Lower Abdominal Pain: When to See a Urologist?

Lower abdominal tenderness inquiry?

Hello Doctor, in the past week, I have experienced localized tenderness in my lower abdomen.
Initially, it was located about one centimeter to the right of my navel, but later it appeared about eight centimeters to the left of my navel, while the tenderness on the right side has resolved.
The tenderness is only noticeable when pressure is applied, and there is no rebound tenderness.
The area is quite small, and after consulting a gastroenterologist and undergoing an abdominal ultrasound, appendicitis or cecitis has been temporarily ruled out.
The pain does not occur spontaneously unless pressure is applied.
I would like to know if I should be referred to a urologist for further examination.
The reason for considering urology is that the gastroenterologist mentioned that this area is somewhat distant from the abdominal cavity and may be related to the bladder.
However, they suggested monitoring the pain changes over time and only prescribed pain relief medication.
Could this possibly be a case of cystitis or another urological issue? I do not smoke or drink alcohol, and although I occasionally feel discomfort when my bladder is full, I do not have issues with frequent urination or nocturia.
The location of the abdominal pain is roughly as shown in the diagram.
I would appreciate your insights.

Li, 20~29 year old female. Ask Date: 2024/05/28

Dr. Lin Wufu reply Internal Medicine

Hello, bladder inflammation typically presents with urinary tract symptoms.
Your tenderness may also be related to the abdominal wall muscle layer.
It is advisable to observe for two to three days, as it often improves on its own.
When visiting a urologist, a urinalysis will likely be performed.
If there are no signs of inflammation in the urine, it is generally recommended to observe first as well.

Reply Date: 2024/05/28

More Info

Understanding lower abdominal pain can be quite complex, especially when the pain is localized and specific, as you have described. Based on your symptoms, it seems that you have already taken a significant step by consulting a gastroenterologist and undergoing an abdominal ultrasound, which has ruled out appendicitis or other gastrointestinal issues. The fact that your pain is only present upon palpation and does not occur spontaneously is an important detail that can help narrow down the potential causes.

Given the location of your pain, particularly the shift from the right lower quadrant to the left lower quadrant, and the fact that it is tender to touch, there are several possibilities to consider. While your gastroenterologist has suggested that the pain may not be related to gastrointestinal issues, it is indeed plausible that it could be linked to urological conditions, especially since the pain is near the bladder area.

One potential condition to consider is a urinary tract infection (UTI) or bladder inflammation, which can sometimes present with localized pain in the lower abdomen. However, your lack of symptoms such as frequent urination, urgency, or nocturia makes a UTI less likely. Another possibility is interstitial cystitis, a chronic condition that causes bladder pressure and pain, which can sometimes be mistaken for other abdominal issues.

Additionally, musculoskeletal issues should not be overlooked. Given that the pain is only present upon pressure, it could be related to muscle strain or irritation in the abdominal wall or pelvic floor muscles. This is particularly relevant if you have engaged in any physical activities that might have strained these muscles.

Considering your situation, it may be beneficial to follow up with a urologist, especially since your gastroenterologist has indicated that the pain could be related to the bladder. A urologist can perform specific tests, such as urinalysis or cystoscopy, to evaluate the bladder and urinary tract more thoroughly. They can also assess for conditions like prostatitis or other pelvic floor disorders that might not be evident through standard imaging.

In summary, while your current symptoms do not strongly indicate a urological issue, the proximity of the pain to the bladder and the nature of the discomfort warrant further investigation by a urologist. It is essential to keep monitoring your symptoms and communicate any changes to your healthcare provider. If the pain persists or worsens, or if you develop new symptoms, seeking further evaluation sooner rather than later would be advisable.
In the meantime, managing your pain with over-the-counter analgesics, as prescribed, and avoiding activities that exacerbate the discomfort can help. Additionally, maintaining hydration and monitoring for any urinary symptoms can provide useful information for your healthcare team.

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