Abdominal Pain: A Comprehensive Guide for Women

Abdominal pain issues?

Doctor, my friend is 37 years old and has been experiencing abdominal pain after her menstrual period for the past few months.
Sometimes, the pain also occurs before her period.
Her menstrual flow is normal, but at times the pain is severe enough to affect her rectal area, although this doesn't happen every time.
Occasionally, the pain extends to her abdomen and lower back.
She has seen a colorectal surgeon who ruled out hemorrhoids, and a gynecologist who suspected endometriosis, but the test results came back normal.
A gastroenterologist suggested it might be gas, and while medication helped, further examination revealed possible kidney stones on an X-ray.
The medication hasn't been very effective, and when the pain occurs, she must take painkillers, as the pain is unbearable without them.
What could be the issue, doctor? Thank you.

Yangyang, 30~39 year old female. Ask Date: 2017/05/04

Dr. Chen Taicheng reply Family Medicine

● It is important to first determine whether abdominal pain is related to menstruation.
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.
During menstruation, menstrual cramps should be differentiated into primary dysmenorrhea (without any other underlying causes) and secondary dysmenorrhea (such as endometriosis, uterine fibroids, adenomyosis, pelvic inflammatory disease, etc.).
Other conditions like inflammatory bowel disease and irritable bowel syndrome can also cause abdominal pain.
Kidney stones may present as dull pain on one side, sometimes radiating to the lower abdomen.
● It is recommended to consult a gynecologist to completely rule out gynecological issues and dysmenorrhea (which may require a pelvic ultrasound) → then visit a gastroenterologist to determine the cause of the abdominal pain → and if necessary, further address any potential kidney stone issues.
Wishing your friend good health, Dr.
Chen Tai-Cheng from Taoyuan Hospital, Family Medicine Department, cares for you~

Reply Date: 2017/05/04

More Info

Understanding abdominal pain, particularly in women, can be complex due to the various potential causes and overlapping symptoms. Your friend's situation, characterized by abdominal pain occurring around her menstrual cycle, is not uncommon, but it does warrant a thorough evaluation to determine the underlying cause.

Firstly, it’s essential to differentiate between primary and secondary dysmenorrhea. Primary dysmenorrhea is menstrual pain that is not associated with any underlying reproductive health issues, while secondary dysmenorrhea is pain that results from a specific condition, such as endometriosis or fibroids. Given your friend's history of pain both before and after menstruation, and the fact that she has undergone evaluations for conditions like endometriosis and has been found to have normal results, it may suggest that her pain could be related to primary dysmenorrhea or other gastrointestinal issues.

The symptoms your friend experiences, including pain radiating to the rectum and lower back, could indicate several possibilities. The fact that she has been evaluated by a colorectal surgeon and found to have no hemorrhoids is a good start, but it does not rule out other gastrointestinal conditions. Conditions such as irritable bowel syndrome (IBS), pelvic inflammatory disease (PID), or even interstitial cystitis could present with similar symptoms. The mention of suspected kidney stones from an X-ray also adds another layer of complexity, as renal colic can cause significant abdominal pain that may be confused with gynecological pain.

In terms of treatment, the reliance on pain medication suggests that her pain is significant enough to impact her quality of life. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can be effective for menstrual pain, but if her pain is more chronic or severe, other options may need to be considered. Hormonal treatments, such as birth control pills, can help regulate menstrual cycles and reduce pain associated with dysmenorrhea. Additionally, if endometriosis is still a concern despite normal imaging, a laparoscopy may be warranted for direct visualization and potential treatment.

It’s also important to consider the psychological aspect of chronic pain. Anxiety and stress can exacerbate pain perception, and if your friend is experiencing significant anxiety about her symptoms, this could contribute to her discomfort. A multidisciplinary approach that includes pain management, physical therapy, and possibly counseling could be beneficial.

In summary, your friend's abdominal pain could stem from a variety of sources, including primary dysmenorrhea, gastrointestinal issues, or even kidney stones. A comprehensive evaluation by a healthcare provider, possibly involving a gynecologist, gastroenterologist, and pain specialist, may be necessary to pinpoint the exact cause and develop an effective treatment plan. Encouraging her to keep a detailed symptom diary, including the timing, intensity, and nature of her pain, as well as any associated symptoms, could provide valuable information for her healthcare team.

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