Lower Abdominal Pain: Possible Causes and Next Steps - Internal Medicine

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Lower abdominal pain can be a perplexing symptom, especially when initial evaluations do not yield a clear diagnosis. In your case, where you experienced significant pain on November 4th, underwent various tests including blood work, ultrasound, and a gynecological examination, yet still left without a definitive cause, it is understandable to seek further clarity.

There are several potential causes of lower abdominal pain that may not have been identified during your emergency visit. Given that your menstrual cycle has been regular and there was no abnormal bleeding, we can rule out some gynecological issues, but it is important to consider that conditions can sometimes be intermittent or not easily detectable during a single examination.

1. Gastrointestinal Issues: Conditions such as irritable bowel syndrome (IBS), constipation, or even diverticulitis can cause episodic abdominal pain. Since you mentioned that you did not experience diarrhea, it is possible that a functional gastrointestinal disorder could be at play. If you have a history of constipation, this could also contribute to abdominal discomfort.

2. Musculoskeletal Pain: Sometimes, pain in the lower abdomen can originate from the muscles or ligaments in the abdominal wall. Strain from physical activity or even prolonged sitting can lead to muscle spasms that mimic abdominal pain.

3. Adhesions or Scar Tissue: Given your history of a previous abortion, it is possible that scar tissue or adhesions could develop in the abdominal cavity, which may not always be visible on imaging studies. These can cause intermittent pain, especially if they affect the movement of the intestines.

4. Ovarian Issues: Although your ultrasound was normal, conditions like ovarian cysts can sometimes cause pain that is not always visible on imaging, especially if they are small or resolving.

5. Urinary Tract Issues: Even though your urine tests were normal, conditions like interstitial cystitis or bladder spasms can cause significant discomfort in the lower abdomen.

6. Psychosomatic Factors: Stress and anxiety can manifest as physical symptoms, including abdominal pain. If you have been under stress, it might be worth considering this as a contributing factor.

Given that you have experienced similar pain in the past, it may be beneficial to keep a symptom diary. Documenting when the pain occurs, its intensity, duration, and any associated symptoms (like changes in bowel habits or urinary symptoms) can provide valuable information for your healthcare provider.


Next Steps:
1. Follow-Up with a Specialist: Since your initial evaluations did not yield a diagnosis, consider following up with a gastroenterologist or a gynecologist for further assessment. They may recommend additional tests, such as a colonoscopy or MRI, to evaluate for conditions that were not visible on ultrasound.

2. Consider a Functional Approach: If gastrointestinal issues are suspected, a trial of dietary changes or medications for IBS may be warranted. Keeping a food diary to identify any potential triggers could also be helpful.

3. Pain Management: If the pain recurs, discussing pain management strategies with your doctor may be beneficial. This could include medications, physical therapy, or alternative therapies like acupuncture.

4. Monitor Symptoms: If the pain returns, especially if it is accompanied by other symptoms such as fever, vomiting, or changes in bowel habits, seek medical attention promptly.

In conclusion, while your recent experience was frustrating, it is important to remain proactive in seeking answers. The complexity of abdominal pain often requires a multifaceted approach to diagnosis and treatment. By working closely with your healthcare providers and possibly seeking additional opinions, you can better navigate this challenging symptom.