assume your thyroid function has been checked?

Customer: replied 3 years ago.

I have been checked for celiac; nagative. i have not had any auto-immune or pancreatic screening unless that is part of a defaul blood test.

OK Rob. What about your thyroid functions and has any change in your diet made any difference with this?
Customer: replied 3 years ago.

Thyroid was tested normal. I have not knowingly changed my diet in any way. I also cannot find any link between what I eat and either how I feel or how my abdomen/urologicalbits/back react

OK--have you had a stool sample for culture, ova and parasites, and fecal stool content?
Customer: replied 3 years ago.

I have had one stool sample apparently tested for mucus for inflammatory bowel which was negative but I don't know about the other things... Any significance in the ache/sensations around bladder/prostate, etc?

Just on last question Rob--have you had a urinalysis and a urine culture?
Customer: replied 3 years ago.

No, neither of those. Early concerns were focused around possible prostatitis (had Cipro) but that made no difference. No focus has yet been placed on my bladder. What's the plan; for you to review all this and feed back an account?

Well, just needed to get as much information as I could Rob, and we can continue after this if you need. Pancreatic insufficiency could be the problem and I'd get a ct scan of your abdomen and lipase and amylase levels to look at that. This could also be what's called intestinal bacterial overgrowth disorder--a bacterial infection in your small intestine--and that takes getting a sample of your jejunal fluid with an endoscope and culturing it. That can be treated successfully with antibiotics. Finally, while I don't think this is irritable bowel syndrome, I might try a course of Levsin or Bentyl. If it's pancreatic insufficiency, you'd need oral pancreatic enzymes.
Customer: replied 3 years ago.

Doctor, I need to leave the computer now but I will return later to ask any remaining question/s and rate your answer. Thank you for the information so far.

No problem Rob--I'll be here when you get back
Customer: replied 3 years ago.



The idea of this service for me was to get a view on what I could legitimately ask my doctor to look into. Your suggestion was that we might consider SIBO and pancreatic insufficiency. You also alluded to screening for culture, ova and parasites and possibly trying Levsin or Bentyl to relieve IBS.


I will ask my doctor to confirm I have been tested for celiac, thyroid function.

Could you please top this advice off by covering:

  1. how you think possible condictions like these with my small bowel could give rise to the stiffness or tenderness in my lower back?

  2. whether your suggestion to look into a pancreatic could equally apply to spleen (I have limited knowledge that dark stools can be related to bile issues)

Thank you, Rob

Hi again Rob. No, I don't think any of these would affect your back.

Dark stools would not be spleen related and I don't think there's anything wrong with your spleen.

Please let me know how it goes and remember to rate my service to you
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Customer: replied 3 years ago.

My doctor said he has tested for amylase and it was normal. while I have not had a culture done for SIBO he implied he had tested for this through another route... He did a urine analysis and all was clear including for micro blood loss. He has put me on a tablet antacid beginning Lans...pole based on some evidence of sub-something inflammation from the duodenum in the gastroscopy. I am going back in a month to review. I still have the feeling of needing to pee more often so continue to be a little concerned about urinary/prostatic involvement.

Did you doctor examine your prostate with his finger?
Customer: replied 3 years ago.

He did DRE in November and it was smooth but he said he thought it felt very slightly 'boggy' and he gave me Cipro for prostatitis (which made no difference). PSA of 1.1. was returned in test.

OK Then it sounds like your prostate is fine