Left Lower Abdominal Pain: Causes and Specialist Consultations

Possible causes of left lower abdominal pain and recommended medical specialties for consultation?

Hello, doctor.
Since I was young, I have had a hard lump about the size of a fingertip in my left lower abdomen that hurts when pressed.
I also feel a dull pain when my menstrual period comes.
Recently, I occasionally experience sharp pains, and when lying flat, I can still feel the hard lump.
In the last few instances, pressing on it has caused me to pass gas continuously.
I had an ultrasound at an obstetrics and gynecology clinic at the end of last year, and there were no foreign objects found.
I then visited a general surgeon; initially, an older doctor at a clinic examined me.
After listening to my description, he suspected it was a hernia and performed a physical examination.
I cried out in pain when he pressed on it (the pain lingered until the next day).
The doctor mentioned there was a small hole, but it wasn't too serious.
Later, I went to a larger hospital for a general surgery consultation, described my clinic visit, and after a young doctor examined me, he arranged for a CT scan but mentioned that not all hernias can be detected.
I thought it was fine to check anyway.
The report came back, and the doctor said there was no hernia, but he didn't know the source of the pain from the hard lump.
Unsure of what to do, I left it alone.
Recently, I was experiencing issues with menstrual blood clots not clearing properly and consulted a traditional Chinese medicine doctor (last year, during a non-menstrual period, I coughed violently and suddenly expelled three large blood clots the size of ten-dollar coins).
I described the pain in my left lower abdomen to the doctor, who examined me and said that the hard lump was the inguinal ligament and advised me to apply acupressure or heat to that area.

I would like to ask the doctor why the inguinal ligament would be hard and painful when pressed, and if pressing on it could stimulate gas release? I do not have this issue on the right side and have always felt that I might have something wrong.
Despite the examinations yielding no results, hearing that it might be a ligament is surprising and raises doubts.
Regarding the situation described, do you think a hernia is possible? Is it true that a CT scan cannot definitively show whether a hernia is present? Since the doctor at the clinic was an experienced older physician who confidently diagnosed a hernia based on physical examination, and because the problems and discomfort have persisted, I am unsure how to view my body's issues.
Should I consult another specialty for further examination? Thank you for your assistance.

Wu, 30~39 year old female. Ask Date: 2023/11/22

Dr. Xu Kaixi reply Surgery

Based on your description, the symptoms in the groin have led to suspicions of an inguinal hernia after evaluations by different physicians and examinations, including a detailed CT scan, which ultimately did not yield a definitive diagnosis.
Physical examination alone cannot confirm the presence of a hernia, but the CT scan does not rule out the possibility of an early hernia, so the possibility of a hernia cannot be excluded at this time.
Theoretically, if it is an inguinal hernia, it occurs due to a defect in the abdominal wall, which may be congenital or acquired.
If this defect is not surgically repaired, it will not heal on its own and will become more pronounced over time.
It is advisable to visit different surgical outpatient clinics at major hospitals to seek further evaluations and opinions from other physicians, as well as additional examinations.

Reply Date: 2023/11/22

More Info

Understanding left lower abdominal pain can be quite complex, especially when previous examinations have not yielded a definitive diagnosis. Based on your description, it seems you have been experiencing a persistent hard lump in your left lower abdomen, which is painful upon pressure, particularly during menstruation. You have also noted that this area can sometimes cause gas to be expelled when pressed.
The differential diagnosis for left lower abdominal pain can include a variety of conditions, such as hernias, gastrointestinal issues, gynecological problems, or even musculoskeletal pain. Given that you have already undergone imaging studies like ultrasound and CT scans, which reportedly did not show any hernia, it’s essential to consider other potential causes.

Possible Causes of Your Symptoms
1. Inguinal Ligament and Musculoskeletal Issues: The inguinal ligament runs from the pubic bone to the iliac crest and can sometimes become tense or inflamed, leading to localized pain. This could explain the hardness you feel and the pain upon pressure. Musculoskeletal pain can also mimic other conditions, and it may be exacerbated by certain movements or positions.

2. Hernia: While the CT scan did not reveal a hernia, it is important to note that not all hernias are visible on imaging. Some may be small or occur in areas that are difficult to visualize. A physical examination by an experienced clinician can sometimes detect subtle signs of a hernia that imaging might miss.

3. Gastrointestinal Issues: Conditions such as diverticulitis, irritable bowel syndrome (IBS), or even localized inflammation of the intestines could cause similar symptoms. The fact that pressing on the area sometimes leads to gas expulsion may suggest some gastrointestinal involvement.

4. Gynecological Concerns: Given your history of menstrual-related pain, conditions such as endometriosis or ovarian cysts should also be considered. These conditions can cause localized pain and may not always be visible on imaging unless they are significant in size.

5. Nerve Entrapment or Neuromuscular Issues: Sometimes, nerve entrapment in the abdominal wall can lead to pain and discomfort, which may be exacerbated by pressure or certain movements.

Next Steps
Given the complexity of your symptoms and the inconclusive results from previous examinations, it may be beneficial to pursue further evaluation. Here are some recommendations:
1. Consult a Specialist: Since you have already seen general surgeons and gynecologists, consider consulting a gastroenterologist for a more in-depth evaluation of potential gastrointestinal issues. They may recommend further tests, such as a colonoscopy or specialized imaging studies.

2. Physical Therapy: If musculoskeletal issues are suspected, a referral to a physical therapist could help. They can assess your posture, movement patterns, and provide exercises to strengthen the abdominal area and alleviate pain.

3. Pain Management: If the pain is significantly affecting your quality of life, discussing pain management options with your healthcare provider may be beneficial. This could include medications, physical therapy, or alternative therapies such as acupuncture.

4. Follow-Up Imaging: If symptoms persist or worsen, consider discussing the possibility of repeat imaging or more advanced imaging techniques, such as MRI, which may provide additional insights.

5. Monitor Symptoms: Keep a detailed record of your symptoms, including when they occur, their intensity, and any associated factors (like diet or activity level). This information can be invaluable for your healthcare provider in determining the next steps.

Conclusion
Your concerns about the potential for a hernia or other underlying issues are valid, especially given the persistent nature of your symptoms. While CT scans are generally reliable, they are not infallible, and clinical judgment based on physical examination remains crucial. Engaging in open dialogue with your healthcare providers about your symptoms and concerns will be key in navigating this complex situation. It’s important to advocate for your health and seek further evaluations until you find a satisfactory explanation for your symptoms.

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