Left Lower Abdominal Pain: Causes and When to Seek Help - Family Medicine

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Left lower abdominal pain can be a perplexing symptom, especially when it persists for an extended period, as you have described. Given that you have already undergone a colonoscopy which returned normal results, it’s essential to consider other potential causes and the appropriate next steps.


Possible Causes of Left Lower Abdominal Pain
1. Musculoskeletal Issues: Since you mentioned that the pain sometimes feels like it could be muscular, it’s worth considering that it may be related to muscle strain or ligamentous pain. Activities such as swimming can sometimes lead to muscle fatigue or strain, particularly if there are sudden increases in activity or improper technique.

2. Gastrointestinal Conditions: Although your colonoscopy was normal, other gastrointestinal issues could still be at play. Conditions such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or even functional gastrointestinal disorders can cause intermittent pain. Symptoms may not always correlate with visible abnormalities on imaging or endoscopy.

3. Urological Issues: Given the proximity of the pain to the groin area, it’s also prudent to consider urological causes. Conditions such as kidney stones or urinary tract infections can sometimes present as lower abdominal pain. If you haven’t had a urinalysis or imaging of the kidneys, this might be worth discussing with your physician.

4. Gynecological Concerns: In females, gynecological issues such as ovarian cysts, endometriosis, or pelvic inflammatory disease can manifest as lower abdominal pain. If you have not seen a gynecologist recently, it may be beneficial to do so, especially if you experience any menstrual irregularities or other related symptoms.

5. Hernias: An inguinal or femoral hernia could cause localized pain in the lower abdomen, especially if it is exacerbated by certain movements or activities. A physical examination by a healthcare provider can help rule this out.

6. Referred Pain: Sometimes, pain in the lower abdomen can be referred from other areas, such as the back or pelvis. Conditions affecting the spine, such as herniated discs or sciatica, can sometimes present with abdominal pain.


When to Seek Further Help
Given that your pain has persisted for nearly six months and has not improved with previous evaluations, it is advisable to follow up with your primary care physician or a specialist. Here are some steps you might consider:
- Consult a Gastroenterologist: Since you have already seen one, if your symptoms persist, you may want to discuss further testing or a second opinion. Tests such as an abdominal ultrasound or CT scan can provide additional insights into potential issues that may not have been visible during the colonoscopy.

- Visit a Urologist: If you have not yet had a urinalysis or imaging of the urinary tract, this could be a logical next step to rule out any urological causes.

- Physical Therapy: If musculoskeletal pain is suspected, a referral to a physical therapist may help. They can assess your posture, movement patterns, and any potential muscle imbalances that could be contributing to your pain.

- Gynecological Evaluation: If you are female and have not had a recent gynecological exam, it may be worthwhile to rule out any reproductive health issues.


Conclusion
In summary, while your colonoscopy has ruled out some gastrointestinal causes, there are still several potential explanations for your left lower abdominal pain. It is essential to continue seeking answers through appropriate medical channels. Keeping a detailed diary of your symptoms, including when they occur, their intensity, and any associated activities, can also be helpful for your healthcare provider in diagnosing the issue. Don’t hesitate to advocate for yourself and request further evaluations if your symptoms persist or worsen.