Abdominal Pain: Possible Causes and Next Steps

Pain in the lower abdomen may be associated with a mass or tumor?

Hello, doctor.
Over the past two weeks, I have experienced lower abdominal pain, initially accompanied by bruising, which has since resolved.
Upon palpation, I can feel two lumps, each less than 1 cm in size.
They are tender to the touch, and when not pressed, I feel a foreign body sensation around them, similar to mild inflammatory pain.
Interestingly, the location of the pain has been changing; sometimes it is in the lower abdomen, and other times it is in the flanks, accompanied by an indescribable sensation of discomfort.
When I press on the pain points, I feel a sensation of inflammation and swelling.

I visited a general surgery clinic where an X-ray indicated the presence of a lipoma, and the pain might be due to a strain.
I was prescribed anti-inflammatory medication and muscle relaxants, but there has been no improvement.
I then went to an internal medicine clinic, where the doctor performed an abdominal ultrasound, which appeared normal, but a 1.6 cm gallstone was detected, which was deemed not to be a concern.
I was given medication for bloating.
Could you please advise what might be causing my symptoms? Is it common for a lipoma to cause tenderness upon palpation? What tests should I undergo, or which specialty should I consult to determine the cause of my pain? Thank you, doctor.

W, 30~39 year old female. Ask Date: 2023/04/28

Dr. Chen Bingze reply Surgery

In fact, X-rays are generally unable to determine the nature of the gallstone; a biopsy may be necessary for further analysis.
If gallstones are present, it is important to consider the possibility of inflammation.
If there is cholecystitis, it can also lead to abdominal discomfort, although it is less likely to cause lower abdominal pain.

Reply Date: 2023/04/28

More Info

Understanding abdominal pain can be quite complex, as it can stem from a variety of causes, ranging from benign to serious conditions. Based on your description, it seems you are experiencing a combination of abdominal pain, localized tenderness, and a sensation of pressure or discomfort that changes location. Let's break down the potential causes and the next steps you might consider.

Possible Causes of Your Symptoms
1. Fatty Tumors (Lipomas): You mentioned that an X-ray indicated a fatty tumor. Lipomas are generally benign and can sometimes cause discomfort if they press against surrounding tissues or nerves. While they are usually painless, some individuals report tenderness, especially if the lipoma is located near a nerve or muscle.

2. Gallstones: The ultrasound revealed a 1.6 cm gallstone, which is typically asymptomatic. However, if it obstructs the bile duct, it can lead to biliary colic, presenting as severe abdominal pain, especially in the upper right quadrant. The fact that your pain is fluctuating might suggest that the gallstone is not currently causing an obstruction but could be a contributing factor if symptoms worsen.

3. Muscle Strain or Injury: Given that you have been prescribed muscle relaxants and anti-inflammatory medication, it is possible that your pain is related to a muscle strain or injury. This could explain the tenderness and the sensation of pain that varies in location, especially if you have engaged in activities that strain your abdominal or back muscles.

4. Inflammatory Conditions: Conditions such as appendicitis, diverticulitis, or even pelvic inflammatory disease (in females) can cause abdominal pain and tenderness. However, these typically present with more severe symptoms and would likely have been identified during your evaluations.

5. Gastrointestinal Issues: Problems such as irritable bowel syndrome (IBS), gastritis, or even peptic ulcers can lead to abdominal discomfort and may cause referred pain to the back or sides. The medication for gas you received suggests that your doctor is considering gastrointestinal causes.

6. Psychosomatic Factors: Anxiety and stress can manifest as physical symptoms, including abdominal pain. If you have a history of anxiety, it may exacerbate your perception of pain or discomfort.

Next Steps for Diagnosis and Management
1. Follow-Up with a Specialist: Given the complexity of your symptoms, it may be beneficial to consult a gastroenterologist. They can perform more specialized tests, such as a CT scan or an MRI, to get a clearer picture of your abdominal organs and any potential issues that may not have been visible on previous imaging.

2. Consider a Pain Management Specialist: If the pain persists and is affecting your quality of life, a pain management specialist can help you explore options for managing chronic pain, including physical therapy, medication adjustments, or alternative therapies.

3. Monitor Symptoms: Keep a detailed diary of your symptoms, noting when the pain occurs, its intensity, and any associated factors (like diet, stress levels, or physical activity). This information can be invaluable for your healthcare provider in diagnosing the issue.

4. Lifestyle Modifications: Consider dietary changes, stress management techniques, and gentle exercises to help alleviate symptoms. Sometimes, simple changes can lead to significant improvements in gastrointestinal and muscular discomfort.

5. Further Testing: If the pain continues or worsens, further testing such as endoscopy or colonoscopy may be warranted to rule out any underlying gastrointestinal conditions.

Conclusion
While your symptoms may be related to benign conditions such as a fatty tumor or muscle strain, it is essential to continue working with your healthcare providers to rule out more serious issues. The fluctuating nature of your pain and the associated symptoms warrant thorough investigation. By following up with the appropriate specialists and monitoring your symptoms closely, you can work towards finding a definitive diagnosis and effective treatment plan. Remember, persistent pain should never be ignored, and seeking further evaluation is always a prudent choice.

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