Is a painful tum a sign that I have gallstones?
UNTIL recently I worked as flight crew for a major airline. During one stop-over in the Far East, I paid to have a full medical check-up. An ultrasound showed I had a 23mm gallstone. I had no symptoms and medical opinion was split on whether to remove my gallbladder or leave it, so I decided to leave it be.
Seven years later, I sometimes get a severe stabbing pain in my left lower abdomen. The pain comes in sharp short throbs, lasting one to ten seconds, and feels like I’m being jabbed with a needle. I am 63.
Robert Bailey, by email.
GALLSTONES are common and affect about one in ten adults. In most cases they cause no symptoms, although studies have shown that about 15 per cent of people whose stones are found ‘accidentally’, as in your case, will go on to develop symptoms at some stage in the next ten years.
The most common symptom is pain, known as biliary colic, which occurs when the stone blocks the bile duct.
The pain is typically felt in the right upper abdomen, although it can be felt more centrally, behind the sternum (breastbone), and may even be mistaken for heart pain. The pain can also radiate in to the back, or right shoulder blade region.
It is usually severe and can last from several minutes to several hours, but remains constant. So the pain that you describe in your left lower abdomen, which occurs in short throbs, is not typical of gallstone pain, either in distribution or character — but I will say more on this later.
As for not having the surgery seven years ago, I believe you made the right decision. It is not normal practice to remove the gallbladder for the sake of symptomless gallstones.
HOWEVER, when the stones do cause symptoms, we do have to remove the gallbladder; the presence of stones is a sign of gallbladder disease and more stones will inevitably form in future, with the risk of other complications, such as infection, so just removing the stones is not an option.
Your symptoms, while unlikely to be due to the gallstone, do merit further investigation.
I wonder whether your problems are linked to a stone that’s migrated from your left kidney to the ureter, the tube that connects the kidney to the bladder.
Stones that originate in the kidney are known as kidney stones, though doctors tend to use the term ‘urinary stones’, as they can become stuck anywhere between the kidney, the bladder or even the urethra on the way out. Urinary stones can cause intermittent pain with few other symptoms.
Another possibility is that your pain is actually intestinal pain originating in the descending or sigmoid colon, both part of the large intestine.
The matter should be looked at further and I would recommend that you discuss this issue with your GP. IN THE past two years, I’ve had bouts of bleeding from the bowel.
My GP was vague about the problem and what caused it; my local pharmacist said it was unusual to get the problem for the first time at my age, 74. I recently read that unabsorbed iron in the gut may cause bowel disease.
For several years now I’ve been eating a great deal of watercress — often four to six bunches a week — for its vitamins and nutrients, one of which is iron. Have I been overdosing on it?
B. Darlow, Kempston, Beds. There are two aspects to your letter: most importantly what should be done about rectal bleeding — and, second, whether eating watercress almost every day can do harm.
In my opinion, rectal bleeding must be investigated.
It is not good enough, particularly in an older patient, to assume that it is due to an unimportant problem such as haemorrhoids (piles) — these are common and, if they cause no symptoms apart from occasional slight blood loss, can be ignored. But an exact diagnosis is needed.
rectal bleeding can be caused by diverticular disease (where small bulges or pockets form in the lining of the intestine), inflammatory bowel disease ( this includes Crohn’s disease and ulcerative colitis and it is certainly true that it’s unusual for either to occur for the first time in someone of your age) and colon cancer.
Your bouts of bleeding should be investigated by an inspection of the colon — the gold standard is a colonoscopy, during which a doctor examines the inner lining of your large intestine using a thin, flexible tube with a tiny camera attached.
The recent article you mention suggested unabsorbed iron in the intestine was linked to inflammation and changes in gut bacteria, which could increase the risk of bowel disease: the article suggested seaweed pills might prevent this by binding to excess iron in the gut.
This is still an area of ongoing research, and it could even be that the watercress you’ve been eating might have the same protective effect as seaweed, rather than the negative effect you fear.
however, studies into any potentially protective effect of watercress have not been conducted.
What I can tell you is that the nutritional constituents of watercress have been evaluated in great detail.
ACCORDING to McCance and Widdowson’s Composition of Foods — the authoritative record of nutrient data for the most commonly consumed foods in the UK — 100g of raw watercress contains 2520mcg of carotene (vitamin A), several milligrams of vitamin e and the B group of vitamins, and 62mg of vitamin C.
In terms of minerals, there is sodium, potassium, calcium, phosphorus, copper, zinc, chloride, manganese — and iron (2.2mg only). All these are very good nutritionally, and none is found in excess in watercress.
I would add that what is important is you are taking care to eat foods that are fresh and unadulterated with additives that are a feature of so many manufactured foods. This attitude is ideal for promoting good health.
do discuss the rectal bleeding once again with your doctor, to consider the possible causes, and have no fear about the watercress, even on a daily basis.