Right Lower Body Pain: Possible Causes and Next Steps

Pain in the lower right side of the body?

Since last August, I have been experiencing sudden pain in my lower right body, which has persisted to this day.
The pain worsens during my menstrual period, and I also experience numbness in my feet and gastrointestinal issues.
I have consulted an orthopedic doctor at a nearby clinic (who suggested it might be piriformis syndrome, but it was not confirmed), a rehabilitation specialist (who only recommended physical therapy), a gynecologist (who said it was not related to gynecology), and I have seen a traditional Chinese medicine practitioner for four months, but there seems to be no improvement.
This menstrual period, my eyes feel very swollen and uncomfortable.
Previously, I mostly only experienced lower back pain before my period, but now I have multiple issues.
What could be causing such discomfort during my menstrual period? What other specialists should I consider seeing?

Yan, 30~39 year old female. Ask Date: 2017/03/13

Dr. Chen Taicheng reply Family Medicine

● There are many possible causes for pain in the right lower body, including numbness in the soles of the feet.
Considering your age, it is advisable to first rule out issues related to the lumbar spine, such as herniated discs or spondylolisthesis.
(For information regarding back pain related to menstruation, the author has provided a separate article for your reference: https://goo.gl/JQayrU).

● The piriformis muscle is located deep in the buttocks.
When the piriformis muscle contracts, it allows for external rotation of the thigh.
The sciatic nerve passes beneath or through the piriformis muscle (https://goo.gl/Ylh6X4).
Therefore, if the piriformis muscle compresses the sciatic nerve due to inflammation or other reasons, the symptoms can resemble sciatica, causing numbness or pain in the buttocks or hip, and sometimes the numbness or pain may radiate along the path of the sciatic nerve down to the thigh or calf.
This is commonly seen in women or in individuals who sit for prolonged periods or maintain poor posture (https://goo.gl/tQzEjn).
● Discomfort experienced before menstruation is referred to as premenstrual syndrome (PMS), with common symptoms including breast tenderness, abdominal bloating, diarrhea, mood swings, sleep disturbances, headaches, and acne.
Generally, PMS is less likely to cause issues specifically in the right lower body or eye problems, but it may exacerbate other physical discomforts during menstruation.
● It is recommended to seek further evaluation from an orthopedic or neurology department at a major hospital, and to consult with a gynecologist to alleviate menstruation-related discomfort.
A dual approach should help improve your symptoms.
Wishing you good health, Dr.
Chen Tai-Cheng from Taoyuan Hospital Family Medicine Department is concerned for you~

Reply Date: 2017/03/13

More Info

Understanding right lower body pain, especially when it has persisted for several months and worsens during menstruation, can be complex. Your symptoms, including pain radiating down the right lower body, foot numbness, and gastrointestinal issues, suggest a multifactorial problem that may involve musculoskeletal, neurological, and possibly gynecological components.

Possible Causes
1. Musculoskeletal Issues: The mention of potential piriformis syndrome by your orthopedic doctor is noteworthy. This condition occurs when the piriformis muscle, located in the buttock region, spasms and causes pain in the buttocks and down the leg. This could explain the pain and numbness in your lower body. Additionally, other musculoskeletal issues such as lumbar disc herniation or sacroiliac joint dysfunction could also contribute to your symptoms.

2. Neurological Factors: The numbness in your foot could indicate nerve involvement, possibly due to compression or irritation of the sciatic nerve or other nerves in the lumbar region. This could be exacerbated by postural issues or muscle tightness.

3. Gynecological Factors: The worsening of symptoms during your menstrual cycle raises the possibility of endometriosis or other gynecological conditions. Endometriosis can cause significant pain and discomfort, especially during menstruation, and can sometimes lead to referred pain in the lower back and legs.

4. Gastrointestinal Issues: Your mention of gastrointestinal discomfort could be related to stress or pain, which can often manifest as digestive issues. However, it’s essential to rule out any underlying gastrointestinal conditions that could be contributing to your symptoms.

Next Steps
Given the complexity of your symptoms and the lack of improvement with previous treatments, consider the following steps:
1. Comprehensive Evaluation: Seek a comprehensive evaluation from a multidisciplinary team. This could include a neurologist to assess for any nerve-related issues, a gynecologist to rule out any reproductive health concerns, and possibly a pain management specialist.

2. Imaging Studies: If not already done, consider advanced imaging studies such as an MRI of the lumbar spine to evaluate for any disc herniation or other structural issues that may not have been visible on X-rays.

3. Physical Therapy: Continue with physical therapy, focusing on strengthening and stretching exercises for the lower back and legs. A physical therapist can also provide guidance on posture and body mechanics to alleviate strain on your muscles and nerves.

4. Pain Management: Discuss pain management options with your healthcare provider. This could include medications, injections, or alternative therapies such as acupuncture or chiropractic care, depending on what has been tried previously.

5. Lifestyle Modifications: Incorporate regular low-impact exercises, such as walking or swimming, which can help improve circulation and reduce muscle tension. Additionally, consider dietary changes to support gastrointestinal health, such as increasing fiber intake and staying hydrated.

6. Monitor Symptoms: Keep a detailed diary of your symptoms, including their intensity, duration, and any potential triggers. This information can be invaluable for your healthcare providers in diagnosing and managing your condition.

Conclusion
Your situation is multifaceted, and it’s essential to approach it holistically. Collaborating with various specialists can help identify the root cause of your pain and discomfort. It’s crucial to advocate for yourself and seek further evaluations until you find a satisfactory explanation and treatment plan for your symptoms. Remember, persistent pain is not something you should have to endure without answers or relief.

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