Right Lower Abdominal Pain: Causes and Next Steps - Gastroenterology and Hepatology

Q: Right Lower Abdominal Pain: Causes and Next Steps

Reply： Hello, <br>1. <br>It may be advisable to perform an abdominal ultrasound to check for any abnormal lesions outside the intestines or to assess if there is abnormal thickening of the intestinal wall. <br>If necessary, a colonoscopy can also be performed to check for mucosal

Right lower abdominal pain?

Hello Doctor: In March of this year, I noticed pain in my lower right abdomen, but it was not significant, so I didn't pay much attention to it.
Recently, over the past month or two, the pain has become more pronounced, with a specific point that hurts.
When I press harder, I can feel a long, strip-like area.
I saw a doctor who ordered a colon X-ray (after bowel preparation), and the report indicated that there were no abnormalities.
However, the doctor noted that the small section in my lower right abdomen was noticeably distended, so they prescribed gastrointestinal medication and advised me not to stress too much.
I used to experience constipation frequently, but my bowel movements have been quite regular over the past year.
Currently, the pain in my lower right abdomen is localized, becoming more noticeable after eating or when I have difficulty with bowel movements.
Sometimes I can feel the pain point when I exert pressure in my abdomen (sometimes I can feel it, sometimes I cannot).
I would like to ask: 1.
Do I need to undergo any additional tests? (Because the medication does not seem to have fully resolved the issue, and I still experience pain at times.) 2.
Why did I not experience pain before, but now I do? 3.
Is the pain caused by irritable bowel syndrome or the distension? 4.
If the pain is due to bowel distension, will it lead to any pathological changes in the future? 5.
What are the causes of bowel distension? Is it possible to recover from it, for example, through exercise and diet? 6.
If it is irritable bowel syndrome, can there be localized pain? I have not seen any improvement from the medication, and I am unsure where to seek further consultation or if I should undergo additional tests, which has left me quite worried.
If this pain continues (it is more of a discomfort rather than severe pain), is it a concern? I hope the doctor can provide some answers.
Thank you.

Dijon, 20~29 year old female. Ask Date: 2004/12/21

Dr. Chen Zhiping reply Gastroenterology and Hepatology

Reply: Hello,
1.
It may be advisable to perform an abdominal ultrasound to check for any abnormal lesions outside the intestines or to assess if there is abnormal thickening of the intestinal wall.
If necessary, a colonoscopy can also be performed to check for mucosal inflammation or lesions.

2.
If bowel movements have improved in recent years but there is now pain, it is important to first rule out organic diseases.
If no issues are found upon examination, it may be attributed to intestinal hypersensitivity.

3.
If there are lesions present, they could be causing pain.
Only after ruling out organic lesions can we consider the possibility of irritable bowel syndrome (IBS).

4.
I do not understand the cause of your abdominal bloating (is it due to abnormal peristalsis?).
As previously mentioned, it is essential to rule out organic lesions first.

5.
If no lesions are found, increasing fiber intake, staying hydrated, exercising, changing lifestyle habits, and avoiding irritating foods may be beneficial.

6.
Typically, symptoms include dull abdominal pain and bloating, but bowel movements usually improve the condition.
For localized pain, it is still necessary to rule out any organic diseases.

Sincerely, Dr.
Chen Zhi-Ping, Internal Medicine.

Reply Date: 2004/12/21

More Info

Right lower abdominal pain can be a complex issue with various potential causes, and it’s important to approach it systematically to determine the underlying problem. Based on your description, it seems that the pain has become more pronounced over the past couple of months, which warrants further investigation.

1. Further Investigations: Since you've already undergone a colon X-ray and your doctor has ruled out any significant masses, it may be beneficial to consider additional tests. A CT scan of the abdomen could provide more detailed images and help identify issues such as appendicitis, diverticulitis, or other gastrointestinal conditions. Additionally, an ultrasound may be useful, especially if there’s a concern about gynecological issues in women. Blood tests, including a complete blood count (CBC) and inflammatory markers, can also help assess for infection or inflammation.

2. Change in Pain Patterns: The change in your pain pattern could be attributed to several factors. It’s possible that changes in your diet, stress levels, or even the development of a new gastrointestinal condition could be contributing to the pain. Sometimes, conditions like irritable bowel syndrome (IBS) can develop or worsen over time, leading to new symptoms.

3. Irritable Bowel Syndrome (IBS) vs. Distension: IBS can indeed cause localized pain, although it is often associated with other symptoms like bloating, gas, and changes in bowel habits. If your pain is related to bowel movements or eating, it could be indicative of IBS. However, if there is significant distension (bloating) in the right lower quadrant, it may suggest that the intestines are distended due to gas or stool buildup, which can also cause discomfort.

4. Long-term Implications of Distension: Chronic distension and pain can lead to complications if not addressed. While distension itself may not directly cause serious disease, it can lead to discomfort and a decreased quality of life. If the underlying cause of the distension is not treated, it could potentially lead to more serious gastrointestinal issues over time.

5. Causes of Distension and Recovery: Distension can be caused by various factors, including dietary choices (high in fiber, lactose intolerance), gastrointestinal motility disorders, or even stress. Recovery is often possible through lifestyle changes, such as adopting a balanced diet, increasing physical activity, and managing stress. Keeping a food diary can help identify triggers that exacerbate your symptoms.

6. Localized Pain with IBS: While IBS typically presents with more diffuse abdominal pain, it can also cause localized discomfort. The key is to identify any patterns associated with your symptoms, such as timing with meals or bowel movements. If your current medications are not providing relief, it may be worth discussing alternative treatments with your healthcare provider, including dietary modifications or different classes of medications.

In conclusion, while your symptoms may not indicate a severe condition, they do require further evaluation to ensure that no underlying issues are being overlooked. It’s essential to maintain open communication with your healthcare provider, discuss your ongoing symptoms, and consider seeking a referral to a gastroenterologist if necessary. Keeping track of your symptoms, dietary habits, and any stressors can also provide valuable information for your healthcare team. Remember, addressing gastrointestinal issues often requires a multifaceted approach, including medical treatment, lifestyle changes, and sometimes psychological support.

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