Left Lower Abdominal Discomfort: When to Seek Further Evaluation

Left lower abdominal discomfort and pain?

Hello, doctor.
Since the middle of last month, I've gradually felt some discomfort in my lower left abdomen.
I initially thought it was a gynecological issue, so I consulted a gynecologist who performed an ultrasound and said there was nothing serious, possibly due to fatigue (no pelvic exam was done).
After my period ended in November, I still felt a dull discomfort, so I visited a gastroenterologist.
They conducted a urinalysis and abdominal ultrasound, which also showed no issues.
The dull pain feels somewhat like the discomfort experienced after eating and then running; it's not very pronounced, but sometimes it feels like lower back pain.
There has been no blood in my stool.
The gastroenterologist mentioned that if the pain persists, they recommend a colonoscopy.
I would like to ask if abdominal ultrasound can diagnose colorectal cancer if it is indeed present.

Fuwuyegirl, 20~29 year old female. Ask Date: 2016/11/16

Dr. Lin Minghui reply Gastroenterology and Hepatology

Young women experiencing lower abdominal pain may have several potential causes, including gynecological issues, ovulation pain, constipation, irritable bowel syndrome, or urinary tract problems.
If there is chronic abdominal pain, irregular diet, blood in the stool, or weight loss, a colonoscopy is recommended.
This procedure allows direct visualization of the intestinal mucosa for signs of inflammation, abscesses, polyps, diverticula, or tumors.
However, it is an invasive examination that requires bowel preparation beforehand.
Colorectal cancer cannot be diagnosed via ultrasound unless the tumor is large, the bowel wall is thickened, or there is metastasis.

Reply Date: 2016/11/16

More Info

When it comes to left lower abdominal discomfort, especially when it persists despite initial evaluations, it is crucial to consider a comprehensive approach to diagnosis and management. Your experience of discomfort that began last month, which you initially attributed to gynecological issues, is not uncommon. Many patients often find that abdominal pain can stem from various sources, including gastrointestinal, urinary, or even musculoskeletal origins.

From your description, it seems that you have already taken the right steps by consulting both a gynecologist and a gastroenterologist. The ultrasound and urinalysis results indicating no significant findings are reassuring, but they do not completely rule out the possibility of underlying issues. The sensation you describe—similar to the discomfort felt after eating and then exercising—could suggest a functional gastrointestinal issue, such as irritable bowel syndrome (IBS), or even a mild case of gastroesophageal reflux disease (GERD), especially if you experience any associated symptoms like bloating or changes in bowel habits.

Regarding your concern about colorectal cancer, it is essential to understand that while abdominal ultrasound can provide valuable information about the organs in the abdominal cavity, it is not the most definitive tool for diagnosing colorectal cancer. Ultrasound can detect some abnormalities, such as large masses or significant changes in organ structure, but it may miss smaller lesions or early-stage cancers. A colonoscopy is the gold standard for evaluating the colon and rectum, as it allows direct visualization and the opportunity to biopsy any suspicious areas.

If your symptoms persist or worsen, it would be prudent to follow through with the gastroenterologist's recommendation for a colonoscopy. This procedure is particularly important if you have risk factors for colorectal cancer, such as a family history of the disease, changes in bowel habits, or unexplained weight loss. Early detection is key in managing colorectal cancer effectively, and a colonoscopy can provide peace of mind or lead to early intervention if necessary.

Additionally, consider keeping a symptom diary to track your discomfort, noting when it occurs, its intensity, and any associated factors such as diet or activity levels. This information can be invaluable for your healthcare provider in determining the next steps in your evaluation and management.

In summary, while your initial evaluations have not indicated significant issues, persistent symptoms warrant further investigation. A colonoscopy is a logical next step in ruling out any serious conditions, including colorectal cancer. It is always better to err on the side of caution when it comes to unexplained abdominal discomfort, especially if it affects your quality of life. Don't hesitate to advocate for your health and seek further evaluation if needed.

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