Unexplained Left Lower Abdominal Pain: Possible Causes and Tests - Gastroenterology and Hepatology

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Unexplained left lower abdominal pain can be quite distressing, especially when multiple medical evaluations have not yielded a clear diagnosis. Given your symptoms, which include intermittent sharp pain that seems to correlate with your menstrual cycle, there are several potential causes and avenues for further investigation.

Firstly, it is important to consider the possibility of gynecological issues, even if initial evaluations have not indicated any problems. Conditions such as endometriosis, ovarian cysts, or pelvic inflammatory disease can sometimes be missed in standard examinations. Endometriosis, in particular, is known to cause cyclical pain that can be quite severe and is often associated with menstruation. A transvaginal ultrasound or MRI may provide more detailed imaging of the pelvic organs and help identify any abnormalities that were not visible in previous tests.

Another potential cause of your pain could be related to gastrointestinal issues. While you mentioned that you have seen a gastroenterologist, it may be worthwhile to consider functional gastrointestinal disorders such as irritable bowel syndrome (IBS), which can cause abdominal pain that is often relieved by bowel movements. If you have not already done so, a trial of dietary modifications or medications specifically for IBS might be beneficial.

Additionally, musculoskeletal issues should not be overlooked. Pain in the left lower abdomen can sometimes be referred from the back or pelvis, especially if there is a history of trauma or injury. A thorough physical examination by a physician, possibly including a musculoskeletal assessment, could help identify any underlying issues related to muscle strain or nerve irritation.

If your pain persists and remains unexplained, further imaging studies such as a CT scan of the abdomen and pelvis may be warranted. This can provide a comprehensive view of the abdominal organs and help rule out conditions such as diverticulitis, which can cause localized pain in the lower abdomen, or other structural abnormalities.

Lastly, consider keeping a detailed pain diary that tracks the timing, duration, and intensity of your pain, as well as any associated symptoms (such as changes in bowel habits, urinary symptoms, or menstrual cycle changes). This information can be invaluable for your healthcare provider in determining the next steps for diagnosis and management.

In summary, while you have already undergone several evaluations, it may be beneficial to revisit your healthcare provider with a focus on potential gynecological conditions, functional gastrointestinal disorders, musculoskeletal issues, and consider further imaging studies if necessary. Open communication with your healthcare team about your symptoms and concerns is crucial in finding the underlying cause of your pain.