Persistent Left Lower Abdominal Pain: Which Specialist to Consult?

Left lower abdominal pain, with occasional pain around the navel?

Hello Doctor: I have been experiencing pain in my lower left abdomen for almost two years.
I have consulted with specialists in obstetrics and gynecology, urology, and gastroenterology, but none have been able to determine the cause.
A CT scan showed a white mass in my lower left abdomen, but all the doctors said it was not serious and were uncertain about what it was.
However, the pain in my lower left abdomen persists, and for the past six months, I have also been feeling a tightness in my bladder, with the pain in my lower left abdomen being the most pronounced.
I constantly feel discomfort and pressure in my abdomen, and my nighttime urination frequency has increased from rarely to 1-2 times per night.
Sometimes, I have to wait longer to urinate.
Recently, I have also started experiencing pain in my upper left abdomen, and I occasionally feel pain around my belly button and the area to the upper right of it.
There is no blood in my urine, but I have been experiencing frequent bloating.
My diet is normal, but I have been having difficulty with bowel movements.
Which specialist should I see? Gastroenterology or nephrology?

W, 20~29 year old female. Ask Date: 2019/01/18

Dr. Chen Qifeng reply Gastroenterology and Hepatology

If there is left lower abdominal pain and a colonoscopy has been performed with no abnormal findings, and there is no history of abdominal surgery or gynecological issues, then the likelihood of colonic dysfunction is quite high.

Reply Date: 2019/01/18

More Info

Persistent left lower abdominal pain can be quite distressing, especially when it has lasted for nearly two years without a clear diagnosis. Given your history of consultations with gynecology, urology, and gastroenterology, it seems that a multidisciplinary approach may be necessary to pinpoint the underlying cause of your discomfort.

Possible Causes of Your Symptoms
1. Gastrointestinal Issues: Conditions such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or even diverticulitis could lead to persistent abdominal pain and changes in bowel habits. The fact that you experience bloating and irregular bowel movements suggests that gastrointestinal issues could be a significant factor.

2. Urological Concerns: Given the bladder pressure and increased nocturia (waking up at night to urinate), it is essential to consider potential urological conditions. Chronic cystitis or interstitial cystitis could cause bladder discomfort and pain in the lower abdomen.
3. Gynecological Factors: Although you have seen a gynecologist, conditions such as endometriosis or ovarian cysts can sometimes be subtle and may not always be detected in initial examinations. If you have not had a pelvic ultrasound recently, it may be worth revisiting this option.

4. Musculoskeletal Pain: Sometimes, pain in the lower abdomen can be referred from musculoskeletal issues, such as a hernia or muscle strain, especially if you have a history of physical activity that may have led to strain.

Recommended Specialists
Given the complexity of your symptoms, I recommend the following steps:
1. Gastroenterologist: Since you have gastrointestinal symptoms, a gastroenterologist should be your primary point of contact. They can perform further diagnostic tests, such as a colonoscopy or advanced imaging studies, to rule out conditions like IBD or diverticulitis.

2. Urologist: If your gastroenterologist rules out gastrointestinal issues, consider revisiting a urologist. They may conduct tests like a cystoscopy to examine the bladder and urethra directly.

3. Gynecologist: If there are still concerns regarding gynecological issues, a follow-up with a gynecologist is advisable. They may recommend imaging studies like an MRI or a more detailed ultrasound to check for conditions like endometriosis.

4. Pain Management Specialist: If all structural causes are ruled out, a pain management specialist may help address the chronic pain aspect, providing therapies that can help manage your symptoms more effectively.

Next Steps
1. Document Symptoms: Keep a detailed diary of your symptoms, including pain intensity, frequency, and any associated factors (like diet or activity). This information can be invaluable for your healthcare providers.

2. Request Comprehensive Testing: When you visit your specialists, ensure to express the need for comprehensive testing. This may include imaging studies, blood tests, and possibly a referral to a pain specialist if necessary.

3. Consider a Multidisciplinary Approach: Sometimes, a team approach involving multiple specialists can provide a more holistic view of your health and lead to better outcomes.

4. Lifestyle Modifications: In the meantime, consider dietary adjustments, stress management techniques, and regular physical activity, which can sometimes alleviate gastrointestinal symptoms.

In conclusion, persistent left lower abdominal pain can arise from various sources, and a thorough investigation is essential to identify the underlying cause. By consulting with the appropriate specialists and advocating for comprehensive testing, you can work towards finding relief and improving your quality of life.

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