Julia

by Julia
(Sydney, Australia)

Hi there - sorry for the long post, however this problem has come on over a relatively long period of time.

I am 30-year-old female, competitive long distance runner. I began running at about 16 years old, and in the first four or five years of running, occasionally experienced sharp diaphragm, stitch-like pain (only when in a race).

I used to just put it down to that - a stitch, and would make sure to do lots of abdominal and flank stretching before a race so that it wouldn't come on. Approximately five years ago, I began experiencing the pain more frequently in races, which also started to come on a bit lower down, in the right quadrant (about midway). I used to think this was my ascending colon, as when I pushed against it, the pain would feel very sharp (but I couldn't understand why, as I didn't get any real symptoms when eating or at rest). Over the next couple of years I began getting the pain randomly in slow training runs and still in races. It would feel extremely tender to press in that area for a few days (and I couldn't run in these few days without the pain returning), and then it would seemingly return to normal.

I decided to see a physio, who recommended I have an ultrasound, which came back with normal results (other than a mild fatty liver). The doctor said this probably wasn't the cause of my pain, and along with my physio recommended I have a month of complete rest, which I did, and plenty of stretching. I returned to running, however the pain returned with it. I decided to just keep training and 'live with it', and for the next few years the pain just remained a sporadic occurrence. However, over the last two years the pain has become so chronic that I can't even run more than one to two minutes without it. About 18 months ago it also began coming on more midline, in the area of the stomach/gallbladder/liver area.

I was taking Ibuprofen and Voltarol for about 18 months before every race, so that I could get through it, and then realized it was only masking the pain and the condition was getting worse. It is also important to mention that approximately 18 months ago, I was very tender in the mid-line area, telling my partner how sore it felt, and then I moved funny on the lounge, and the pain seemed to shoot into my upper chest/shoulder-tip area - making it very difficult for me to breathe, lie on that side, laugh, do anything basically. I also seemed to have a fever with it - I took lots of aspirin, which calmed it down for the night.

The doctor said it sounded like pleurisy. Ever since, I have also had pain in the same chest/shoulder-tip area when running. I often get a sore right quadratus lumborum muscle, but not when running - it just feels tender to press.

Over the last two years I have had a CT scan (clear), laparoscopy (clear), abdominal and chest MRI (clear), angiogram to check blood flow from the phrenic artery to the diaphragm (clear), lung function tests (higher than average), and thoracic spine MRI (Scheuermann's changes). I am currently seeing a musculoskeletal specialist and respiratory specialist, who are considering possible nerve referral from the ribcage, or some sort of diaphragm dysfunction (however for me, this does not explain the pain lower down). I am booked in for an endoscopy and colonoscopy in one month's time.


This sharp, cramping pain mainly occurs with activity that has impact (i.e. running, skipping, horse-riding). Swimming, cycling and walking are generally fine and don't bring on the pain, so over the last year I have been doing mainly these activities - only running to see how the pain's going, but so far is just as bad, if not worse.

The pain also seems to be worse when my stomach is empty - I once did a bowel cleanse and had cramping all over the right side the following day when walking around! The upper right quadrant is always tender when pushed deeply, especially into the side of the duodenum/ascending colon areas. I don't suffer from constipation, diarrhea, bloating or sickness after eating, however do have a bit of difficulty swallowing after eating (it feels as though there is a lump in my throat), and need to clear my throat. A GP once told me it could be a bit of acid reflux. I also get quite short of breath at random times, including when lying down. I am wit's end with this pain. I know there is something definitely wrong - firing all this pain away that debilitates me from doing what I love - but as yet, no one can put their finger on it. I feel as though it's something that gets irritated with impact, but the fact that it's now migrated to three different places makes me think - what???

I know runners often struggle with stitch problems, but this is beyond the ridiculous! Any ideas/advice on what the problem could be would be greatly appreciated!

Thank you
Julia

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Hello Julia.

I can "see" that you are terribly distressed by this yet to be diagnosed right to midline pain that has been ongoing since the last decade and a half.

Thanks for your very detailed story.

I strongly think the pain you are describing might be musculoskeletal in origin. It sounds like you most likely have one of these rare hernias called interstitial hernia. That explains the pain that arises with exertion. Interstitial hernias, like epigastric hernias are very rare hernias known to occur in "sport" individuals (though also in the obese). There are often due to sudden strain tearing the interlacing fibres of where muscles join one another or where blood vessels pass through into a muscle.

You might benefit from another detailed and more defining ultrasound scan.

Adjusting your lifestyle mean while might be the only way of coping with this debilitating pain. Could you concentrate on other types of sports that does not bring this pain on, while it is being investigated?

Please accept our profound empathy and be sure our prayers are with you that we come to the bottom of this pain and get through with it so that you can lead your normal life again. That is why this site was put up: To Help Unravel the causes of abdominal pain.

Please keep us posted with developments as you go.

Thanks again for stopping by.

Dr. Edema