Left Lower Abdominal Discomfort: Possible Causes and Next Steps

Q: Left Lower Abdominal Discomfort: Possible Causes and Next Steps

Hello： The causes of discomfort in the lower left abdomen, aside from gynecological organs, can be related to the intestines. <br>If it occurs regularly every month and is associated with menstruation, it may be due to endometriosis affecting the intestines or simply the stimulat

Discomfort in the lower abdomen?

Hello Dr.
Yang,
I have a question that I hope you can help me with or provide some advice.
I have a history of irritable bowel syndrome during high school, but I recovered after entering the workforce.
There is no family history of colorectal cancer.
In recent years, I have noticed that almost every month, around the mid-cycle of my menstrual period (sometimes the week before), I experience a heavy and uncomfortable sensation in my lower left abdomen one night.
Even during bowel movements, I feel a slight pulling pain (sharp pain).
After resting (sleeping), the symptoms disappear the next day.

I have suspected it might be an ovarian issue and have visited a gynecologist several times.
I underwent a sonogram and a transvaginal ultrasound, which confirmed that there are no issues with my ovaries or uterus.
Interestingly, during one of my uncomfortable episodes, a sonogram revealed that ovulation was occurring in my right ovary, not the left.
However, I consistently feel discomfort on the left side.

This leads me to wonder if there might be an issue with my sigmoid colon or left colon.
Could there be a tumor or cancer developing? If it were a bowel issue, would resting for one night alleviate the symptoms? Is it normal for this to occur once a month (for one day) in such a regular pattern? I had a fecal occult blood test last year, which was negative.
Given my symptoms, should I quickly schedule an appointment with a gastroenterologist for further examination? What kind of tests might they perform? I am quite apprehensive about potentially painful procedures, such as endoscopy.

Yun Jie, 20~29 year old female. Ask Date: 2003/05/02

Dr. Yang Peizhen reply Gastroenterology and Hepatology

Hello: The causes of discomfort in the lower left abdomen, aside from gynecological organs, can be related to the intestines.
If it occurs regularly every month and is associated with menstruation, it may be due to endometriosis affecting the intestines or simply the stimulation of the intestines by uterine contractions.
To rule out any lesions in the colon itself, a sigmoidoscopy must be performed.
If no abnormalities are found, medication can be administered.
Best wishes for your health from Dr.
Yang Pei-Chen, Gastroenterology Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2003/05/02

More Info

Understanding left lower abdominal discomfort can be quite complex, especially when symptoms are recurrent and specific to certain times of the month. Based on your description, it seems that you experience a heavy and uncomfortable sensation in the left lower abdomen, particularly during the mid-cycle of your menstrual period. This discomfort is accompanied by mild pain during bowel movements and tends to resolve after a good night's rest.

Given your history of irritable bowel syndrome (IBS) and the absence of any significant findings from gynecological evaluations, it is reasonable to consider gastrointestinal issues as a potential cause of your symptoms. The fact that your discomfort is cyclical and correlates with your menstrual cycle could suggest a few possibilities:
1. Irritable Bowel Syndrome (IBS): Since you have a history of IBS, it is possible that your symptoms are related to this condition. IBS can cause abdominal pain, bloating, and changes in bowel habits, and symptoms can fluctuate with hormonal changes during the menstrual cycle.

2. Ovarian or Uterine Issues: Although you have had ultrasounds that ruled out significant ovarian or uterine problems, conditions like endometriosis can sometimes cause pain that is not easily detected on imaging. Endometriosis can lead to cyclical pain that coincides with the menstrual cycle.

3. Colonic Issues: Given your concern about the sigmoid colon or left colon, it is possible that you could be experiencing issues related to bowel function, such as constipation or even diverticulitis, which can cause localized pain. The fact that your symptoms resolve after rest may indicate that they are related to bowel function rather than a structural issue.

4. Referred Pain: Sometimes, pain in the abdomen can be referred from other areas, such as the back or pelvis. This could explain why you feel discomfort in the left lower abdomen without a clear source.

Regarding your question about whether to see a gastroenterologist, it would be a prudent step. A gastroenterologist can perform a thorough evaluation and may recommend several tests, including:
- Colonoscopy: This is a common procedure that allows the doctor to examine the inner lining of your colon and rectum. While it may sound daunting, it is generally well-tolerated, and sedation is used to minimize discomfort.

- CT Scan or MRI: These imaging studies can provide detailed pictures of your abdominal organs and help identify any structural issues that may not be visible on ultrasound.

- Stool Tests: These can help rule out infections or other gastrointestinal issues.

- Dietary Assessment: Sometimes, keeping a food diary can help identify any dietary triggers that may be contributing to your symptoms.

It's understandable to be apprehensive about certain procedures, but discussing your concerns with your doctor can help alleviate some of that anxiety. They can provide reassurance and explain the benefits of each test in relation to your symptoms.

In summary, while your symptoms may be related to IBS or other gastrointestinal issues, it is essential to consult with a gastroenterologist for a comprehensive evaluation. They can guide you through the necessary tests and help determine the underlying cause of your discomfort, ensuring that you receive appropriate treatment and management.

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