Chronic Lower Abdominal Discomfort: Possible Causes and Solutions

Persistent discomfort below the navel?

Hello Doctor: I have gastroesophageal reflux disease and have been under treatment with medication for over a year, primarily using traditional Chinese medicine.
My TCM physician mentioned that I have signs of gastritis, as I experience sharp or dull pain in various areas, but I do not have tenderness upon palpation (although it has improved recently).
However, I often feel a sense of heaviness in my lower abdomen (just below the navel) that can last for a long time; it does not occur every day, but sometimes it can persist for an entire day or several days of discomfort.
This feeling of heaviness has been present for over six months but less than a year.
At the end of last year, I visited a gynecologist due to pubic bone pain and underwent an abdominal ultrasound, which showed no issues (but I did not mention the heaviness at that time).
Earlier last year, I had a comprehensive health check-up, including blood tests for cancer, and both ovarian cancer and colorectal cancer results were normal.
Four to five years ago, I was diagnosed with irritable bowel syndrome due to excessive stress, but I am unsure if I still have it now, as I currently have a persistent urge to pass gas, and I experience significant bloating on the right side of my abdomen, along with occasional pellet-like stools.
I would like to inquire about what could be causing this prolonged heaviness in my abdomen.

ra, 20~29 year old female. Ask Date: 2023/07/26

Dr. Chen Shidian reply Gastroenterology and Hepatology

If the fecal occult blood test is normal, it is still possible to have irritable bowel syndrome (IBS).
Medical consultation and adjustments to lifestyle and dietary habits may be necessary.

Reply Date: 2023/07/26

More Info

Chronic lower abdominal discomfort can be quite challenging to diagnose and manage, especially when the symptoms are vague and intermittent. Based on your description, it seems you have been dealing with this discomfort for quite some time, and it is understandable that you are seeking clarity on the potential causes and solutions.

Possible Causes
1. Gastroesophageal Reflux Disease (GERD): Since you have a history of GERD, it is possible that the discomfort in your lower abdomen could be related to gastrointestinal issues stemming from acid reflux. GERD can lead to inflammation in the gastrointestinal tract, which may contribute to sensations of discomfort or pain.

2. Irritable Bowel Syndrome (IBS): Your previous diagnosis of IBS could still be relevant. IBS is characterized by abdominal pain, bloating, and changes in bowel habits, such as diarrhea or constipation. The sensation of needing to pass gas frequently and experiencing "sheep-like" stools can also be indicative of IBS.

3. Gastroenteritis or Inflammation: Your mention of gastrointestinal inflammation aligns with the possibility of chronic gastritis or enteritis. This inflammation can cause discomfort and may not always present with severe symptoms, making it easy to overlook.

4. Pelvic Floor Dysfunction: Given your history of pelvic pain and the fact that you have undergone imaging studies that ruled out significant pathology, pelvic floor dysfunction could be a contributing factor. This condition can lead to a sensation of heaviness or discomfort in the lower abdomen.

5. Psychosomatic Factors: Anxiety and stress can manifest physically, leading to gastrointestinal symptoms. If you have a history of anxiety, it may be worthwhile to consider how your mental health could be impacting your physical symptoms.

6. Hormonal Changes: If you are a woman, hormonal fluctuations related to your menstrual cycle could also contribute to abdominal discomfort. Conditions like endometriosis or fibroids can cause chronic pain, although your ultrasound ruled out significant findings.

Recommended Solutions
1. Dietary Modifications: Consider keeping a food diary to identify any potential triggers for your symptoms. A diet low in FODMAPs may help alleviate symptoms associated with IBS. Additionally, avoiding spicy, fatty, or acidic foods can help manage GERD.

2. Medication Review: Since you are currently on medication for GERD, it may be beneficial to discuss with your healthcare provider whether adjustments are needed. Sometimes, a combination of medications may be necessary to manage symptoms effectively.

3. Stress Management: Engaging in stress-reducing activities such as yoga, meditation, or cognitive-behavioral therapy can help alleviate symptoms related to anxiety and IBS.

4. Follow-Up with Specialists: Given your complex history, it may be beneficial to follow up with a gastroenterologist for further evaluation. They may recommend additional tests, such as a colonoscopy or endoscopy, to rule out any underlying conditions that may not have been detected previously.

5. Physical Therapy: If pelvic floor dysfunction is suspected, pelvic floor physical therapy can be an effective treatment option. A specialized therapist can help you learn exercises to strengthen and relax the pelvic floor muscles.

6. Regular Monitoring: Since you have already undergone extensive testing, it is essential to maintain regular check-ups with your healthcare provider to monitor your symptoms and adjust treatment as necessary.

In conclusion, chronic lower abdominal discomfort can arise from a variety of causes, and it often requires a multifaceted approach to management. By addressing dietary habits, medication, stress levels, and seeking appropriate specialist care, you can work towards alleviating your symptoms and improving your quality of life. Always consult with your healthcare provider before making any changes to your treatment plan.

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