Differential Diagnosis for Stomach Pain and Urge to Pass Stool

The patient's symptoms of stomach pain exactly below the umbilicus, accompanied by an urge to pass stool, which relieves the pain temporarily, suggest a gastrointestinal issue. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Irritable Bowel Syndrome (IBS): This condition is characterized by abdominal pain associated with a change in bowel habits, such as diarrhea or constipation, without any visible signs of damage or disease in the digestive tract. The pain's location below the umbilicus and its relief after passing stool are classic symptoms of IBS.

• Other Likely Diagnoses

  • Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause abdominal pain, changes in bowel habits, and urgency. While they are more severe and might include additional symptoms like weight loss, fever, or blood in the stool, they should be considered.
  • Gastroenteritis: Infections of the stomach and intestines can cause abdominal pain, diarrhea, and a feeling of urgency. The pain might be more diffuse but can be localized.
  • Diverticulitis: Inflammation of the diverticula in the wall of the colon can cause pain, usually in the lower left abdomen, but can sometimes be more central. It might be accompanied by changes in bowel habits.

• Do Not Miss Diagnoses

  • Appendicitis: Although the pain of appendicitis typically starts near the navel and then moves to the lower right abdomen, atypical presentations can occur, especially in children or the elderly. Missing appendicitis can lead to severe consequences, including perforation and peritonitis.
  • Intestinal Obstruction: This is a blockage that prevents the normal flow of the products of digestion, including food, fluid, and gas. It can cause severe abdominal pain, vomiting, and constipation or obstipation (inability to pass gas or stool). The pain can be diffuse or localized.
  • Mesenteric Ischemia: A condition where there's insufficient blood flow to the intestine, which can cause severe abdominal pain out of proportion to the physical examination, and can be accompanied by diarrhea or bloody stools.

• Rare Diagnoses

  • Meckel's Diverticulum: A congenital anomaly of the small intestine that can cause abdominal pain, gastrointestinal bleeding, or intestinal obstruction.
  • Intussusception: A condition where a part of the intestine slides into an adjacent part, potentially causing bowel obstruction or ischemia. It's more common in children but can occur in adults.
  • Colonic Cancer: Although less likely in the absence of other symptoms like weight loss, anemia, or a family history, it should be considered, especially in older adults, as it can cause changes in bowel habits and abdominal pain.

Each of these diagnoses requires careful consideration of the patient's full clinical picture, including history, physical examination, and potentially, diagnostic tests to determine the underlying cause of their symptoms.