Persistent Abdominal Pain: Your Symptoms and Next Steps

Q: Persistent Abdominal Pain: Your Symptoms and Next Steps

Hello： Some discomfort may not necessarily indicate an issue with the organs, but rather a functional problem. <br>If you have already undergone gastroscopy, colonoscopy, and ultrasound without any significant abnormalities, it may be necessary to improve your condition through e

There has been a dull pain in the lower left abdomen and the upper right abdomen for more than three months?

Hello Doctor, I have been experiencing intermittent pain in my left lower abdomen and right upper abdomen for over three months (the pain in the right upper abdomen is more frequent than in the left lower abdomen).
Due to a long-standing issue with constipation, I suspect it might be related to my intestines.
I went to the hospital's colorectal surgery department for a colonoscopy and gastroscopy, as well as blood tests.
The results showed inflammation and multiple polyps in the colon and stomach (which were removed at that time).
My blood tests indicated elevated metabolic markers.
After taking gastrointestinal anti-inflammatory medication for a week, I still feel uncomfortable.

Later, during a follow-up visit, I had an abdominal ultrasound, which did not reveal any specific issues.
I was then prescribed medication to slow down intestinal motility, but after a week of taking it, I still see no improvement.
Although my pain comes and goes and is not unbearable, it is still uncomfortable, and I have never experienced this before.
When I asked the doctor what I should do about it, he replied, "You just have to get used to this pain; otherwise, you'll still feel uncomfortable when we do a CT scan." His response seems a bit strange to me.

I have also had a gynecological examination, and my uterus is fine.
Could you please help me understand what might be wrong with my body? Should I consider seeing a hepatobiliary and gastrointestinal specialist for further evaluation? I am concerned that the organs in my right upper abdomen, such as the liver and gallbladder, might be involved.
I am worried that if it is a serious condition, delaying treatment could be detrimental.
I look forward to your response.
Thank you, doctors.

Ms. Su, 20~29 year old female. Ask Date: 2020/02/11

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: Some discomfort may not necessarily indicate an issue with the organs, but rather a functional problem.
If you have already undergone gastroscopy, colonoscopy, and ultrasound without any significant abnormalities, it may be necessary to improve your condition through emotional management, stress reduction, diet, and exercise.
Avoid stimulating foods such as tea, coffee, and fried items.
If there is still no improvement, follow your physician's advice and consider a CT scan.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2020/02/11

More Info

Persistent abdominal pain can be a challenging issue to navigate, especially when it has been ongoing for several months. Your symptoms, particularly the pain in the left lower abdomen and right upper abdomen, combined with a history of constipation and the recent findings of inflammation and polyps during your colonoscopy, warrant a thorough evaluation to determine the underlying cause.

Firstly, it’s important to recognize that abdominal pain can arise from a variety of sources, including gastrointestinal, gynecological, urological, and even musculoskeletal issues. Given your history of constipation, it is plausible that your symptoms could be related to bowel function. Chronic constipation can lead to abdominal discomfort due to distension and increased pressure in the intestines. Additionally, the presence of polyps, although benign, can sometimes be associated with discomfort, especially if they cause any obstruction or irritation.

The right upper quadrant pain you are experiencing could be related to several organs, including the liver, gallbladder, and parts of the small intestine. Since you have already undergone a thorough evaluation with a gastroenterologist, including a colonoscopy and upper endoscopy, and have ruled out significant issues in the gastrointestinal tract, it may be beneficial to consider other potential causes.
1. Hepatic Issues: Given that the right upper quadrant houses the liver, it would be prudent to have liver function tests performed if they haven’t been done recently. Conditions such as fatty liver disease or hepatitis can cause discomfort in this area.

2. Biliary System: The gallbladder can also be a source of pain, particularly if there are gallstones or inflammation (cholecystitis). An ultrasound of the gallbladder can help assess for any abnormalities.

3. Musculoskeletal Pain: Sometimes, abdominal pain can be referred from musculoskeletal issues, especially if there is any strain or injury to the abdominal muscles or the diaphragm. Physical therapy or a consultation with a pain specialist may be helpful in these cases.

4. Functional Gastrointestinal Disorders: Conditions such as Irritable Bowel Syndrome (IBS) can cause chronic abdominal pain and discomfort, often associated with changes in bowel habits. If your pain is intermittent and not associated with any alarming symptoms (like significant weight loss, fever, or blood in the stool), it may be worth discussing with your doctor the possibility of a functional gastrointestinal disorder.

5. Psychosomatic Factors: Chronic pain can sometimes be exacerbated by stress and anxiety. Given that you have expressed concerns about your health, it might be beneficial to explore stress management techniques or even speak with a mental health professional.

Regarding your concern about the physician's response to "getting used to the pain," it is understandable to feel unsettled by that comment. While chronic pain can sometimes be managed with lifestyle adjustments and medications, it is essential to continue seeking answers and advocating for your health. If you feel that your concerns are not being adequately addressed, consider seeking a second opinion from another gastroenterologist or a specialist in functional gastrointestinal disorders.

In conclusion, while your symptoms may not indicate a severe underlying condition, it is crucial to continue monitoring your health and pursuing further evaluations as needed. If your pain persists or worsens, or if you develop new symptoms, do not hesitate to seek immediate medical attention. Your health and comfort are paramount, and you deserve a comprehensive approach to your ongoing abdominal pain.

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