Right Lower Abdominal Pain: When to Consult a Specialist

Right lower abdominal discomfort and pain?

Hello Doctor: Since the end of my menstrual period in May, I have been experiencing a dull pain in my lower right abdomen near the pelvic area.
Sometimes the pain is more pronounced.
My menstrual cycle is 21 days, and I consistently feel significant abdominal discomfort and bloating during ovulation.
The amount of menstrual bleeding has been irregular; typically, my period lasts about 7-8 days before completely stopping, but this time it lasted only five days before there was no discharge, accompanied by a dull bloating pain that radiated downward.
At times, I also feel nauseous with a lack of appetite and lower back pain.
I previously consulted a gynecologist who performed an ultrasound and blood tests.
Initially, the doctor suspected a gastrointestinal issue, but there was a clear point of tenderness in the right pelvic area, which the doctor indicated was related to the ovary, showing some enlargement.
There was also a small fibroid on the left side of the uterus, but it was not concerning.
The doctor suggested that this might be due to early ovulation and that my next menstrual period would likely arrive two weeks early.
I was advised to use heat therapy for relief, but my next period did not come early, and the heat therapy did not provide significant improvement.
The intensity of the dull pain has varied, and the blood test results indicated no issues, recommending annual follow-up.
If the pain persists, gastrointestinal problems should be considered.
Due to discomfort in my upper left abdomen, I underwent an upper gastrointestinal endoscopy, ultrasound, and blood tests last August, which revealed a gastric ulcer.
I had a colonoscopy in November and an abdominal CT scan in January, and the gastroenterologist found no abnormalities, suggesting I see a gynecologist.
I followed up with the gastroenterologist at the end of June and informed them about my lower right abdominal condition.
The doctor mentioned it could also be an appendiceal issue and advised me to monitor it.
However, I currently do not have significant gastrointestinal pain or noticeable changes in bowel habits.
Should I inform the gastroenterologist about my discomfort during my next visit, or should I return to the gynecologist? Thank you for your assistance.

Sung, 30~39 year old female. Ask Date: 2016/09/10

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, pain in the lower right abdomen could potentially be related to issues in obstetrics and gynecology, gastroenterology, surgery, or urology.
It is recommended to first consult with an obstetrician-gynecologist.
If no issues are found, you can gradually check with each specialty.
Wishing you good health.

Reply Date: 2016/09/10

More Info

When dealing with right lower abdominal pain, especially in the context of your menstrual cycle and previous medical evaluations, it is essential to consider a multifaceted approach to diagnosis and treatment. Your symptoms, including the dull pain in the pelvic area, irregular menstrual bleeding, and the presence of a small fibroid, suggest that there may be gynecological factors at play. However, the possibility of gastrointestinal issues cannot be overlooked, especially given the history of gastrointestinal evaluations that have returned normal results.

From your description, it seems that the pain has been persistent since your last menstrual period, with notable discomfort during ovulation. This could indicate a condition known as mittelschmerz, which is ovulation pain that some women experience. However, the fact that you have also been experiencing a sense of bloating and discomfort that radiates downwards, along with the irregularities in your menstrual cycle, warrants further investigation.

Given that you have already consulted with both gynecologists and gastroenterologists, it might be beneficial to take the following steps:
1. Follow-Up with Gynecology: Since the ultrasound indicated some enlargement of the ovary and the presence of a fibroid, it would be prudent to revisit your gynecologist. They may want to conduct further imaging, such as a pelvic MRI, to get a clearer picture of the ovaries and surrounding structures. Additionally, they can evaluate if the fibroid is contributing to your symptoms, as fibroids can sometimes cause pain, especially if they are located in a position that puts pressure on surrounding organs.

2. Consult a Gastroenterologist Again: If your gynecological evaluations do not yield a definitive diagnosis, it may be worthwhile to return to the gastroenterologist. While you mentioned that there are no significant gastrointestinal symptoms, the possibility of conditions like appendicitis or even irritable bowel syndrome (IBS) should be considered. Sometimes, gastrointestinal issues can manifest as referred pain in the lower abdomen.

3. Consider a Multidisciplinary Approach: Given the complexity of your symptoms, a multidisciplinary approach may be beneficial. This could involve both a gynecologist and a gastroenterologist working together to determine if there is an overlap in symptoms that could be causing your discomfort.

4. Symptom Tracking: Keep a detailed diary of your symptoms, including the timing of your menstrual cycle, the nature of the pain (sharp, dull, constant, intermittent), and any other accompanying symptoms (nausea, changes in bowel habits, etc.). This information can be invaluable for your healthcare providers in making a diagnosis.

5. Pain Management: While you are seeking a definitive diagnosis, managing your pain is also crucial. Over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen can help alleviate pain and reduce inflammation. However, consult with your healthcare provider before starting any new medication, especially if you have a history of gastrointestinal issues.

In conclusion, your right lower abdominal pain could stem from a combination of gynecological and gastrointestinal factors. Given the complexity of your symptoms and the previous evaluations, it is advisable to continue seeking answers through both gynecological and gastrointestinal consultations. Keeping an open line of communication with your healthcare providers and advocating for further testing when necessary will be key in finding relief and understanding the underlying causes of your discomfort.

Similar Q&A

Understanding Right Lower Abdominal Pain: When to See a Gastroenterologist

Hello, Dr. Chen... I have been experiencing sharp pain in my lower right abdomen for about 1-2 months. The pain usually occurs after 2 PM and is accompanied by a feeling of urgency and heaviness, but there is no bowel movement. Earlier this year, I had severe pain in my lower rig...

Dr. Chen Qifeng reply Gastroenterology and Hepatology
It is recommended to first consult a gastroenterologist.

Understanding Abdominal Pain: Which Specialist to Consult?

Hello Doctor: I have recently noticed pain in the upper right quadrant of my abdomen for the past two weeks. I haven't engaged in any intense physical activity lately, and the pain doesn't feel like a strain. I'm unsure which specialty I should consult. Could you p...

Dr. Xie Rongyuan reply Internal Medicine
If you experience persistent pain in the upper right abdomen, you should visit an internal medicine clinic for evaluation and treatment. It is advisable to arrange for an abdominal ultrasound to check for any issues with the liver or gallbladder.

Persistent Right Lower Abdomen Discomfort: Which Specialist to Consult?

I have been experiencing dull abdominal pain for the past two weeks. The pain is intermittent and of moderate intensity, located near the right pelvic area. When lying flat, I notice a pulsating sensation to the right of my navel. However, a gynecological examination showed norma...

Dr. Chen Qifeng reply Gastroenterology and Hepatology
Hello, seeing a gastroenterologist is indeed appropriate. If there is no fever, it is likely due to gastrointestinal dysfunction or indigestion. In addition to medication, it is recommended to choose a mild diet that is low in oil, dairy, irritants, and meat. Sincerely, Dr. Chi-F...

Understanding Right Lower Abdominal Pain: When to Consult a Gynecologist

Hello, Doctor: I have been experiencing irregular menstrual cycles for about 2 to 3 years now, sometimes my period only comes every two months. However, I have not reached menopause yet; it just varies in timing. Since mid-October this year, I have felt a dull ache in my lower ri...

Dr. Cao Guotao reply Obstetrics and Gynecology
Hello, I have pain in the lower right abdomen. The gynecological ultrasound did not reveal any significant findings or tumors, and I have also seen a gastroenterologist, who found no major issues. The general treatment approach would primarily involve conservative supportive ther...