Intermittent Lower Abdominal Pain: Which Specialist to Consult?

If you are experiencing alternating pain on both sides of the lower abdomen, you should consult a gastroenterologist or a general practitioner?

Bilateral lower abdominal spontaneous pain occurs intermittently (not daily, but occasionally for about 1 to 2 months).
Sometimes, there is tenderness upon palpation and bloating.
I went to a gynecology clinic for an ultrasound, but nothing significant was found, and I was prescribed antibiotics for 9 days, which did not seem to make much difference.
Previously, I experienced menstrual cramps during my regular menstrual cycle, but in the past two months, the cramps have been particularly severe and cramp-like.
Urination, bowel movements, and discharge have been relatively normal, and my white blood cell count before taking antibiotics was not above the standard range.
I would like to ask: 1.
Is there a connection between the pain experienced during intercourse and the recent symptoms, or are they unrelated? 2.
What could be the possible issues? Should I continue to see a gynecologist, or should I consult a gastroenterologist, urologist, or another specialist?

Dora, 20~29 year old female. Ask Date: 2021/10/22

Dr. Ye Qianyu reply Family Medicine

Hello! Please continue with your follow-up in obstetrics and gynecology, and also seek medical attention from a gastroenterologist.

Reply Date: 2021/10/22

More Info

Intermittent lower abdominal pain can be a complex issue, especially when it has persisted for a month or two. Given your symptoms, including the alternating pain on both sides of the lower abdomen, pressure pain, and bloating, it is essential to consider various potential causes and the appropriate specialists to consult.

1. Understanding Your Symptoms: The intermittent nature of your pain, combined with the bloating and the history of menstrual cramps, suggests that there could be several underlying issues. Conditions such as ovarian cysts, endometriosis, or pelvic inflammatory disease (PID) could cause similar symptoms. The fact that you experienced increased pain during your menstrual cycle may indicate a gynecological issue, particularly if the pain is more intense than usual.

2. Previous Investigations: You mentioned that you had an ultrasound at a gynecological clinic, which did not reveal any significant findings. This is a good first step, but it may not always capture all potential issues, especially if they are related to the gastrointestinal tract or urinary system. The antibiotics prescribed for nine days suggest that there was a concern for an infection, but if your symptoms have not improved, further investigation is warranted.

3. Potential Causes: Given your symptoms, here are some possible causes to consider:
- Gynecological Issues: Conditions like endometriosis or ovarian cysts can cause cyclical pain and may not always be visible on an ultrasound, especially if they are small or in a location that is difficult to visualize.

- Gastrointestinal Issues: Conditions such as irritable bowel syndrome (IBS), diverticulitis, or even inflammatory bowel disease (IBD) could lead to similar symptoms, including bloating and abdominal pain.

- Urinary Tract Issues: Although you mentioned that urination and discharge are normal, conditions like interstitial cystitis or urinary tract infections (UTIs) can sometimes present with abdominal pain.

4. Which Specialist to Consult: Given the complexity of your symptoms, it may be beneficial to consult multiple specialists:
- Gynecologist: Since your symptoms may be related to your menstrual cycle and gynecological health, a follow-up with a gynecologist is advisable. They may consider additional imaging, such as a pelvic MRI, or perform a laparoscopy if endometriosis is suspected.

- Gastroenterologist: If gastrointestinal issues are suspected, a gastroenterologist can evaluate for conditions like IBS or IBD. They may recommend tests such as a colonoscopy or other imaging studies.

- Urologist: If urinary issues are suspected, particularly if you experience any changes in urination or additional symptoms, a urologist may be able to provide insight.

5. Lifestyle and Management: In the meantime, keeping a symptom diary can be beneficial. Note when the pain occurs, its intensity, any associated symptoms (like changes in bowel habits or urinary symptoms), and any potential triggers (such as certain foods or activities). This information can be invaluable for your healthcare providers in diagnosing the issue.

6. Conclusion: It is crucial to continue seeking answers, especially since your symptoms have persisted and have not improved with initial treatment. A multidisciplinary approach involving gynecology, gastroenterology, and possibly urology will provide a comprehensive evaluation of your symptoms. Do not hesitate to advocate for further testing or referrals if you feel your concerns are not being adequately addressed. Your health and comfort are paramount, and persistent abdominal pain should always be taken seriously.

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