Lower Abdominal Pain and Frequent Urination in Women

Lower abdominal pain and frequent urination?

Dear Dr.
Cheng,
Hello.
Since I had a cesarean section four years ago, I have occasionally experienced dull pain in my lower abdomen after sexual intercourse, accompanied by frequent urination, but it usually resolves after a few days.
Recently, however, I have not engaged in sexual activity, yet I still experience dull pain and tenderness in my lower abdomen, along with lower back pain and increased frequency of urination.
When standing for extended periods, the sensation of heaviness and pain in my lower abdomen increases, which affects both my sexual activity and daily life.

Regarding vaginal discharge, I have not noticed any abnormalities, and there is no pain during urination.
I have consulted related literature and have ruled out pelvic inflammatory disease (PID) or uterine ligament laxity, but I am unsure how to proceed with treatment.

I would like to seek your advice on this matter.
Thank you very much!
Sincerely,
Grace

grace, 30~39 year old female. Ask Date: 2002/10/08

Dr. Li Guanghan reply Obstetrics and Gynecology

I suggest that you first undergo an examination of the urinary system, such as tests for cystitis or urodynamics.
Some women who have given birth may experience pelvic relaxation issues.
If these problems are ruled out, you can directly consult the obstetrician-gynecologist who performed your surgery to inquire whether there was endometriosis or other related conditions during the procedure.

Reply Date: 2002/10/08

More Info

Understanding lower abdominal pain and frequent urination in women can be complex, particularly when considering a history of cesarean delivery and the various physiological changes that can occur post-pregnancy. Based on the symptoms you've described—lower abdominal discomfort after sexual activity, persistent pain without sexual activity, frequent urination, and associated back pain—there are several potential causes to consider.

Firstly, the pain you experience after sexual activity could be related to several factors, including pelvic floor dysfunction, which can occur after childbirth. The pelvic floor muscles may become weakened or overly tense, leading to discomfort during and after intercourse. Additionally, conditions such as pelvic inflammatory disease (PID) or endometriosis could also contribute to pain during sexual activity and general pelvic discomfort. However, since you mentioned that you have not observed any abnormal vaginal discharge or pain during urination, PID may be less likely, but it should still be evaluated by a healthcare professional.

The persistent lower abdominal pain and frequent urination you are experiencing could also be indicative of a urinary tract infection (UTI) or interstitial cystitis, a chronic condition that causes bladder pressure and pain. Although you do not report pain during urination, it is still important to rule out any underlying urinary issues, especially since frequent urination is a significant symptom.

Another possibility is that your symptoms may be related to the anatomical changes that can occur after a cesarean section. Scar tissue formation (adhesions) can lead to discomfort and may affect surrounding organs, including the bladder and uterus. This can result in sensations of pressure or pain, particularly when standing for prolonged periods.

The sensation of heaviness or a "downward" feeling in the lower abdomen could also suggest pelvic organ prolapse, which can occur after childbirth. This condition involves the descent of pelvic organs (such as the bladder or uterus) into the vaginal canal, leading to discomfort and urinary symptoms.
Given the complexity of your symptoms, it is crucial to seek a thorough evaluation from a healthcare provider, preferably a gynecologist or a urologist. They may recommend a pelvic examination, ultrasound, or other imaging studies to assess the pelvic organs and identify any abnormalities.
In terms of treatment, it will depend on the underlying cause of your symptoms. If pelvic floor dysfunction is diagnosed, pelvic floor physical therapy may be beneficial. For urinary issues, medications or lifestyle changes may be recommended. If there is a concern for endometriosis or other gynecological conditions, further treatment options may include hormonal therapies or surgical interventions.

In conclusion, while your symptoms can be distressing and impact your daily life and sexual health, a comprehensive evaluation by a medical professional is essential to determine the exact cause and appropriate treatment. Do not hesitate to reach out to your healthcare provider to discuss your symptoms in detail and explore the best options for management. Thank you for sharing your concerns, and I hope you find relief soon.

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