Chronic Right Lower Abdominal Pain: Causes and Diagnostic Options - Surgery

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Chronic right lower abdominal pain can be a perplexing issue, especially when previous diagnostic tests such as CT scans and colonoscopies have not revealed any abnormalities. Your situation, characterized by persistent pain and a sensation of incomplete bowel evacuation, raises several important considerations regarding potential causes and further diagnostic options.

1. Need for Additional Imaging: Given that you have already undergone a high-resolution CT scan and a colonoscopy within the last two years, the necessity for further imaging, such as a lower gastrointestinal (GI) series, may depend on the clinical judgment of your gastroenterologist. While the CT scan can provide detailed images of the abdominal organs, a lower GI series can help visualize the colon and rectum more specifically, particularly if there are concerns about motility disorders or structural issues that might not have been evident in previous tests. If your symptoms persist or worsen, discussing the potential benefits of this imaging with your doctor could be worthwhile.

2. Potential Causes of Right Lower Abdominal Pain: The pain you are experiencing in the right lower quadrant, especially near the inguinal region, could be related to several factors. Common causes include:
- Irritable Bowel Syndrome (IBS): This functional gastrointestinal disorder can lead to chronic abdominal pain and altered bowel habits, including the sensation of incomplete evacuation.

- Appendicitis: Although less likely given your previous imaging, chronic appendicitis can sometimes present with intermittent pain.

- Hernias: An inguinal hernia could cause localized pain, particularly if it becomes incarcerated or strangulated.

- Gynecological Issues: In females, conditions such as ovarian cysts or endometriosis can manifest as lower abdominal pain.

- Musculoskeletal Pain: Chronic pain can sometimes be referred from musculoskeletal issues, especially if there has been a history of heavy lifting or physical strain.

3. Relationship Between Rectal Symptoms and Pain: The sensation of incomplete evacuation and the presence of hemorrhoids can indeed be interconnected. Internal hemorrhoids can cause discomfort and a feeling of pressure in the rectal area, which may contribute to the sensation of residual stool. Additionally, if you are experiencing constipation or straining during bowel movements, this can exacerbate both the pain and the sensation of incomplete evacuation. It is essential to manage these symptoms through dietary modifications, increased fiber intake, and possibly the use of stool softeners or laxatives as recommended by your healthcare provider.

In summary, while you have undergone significant diagnostic testing, the persistence of your symptoms warrants a thorough review of your case. It may be beneficial to revisit your gastroenterologist to discuss your ongoing symptoms, the potential need for further imaging, and a comprehensive management plan that addresses both the abdominal pain and the rectal symptoms. Keeping a symptom diary, noting the frequency, duration, and triggers of your pain, can also provide valuable information for your healthcare provider in determining the next steps in your care.