Intermittent Left Lower Abdominal Pain: Is It IBS? - Gastroenterology and Hepatology

Occasional left lower abdominal pain that sometimes bulges and then subsides?

Hello Dr.
Lin, I have been troubled by this issue for over five years.
I experience intermittent sharp pain in my lower left abdomen, sometimes intense enough to make me roll on the bed.
The frequency is about every two to three days, and each episode lasts around 10 minutes before it subsides.
During the intense pain, my lower left abdomen (below the navel) sometimes becomes distended, but it usually goes down within two minutes.
Typically, the pain alleviates after a bowel movement, but not every time is the pain severe enough to prompt a bowel movement; often, I just feel a tightness (which is mostly the case).
The frequency is higher in the morning upon waking and before going to bed.
I would like to know what might be causing this issue.
Could it be irritable bowel syndrome? I initially suspected a gynecological issue and had an ultrasound done, which ruled out such problems.
Recently, I experienced intense pain after my menstrual period ended, which subsided after a bowel movement, and taking medications like Ruo Yuan tablets has reduced the pain to a tight feeling.
Could this be classified as irritable bowel syndrome? Also, do I need to undergo a colonoscopy or other related examinations? Although the frequency is high, each episode is very brief (10 minutes, occasionally 30 minutes, and relieved by bowel movements), so it doesn't seem urgent.
I would like to hear your opinion, thank you!

Cloey, 20~29 year old female. Ask Date: 2021/07/29

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello, a 29-year-old female presents with intermittent left lower abdominal pain that occasionally becomes distended and then subsides.
The pain is severe during episodes and is relieved after bowel movements.
Possible causes for the left lower abdominal pain include gastrointestinal issues, gynecological conditions (such as ovulation pain, pelvic inflammatory disease, endometriosis, etc.), and renal or urinary tract disorders.
The pain tends to occur more frequently in the morning and evening, with tightness at the edges.
Relief is noted after bowel movements, and medication has shown improvement.
Gynecological issues have been ruled out.
Although abdominal pain is relieved after bowel movements and medication is effective, irritable bowel syndrome must be differentiated from other causes.
Due to the high frequency of pain episodes, it is recommended to follow up with tests such as stool analysis for any issues, as well as imaging studies or colonoscopy.
Wishing you peace and health! Sincerely, Dr.
Ming-Hui Lin, Attending Physician, Gastroenterology Department, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2021/07/29

More Info

Intermittent left lower abdominal pain can be a perplexing issue, especially when it has persisted for over five years. Based on your description, it seems that the pain is sharp and can be severe enough to cause significant discomfort, even leading to rolling on the bed. The fact that the pain is often relieved by bowel movements is a key detail that can help in understanding your condition.

Your symptoms could indeed be indicative of Irritable Bowel Syndrome (IBS), a common gastrointestinal disorder characterized by a combination of abdominal pain and altered bowel habits. IBS is often associated with symptoms such as cramping, bloating, and changes in stool consistency. The fact that your pain is intermittent and often occurs in conjunction with bowel movements aligns with typical IBS presentations. Additionally, the relief you experience after defecation is a common feature of IBS, as the act of passing stool can alleviate the pressure and discomfort in the intestines.

However, it is essential to consider other potential causes of your symptoms. Given that you have already ruled out gynecological issues through ultrasound, it might be worthwhile to explore other gastrointestinal conditions. For instance, diverticulitis, which is inflammation of the diverticula in the colon, can cause similar symptoms, particularly if there is a history of diverticular disease. Additionally, conditions such as inflammatory bowel disease (IBD), including Crohn's disease or ulcerative colitis, could also present with intermittent abdominal pain and changes in bowel habits.

The fact that you experience a "tight" sensation in your abdomen, along with the pain, could suggest a spasm of the intestinal muscles, which is often seen in IBS. Stress and anxiety can exacerbate IBS symptoms, leading to increased muscle tension and spasms in the gut. You mentioned that your symptoms are more pronounced in the morning and before bed, which could also correlate with daily stressors and dietary habits.

Regarding the need for further testing, while your symptoms may not seem urgent, it is still advisable to undergo a thorough evaluation. A colonoscopy can be beneficial, especially considering your long-standing symptoms. It can help rule out any structural abnormalities, polyps, or inflammatory conditions that may not be evident through other imaging techniques. Additionally, stool tests can help identify any infections or inflammatory markers that could provide further insight into your condition.

In summary, while your symptoms are suggestive of IBS, it is crucial to consider other potential gastrointestinal disorders. A comprehensive evaluation, including a colonoscopy and possibly other imaging or laboratory tests, would be prudent to ensure an accurate diagnosis and appropriate management. Managing stress through lifestyle changes, dietary adjustments, and possibly medication can also be beneficial in alleviating your symptoms. If IBS is confirmed, dietary modifications, such as increasing fiber intake and avoiding trigger foods, along with medications like antispasmodics or laxatives, may help in managing your symptoms effectively.

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