Persistent Right Lower Abdominal Pain: When to Seek Further Medical Evaluation

Persistent pain in the lower right abdomen that worsens with walking or other movements?

Hello Doctor: I have been suffering from gastroenteritis for almost a month.
Initially, the pain was located in the lower abdomen and was not very specific.
One night, I suddenly experienced severe pain in the left lower abdomen and went to the emergency room, where they conducted a urinalysis and a bacterial culture (I believe that's what it's called).
The urinalysis showed a slight infection.
After three days, when I reviewed the report, the doctor indicated that the bacterial culture results appeared normal.
I continued taking medication for two weeks until my menstrual period started, at which point the pain shifted to the right lower abdomen.
Even slight movements cause pain.
The doctor at the clinic examined me and suggested continuing the medication and monitoring the situation.
However, on the day of the consultation, the right lower abdominal pain was not severe, but after two days, the abdominal pain significantly affected my daily life.
I have to walk carefully whenever I engage my right lower abdomen.
I do not have a fever, and my bowel movements are normal.
Should I go to the hospital for further examinations?

Rou, 20~29 year old female. Ask Date: 2018/10/30

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Treat the urinary tract and pelvic infections, and simultaneously visit the gastroenterology department for an abdominal X-ray to assess bloating and bowel movement conditions.

Reply Date: 2018/10/30

More Info

Persistent right lower abdominal pain can be a concerning symptom, especially when it has been ongoing for a month and has changed in character. Given your history of gastroenteritis and the recent shift in pain location, it is essential to consider several potential causes and the appropriate steps for further evaluation.

Firstly, the right lower abdomen is home to several critical structures, including the appendix, parts of the intestines, and in females, the ovaries and fallopian tubes. Conditions such as appendicitis, ovarian cysts, or even ectopic pregnancy (in women) can present with pain in this area. Since you mentioned that the pain has become more pronounced and affects your daily activities, it is advisable to seek further medical evaluation.

Here are some steps you might consider:
1. Consult a Gastroenterologist or General Surgeon: Given your symptoms and the location of the pain, a gastroenterologist or a general surgeon would be well-equipped to evaluate your condition. They can perform a thorough physical examination and assess whether there are signs of appendicitis or other gastrointestinal issues.

2. Imaging Studies: It may be beneficial to undergo imaging studies such as an abdominal ultrasound or a CT scan. These tests can help visualize the organs in your abdomen and identify any abnormalities, such as inflammation, masses, or signs of infection.

3. Laboratory Tests: While you have already undergone urine tests, additional blood tests may be warranted. A complete blood count (CBC) can help identify signs of infection or inflammation, while liver function tests can assess the health of your liver, especially considering your history as a hepatitis B carrier.

4. Monitor Symptoms: Keep a detailed record of your symptoms, including the intensity of the pain, any associated symptoms (like nausea, vomiting, changes in bowel habits, or fever), and any factors that worsen or alleviate the pain. This information can be invaluable to your healthcare provider.

5. Consider a Gynecological Evaluation: If you are female, it may also be wise to consult a gynecologist to rule out any reproductive system issues, such as ovarian cysts or pelvic inflammatory disease, which can also cause right lower abdominal pain.

6. Follow-Up: If your symptoms worsen or if you develop new symptoms such as fever, vomiting, or significant changes in bowel habits, seek immediate medical attention.
In summary, while some abdominal pain can be benign and resolve on its own, persistent pain, especially when it affects your daily life, warrants further investigation. It is crucial to communicate openly with your healthcare provider about your symptoms and concerns to ensure you receive the appropriate care. Early diagnosis and treatment can significantly improve outcomes, especially for conditions that may require surgical intervention.

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