Chronic Lower Abdominal Pain: Possible Causes and Concerns

Lower abdominal pain for two months?

Hello Dr.
Tsao, I started experiencing bloating in my lower abdomen (which causes pain) at the beginning of January this year.
I consulted a gastroenterologist and was prescribed medication.
There were times when my symptoms improved (around 1-2 weeks), but I still occasionally feel gastrointestinal discomfort.
In early February, I visited a gynecologist who performed a pelvic exam and a transvaginal ultrasound, indicating that there were no issues.
However, recently, the gastrointestinal discomfort has been recurring, and I even feel some swelling in the perineal area and slight urinary frequency.
I also experience sensations similar to round ligament pain during pregnancy and abdominal movements (similar to fetal movement).
These symptoms do not occur daily, but their frequency is quite high.
Because the symptoms resemble those I experienced during pregnancy, I took a home pregnancy test, which showed a very faint second line.
However, I should not be pregnant, as it has been nearly six months since my last sexual intercourse (and I used a condom), and my menstrual cycle has been regular.
I would like to ask the doctor if it is possible to have gastrointestinal discomfort while also having an ovarian or uterine tumor that could be missed on a transvaginal ultrasound.
If a transvaginal ultrasound was performed and nothing was found, can I be reassured that there are no gynecological tumors? Yesterday, I visited another gynecology clinic, and during the pelvic exam, I experienced pain.
The doctor immediately diagnosed it as pelvic inflammatory disease (PID) without performing an ultrasound, and I did not have the opportunity to discuss my previous symptoms.
I would like to ask Dr.
Tsao if chronic pelvic inflammatory disease can occur without discharge, fever, or elevated white blood cell count (I have symptoms similar to PID, but I do not have the aforementioned three conditions).
Thank you, Dr.
Tsao, for taking the time to review and respond to my questions.

hen dan xin, 30~39 year old female. Ask Date: 2023/03/07

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, it seems that there are no major issues in obstetrics and gynecology.
It could possibly be chronic pelvic inflammatory disease.
You can start treatment to see if there is any improvement; if not, it may still be a gastrointestinal issue.
Wishing you good health.

Reply Date: 2023/03/07

More Info

Chronic lower abdominal pain can be a complex issue with a variety of potential causes, and your symptoms suggest that there may be multiple factors at play. It's important to understand that while some conditions can be diagnosed through imaging and physical examinations, others may require more nuanced approaches to identify.

Possible Causes of Chronic Lower Abdominal Pain
1. Gastrointestinal Disorders: Conditions such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or even functional dyspepsia can lead to chronic abdominal discomfort. Symptoms like bloating and pain can often be linked to dietary factors or stress.

2. Gynecological Issues: Since you mentioned having undergone a pelvic ultrasound and a gynecological examination, it’s reassuring that no immediate issues were found. However, conditions like endometriosis or ovarian cysts can sometimes be elusive on imaging studies. These conditions can cause cyclical pain or discomfort that may mimic gastrointestinal symptoms.

3. Pelvic Inflammatory Disease (PID): This is an infection of the female reproductive organs that can occur without the classic symptoms of fever or abnormal discharge. Chronic PID can lead to scarring and chronic pain, and it is possible to have PID with normal white blood cell counts and without fever.

4. Musculoskeletal Issues: Sometimes, pain in the lower abdomen can stem from musculoskeletal problems, such as pelvic floor dysfunction or muscle strain. This could explain the pain during certain movements or positions.

5. Psychosomatic Factors: Anxiety and stress can exacerbate physical symptoms, leading to a cycle of discomfort. Chronic pain can also lead to increased anxiety, creating a feedback loop that can be difficult to break.

Diagnostic Considerations
Given your symptoms and the fact that you have already undergone several tests, it may be beneficial to consider the following:
- Further Imaging: If there is a suspicion of endometriosis or other gynecological issues that may not have been visible on the initial ultrasound, a pelvic MRI could provide more detailed information.

- Laparoscopy: In some cases, a minimally invasive surgical procedure may be necessary to directly visualize the pelvic organs and diagnose conditions like endometriosis.

- Gastroenterology Referral: If gastrointestinal symptoms persist, a referral to a gastroenterologist for further evaluation, including possible endoscopy or colonoscopy, may be warranted.

- Pain Management and Physical Therapy: Engaging in physical therapy focused on the pelvic floor may help alleviate some of the discomfort, especially if there is a musculoskeletal component.

Conclusion
While it is understandable to be concerned about the possibility of undiagnosed conditions, the fact that you have undergone multiple evaluations and imaging studies is a positive step. If your symptoms persist or worsen, it is crucial to continue advocating for your health by seeking further evaluations and possibly exploring multidisciplinary approaches that include both gynecological and gastrointestinal specialists.
In summary, chronic lower abdominal pain can arise from a variety of sources, and while some conditions may be ruled out through imaging and exams, others may require more in-depth investigation. Keeping a detailed symptom diary, including any triggers or patterns, can also be helpful for your healthcare providers in diagnosing and managing your condition effectively.

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