Persistent Lower Abdominal Pain: A Month of Discomfort After Surgery

Unexplained lower abdominal pain for over a month?

Hello, I underwent laparoscopic surgery to remove a chocolate cyst in April last year and received Lupron injections, which stopped my menstruation for six months.
My menstrual cycle resumed in December last year, and it has been approximately 31 to 33 days, similar to before the surgery.
My husband and I started trying to conceive in early February.
After completing the recommended timing for intercourse four times, one day, while riding a motorcycle on a very bumpy mountain road, I experienced abdominal discomfort after being jolted in the back seat.
Since that day, it has been over a month, and I have been experiencing persistent soreness, cramping, or sharp pain in my lower abdomen, with pain alternating between the left lower abdomen, right lower abdomen, and sharp pain in the center of the lower abdomen, occurring at different times.
In February, I consulted several obstetricians and gynecologists who all said everything was normal.
However, on February 19, I experienced noticeable pain in my right abdomen accompanied by bleeding for one day.
An ultrasound at that time revealed a cyst, but by my next appointment, the cyst had disappeared.
At the end of February, another hospital discovered a 4 cm adenomyoma, but two days later, examinations at Taipei Veterans General Hospital and other clinics indicated that my ovaries and uterus were normal.
By this time, my menstruation had been delayed for nearly a week, and I was not pregnant.
In March, we tried again, but there has been no news.
On the evening of March 20, I experienced severe pain in my right lower abdomen, which was the most intense pain I had felt since that day on the mountain road over a month ago.
I went to the emergency room for pain relief and underwent a CT scan of the abdomen.
The doctor concluded that the issue was still gynecological in nature.
Currently, I feel a lot of bloating in my lower abdomen, and I continue to experience intermittent pain in the left, middle, and right lower abdomen...
This symptom has persisted for over a month.

Liu Xiaojie, 20~29 year old female. Ask Date: 2016/03/22

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, it could possibly be a gastrointestinal issue or something else.
If you are still experiencing discomfort, it is advisable to consider seeing a surgeon or a gastroenterologist.
Wishing you good health.

Reply Date: 2016/03/22

More Info

Experiencing persistent lower abdominal pain after surgery can be concerning, especially when the discomfort lasts for more than a month. In your case, it appears that you have undergone laparoscopic surgery for a chocolate cyst and have been trying to conceive since then. The pain you describe, which varies in location and intensity, could be attributed to several factors related to your surgical history and current activities.

Firstly, it is important to recognize that post-operative pain can be a normal part of the healing process. After laparoscopic surgery, the body undergoes a significant amount of healing, and it is not uncommon for patients to experience discomfort for weeks or even months following the procedure. This discomfort can stem from the surgical site itself, as well as from surrounding tissues that may be inflamed or irritated. The fact that you have experienced pain in different areas of your lower abdomen suggests that there may be multiple factors at play.

One possibility is that the pain could be related to adhesions, which are bands of scar tissue that can form after surgery. Adhesions can cause organs to stick together or to the abdominal wall, leading to pain and discomfort, especially during movements or activities that put strain on the abdominal area. Given that you mentioned experiencing discomfort after riding on a bumpy road, it is plausible that the jarring motion could have exacerbated any underlying adhesions or irritation in the abdominal cavity.

Additionally, the presence of a uterine adenomyosis (the 4 cm adenomyoma you mentioned) could also contribute to your symptoms. Adenomyosis can cause significant pelvic pain, particularly during menstruation, and can lead to chronic discomfort. The fact that you have had varying pain patterns could indicate that your menstrual cycle and hormonal changes are influencing your symptoms.

It is also worth considering the psychological aspect of pain. The stress and anxiety associated with trying to conceive, coupled with the physical discomfort, can create a cycle of heightened sensitivity to pain. This phenomenon, known as central sensitization, can make existing pain feel more intense and persistent.

Given that you have consulted multiple gynecologists and undergone various imaging studies, it is essential to continue working closely with your healthcare providers. If the pain persists or worsens, further evaluation may be warranted. This could include additional imaging studies, such as an MRI, to assess for any underlying issues that may not have been visible on previous ultrasounds or CT scans.

In the meantime, there are several strategies you can employ to manage your pain. Gentle exercises, such as walking or pelvic floor exercises, can help improve circulation and reduce stiffness. Additionally, heat therapy, such as using a heating pad on your abdomen, may provide temporary relief. Over-the-counter pain medications, such as ibuprofen or acetaminophen, can also be helpful, but be sure to consult with your doctor before taking any new medications.

Lastly, consider discussing your symptoms with a pain management specialist or a physical therapist who specializes in pelvic pain. They can provide tailored strategies to help alleviate your discomfort and improve your quality of life.

In conclusion, while persistent lower abdominal pain after surgery can be concerning, it is often a multifactorial issue that may involve surgical recovery, adhesions, hormonal changes, and psychological factors. Continued communication with your healthcare team is crucial to ensure that you receive appropriate care and support as you navigate this challenging time.

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