Severe pain in right upper abdomen spreading through to the back for last month

by Sarah
(London)

For the last 4 weeks I have been woken up at between 5am and 5.30 am every day with a severe pain. This is located just below my right ribs and goes through to my back. The pain lasts about 1 to 2 hours and then goes. It is not relieved by going to the loo.

I do not eat late at night. It is slightly relieved by curling into a ball. For the last 2 nights I have set my alarm clock for 4.30am and have sat up in bed to see if this had an effect. I can feel the pain staring but it somehow does not take hold in the same way.

It's almost as though something in my body 'gets going' at this time of day and is coming across a blockage of some sort.

I went to the doctors a week ago and a very young doctor said he had no idea! I have had a fasting blood test and will get the results in a week.

In 1992 I had 3 operations for an anal fistula and I now have a rectocele. I have high blood pressure and take 10mg ramipril daily.I would be interested to see if you had any thoughts on this problem as it is getting me down!I am a 53 year old woman.


..................................................

Dear Sarah,

Thank you for using our free online consultation service. I can only imagine the frustration that comes with not knowing the cause of this severe pain in your right upper abdomen spreading through to your back for last month.

The pain you have described here, Sarah, sounds very much like that arising from gallbladder stones popularly referred to as gallstones pain or biliary colic.

Biliary colic is a pain that comes on from contraction of the gallbladder in a bid to expel stone or a sludge that may be obstructing the lumen of the gall bladder. The gall bladder is a small pear-shaped sac that lies just under the surface of the right half of the liver. It is where bile is stored. If the bile, for some reasons becomes too concentrated, it forms little crystals which in time coalesce together to form stones.

When the stone causes a blockade, the gallbladder intermittently tries to contract to expel it. This brings about severe upper right sided abdominal pain, just under the right breast. The pain comes in waves - it is continuous in most cases, but with periods of severe exacerbation.
The pain may spread through the right side of the lower chest towards the back, under the tip of the right shoulder blade bone.

The pain could be so severe that the sufferer may pacing about or coiling, looking for a position of comfort. There could be associated feeling of nausea and in some cases vomiting.

After lasting a few minutes to hours (in some cases, the pain could last up to 72 hours!), the pain often resolves by itself, only to come on again.

Does that sound like you?

Gallstones are found in over 1 in four persons. Women, especially after the age of forty are more prone to this condition.

The good news, is that this condition can be treated once a diagnosis is confirmed.

You will need an abdominal ultrasound scan. In North America, HIDA scan is also done to give more details than what an ultrasound scan does.

Once the diagnosis is made, provided there is no ongoing infection (you will know if you have infection because you may develop fever, and could be jaundiced - yellow discoloration of the white of the eye), an option would be to removed the gallbladder with the stone.

Another option, if the pain is not too disabling and if you are not keen on having a surgical operation to remove the gallbladder immediately, is to try "dissolving" the stone with a strict gallstone diet combined with the use of a drug called ursodeoxycholic acid. Shockwave lithotripsy is another option. These are rarely used though.

Acupuncture has been scientifically shown to reduce gallstone concentration in the gallbladder and it is a common method of gallstone treatment in China.

There is no doubt that from a professional perspective, surgery to remove the gallbladder (called cholecystectomy - which is now more often done as a keyhole surgery or laparoscopic surgery) is still the best and most reliable way of dealing with troublesome gallstones. It is not without its risks though.

Hmm. A lot of information there.

If you having pain before your result comes or before having your ultrasound scan, it would be a good idea to try some pain killers and if the pain persists, to go into your local hospital's Emergency Department. You may be able to get scanned the same day, to confirm the diagnosis, depending on the severity of your condition.

I hope this helps.

Please read more here about gallbladder stones , should you have more query or indeed feel free to contact us should you have any specific questions or concerns and we would be more than happy to help.

Wishing you a quick resolution of this annoying pain.

Good Health To You.

Dr Omatseye Edema MD MRCGP CCFP MSc DRCOG
Family Physician, Emergency Medicine Practitioner and WebMD
Abdopain.com.

Get regular top medical information on a wide range relevant of health issues. Subscribe to our Newsletter here.