Right Lower Abdominal Pain: Causes and Insights - Gastroenterology and Hepatology

Right lower abdominal pain?

Hello Doctor, I have been experiencing frequent pain in my lower right abdomen recently, and I feel bloated even after eating a small amount.
About a month ago, I sought medical attention for this issue, and at that time, I was diagnosed with a right ovarian cyst (5.5 x 2.5 x 0.5 cm), which was subsequently surgically removed.
Shortly after, the pain in my lower right abdomen returned, especially when riding on the back of a motorcycle or when sitting and then standing up.
I also experience frequent bloating.
I have bowel movements about three times a day, but I sometimes experience constipation as well.
Interestingly, the pain tends to lessen after a bowel movement.
I consulted a gastroenterologist, who, after listening to my symptoms, diagnosed me with irritable bowel syndrome (IBS).
However, even after taking the prescribed medication, I still experience pain.
Two days ago, I went to the emergency room due to severe abdominal pain.
Blood tests came back normal, ruling out appendicitis.
An X-ray revealed a significant amount of gas in the intestines, and a CT scan showed a 15 mm cyst near the original site of the right ovary (I will follow up with gynecology regarding the cyst).
The abdominal X-ray report stated: KUB routine [supine view] showed: No definite radiopaque renal stone.
Some fecal material could be seen.
Narrowing of the sacroiliac joint.
No definite focal mass.
Some bowel loops with gas content in the abdomen.
Calcified density noted in the right pelvis; possibly a phlebolith or lower ureteral stone.
Suggest follow-up.
There are some medical terms I don't understand, so I would appreciate your help.
Currently, the pain in my lower right abdomen persists, and I frequently feel the urge to pass gas.
I would like to know more about the nature of this pain.

Ms. Li, 20~29 year old female. Ask Date: 2024/06/03

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello, the X-ray report indicates that there is a significant amount of intestinal gas, with some parts of the intestines appearing distended and the presence of fecal impaction.
Additionally, there are some calcifications noted in the pelvic cavity, which may be due to vascular wall calcification or lower urinary tract stones.
The discomfort in the lower right abdomen, constipation, fecal impaction, diarrhea, irritable bowel syndrome, and even possible adhesions from previous surgery, as well as issues related to the urinary tract and pelvic cavity, are all potential causes of your discomfort.
It is recommended to consult with a relevant physician to identify the underlying causes.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2024/06/03

More Info

Understanding right lower abdominal pain can be complex, especially when it is accompanied by symptoms such as bloating, changes in bowel habits, and a history of ovarian cysts. Based on the information provided, there are several potential causes and considerations to explore.

Possible Causes of Right Lower Abdominal Pain
1. Ovarian Cyst: You mentioned having a right-sided ovarian cyst that was surgically removed. While the cyst was removed, it is possible that the surrounding tissue may still be sensitive or inflamed. Additionally, new cysts can develop, which could lead to similar pain.

2. Irritable Bowel Syndrome (IBS): The diagnosis of IBS by your gastroenterologist is significant. IBS is a functional gastrointestinal disorder characterized by symptoms such as abdominal pain, bloating, and changes in bowel habits (diarrhea or constipation). The pain often improves after a bowel movement, which aligns with your experience.

3. Gas and Bloating: The X-ray findings indicating gas in the bowel suggest that you may be experiencing excessive gas production or difficulty in gas expulsion. This can lead to distension and discomfort, particularly in the lower abdomen.

4. Pelvic Inflammatory Disease (PID): Although less likely given your recent surgery, PID can cause lower abdominal pain and is often associated with other symptoms such as fever or unusual discharge. If you experience any additional symptoms, this should be ruled out.

5. Musculoskeletal Issues: Pain that worsens with movement, such as getting on and off a motorcycle or standing up from a seated position, could also indicate a musculoskeletal issue. Strain or irritation of the muscles or ligaments in the abdominal area can contribute to pain.

6. Gastrointestinal Conditions: Conditions such as diverticulitis, appendicitis, or even bowel obstructions can cause localized pain. However, your recent imaging studies have ruled out acute conditions like appendicitis.

Insights and Recommendations
Given your symptoms and the results from your recent medical evaluations, here are some insights and recommendations:
- Follow-Up with Gynecology: Since you have a history of ovarian cysts, it is important to follow up with your gynecologist regarding the new cyst noted on the CT scan. They can provide further evaluation and management options.

- Dietary Adjustments: If IBS is indeed the diagnosis, dietary changes may help alleviate symptoms. Consider keeping a food diary to identify any triggers. Common triggers include dairy, gluten, and high-fat foods. Increasing fiber intake gradually can also help with bowel regularity.

- Medication Review: If the medications prescribed for IBS are not providing relief, discuss this with your doctor. There are various treatment options available, including antispasmodics, laxatives, or medications specifically for IBS.

- Physical Activity: Gentle exercise can help with gas and bloating. Activities like walking or yoga may promote bowel motility and reduce discomfort.

- Stress Management: Since IBS can be exacerbated by stress and anxiety, consider incorporating stress-reducing techniques such as mindfulness, meditation, or counseling.

- Monitor Symptoms: Keep track of your symptoms, including the frequency and intensity of pain, bowel habits, and any other associated symptoms. This information can be valuable for your healthcare providers in managing your condition.

Conclusion
Right lower abdominal pain can arise from various causes, and your situation appears to be multifaceted, involving both gastrointestinal and possibly gynecological factors. Continued communication with your healthcare providers, along with lifestyle adjustments, can help manage your symptoms effectively. If your pain worsens or new symptoms arise, seek medical attention promptly.

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