Can Pelvic Inflammatory Disease Cause Upper Abdominal Discomfort?

Can pelvic inflammatory disease cause upper abdominal discomfort?

Hello Dr.
Wu,
I visited a gynecology clinic on November 16 due to urethritis and was prescribed a 10-day course of antibiotics.
After finishing the medication on November 26, I felt fine, but starting November 29, I experienced some itching (not excessively as described online), a slight odor, and mild lower abdominal discomfort, leading me to suspect a vaginal infection.
On November 30, I returned to the doctor, who noted tenderness during the pelvic exam and took a sample from the vaginal mucosa for bacterial testing, confirming an infection caused by anaerobic bacteria and fungi.
I was then prescribed metronidazole-coated tablets, Johnson's Rephresh vaginal tablets (containing MICONAZOLE NITRATE), and a cream (MeiKang cream).
I was given a 7-day supply.

During the week of treatment, I developed lower back pain (which I did not have before starting the medication).
When I returned on December 7, I informed the doctor about the back pain.
The doctor performed another pelvic exam and bacterial testing, noting slight tenderness, but much less than before, and the test results indicated improvement.
The doctor advised me to continue the medication for another 7 days and to apply the cream for 14 days, stating that if there were no symptoms, I would not need to return for a follow-up.
By December 14, I had completed the antibiotics and the vaginal suppositories, and all symptoms had disappeared.
I continued using the cream, but after stopping the antibiotics for 3-4 days, I began to experience mild abdominal cramping (intermittent).
Initially, I thought it was just bloating, but by December 20, the symptoms worsened (persistent cramping and nausea, which I had not experienced before).

On December 21, I returned for another visit, and this time the pelvic exam was extremely painful.
The doctor mentioned that there might still be pelvic inflammation and that the vaginal condition was nearly resolved.
I was prescribed a single dose of Clindamycin vaginal tablets, switched to a different antibiotic (Bifidobacterium capsules), and changed the cream to Miconazole cream, with instructions to return after another 7 days.
Regarding the nausea, the doctor attributed it to antibiotic side effects, but I only experienced this after stopping the antibiotics, leading the doctor to suggest it might be indigestion.

I decided to monitor the situation, but after taking the medication, by the evening of December 22, my condition had not improved and had actually worsened, with upper abdominal discomfort and tenderness in the right upper abdomen.
I can eat, but I feel full easily.
My bowel movements are normal, and my sleep is also unaffected.
Since November 30, my vaginal symptoms have not been prominent; there has been no discharge, itching, or odor.
Although tenderness during the pelvic exam is a fact, I am concerned about whether there might be other underlying issues, as the medication does not seem to be effective.
I am worried that after completing the 14-day course, I might still have the same issues, especially with the emergence of upper abdominal symptoms.
I would like to ask if pelvic inflammatory disease can cause discomfort in the upper abdomen? I am uncertain whether I should see a gastroenterologist or continue with gynecology.
Also, is a 14-day treatment course for pelvic inflammatory disease considered normal? What should I do? I am very anxious about not seeing improvement despite ongoing medication.
Thank you, doctor, for your patience in reading and responding.
🙏

Shidiqi, 20~29 year old female. Ask Date: 2020/12/23

Dr. Wu Xianghui reply Obstetrics and Gynecology

1.
Vaginal infections can cause abnormal discharge, itching, fever, bleeding, and lower abdominal pain, which are among the most common symptoms in women.
The causes are numerous, and treatment should be accompanied by comprehensive health education.
It is recommended to visit an outpatient clinic for evaluation by a specialist in obstetrics and gynecology.
2.
Your condition is complex and has a prolonged course; it is advisable to seek examination and treatment at a major hospital.

Reply Date: 2020/12/23

More Info

Pelvic Inflammatory Disease (PID) is an infection of the female reproductive organs, which can lead to various symptoms, including lower abdominal pain, fever, and unusual vaginal discharge. However, it is important to note that PID can also have effects beyond the pelvic region, potentially causing discomfort in the upper abdomen.
In your case, the progression of symptoms from lower abdominal discomfort to upper abdominal pain raises several considerations. PID can lead to complications such as the formation of abscesses or peritonitis, which can cause referred pain to the upper abdomen. Additionally, the inflammation associated with PID can irritate surrounding structures, including the intestines and diaphragm, leading to discomfort in areas that may not seem directly related to the reproductive organs.

Your symptoms of nausea and upper abdominal pain, especially after completing a course of antibiotics, could suggest that the infection has not fully resolved or that there may be another underlying issue. It is also possible that the antibiotics may have disrupted your normal gut flora, leading to gastrointestinal symptoms such as bloating and discomfort.

Given your situation, it is advisable to continue monitoring your symptoms closely. If the upper abdominal pain persists or worsens, it would be prudent to consult a gastroenterologist or a general surgeon, as they can evaluate for other potential causes of your symptoms, such as gallbladder disease, pancreatitis, or gastrointestinal issues.
As for the duration of treatment for PID, while a typical course of antibiotics may last around 14 days, the response to treatment can vary significantly among individuals. Some may require longer courses or additional follow-up treatments, especially if symptoms persist. It is essential to communicate openly with your healthcare provider about your ongoing symptoms and concerns.
In summary, while PID primarily affects the pelvic region, it can indeed lead to upper abdominal discomfort due to various complications or referred pain. It is crucial to follow up with your healthcare provider, consider additional evaluations if symptoms do not improve, and ensure that all potential causes of your discomfort are thoroughly investigated. Your health and well-being are paramount, and seeking a comprehensive approach to your symptoms will be beneficial in achieving a proper diagnosis and treatment plan.

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