Persistent Left Lower Abdominal Pain: Seeking Answers and Solutions

Left lower abdominal pain?

Two months ago, I went to a gynecology clinic several times due to left lower abdominal pain, but there was no improvement.
As the pain worsened, I went to the emergency room, where the doctor diagnosed me with a bladder infection and recommended hospitalization for further examination, but stated that it was unrelated to the left lower abdominal pain.
After being discharged, I continued taking medication, but the pain persisted.
Due to the inability to sit or stand for long periods, I returned to the emergency room multiple times.
Blood tests, urine tests, X-rays, abdominal ultrasounds, and CT scans all returned normal results.
I then visited the gynecology outpatient clinic, where both a comprehensive ultrasound and a transvaginal ultrasound were also normal.
Due to the ongoing stabbing pain in my left lower abdomen, I followed the doctor's advice to undergo a colonoscopy.
That night, I experienced severe pain in my left lower abdomen, and the next day I went back to the emergency room.
After examination, the doctor stated that there was no inflammation and that my intestines were normal, so I could only take pain relief.
On September 10, during the colonoscopy, the doctor said there was nothing that warranted surgery, only a biopsy was performed.
However, the stabbing pain in my left lower abdomen has continued to this day, making it difficult for me to sit or stand for extended periods.
I am unsure how to proceed.
Please provide advice.
Thank you.

Zou Xiao Zhen, 50~59 year old female. Ask Date: 2019/10/03

Dr. Yang Zhichao reply Gastroenterology and Hepatology

Dear Ms.
Zou, you have undergone many examinations.
Essentially, clinical issues should be discussed with your current attending physician.
What were the findings from the endoscopy? Why was a biopsy performed? What were the results of the biopsy? How will treatment for the pain be addressed moving forward? This approach is more practical.
Additionally, the inability to stand or sit for long periods may be related to nerve compression.
If the gastroenterology department cannot resolve the clinical issues, you may consider consulting a neurologist or neurosurgeon.
Thank you for your inquiry.

Reply Date: 2019/10/03

More Info

Persistent left lower abdominal pain can be a complex and frustrating issue, especially when multiple medical evaluations yield normal results. Your experience of enduring pain despite numerous tests and consultations is not uncommon, and it highlights the challenges in diagnosing abdominal pain, particularly when the source is not immediately apparent.

Given your history, it is essential to consider several potential causes for your persistent left lower abdominal pain. While you have undergone various imaging studies, including CT scans, ultrasounds, and a colonoscopy, which have returned normal results, there are still several avenues to explore.

1. Functional Gastrointestinal Disorders: Conditions such as Irritable Bowel Syndrome (IBS) can cause significant abdominal pain without any structural abnormalities. IBS is characterized by a combination of abdominal pain and altered bowel habits, which may not always be evident during imaging studies. If you have experienced changes in your bowel habits, this could be a potential diagnosis.

2. Musculoskeletal Issues: Sometimes, abdominal pain can be referred from musculoskeletal problems, particularly if you have a history of trauma or injury. Conditions like myofascial pain syndrome or even issues related to the pelvic floor can manifest as abdominal pain. A thorough physical examination by a specialist in musculoskeletal disorders or a physical therapist may provide insights into whether your pain is related to muscle or joint issues.

3. Neuropathic Pain: Nerve-related pain can also be a source of persistent discomfort. Conditions such as neuralgia or entrapment syndromes can cause pain that feels sharp or stabbing, similar to what you describe. A neurologist may be able to assess this possibility further.

4. Pelvic Inflammatory Disease (PID): Although you have seen gynecologists and had normal results, it is worth considering that some cases of PID can be subtle and may not always present with the classic signs. A thorough evaluation by a specialist in reproductive health may be warranted.

5. Chronic Appendicitis or Other Abdominal Conditions: In rare cases, chronic appendicitis or other conditions such as diverticulitis can present with persistent pain without clear acute symptoms. If your pain is localized and persistent, further evaluation by a gastroenterologist may be necessary.

6. Psychosomatic Factors: Chronic pain can sometimes be exacerbated by psychological factors. Stress, anxiety, and depression can contribute to the perception of pain and may require a multidisciplinary approach that includes mental health support.

Recommendations for Next Steps:
1. Consult a Gastroenterologist: Since you have already undergone a colonoscopy, it may be beneficial to revisit a gastroenterologist who specializes in functional gastrointestinal disorders. They can provide further insights into conditions like IBS or other functional disorders.

2. Physical Therapy: Engaging in physical therapy may help address any musculoskeletal components of your pain. A physical therapist can work with you to develop a tailored exercise program that may alleviate discomfort.

3. Pain Management Specialist: If pain persists, consider consulting a pain management specialist. They can offer various interventions, including medications, nerve blocks, or other therapies aimed at managing chronic pain.

4. Psychological Support: If you find that your pain is affecting your mental health, seeking support from a psychologist or counselor may help you cope with the emotional aspects of chronic pain.

5. Keep a Pain Diary: Documenting your pain patterns, triggers, and any associated symptoms can provide valuable information to your healthcare providers and may help in identifying potential causes.

In conclusion, persistent left lower abdominal pain can stem from various sources, and it often requires a comprehensive and multidisciplinary approach to diagnosis and management. Continue to advocate for your health, and do not hesitate to seek further evaluations if your symptoms persist. Your well-being is paramount, and finding the right healthcare team to support you is crucial in navigating this challenging situation.

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