Lower Abdominal Pain: Is It Menstrual or Uterine Inflammation?

Pain upon palpation in the lower abdomen?

Hello, doctor.
On the night of February 2nd, I experienced a cramping pain in my lower abdomen, which was a sensation I had never felt before.
The pain didn't last long, but it was quite uncomfortable.
On February 3rd, I visited the obstetrics and gynecology department, and during the internal examination, the doctor suggested that it might be uterine inflammation.
I have never had uterine inflammation before.
The doctor mentioned that my late-night sleeping habits might have weakened my immune system, allowing bacteria to reach the uterus.
I was prescribed a seven-day course of antibiotics and a three-day course of suppositories.
I only felt pain on the night of February 2nd, and then my menstrual period started on February 6th.

1.
I would like to ask if the pain I experienced was related to my menstrual period or if it was indeed due to uterine inflammation.

2.
I have a history of needing to get up at night to urinate, and I usually experience frequent urination.
However, recently I haven't needed to get up at night to urinate.
Yesterday, when I pressed on the area just below my navel on the right side, it was painful, and I felt a sensation of needing to urinate, but I didn't really have the urge to go.
Normally, my abdomen doesn't hurt.
Which specialist should I see, gynecology or urology? Do I need any specific tests?
3.
Is it normal for pressing on the abdomen to cause pain?
4.
I had a biliary bypass surgery on October 31st of last year.
Could the pain I felt that day be related to my intestines? Additionally, I had a Pap smear on December 30th of last year, which was normal, and I have annual vaginal ultrasounds, all of which have also been normal.

Wenwen, 40~49 year old female. Ask Date: 2023/03/06

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, it could be related to your upcoming menstruation.
It seems that there are no abnormalities in the gynecological examination.
If you still feel unwell, you may consider consulting a gastroenterologist or a urologist.
Wishing you good health.

Reply Date: 2023/03/06

More Info

Understanding lower abdominal pain can be quite complex, as it can stem from various causes, including menstrual issues, infections, or even gastrointestinal problems. Based on your description, it seems you are experiencing a combination of symptoms that could relate to both menstrual cycles and potential uterine inflammation.

1. Menstrual Pain vs. Uterine Inflammation: The pain you felt on the evening of February 2nd could indeed be related to your menstrual cycle. Many women experience premenstrual syndrome (PMS) or dysmenorrhea, which can manifest as cramping or sharp pain in the lower abdomen. However, since you mentioned that a healthcare provider diagnosed you with possible uterine inflammation, it is essential to consider that as well. Uterine inflammation, or endometritis, can occur due to infections, often exacerbated by factors like poor immune response or stress. The fact that you were prescribed antibiotics suggests that your doctor was concerned about a bacterial infection.

2. Changes in Urination: The change in your urination pattern, where you no longer feel the need to wake up at night to urinate, could be related to several factors. It might indicate a temporary change in your bladder function or could be linked to the inflammation in your uterus. The sensation of needing to urinate without the actual urge could also be a symptom of irritation in the pelvic area, which can happen with inflammation.

3. Pain upon Pressure: Experiencing pain when pressing on your abdomen, particularly in the area just below the navel, is not uncommon. This could be due to localized inflammation or sensitivity in the tissues surrounding the uterus and bladder. It is essential to monitor this symptom, especially if it persists or worsens.

4. Post-Surgical Considerations: Given your history of abdominal surgery, including the biliary bypass, it is crucial to consider that some of your symptoms could be related to post-operative changes. Scar tissue or adhesions from previous surgeries can sometimes lead to discomfort or pain in the abdominal area. If your pain is persistent or if you notice any changes in your bowel habits, it would be wise to consult with a healthcare provider who specializes in gastrointestinal issues.

Next Steps: Given your symptoms, it would be advisable to follow up with both a gynecologist and a urologist. The gynecologist can further evaluate the possibility of uterine inflammation or other gynecological issues, while the urologist can assess any potential urinary tract concerns.
In terms of examinations, you may want to consider:
- A pelvic ultrasound to evaluate the uterus and ovaries for any abnormalities.

- A urinalysis to check for signs of infection or other urinary issues.

- If symptoms persist, further imaging studies, such as a CT scan or MRI, may be warranted to rule out any complications related to your previous surgery.

In conclusion, while your symptoms could be related to your menstrual cycle, the possibility of uterine inflammation and changes in urinary habits necessitates a thorough evaluation. It is essential to communicate openly with your healthcare providers about all your symptoms, including any changes in pain, urination, or bowel habits, to ensure a comprehensive approach to your care.

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