New PD pain, not related to draining

Hi there.

I am 39 and have been on PD for about 3 months. On the whole it has vastly improved how I feel and other than drainage pain at when I first started and some difficulty with the catheter getting lodged where it wouldn’t drain it’s been pretty tolerable. However, in the last month I have been having significant liver area pain, and bloating. When I’m empty, I look like I’ve swallowed a watermelon. The only time this has been alleviated is the week when I had my period, and a few days after. Painkillers aren’t helping and it’s making taking a deep breath or standing up straight near impossible. Lying flat on my back makes the pain recede to some degree. I have had an ultrasound but it shows nothing abnormal. Can low protein or any other PD related thing cause pain like this? Its sharp and burning and constant and it’s ticking me off.


Dear Karen,
I am very concerned about your abdominal pain. PD is not supposed to be painful. When it is, there are remedies. For example, when you had drainage pain, the remedy is usually to change the cycler to another program called tidal dialysis which leaves a small amount of fluid in the abdomen and does not require a full drainage. Or if you are on CAPD the tubing is clamped when the pain begins, again to allow a small amount of fluid to cushion the abdomen from pain experienced at the end of the drain. Your description of pain around you liver area makes me wonder if you are somehow getting air into the tubing. Air in the abdomen would rise to top of the abdomen when standing (and be right under the diaphragm which is about the location of your liver). Lying down might allow the air to be freely distributed throughout the abdomen and thus be the reason you have no pain in that position. An xray would demonstrat the air but I do not think an ultrasound would show it. The reason air might get into the tubing is that the tubing is not properly flushedwith fluid prior to an exchange. So with CAPD, that would mean not allowing the “flush before fill” part of the procedure, and with the cycler, perhaps some malfunction of the machine which is designed to automatically flush before fill. Remember that the sterile tubing is all filled with air before fluid is introduced into the tubing. I would like to know if your drain volumes have been low or normal since the pain began, and if your weight has gone up or stayed the same, and if you think you could have been introducing air into the system as I have described. Hope this helps and that you will write back.