Abdominal Pain: Insights into Gastrointestinal Issues

Q: Abdominal Pain: Insights into Gastrointestinal Issues

Hello： Without seeing the imaging results and physical examination, it is indeed difficult to determine if there are any issues. <br>I recommend that you follow the current physician's prescription and return for a follow-up appointment for evaluation. <br>If your condition worse

Abdominal issues?

Hello Doctor: I apologize for the lengthy description, but I appreciate your patience in reading it...
Thank you for previously examining my right lower abdomen and feeling something that wasn't a hard mass, which didn't hurt when pressed.
However, sometimes when lying down or sitting for a long time, I experience a sharp pain in the right lower abdomen.
Initially, I didn't pay much attention to it, but over time, I felt that the mass in my abdomen was getting larger, so I went to Chang Gung Memorial Hospital's Department of Obstetrics and Gynecology.
They discovered an 8 cm cyst in my left lower abdomen.
I questioned why the cyst was located in a different area from where I felt pain.
The doctor mentioned that the cyst might have shifted to the left lower abdomen.
Later, in mid-February, I underwent laparoscopic surgery to remove the cyst, and I thought my abdominal issues were resolved...
However, in early March, I suddenly felt an increase in sharp pain in my right lower abdomen (painful with breathing, walking, and pressing) and developed a low-grade fever.
That day, I went back to Chang Gung for further examination...
They performed blood tests, urine tests, and a CT scan, and I also asked the surgeon who performed the operation to do an ultrasound.
The blood tests, urine tests, and ultrasound results were all normal.
The doctor reviewed the surgical records and informed me that both my uterus and appendix were fine (during laparoscopic surgery, the ovaries, fallopian tubes, and appendix are checked for issues).
During the CT scan, the doctor noted that there was a mass in my right lower abdomen, but it was "hollow" inside (likely fluid or gas).
The entire examination process left me feeling confused...
Initially, the preliminary diagnosis was possibly appendicitis or an issue with the surgical site, but later it was thought to be gas (after a few minutes, they said gas couldn't form a mass).
Eventually, they suspected it was fecal impaction...
(but I informed them that I have daily bowel movements and inquired why fecal impaction would cause a low-grade fever).
The doctor left for a few minutes and then returned...
After spending half a day on examinations and waiting, the final conclusion was "unable to determine the cause," and they prescribed three days of antibiotics and a stool softener...
Now, when I press on my right lower abdomen, I still feel something, and occasionally there is a sharp pain...
I've undergone all the necessary tests...
Is there really no problem? I feel very uneasy...
I would like to ask Dr.
Tsai, am I worrying too much??

Miss Yang, 30~39 year old female. Ask Date: 2018/03/23

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: Without seeing the imaging results and physical examination, it is indeed difficult to determine if there are any issues.
I recommend that you follow the current physician's prescription and return for a follow-up appointment for evaluation.
If your condition worsens, seek medical attention immediately.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2018/03/23

More Info

Abdominal pain can be a complex and challenging issue to diagnose, especially when multiple tests have been performed and no clear cause has been identified. Your experience highlights a common scenario in clinical practice where patients undergo extensive evaluations, yet the source of their discomfort remains elusive.
From your description, it seems you have undergone a thorough workup, including imaging studies and laboratory tests, which have not revealed any significant abnormalities. The presence of a fluid-filled cyst (water tumor) in the left lower abdomen that was surgically removed may have contributed to your symptoms, but the subsequent development of right lower abdominal pain raises several considerations.

1. Differential Diagnosis: The right lower quadrant (RLQ) pain you are experiencing could be due to several factors. Common causes include appendicitis, which can sometimes present with atypical symptoms, or complications from previous surgeries, such as adhesions or infections. However, given that imaging studies did not show any acute issues with the appendix or surgical site, these possibilities may be less likely.

2. Functional Disorders: Another possibility is that your symptoms may be related to functional gastrointestinal disorders, such as irritable bowel syndrome (IBS). IBS can cause abdominal pain and discomfort, often associated with changes in bowel habits, bloating, and gas. The fact that you have regular bowel movements does not entirely rule out IBS, as it can still occur in individuals who do not experience constipation or diarrhea.

3. Visceral Pain: The sensation of pain in the abdomen can also be influenced by visceral pain pathways. This type of pain can be referred from other organs or may arise from the gastrointestinal tract itself, even if there is no structural abnormality. Stress and anxiety can exacerbate these sensations, leading to a cycle of discomfort that can be difficult to break.

4. Psychosomatic Factors: It is also essential to consider the psychological aspect of chronic pain. Anxiety and stress can manifest as physical symptoms, including abdominal pain. If you are experiencing heightened anxiety about your health, this could contribute to your perception of pain.

5. Next Steps: Since you have already undergone extensive testing, it may be beneficial to consult with a gastroenterologist who specializes in functional gastrointestinal disorders. They may recommend further evaluation or treatment options, such as dietary modifications, medications to manage symptoms, or even psychological support to address any underlying anxiety.

6. Monitoring Symptoms: Keep a detailed diary of your symptoms, noting when they occur, their intensity, and any associated factors (such as diet, stress levels, and physical activity). This information can be invaluable for your healthcare provider in determining the next steps in your care.

In conclusion, while it is understandable to feel anxious when faced with persistent abdominal pain without a clear diagnosis, it is essential to approach this situation with a comprehensive perspective. Engaging with a specialist who can explore functional aspects of your symptoms and provide a tailored management plan may help alleviate your concerns and improve your quality of life. Remember, you are not alone in this journey, and there are avenues for support and treatment available.

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