Post-Appendectomy Pain: Discomfort and Concerns - Gastroenterology and Hepatology

Postoperative pain after appendectomy?

Hello Doctor, I underwent laparoscopic appendectomy on September 11, with three small incisions located at my belly button, lower right abdomen, and lower abdomen.
After being discharged on September 14, I started experiencing pain in my upper left abdomen, and sometimes in my upper right abdomen as well.
I have returned to the hospital for follow-up visits twice.
During the first visit, the doctor pressed on my abdomen and suggested that the pain might be due to nerve irritation near the incision site, which should improve over time.
However, since the pain persisted, I went for a second visit.
The doctor mentioned that if it were adhesions, symptoms would not appear so quickly, and after an X-ray, it was found that I had a significant amount of stool in my colon.
I was prescribed stool softeners and laxatives, and the doctor advised that if the pain continues, I should undergo a colonoscopy.
However, I feel that the issue may not be related to my colon.
I still feel uncomfortable and am worried because I cannot identify the cause.
I had a natural delivery on August 10 and am currently breastfeeding, which I wonder might be affecting my condition due to constantly holding my baby.
My lower back also aches daily, and most of the abdominal pain is concentrated in the upper left abdomen.
Sometimes I feel pain in my ribs, which can be sharp or mildly aching.
Just yesterday, I began to feel pain around my belly button.
I took the pain medication prescribed by the doctor last night, but it didn't seem to help much.
Today, the area around my belly button still feels slightly painful, and I occasionally experience sharp pain in my upper left abdomen and ribs, especially noticeable when I am breastfeeding.
I am confused about whether it is normal to feel pain in the upper left abdomen, which is quite far from the incision site, and why I only started feeling pain around my belly button yesterday.
Is this normal? Would you recommend any other medical examinations? Although the pain is within a tolerable range, I am quite worried about feeling uncomfortable every day.
Thank you very much for your assistance!

Cheng Cheng's Mom, 30~39 year old female. Ask Date: 2018/10/29

Dr. Cai Jinji reply Gastroenterology and Hepatology

Hello, since the description is a bit abstract, could you please find time to see a gastroenterologist for evaluation to better determine the issue, and then proceed with further examinations?

Reply Date: 2018/10/29

More Info

Post-appendectomy pain can be a concerning issue, especially when it persists beyond the expected recovery period. After undergoing laparoscopic appendectomy, it is common for patients to experience discomfort in the abdominal area, particularly around the incision sites. However, the pain you are describing, which is radiating to the left upper abdomen and around the belly button, raises some important considerations.

Firstly, it is essential to understand that post-operative pain can arise from several sources. The surgical procedure itself can lead to irritation of the surrounding nerves, which may cause referred pain in areas that seem distant from the surgical site. This phenomenon is known as neuropathic pain, where the nerves in the area of surgery become hypersensitive or irritated, leading to sensations of pain in adjacent regions.

The fact that you are experiencing pain in the left upper abdomen and around the belly button could be attributed to several factors:
1. Nerve Irritation: As your doctor mentioned, it is possible that the nerves near the incision sites are still healing and may be causing discomfort. This type of pain can sometimes take weeks to months to resolve.

2. Adhesions: While your doctor indicated that adhesions typically do not present symptoms so soon after surgery, it is still a possibility. Adhesions are bands of scar tissue that can form after surgery and may cause discomfort or pain as they develop. However, they usually take longer to form and cause symptoms.

3. Gastrointestinal Issues: The presence of significant stool in your colon, as noted in your X-ray, could also contribute to abdominal discomfort. Constipation can lead to abdominal pain, bloating, and discomfort, especially if you are straining during bowel movements. The medications prescribed for constipation should help alleviate this issue.

4. Muscle Strain: Given that you are caring for a newborn and frequently lifting and holding your child, it is possible that you are experiencing muscle strain in your back and abdomen. This can lead to referred pain in the abdominal area, especially if you are using your abdominal muscles more than usual.

5. Infection or Complications: Although less common, it is important to rule out any potential post-operative complications such as infection or abscess formation. If the pain worsens or is accompanied by fever, chills, or other concerning symptoms, it would be prudent to seek immediate medical attention.

Given your ongoing discomfort, it may be beneficial to follow up with your healthcare provider for further evaluation. They may consider additional imaging studies, such as an ultrasound or CT scan, to assess for any complications that may not have been evident on the initial X-ray. Additionally, if the pain persists or worsens, a referral to a gastroenterologist for further evaluation of your gastrointestinal symptoms may be warranted.

In the meantime, managing your pain with over-the-counter medications, ensuring adequate hydration, and maintaining a high-fiber diet may help alleviate some of your symptoms. Gentle abdominal exercises, as tolerated, may also assist in improving your overall comfort.

It is understandable to feel anxious about your symptoms, especially as a new parent. Open communication with your healthcare provider about your concerns and symptoms is crucial in ensuring you receive the appropriate care and support during your recovery.

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