How to manage severe stomach pain in a 17-year-old boy?

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The most common cause of abdominal pain is functional and it is related to multiple problems such as constipation and regurgitation of food. As organic causes are ruled out, it is necessary to rule out functional causes. I think that your son seems to have chronic constipation and it can cause pain. Sometimes, it seems to be unnoticed. But it manifests with some features such as prolonged sitting on the toilet or excessive straining or missing of defecation. I suggest taking laxatives helps a lot in cases of severe constipation. Kindly attach the reports of X-rays.

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Your attached reports are not clear. Please send a new one.

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Your son can start taking treatment for constipation. It takes some days to get resolved. Take a high-fiber diet. Take plenty of water. Take one packet of Peglec (potassium chloride, sodium bicarbonate, polyethylene glycol, sodium chloride, and sodium sulfate) and dissolve it in two liters of water. Finish them in four hours. Repeat it again if your son does not have stools. He can take Laxopeg (Polyethylene glycol) two sachets at night time once a day. Your son can continue taking it for few months. Regular follow-up is necessary to titrate its dosage. You can decrease its dosage if you have loose stools. Do regular exercise. Revert back after a week.

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Stop taking laxatives. Please mention in detail about the appearance of the stool. If he has severe pain, he can consult a doctor soon. He can be given with Diclofenac injection 75 mg IM (intramuscular).

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IBS (irritable bowel syndrome) can be managed by symptomatic treatment with the removal of stress factors and dietary management. Colonoscopy should be done in full length. If he has constipation, you can give him laxatives. Do bowel training twice a day. Do not take much analgesics. This kind of bowel disturbance occurs as a spectrum of IBS. Have a review soon and maintain pain dairy regularly.

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If there is excessive bloating, then it indicates that he has bacterial overgrowth. Rifaximin can be taken and it suppresses the growth.

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If the breath test shows a negative result, then there is no need to take Rifaximin. It does not cause any side effects as they do not get absorbed. So you can try to take it. Monitor his stool consistency. Avoid straining while defecating or prolonged sitting on the toilet. Give him curd rather than milk. Avoid giving fast foods and give him a high-fiber diet. Manage his stress.