Unexplained Abdominal Pain: What Tests to Consider Next?

Abdominal pain with normal test results?

Hello, doctor.
Since November 11, I have been experiencing abdominal pain when bending over, particularly with certain movements that put pressure on my abdomen.
Specifically, I feel a sudden sharp pain on the left side of my abdomen (near the navel) that lasts about one second, and there is a continuous dull pain in my left lower abdomen.
This pain has persisted for three weeks.
During this time, I have seen a gynecologist and undergone ultrasounds of my liver, gallbladder, kidneys, uterus, and ovaries, as well as gastroscopy and colonoscopy, all of which showed no issues.
Now, I also have soreness in my left back, and the pain in my left mid-abdomen is no longer limited to specific movements; sometimes it occurs even when sitting or lying down.
It is not excruciating pain, but I can sense discomfort in my abdomen.
What further examinations can I undergo? Thank you!

Aasta, 20~29 year old female. Ask Date: 2022/12/13

Dr. Yang Zhichao reply Gastroenterology and Hepatology

Hello Ms.
Aasta, based on the symptoms you described, an abdominal ultrasound can be arranged.
Additionally, if there is not much improvement with medication treatment, you should discuss further examinations with your attending physician, and possibly arrange for a CT scan.
Thank you for your inquiry.

Reply Date: 2022/12/13

More Info

Unexplained abdominal pain can be quite distressing, especially when it persists despite undergoing various diagnostic tests. Given your situation, where you've already had ultrasounds of the abdomen and pelvis, as well as endoscopic evaluations (gastroscopy and colonoscopy) without any clear findings, it’s important to consider a few additional steps and tests that might help identify the underlying cause of your symptoms.

Firstly, it’s crucial to understand that abdominal pain can arise from a multitude of sources, including gastrointestinal, musculoskeletal, urological, and even gynecological issues. Since you mentioned that the pain is localized to the left side of your abdomen and sometimes radiates to your back, it could be related to several potential causes.

1. Imaging Studies: If you haven't already, a CT scan of the abdomen and pelvis could be beneficial. This imaging modality provides a more detailed view of the abdominal organs and can help identify issues that may not be visible on ultrasound, such as small abscesses, lymphadenopathy, or even subtle bowel obstructions.
2. MRI: In some cases, an MRI may be warranted, especially if there is a suspicion of soft tissue abnormalities or if the pain is thought to be related to the spine or surrounding structures.

3. Functional Tests: If structural abnormalities are ruled out, consider discussing with your physician the possibility of functional gastrointestinal disorders. Tests such as esophageal manometry or 24-hour pH monitoring can help evaluate for conditions like gastroesophageal reflux disease (GERD) or esophageal motility disorders.
4. Referral to Specialists: Given that you've seen a gynecologist and had relevant imaging, it may be worthwhile to consult a gastroenterologist if you haven't already. They can provide insights into functional gastrointestinal disorders, such as irritable bowel syndrome (IBS), which can cause abdominal pain without identifiable structural issues.
5. Musculoskeletal Evaluation: Since you mentioned that certain movements exacerbate the pain, a referral to a physiatrist or a physical therapist might be beneficial. They can assess for any musculoskeletal causes of pain, such as muscle strain or referred pain from the spine.

6. Pain Management Consultation: If the pain persists and significantly affects your quality of life, a consultation with a pain management specialist may be appropriate. They can offer various treatment modalities, including medications, physical therapy, or interventional procedures.

7. Psychological Evaluation: Lastly, considering your history of anxiety, it may be beneficial to explore whether psychological factors could be contributing to your pain. Chronic pain can sometimes be exacerbated by stress and anxiety, and addressing these issues through therapy or counseling could provide relief.

In summary, while you've already undergone a comprehensive evaluation, further imaging studies like a CT scan, consultations with specialists, and consideration of functional disorders or psychological factors may help uncover the cause of your unexplained abdominal pain. It’s essential to maintain open communication with your healthcare providers and advocate for further testing if your symptoms persist.

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