Persistent Pain After Suspected Muscle Strain in the Abdomen

Suspected muscle strain in the lower right abdomen, with pain radiating to multiple areas?

Initially, I experienced a small pain in the lower right abdomen (approximately 5-6 cm above the pubic area on the right side) during the Spring Festival.
However, after the festival, the pain continued to expand.
I first visited a gastroenterologist and underwent an X-ray, where the doctor noted some dark spots in the intestines, attributing them to gas, which is a normal finding.
No significant abnormalities were detected in other organs, and it was suggested that the pain might be muscular in origin.
The following day, I consulted a rehabilitation specialist who also diagnosed it as a muscle strain and prescribed anti-inflammatory and muscle relaxant medications.
Although the symptoms slightly improved the next day, by the afternoon, I felt increasingly uncomfortable, and by the second day, the pain was so severe that I could not get out of bed.
After three days of rest, I visited another rehabilitation clinic where an ultrasound was performed, revealing no muscle injury.
Currently, while the pain persists, it hampers my mobility.
It tends to ease slightly around noon but is particularly bothersome in the early morning and evening.
Additionally, during meals, gastric motility causes soreness and sharp pain in the surrounding areas.
I am uncertain whether this condition is still related to the muscle strain or if further investigation is warranted.

27-year-old male with abdominal pain issues., 20~29 year old female. Ask Date: 2023/02/07

Dr. Lin Minghui reply Gastroenterology and Hepatology

Muscle strains can sometimes lead to difficulty in movement.
Discomfort may occur in the early morning and evening, with gastric motility triggering soreness in nearby areas.
The pain from a muscle strain can take some time to alleviate, and there are many potential causes of abdominal pain, including muscular, neurological, and visceral factors.
It is advisable to undergo clinical follow-up assessment for abdominal pain, and a physician should evaluate whether further examination is necessary.
Wishing you good health!

Reply Date: 2023/02/07

More Info

Persistent abdominal pain, especially after suspected muscle strain, can be quite distressing and warrants careful evaluation. Based on your description, it seems that your pain initially localized in the right lower abdomen has expanded and persisted despite medical evaluations and treatments. This situation raises several considerations regarding the underlying causes of your symptoms and the appropriate next steps for management.

Firstly, it is essential to understand that abdominal pain can arise from various sources, including gastrointestinal, musculoskeletal, and even referred pain from other organs. In your case, the initial assessment by the gastroenterologist, which included an X-ray, indicated that there were no significant abnormalities in the gastrointestinal tract, and the presence of gas was deemed normal. This suggests that the pain may not be primarily gastrointestinal in nature.

The subsequent evaluation by the rehabilitation specialist, who suspected a muscle strain, aligns with your symptoms. Muscle strains can indeed cause localized pain, and inflammation can lead to discomfort that may worsen with movement or certain activities. However, the persistence and worsening of your pain, especially to the point of being unable to rise from bed, is concerning and suggests that there may be more than just a simple muscle strain at play.

The fact that your pain fluctuates throughout the day, being more intense in the morning and evening, and is exacerbated by activities such as eating, could indicate that there is an underlying issue that needs further investigation. For instance, conditions such as hernias, abdominal wall syndromes, or even issues related to the internal organs (like appendicitis or gynecological conditions in females) could present with similar symptoms.
Given that ultrasound did not reveal any muscle injury, it may be prudent to consider further imaging studies, such as an MRI or CT scan, which can provide a more comprehensive view of the abdominal structures, including muscles, organs, and any potential hernias or other abnormalities that might not be visible on ultrasound or X-ray.

Additionally, the presence of symptoms like difficulty moving, significant pain, and the impact on your daily activities suggests that a multidisciplinary approach may be beneficial. This could involve consulting with a pain management specialist, physical therapist, or even a surgeon if a surgical issue is suspected.

In summary, while muscle strain is a plausible explanation for your initial symptoms, the persistence and nature of your pain indicate that further evaluation is necessary. It is advisable to follow up with your healthcare provider to discuss the possibility of additional imaging studies and to explore other potential causes of your symptoms. Early intervention can be crucial in managing pain effectively and preventing further complications.

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