Chronic Abdominal Pain and Urinary Issues: A Patient's Journey

Urinary issues and neuropathic pain?

Hello Doctor: I have been troubled by a symptom for many years, which I will describe as follows: 1.
Onset: The first time I felt pain was around the second grade of elementary school.
I am currently 28 years old and experience this pain almost 1 to 2 times a year.
2.
Duration of pain: Approximately half a day.
3.
Nature of pain: I initially feel tightness in my abdomen, and pressing down feels like a muscle tear.
During urination, as urine is expelled, the tightness in my abdomen increases to the point where I cannot straighten my body.
If I try to straighten up, I feel a sharp pain just below my navel, as if being stabbed with a needle.
4.
Other: Lying flat and resting for about 4 to 5 hours gradually alleviates the pain, and there is no blood in my urine.
5.
Self-observation of accompanying conditions during pain episodes: (1) A few days before menstruation (2) A few hours after drinking red wine (3) When overly excited or anticipating something, such as a middle school graduation trip (4) Pain without any apparent cause.
6.
Opinions from doctors I have consulted: (1) General practitioner: muscle tightness from prolonged sitting (2) Gynecologist in college: after an abdominal ultrasound, the doctor said my uterus is normal but mentioned it could be related to the corpus luteum.
(3) Gynecologist I saw two years ago: after an abdominal CT scan, no abnormalities were found.
This is a general description of my condition.
Although this pain is not life-threatening, the uncertainty of when it will occur has been a constant source of anxiety for me.
As I grow older, I become more fearful because when the pain strikes, I am unable to walk, cannot exert pressure on my abdomen, and hesitate to urinate.
It feels like I am on the verge of a mental breakdown.
I am unsure whether I should see a urologist or a neurologist, and I would appreciate your advice.
Thank you.

Ms. Li, 20~29 year old female. Ask Date: 2016/10/01

Dr. Sun Hongshun reply Urology

Hello, I’m sorry to hear that this symptom has been troubling you for so long.
I wonder if you are easily anxious or if you are feeling overwhelmed due to discomfort.
Since your previous outpatient visits were many years ago, I recommend that you first see a urologist and a gynecologist for further evaluation.
Wishing you good health.

Reply Date: 2016/10/01

More Info

Chronic abdominal pain and urinary issues can significantly impact a patient's quality of life, especially when symptoms have persisted for many years. Based on the detailed description provided, it appears that the patient has been experiencing recurrent abdominal pain since childhood, with episodes occurring 1 to 2 times a year. The pain is characterized by a feeling of tightness in the abdomen, which intensifies during urination, and is accompanied by a sharp, stabbing sensation when attempting to straighten the body. The patient has also noted that these episodes often coincide with specific triggers, such as premenstrual syndrome, alcohol consumption, and emotional excitement.

Given the complexity of the symptoms and the history of consultations with various specialists, it is essential to approach this situation systematically. Here are some considerations and recommendations based on the information provided:
1. Differential Diagnosis: The symptoms described could stem from several potential causes, including:
- Gynecological Issues: Conditions such as ovarian cysts, endometriosis, or issues related to the menstrual cycle could lead to abdominal pain that correlates with the menstrual cycle. The fact that the pain often occurs a few days before menstruation suggests a possible hormonal influence.

- Urinary Tract Issues: The pain during urination and the tightness in the abdomen could indicate a urinary tract infection (UTI) or bladder irritation. Although the patient has not reported blood in the urine, it is still worth investigating further.

- Gastrointestinal Disorders: Conditions such as irritable bowel syndrome (IBS), constipation, or other gastrointestinal issues could also contribute to abdominal pain and discomfort.

- Musculoskeletal Factors: Chronic muscle tension or issues related to posture and prolonged sitting could also be contributing factors, particularly if the pain is exacerbated by certain positions.

2. Recommended Specialists: Given the multifaceted nature of the symptoms, it may be beneficial to consult with the following specialists:
- Gynecologist: Since the pain is linked to the menstrual cycle, a thorough evaluation by a gynecologist is warranted. They may consider additional imaging studies, such as an MRI or laparoscopy, to assess for conditions like endometriosis or other pelvic pathologies.

- Urologist: A urologist can evaluate for any underlying urinary tract issues. They may recommend urine tests, bladder function tests, or imaging studies to rule out conditions such as interstitial cystitis or bladder infections.

- Gastroenterologist: If gastrointestinal issues are suspected, a gastroenterologist can perform further evaluations, including endoscopy or colonoscopy, to assess for any abnormalities in the digestive tract.

3. Psychological Factors: The patient has expressed feelings of anxiety related to the unpredictability of the pain. It may be beneficial to consider a referral to a mental health professional or a pain management specialist who can help address the psychological aspects of chronic pain. Cognitive-behavioral therapy (CBT) or mindfulness-based stress reduction techniques may be effective in managing anxiety and improving coping strategies.

4. Lifestyle Modifications: In addition to medical evaluations, lifestyle changes may help alleviate symptoms. These could include:
- Keeping a symptom diary to identify potential triggers.

- Engaging in regular physical activity to reduce muscle tension and improve overall well-being.

- Practicing relaxation techniques, such as yoga or meditation, to manage stress and anxiety.

In conclusion, the patient's chronic abdominal pain and urinary issues warrant a comprehensive evaluation by multiple specialists. A multidisciplinary approach will likely yield the best results in identifying the underlying causes and developing an effective treatment plan. It is essential for the patient to communicate openly with healthcare providers about their symptoms and concerns to ensure a thorough investigation and appropriate management.

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