Persistent Left Lower Abdominal Pain: Possible Causes After Pelvic Surgery - Gastroenterology and Hepatology

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Persistent left lower abdominal pain following pelvic surgery can be a complex issue, especially when the pain has lasted for several months and has not responded to initial treatments. Given your history of pelvic surgery after a car accident, there are several potential causes for your ongoing discomfort that should be considered.

1. Post-Surgical Changes: After any surgical procedure, especially those involving the pelvis, it is common to experience changes in the surrounding tissues. Scar tissue (adhesions) can form as part of the healing process, which may lead to pain. These adhesions can sometimes cause organs to stick together or to the abdominal wall, leading to discomfort, especially during movement or physical activity.

2. Nerve Entrapment: Surgical procedures can sometimes lead to nerve damage or entrapment. The pain you are experiencing could be due to irritation or compression of nerves in the pelvic region. This type of pain can manifest as sharp, shooting, or aching sensations and may be exacerbated by certain movements or positions.

3. Musculoskeletal Issues: The pain could also be related to musculoskeletal problems, such as muscle strain or ligamentous injury, particularly if you have altered your movement patterns post-surgery. Weakness or imbalance in the pelvic floor or abdominal muscles can lead to pain during activities like walking, climbing stairs, or bending.

4. Visceral Pain: Sometimes, pain can originate from internal organs. Given that you have already consulted with gynecology and urology, it may be worth considering gastrointestinal issues, such as irritable bowel syndrome (IBS) or other functional gastrointestinal disorders, which can cause referred pain to the lower abdomen.

5. Infection or Inflammation: Although you mentioned that antibiotics were prescribed without improvement, it is still essential to rule out any underlying infections or inflammatory conditions that may not have been detected through initial imaging studies. Conditions like diverticulitis or appendicitis (even if the appendix is not present, residual inflammation can occur) could present with similar symptoms.

6. Hernia: A hernia, particularly an inguinal or femoral hernia, could also be a source of pain. This occurs when an organ or tissue protrudes through a weak spot in the abdominal muscles. If you notice a bulge or if the pain worsens with straining, this could be a possibility.

7. Psychosomatic Factors: Chronic pain can also have psychological components. Stress and anxiety related to your surgery and recovery can manifest as physical symptoms. It may be beneficial to explore this aspect with a healthcare provider.

Given the complexity of your symptoms and the lack of improvement with initial treatments, it is advisable to pursue further evaluation. A referral to a pain management specialist or a physical therapist who specializes in pelvic health may provide additional insights and treatment options. Additionally, considering a colonoscopy, as you mentioned, could help rule out any gastrointestinal issues that may not have been previously identified.

In summary, persistent left lower abdominal pain after pelvic surgery can arise from various causes, including post-surgical changes, nerve entrapment, musculoskeletal issues, visceral pain, infections, hernias, or psychosomatic factors. A comprehensive approach involving further diagnostic evaluations and possibly multidisciplinary care may be necessary to address your symptoms effectively. Always communicate openly with your healthcare providers about your concerns and the impact of your symptoms on your daily life.