Persistent Right Lower Abdominal Pain: Causes and Next Steps - Gastroenterology and Hepatology

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Right lower abdominal pain?


At the beginning of October, I experienced persistent pain in the lower right abdomen for 3 to 5 days.
The pain worsened when standing or lying down, but then it eased.
Now, if I stand or walk for about ten minutes, the pain returns, but it subsides when I sit down.
In mid-November, I had another episode of severe pain and consulted a gastroenterologist, but they could not determine the cause.
There was no pain upon palpation.
Currently, I only experience pain when standing or walking.
Additionally, I had a similar episode of right lower abdominal pain two years ago and went to the emergency room, where a CT scan did not reveal the cause of the pain.
I am unsure of what to do next; do I still need to undergo a colonoscopy?

Ms. Chen, 20~29 year old female. Ask Date: 2023/11/16

Dr. Lin Minghui reply Gastroenterology and Hepatology


Possible causes of right lower abdominal pain include gastrointestinal, urinary tract, and gynecological issues (such as inflammation or ovulation).
The pain is recurrent, lasting three to five days, and is aggravated by standing or walking, while sitting provides relief.
A CT scan conducted a year ago showed no abnormalities.
Given the frequent right lower abdominal pain or other gastrointestinal symptoms, it is recommended to follow up in an outpatient setting and arrange for appropriate examinations.
Wishing you good health! Dr.
Lin's response!

Reply Date: 2023/11/16

More Info


Persistent right lower abdominal pain can be a complex issue, and understanding its potential causes is crucial for determining the next steps in management. Given your symptoms and history, let's explore some possible reasons for your pain and the appropriate actions you might consider.


Possible Causes of Right Lower Abdominal Pain
1. Appendicitis: This is a common cause of right lower abdominal pain, especially if the pain is acute and associated with nausea or fever. However, since you mentioned that pressing on the area does not elicit pain, this may be less likely.

2. Gastrointestinal Issues: Conditions such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or diverticulitis can cause intermittent pain. Since your pain seems to be related to standing or walking, it might suggest a functional gastrointestinal issue rather than an acute inflammatory process.

3. Musculoskeletal Pain: Given that your pain worsens with certain positions (standing or walking) and improves when sitting, it may be related to musculoskeletal issues, such as muscle strain or ligamentous pain in the abdominal wall.

4. Urological Issues: Kidney stones or urinary tract infections can also present with lower abdominal pain, particularly if the pain radiates to the back or groin. However, the absence of urinary symptoms makes this less likely.

5. Gynecological Issues: In females, conditions such as ovarian cysts, ectopic pregnancy, or pelvic inflammatory disease can cause right lower abdominal pain. If you are female and sexually active, this should be considered, and a gynecological evaluation may be warranted.

6. Hernias: An inguinal or femoral hernia could also present with localized pain, especially with certain movements or positions.


Next Steps
Given that you have experienced recurrent episodes of pain and previous imaging (CT scan) did not reveal any abnormalities, it may be beneficial to pursue further evaluation. Here are some recommendations:
1. Consult a Gastroenterologist: Since you have already seen a hepatobiliary gastroenterologist, consider asking for a referral to a gastroenterologist who specializes in functional gastrointestinal disorders. They may suggest further testing, such as a colonoscopy, especially if there are concerns about inflammatory bowel disease or other gastrointestinal pathologies.

2. Consider Imaging Studies: If your symptoms persist or worsen, a repeat CT scan or an abdominal ultrasound might be helpful to rule out any structural abnormalities that were not previously detected.
3. Physical Examination: A thorough physical examination by a healthcare provider can help identify any musculoskeletal issues. They may assess for tenderness, range of motion, and any signs of hernias.

4. Pain Management: While awaiting further evaluation, consider discussing pain management strategies with your healthcare provider. This may include over-the-counter pain relievers or physical therapy to strengthen the abdominal muscles and improve posture.

5. Monitor Symptoms: Keep a detailed diary of your symptoms, noting when they occur, their intensity, and any associated activities. This information can be invaluable for your healthcare provider in diagnosing the issue.

6. Lifestyle Modifications: If certain activities exacerbate your pain, consider modifying those activities. For example, if standing for long periods triggers your pain, try to incorporate more sitting breaks or use supportive footwear.


Conclusion
Persistent right lower abdominal pain can stem from various causes, and a comprehensive approach is necessary to identify the underlying issue. Given your history and the nature of your symptoms, further evaluation is warranted. Collaborate closely with your healthcare provider to explore these options and ensure that you receive appropriate care tailored to your specific situation. Remember, early intervention can often lead to better outcomes, so do not hesitate to seek further medical advice.

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