Right Abdominal Swelling and Abnormal Bleeding: Possible Causes and Concerns

Right abdominal swelling with abnormal bleeding?

Hello, doctor.
Recently, I have been experiencing abnormal bleeding, but it's very minimal—just a little bit.
The bleeding has been ongoing for almost a month, but I thought it was just a precursor to my menstrual period since I did have my period during this time.
I also have swelling in the right lower abdomen (below the navel) and occasional pain, as I had a cyst several years ago.
I was concerned that it might have returned.
A few days ago, I visited a gynecologist who performed an ultrasound and confirmed that there were no tumors on my uterus or ovaries.
The doctor mentioned that the swelling could be due to some inflammation of the muscle membrane and sprayed something cool on the area.
During the examination, the doctor applied significant pressure on my abdomen, which was very painful.
After returning home, I noticed that my entire lower abdomen (below the navel) is swollen, even more than before.
It hurts to touch lightly, and there are some bruises.
I am currently on the third day of the medication prescribed by the doctor, but there has been no improvement.
Occasionally, I still feel pain in the right lower abdomen, and the area that was pushed on remains swollen and painful.
Could you please advise what might be causing this?

yu, 20~29 year old female. Ask Date: 2017/09/18

Dr. Huang Jianzhong reply Obstetrics and Gynecology

Recently, I have experienced abnormal bleeding, but it has been very minimal.
The bleeding has lasted for almost a month, and during this time, I also had my menstrual period, so I thought it was just a sign of my period approaching.
I have swelling in the right lower abdomen (below the navel), and sometimes it hurts because I had a cyst several years ago.
I suspected that it might have returned.
However, a few days ago, I visited a gynecologist who performed an ultrasound and confirmed that there were no tumors in my uterus or ovaries.
The doctor mentioned that the swelling could be due to some inflammation of the muscle membrane.
The doctor sprayed something cool and applied significant pressure on my abdomen, which was extremely painful.
After returning home, I noticed that my entire lower abdomen (below the navel) was swollen, even more than before.
It is very painful to touch, and there are some bruises.
Now, on the third day of taking the medication prescribed by the doctor, there has been no improvement, and I still occasionally feel pain in the right lower abdomen.
As for the swollen and painful abdomen from the pressure applied, it remains swollen and painful.
Could you please tell me what might be the cause?
Answer: 1.
The ultrasound indicated that there are no tumors in the uterus or ovaries, which suggests there are no gynecological issues.
2.
The application of pressure and the cool spray are not typical treatment methods used by gynecologists.
3.
It is advisable to seek a second opinion from another physician.

Reply Date: 2017/09/18

More Info

It sounds like you are experiencing a complex set of symptoms that can be concerning. Based on your description, you have been dealing with abnormal bleeding, abdominal swelling, and pain in the right lower quadrant. Let's break down these symptoms and explore potential causes and concerns.

Abnormal Bleeding
The abnormal bleeding you mentioned, which occurs intermittently and is described as light, could be due to several factors. Given that you have a regular menstrual cycle, it is important to consider the timing of this bleeding in relation to your menstrual cycle. If this bleeding occurs outside of your expected menstrual period, it could be indicative of ovulation bleeding, hormonal imbalances, or other gynecological issues.
Ovulation bleeding is relatively common and can occur around the midpoint of your cycle, typically between days 10 to 16. This type of bleeding is usually light and may be accompanied by other symptoms such as mild cramping. However, if the bleeding persists or increases in volume, it is essential to seek further evaluation.

Abdominal Swelling and Pain
The swelling in your right abdomen, particularly if it is accompanied by pain, warrants further investigation. You mentioned a history of a cyst (water tumor) in the past, which raises the possibility of recurrent cyst formation or other ovarian issues. While your recent ultrasound indicated no tumors on your uterus or ovaries, it is still possible for functional cysts to develop, which may not always be visible on imaging.

The pain you are experiencing could also be related to inflammation of the pelvic organs, such as endometriosis or pelvic inflammatory disease (PID). These conditions can cause swelling, pain, and abnormal bleeding. Additionally, if there is any concern about appendicitis or other gastrointestinal issues, these should be ruled out, especially given the location of your pain.

Possible Causes of Your Symptoms
1. Hormonal Imbalances: Fluctuations in hormone levels can lead to irregular bleeding and abdominal discomfort. Conditions such as polycystic ovary syndrome (PCOS) or thyroid dysfunction can contribute to these symptoms.

2. Ovarian Cysts: Functional cysts can develop during the menstrual cycle and may cause pain and swelling. If they rupture, they can lead to significant discomfort and bleeding.

3. Endometriosis: This condition occurs when tissue similar to the lining of the uterus grows outside of it, leading to pain, swelling, and abnormal bleeding.

4. Pelvic Inflammatory Disease (PID): An infection of the reproductive organs can cause pain and abnormal bleeding. It is often associated with sexually transmitted infections.

5. Gastrointestinal Issues: Conditions such as appendicitis, diverticulitis, or irritable bowel syndrome (IBS) can also cause abdominal pain and swelling.

Recommendations
Given your ongoing symptoms, it is crucial to follow up with your healthcare provider. Here are some steps you might consider:
- Further Imaging: If your symptoms persist, additional imaging studies, such as a pelvic MRI or repeat ultrasound, may be necessary to evaluate for any changes or new developments.

- Blood Tests: Hormonal panels, complete blood counts, and tests for infections may provide more insight into your condition.

- Consultation with a Specialist: If your symptoms do not improve, consider seeking a second opinion from a gynecologist or a specialist in reproductive health.

- Symptom Management: In the meantime, managing pain with over-the-counter medications and monitoring your symptoms can be helpful.

Conclusion
Your symptoms of abnormal bleeding, abdominal swelling, and pain should not be ignored, especially given your medical history. While some causes may be benign, others could require more urgent attention. It is essential to maintain open communication with your healthcare provider and advocate for further evaluation to ensure your health and well-being.

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Ultrasound examination.