Left Lower Abdomen Pain: When to See a Specialist - Urology

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It sounds like you are experiencing persistent left lower abdominal pain that has been ongoing for about three months. Given your history of varicocele surgery and the location of your pain, it is important to consider a few potential causes and the appropriate steps to take for further evaluation.

Firstly, the pain you describe, particularly when transitioning from sitting to standing or during certain movements, could be related to several factors. Since you have already consulted with a gastroenterologist and a urologist, and both have ruled out significant issues through examinations like colonoscopy and bladder ultrasound, we can consider other possibilities.

1. Scar Tissue or Adhesions: Given your history of surgery for varicocele, it is possible that scar tissue (adhesions) has formed around the surgical site. Adhesions can sometimes cause pain, especially when certain movements or positions put stress on the area. This is particularly relevant if the pain coincides with the location of your surgical scar.

2. Musculoskeletal Issues: The pain could also be musculoskeletal in nature. Strain or injury to the muscles or ligaments in the abdominal area can lead to pain that is exacerbated by movement. This could be particularly relevant if you have engaged in any activities that might have strained your abdominal muscles.

3. Nerve Entrapment: Sometimes, nerves can become entrapped or irritated due to previous surgeries or other factors, leading to localized pain. This could explain why certain movements trigger your pain.

4. Hernia: Although you have had surgery in the area, it is still possible to develop a hernia, which could cause localized pain. A physical examination by a specialist could help determine if this is a possibility.

Given these considerations, I recommend the following steps:
- Consult a Specialist: Since you have already seen a gastroenterologist and urologist, it may be beneficial to consult with a general surgeon or a specialist in abdominal pain. They can perform a thorough physical examination and assess the surgical site for any signs of complications such as hernias or adhesions.

- Imaging Studies: If the physical examination suggests the possibility of adhesions or other structural issues, your doctor may recommend imaging studies such as an abdominal ultrasound or MRI. These can provide more detailed information about the soft tissues and any potential complications from your previous surgery.

- Physical Therapy: If musculoskeletal issues are suspected, a referral to a physical therapist could be beneficial. They can help you strengthen the surrounding muscles and improve flexibility, which may alleviate some of the pain.

- Pain Management: While you seek a definitive diagnosis, discussing pain management strategies with your healthcare provider may help improve your quality of life. This could include medications, physical therapy, or other modalities.

In conclusion, while your previous evaluations have ruled out some serious conditions, the persistence of your symptoms warrants further investigation. Consulting with a general surgeon or a specialist in abdominal pain, along with appropriate imaging studies, will help clarify the cause of your pain and guide you toward effective treatment options.