Chronic Left Lower Abdominal Pain: Causes and Solutions - Gastroenterology and Hepatology

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Chronic left lower abdominal pain can be a perplexing issue, especially when it persists for an extended period, as in your case of four years. Given that you've already consulted various specialists, including gastroenterologists, gynecologists, orthopedists, and urologists, and have undergone multiple diagnostic tests such as colonoscopy and gastroscopy without revealing any significant abnormalities, it’s essential to consider a few potential causes and management strategies.


Possible Causes
1. Irritable Bowel Syndrome (IBS): One common cause of chronic abdominal pain, particularly in the lower quadrants, is IBS. This functional gastrointestinal disorder can lead to symptoms such as bloating, gas, and abdominal pain that may fluctuate with dietary habits or stress levels. Since you mentioned experiencing bloating and pain, this could be a potential diagnosis.

2. Chronic Constipation: The presence of "宿便" (stool retention) and bloating suggests that chronic constipation might be contributing to your discomfort. Even with medications aimed at alleviating constipation, some individuals may not experience complete relief, indicating that dietary changes or additional treatments may be necessary.

3. Pelvic Floor Dysfunction: This condition can lead to chronic pain and discomfort in the lower abdomen and may not always be diagnosed through standard imaging or endoscopic procedures. It involves the muscles of the pelvic floor not functioning correctly, which can lead to issues with bowel movements and pain.

4. Endometriosis: In women, endometriosis can cause chronic pelvic pain, especially if it involves the lower abdomen. This condition occurs when tissue similar to the lining inside the uterus grows outside of it, leading to pain that may be cyclical or constant.

5. Psychosomatic Factors: Chronic pain can sometimes be exacerbated by psychological factors such as anxiety or stress. Given your history of anxiety, it’s worth considering whether psychological support or therapy could help manage your symptoms.


Management Strategies
1. Dietary Modifications: Keeping a food diary to identify potential triggers can be beneficial. Consider working with a dietitian to explore a low-FODMAP diet, which has been shown to help many individuals with IBS.

2. Regular Exercise: Engaging in regular physical activity can help stimulate bowel function and reduce symptoms of bloating and discomfort.

3. Pelvic Floor Physical Therapy: If pelvic floor dysfunction is suspected, a physical therapist specializing in this area can provide targeted exercises and treatments to alleviate pain.

4. Medication Review: Since you've been on various medications for an extended period, it may be worthwhile to review these with your healthcare provider. Sometimes, a different class of medication or a combination of therapies may yield better results.

5. Psychological Support: If anxiety is a contributing factor, cognitive-behavioral therapy (CBT) or other forms of psychological support can be beneficial in managing chronic pain.

6. Follow-Up with Specialists: If your symptoms persist despite these interventions, consider seeking a second opinion from a specialized pain management clinic or a gastroenterologist with expertise in functional gastrointestinal disorders.


Conclusion
Chronic left lower abdominal pain can stem from a variety of causes, and it often requires a multifaceted approach to management. Since you have already undergone extensive testing, focusing on dietary changes, physical therapy, and psychological support may provide relief. It’s essential to maintain open communication with your healthcare providers and advocate for your health, ensuring that all potential avenues for treatment are explored. If symptoms persist, seeking a specialized clinic that focuses on chronic pain management may be the next best step.