Persistent Abdominal Pain for Over a Month: Seeking Answers

Q: Persistent Abdominal Pain for Over a Month: Seeking Answers

Dear Ms. Ake： 1. Abdominal pain is inherently challenging in clinical practice due to the wide range of organs and systems involved. 2. Taking upper abdominal pain or discomfort as an example, common diagnoses include gastric ulcers or gastritis, duodenal u

Abdominal pain lasting for one month?

Hello doctor, I have been experiencing abdominal pain for over a month.
I have undergone examinations in gynecology, gastroenterology, and orthopedics, and everything came back normal.
The tests I have had include a Pap smear, vaginal ultrasound, abdominal ultrasound, urinalysis, and blood tests, all of which were fine.
However, the abdominal pain persists.
The pain is described as a dull ache, with a burning sensation and a feeling of pressure, and it worsens when sitting or lying down.
It could possibly be stress-induced irritable bowel syndrome, but I usually manage stress well.
I am unsure what is causing the abdominal pain.
A few days ago, the pain was severe enough for me to visit the emergency room, where I underwent a bowel evaluation, yet the pain continues.
I hope to find an answer.
Thank you.

Ake, 20~29 year old female. Ask Date: 2022/10/19

Dr. Xiao Yongxun reply Family Medicine

Dear Ms.
Ake:
1.
Abdominal pain is inherently challenging in clinical practice due to the wide range of organs and systems involved.

2.
Taking upper abdominal pain or discomfort as an example, common diagnoses include gastric ulcers or gastritis, duodenal ulcers or duodenitis, gastroesophageal reflux disease, gallbladder or biliary stones, gallbladder or biliary inflammation, liver abscesses or tumors, pancreatitis or lesions, lung infections or tumors, colonic lesions, early herpes zoster, early acute appendicitis, and spasms of the abdominal muscles or diaphragm, among others.
Additionally, there are many less common conditions such as irritable bowel syndrome, intestinal tumors, vascular diseases, superior mesenteric artery occlusion, autoimmune diseases, and anxiety disorders.
3.
For lower abdominal pain or discomfort in women, potential causes include gynecological, urological, musculoskeletal, gastrointestinal, vascular, and metabolic diseases.
Common conditions include appendicitis, bowel obstruction, constipation, diverticulitis, gastritis, hernias, irritable bowel syndrome, mesenteric vein thrombosis, anal abscesses, and tumors.
Urological diseases to consider include cystitis, pyelonephritis, ureteral stones, and tumors.
Gynecological conditions to be aware of include adenomyosis, uterine fibroids, ectopic pregnancy, endometriosis, ovarian torsion, pelvic inflammatory disease, ruptured corpus luteum cysts, and ovarian or fallopian tube abscesses or tumors.
Of course, for postmenopausal women, some gynecological diseases may be rare and almost negligible.
In fact, conditions such as aortic dissection, lead poisoning, sickle cell crisis, ketoacidosis, and anxiety disorders may still be encountered clinically.
4.
Therefore, the diagnosis of abdominal pain typically requires a detailed medical history and physical examination to identify possible diagnoses and facilitate subsequent management.
5.
I personally recommend that you compile your examination reports and discuss them thoroughly with a trusted physician.
It is important to avoid requesting a physician to review reports, take a history, and conduct a physical examination in a rushed manner during busy outpatient visits, as physicians also need time to think carefully.

Reply Date: 2022/10/19

More Info

Persistent abdominal pain lasting over a month can be a challenging issue to address, especially when extensive medical evaluations have yielded no clear diagnosis. Given the symptoms you've described—dull pain, burning sensations, and pressure that worsens when sitting or lying down—there are several potential avenues to explore.

Firstly, it is essential to consider the possibility of functional gastrointestinal disorders, such as Irritable Bowel Syndrome (IBS). IBS can manifest as abdominal pain, bloating, and changes in bowel habits, and it is often exacerbated by stress, even if you feel you manage stress well. The brain-gut connection is complex, and psychological factors can influence gastrointestinal function significantly. Even if you typically handle stress effectively, there may be underlying emotional or psychological components that could be contributing to your symptoms.

Another possibility is that your abdominal pain could be related to musculoskeletal issues. Given that you experience increased discomfort when sitting or lying down, it might be worth considering whether there are any underlying muscle or nerve issues in the abdominal or pelvic region. Conditions such as myofascial pain syndrome or nerve entrapment can lead to persistent pain that may not be easily diagnosed through standard imaging or tests.

Additionally, since you have undergone various examinations, including gynecological and gastrointestinal assessments, it might be prudent to revisit these specialists or seek a multidisciplinary approach. Sometimes, a fresh perspective from a different physician or a specialist in pain management can provide new insights. A thorough review of your medical history, along with a detailed physical examination, may help identify any overlooked factors.

If your pain is associated with specific activities or positions, keeping a pain diary could be beneficial. Documenting when the pain occurs, its intensity, and any accompanying symptoms can help healthcare providers better understand your condition. This information can be invaluable in guiding further diagnostic testing or treatment options.

In terms of immediate management, you might consider exploring physical therapy, particularly if musculoskeletal issues are suspected. A physical therapist can assess your posture, movement patterns, and any potential muscle imbalances that could be contributing to your pain. Additionally, relaxation techniques, mindfulness, or cognitive-behavioral therapy may be helpful in managing pain and addressing any underlying anxiety or stress.

Lastly, if you have not yet done so, discussing the possibility of a referral to a pain specialist or a gastroenterologist with expertise in functional gastrointestinal disorders may be worthwhile. They can offer targeted treatments, including medications that address nerve pain or gastrointestinal motility issues.

In summary, while the absence of a clear diagnosis can be frustrating, persistent abdominal pain can stem from various sources, including functional disorders, musculoskeletal issues, or psychological factors. A comprehensive approach that includes a detailed history, physical examination, and possibly a multidisciplinary evaluation may be necessary to uncover the underlying cause of your symptoms and guide appropriate treatment. Always ensure to communicate openly with your healthcare providers about your concerns and the impact of your symptoms on your daily life.

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