Right Lower Abdominal Pain: Causes and Solutions - Gastroenterology and Hepatology

Right lower abdominal cramping pain?

Hello, Doctor.
For the past six months, I have been experiencing unexplained cramping pain in my lower right abdomen.
Sometimes it lasts for 1-2 days, and other times up to a week.
Typically, the pain only lasts for 5-10 minutes each day before improving.
I do not have any other sensations, such as colicky pain or a feeling of bloating; it feels more like nerve-related cramping, occurring intermittently, but always in the same spot (slightly off-center in the lower right abdomen).
I have consulted a gynecologist, and after examinations, they found no issues, as the pain does not necessarily coincide with ovulation.
I later visited a gastroenterologist, who conducted a stool occult blood test and an ultrasound, both of which were normal.
An abdominal X-ray showed no obstruction, but there was evidence of fecal impaction.
My bowel habits and stool consistency are normal, and the outpatient physician believes that a colonoscopy is unnecessary.
However, I am still concerned as we have not identified the cause.
Do you have any suggestions? Could this be related to fecal impaction? (I typically have a bowel movement once a day, occasionally every other day.) Is there anything I can try to improve this situation? Thank you for your patient response.

Ms. Lu, 20~29 year old female. Ask Date: 2022/11/10

Dr. Chen Shidian reply Gastroenterology and Hepatology

Apply local heat therapy and stretching, paying attention to posture, while also monitoring changes in symptoms.

Reply Date: 2022/11/10

More Info

Right lower abdominal pain can be a perplexing symptom, especially when it has been ongoing for several months with intermittent episodes of sharp, cramp-like discomfort. Given your detailed description, it seems that you have already taken significant steps to investigate the cause of your pain, including consultations with gynecologists and gastroenterologists, as well as undergoing various diagnostic tests such as ultrasound, X-rays, and stool tests. The fact that these tests have returned normal results is reassuring, but it understandably leaves you searching for answers.

There are several potential causes of right lower abdominal pain that may not have been fully explored yet. While you mentioned that your pain does not feel like typical cramping or bloating, it is still important to consider a few possibilities:
1. Irritable Bowel Syndrome (IBS): This is a common gastrointestinal disorder that can cause intermittent abdominal pain, often relieved by bowel movements. Symptoms can vary widely, and some patients experience pain that feels like nerve pain or cramping without significant changes in bowel habits. Stress and anxiety can exacerbate IBS symptoms, so it might be worth considering if there are any lifestyle factors that could be contributing.

2. Musculoskeletal Issues: Sometimes, abdominal pain can be referred from musculoskeletal sources, such as muscle strain or irritation of the abdominal wall. If you engage in activities that involve heavy lifting or twisting, this could lead to localized pain that mimics internal organ pain.

3. Chronic Constipation: Although you mentioned having regular bowel movements, the presence of "宿便" (stool retention) could still be a contributing factor. Even if you are passing stool daily, if the stool is hard or difficult to pass, it can lead to discomfort and pain in the lower abdomen. Increasing fiber intake, staying hydrated, and possibly using over-the-counter stool softeners or laxatives could help alleviate this issue.

4. Ovarian Cysts or Other Gynecological Issues: Even though you have seen a gynecologist and had normal results, it might be worth revisiting this area, especially if your pain correlates with your menstrual cycle. Conditions like functional ovarian cysts can cause intermittent pain that may not always be detected on imaging.

5. Nerve Entrapment or Neuropathic Pain: Given that you describe the pain as "nerve-like," it is possible that there could be some form of nerve entrapment or irritation in the pelvic region. This could be due to anatomical variations or previous injuries.

6. Psychosomatic Factors: Anxiety and stress can manifest physically, leading to symptoms that may not have an identifiable organic cause. If you are prone to anxiety, it might be beneficial to explore stress management techniques, such as mindfulness, yoga, or cognitive behavioral therapy.

In terms of management, here are some suggestions:
- Dietary Adjustments: Consider keeping a food diary to identify any potential triggers for your pain. Increasing fiber intake through fruits, vegetables, and whole grains can help with bowel regularity and may alleviate discomfort.

- Hydration: Ensure you are drinking enough water throughout the day, as dehydration can contribute to constipation and abdominal discomfort.

- Physical Activity: Regular exercise can help promote healthy digestion and alleviate stress, which may, in turn, reduce your abdominal pain.

- Follow-Up with Specialists: If your symptoms persist, consider seeking a second opinion from a gastroenterologist or a pain specialist who may offer additional insights or treatment options.

- Pain Management: Over-the-counter pain relief, such as NSAIDs, may help during episodes of pain, but it is essential to use them judiciously and consult with your healthcare provider.

In conclusion, while it can be frustrating to experience ongoing abdominal pain without a clear diagnosis, there are multiple avenues to explore. It is crucial to maintain open communication with your healthcare providers and advocate for further evaluation if your symptoms do not improve. Your health and well-being are paramount, and finding the right approach to manage your symptoms is essential.

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