Intermittent Left Lower Abdominal Pain: Causes and Solutions

Intermittent dull pain in the lower left abdomen?

Hello, Doctor! About three weeks ago, I suddenly experienced dull pain in my lower left abdomen, along with general gastrointestinal discomfort.
A day or two later, I had severe diarrhea.
At that time, I thought it was just food poisoning, so I fasted for a day (while supplementing with electrolytes) and gradually transitioned back to a normal diet with plain bread and toast.
I felt better for a few days, but occasionally I still felt a lingering dull pain in my lower left abdomen.
When the pain is not very noticeable, my appetite is normal, and my bowel movements are regular.
However, when the pain is more pronounced, I also experience soreness in my lower back and feel the urge to have a bowel movement frequently, possibly six to seven times a day.
The stools are normal, but towards the end, it becomes loose stools.
During this time, my diet has remained consistent (light fruits, vegetables, and plain rice) without any special restrictions.
This cycle of feeling better for a few days and then experiencing a flare-up has left me feeling somewhat fatigued, and I worry that there might be something serious, like a growth in my colon.
Three years ago, I had a colonoscopy that removed a hyperplastic polyp, and I am considering whether to undergo another one.
However, since I have chronic kidney disease, my nephrologist advised against it unless absolutely necessary, as laxatives can harm kidney function, and only if there is a concern for colon cancer should I proceed.
The gastroenterologist suggested medication, but there’s no guarantee that it will alleviate my symptoms, and ultimately, the decision to undergo further testing is left to me.
I am seeking more professional advice rather than just being told it’s up to me! I have been seeing doctors at the Municipal United Hospital.
As a busy working mother with two young children, this situation has made me somewhat anxious, and I believe that anxiety may be exacerbating my symptoms.
I hope you can provide me with more insights.
Thank you for your help!

Jinzhang de mama, 40~49 year old female. Ask Date: 2018/09/16

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, it is recommended to first perform a fecal occult blood test before deciding whether to proceed with invasive endoscopic examination.
Changhua Hospital cares about your health.
Chen Shidian.

Reply Date: 2018/09/16

More Info

Understanding intermittent left lower abdominal pain can be quite complex, especially when it is accompanied by gastrointestinal discomfort and changes in bowel habits. Based on your description, it seems that you have been experiencing a cycle of symptoms that include dull pain in the left lower abdomen, occasional diarrhea, and a general feeling of malaise. Let's break down the potential causes and considerations for your situation.

Potential Causes
1. Gastrointestinal Issues: Given your history of gastrointestinal symptoms, it is possible that you are experiencing a form of irritable bowel syndrome (IBS) or a mild gastrointestinal infection. IBS can cause intermittent abdominal pain, changes in bowel habits, and discomfort that can fluctuate with stress and diet.
2. Diverticular Disease: Since you mentioned having a history of diverticulosis (the presence of diverticula in the colon), it is important to consider diverticulitis, which is the inflammation of these diverticula. This condition can cause localized pain, particularly in the left lower abdomen, and can be accompanied by changes in bowel habits.

3. Musculoskeletal Pain: Sometimes, abdominal pain can be referred from the lower back or pelvic region, especially if you are experiencing back pain as well. This could be due to muscle strain or other musculoskeletal issues, particularly if you have been lifting or engaging in activities that put strain on your back and abdomen.

4. Kidney Issues: Given your history of chronic kidney disease, it is crucial to rule out any renal-related issues. Pain in the lower abdomen can sometimes be associated with kidney stones or infections, which may also cause referred pain to the lower back.

5. Psychological Factors: Anxiety and stress can exacerbate gastrointestinal symptoms. The worry about your health can lead to a cycle of increased symptoms, which can further heighten anxiety.

Recommendations
1. Consultation with a Specialist: Since you have a complex medical history, including chronic kidney disease, it would be prudent to consult with a gastroenterologist who can provide a thorough evaluation. They may recommend imaging studies, such as a CT scan, to assess for diverticulitis or other structural issues in the abdomen.

2. Dietary Adjustments: Keeping a food diary can help identify any dietary triggers that may be exacerbating your symptoms. A diet low in processed foods and high in fiber may help regulate bowel movements and reduce symptoms.

3. Stress Management: Consider incorporating stress-reducing techniques such as mindfulness, yoga, or meditation into your routine. These practices can help alleviate anxiety and may improve your gastrointestinal symptoms.

4. Medication Review: If your symptoms persist, it may be worth discussing with your doctor the possibility of trying medications that target IBS or other gastrointestinal conditions. However, given your kidney condition, any medication should be carefully considered.

5. Follow-Up on Previous Conditions: Since you had a polyp removed three years ago, it is essential to maintain regular follow-ups with your gastroenterologist to monitor for any new developments. While your nephrologist advises caution regarding further procedures, it is crucial to balance this with the need for thorough evaluation of your gastrointestinal health.

Conclusion
Your symptoms warrant a comprehensive approach that considers both physical and psychological factors. It is understandable to feel anxious, especially as a busy working mother. Prioritizing your health is essential, and seeking a second opinion or further evaluation may provide you with the clarity and reassurance you need. Remember, you are not alone in this, and there are healthcare professionals who can help guide you through these challenges.

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