Right Lower Abdominal Pain: Possible Causes and Concerns

Dull pain in the lower right abdomen?

Hello, doctor.
I've been experiencing pain in my lower right abdomen for about six months now, and during the pain, my right leg also feels numb.
My bowel movements are normal, and my menstrual cycle is regular.
I have itching in the genital area, especially during my period when the symptoms are more pronounced.
I previously visited a gynecologist who diagnosed me with pelvic inflammatory disease.
Today, I went to another gynecologist, Dr.
Ma Da-Hsun, who performed an ultrasound and said, "Everything is normal!" Since pelvic inflammatory disease is usually associated with sexual activity, is it possible that a bacterial infection in the genital area could lead to pelvic inflammatory disease? Is there any validity to this claim?

Haha, 20~29 year old female. Ask Date: 2004/12/12

Dr. Li Guanghan reply Obstetrics and Gynecology

Pelvic inflammatory disease (PID) causes pain in the entire lower abdomen, typically not just on one side.
There is often an increase in vaginal discharge that may have an unpleasant odor, and in severe cases, fever may occur.
What you described does not closely resemble PID.
PID is usually caused by an ascending infection from vaginitis and is more likely to occur in individuals who are sexually active.
You should consider seeing an internist (gastroenterologist).
Dr.
Cheng Jin-He from Hsinchu City Hospital, Department of Obstetrics and Gynecology.

Reply Date: 2004/12/12

More Info

Understanding right lower abdominal pain can be complex, especially when symptoms persist over an extended period, as in your case. Given that you have been experiencing this pain for about six months, along with associated symptoms such as tingling in your right leg and increased discomfort during your menstrual cycle, it is essential to consider various potential causes and their implications.

Possible Causes of Right Lower Abdominal Pain
1. Pelvic Inflammatory Disease (PID): As you mentioned, a previous diagnosis of pelvic inflammatory disease could be relevant. PID is an infection of the female reproductive organs, often caused by sexually transmitted infections (STIs) like chlamydia or gonorrhea. It can lead to chronic pain if not treated adequately. Symptoms can include lower abdominal pain, abnormal vaginal discharge, and pain during intercourse.

2. Ovarian Issues: Conditions such as ovarian cysts or ovarian torsion can cause significant pain in the lower abdomen. Cysts can be asymptomatic or cause discomfort, especially if they rupture. An ultrasound can help identify these issues, but if your recent ultrasound showed normal results, this may be less likely.

3. Endometriosis: This condition occurs when tissue similar to the lining inside the uterus grows outside it, often affecting the ovaries, fallopian tubes, and the tissue lining the pelvis. It can cause severe pain, especially during menstruation, and may lead to chronic pelvic pain.

4. Irritable Bowel Syndrome (IBS): IBS can cause abdominal pain, bloating, and changes in bowel habits. While you mentioned that your bowel movements are normal, IBS can still be a consideration, especially if the pain is associated with stress or dietary changes.

5. Musculoskeletal Issues: Sometimes, pain in the lower abdomen can be referred from musculoskeletal problems, such as a strained muscle or ligament in the pelvic area. This could explain the tingling sensation in your leg if there is nerve involvement.

6. Urinary Tract Infections (UTIs): Although UTIs typically present with urinary symptoms, they can sometimes cause lower abdominal pain. If there is any suspicion of a UTI, a urinalysis could be beneficial.

Concerns Regarding Bacterial Infections
You raised a valid concern about bacterial infections potentially leading to pelvic inflammatory disease. Indeed, bacterial infections can occur in the vaginal area and may ascend to the reproductive organs, particularly if there is a history of unprotected sexual activity. It is crucial to practice safe sex to minimize the risk of STIs, which can lead to PID and other complications.

Recommendations
1. Follow-Up with a Specialist: Since your ultrasound results were normal, it may be beneficial to follow up with a gynecologist or a specialist in pelvic pain. They may recommend further testing, such as laparoscopy, to investigate conditions like endometriosis.

2. Consider STI Testing: If you have not already done so, consider getting tested for STIs, as this could provide clarity on whether an infection is contributing to your symptoms.

3. Pain Management: Discuss pain management strategies with your healthcare provider. This may include medications, physical therapy, or lifestyle modifications.

4. Monitor Symptoms: Keep a detailed record of your symptoms, including their frequency, intensity, and any associated factors (like menstrual cycle changes). This information can be invaluable for your healthcare provider in diagnosing the issue.

5. Lifestyle Modifications: Stress management techniques, dietary adjustments, and regular exercise can also help alleviate some symptoms associated with pelvic pain.

In conclusion, while there are several potential causes for your right lower abdominal pain, a thorough evaluation by a healthcare professional is essential to determine the underlying issue and appropriate treatment. Your proactive approach to seeking medical advice is commendable, and continuing to advocate for your health will be crucial in finding a resolution.

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