Chronic Lower Abdominal Pain: Seeking Answers in Gynecology and Beyond

Lower abdominal pain issues..?

Hello, Doctor.
I have been experiencing intermittent lower abdominal pain for a long time, sometimes accompanied by sharp pain in the clitoris and vagina.
The lower abdominal pain varies between sharp and bloated sensations, and at times, I feel a dull discomfort (the pain is located near the uterus and ovaries and has persisted for over a year).
I also experience soreness and a feeling of pressure in my lower back and upper back.
The pain in my lower abdomen intensifies significantly before my menstrual period.
I have undergone numerous gynecological ultrasounds and pelvic exams, all of which showed no issues.
However, during one ultrasound, the doctor quickly noted my intestines and referred me to a gastroenterologist.
The gastroenterologist prescribed medication for irritable bowel syndrome, which I have been taking for over a year without improvement.
I have also had stool tests, liver and gallbladder ultrasounds, colon X-rays, and endoscopies, all of which returned normal results.
The gastroenterologist asked if I had seen a gynecologist, and I explained that I have visited many gynecologists multiple times, all of whom found no problems.
I have also consulted a urologist, and urine tests and kidney ultrasounds showed no issues.
They mentioned that lower abdominal pain should first rule out gynecological problems, but I have seen many gynecologists already.
What should I do? Doctor, I would like to ask for your advice on what steps I should take next.
Should I continue to seek further evaluations?

MO, 20~29 year old female. Ask Date: 2012/06/05

Dr. Liu Yuhong reply Obstetrics and Gynecology

Based on your description of "long-term intermittent lower abdominal pain," "pain near the uterus and ovaries for over a year," "gynecological ultrasound and pelvic examination showing no issues," and "ultrasound of the liver and gallbladder, colon X-ray, and gastroscopy all showing no problems," I personally suspect that you may be experiencing chronic pelvic pain.
Chronic pelvic pain is defined as pain in the pelvic region lasting more than six months.
Some causes of chronic pelvic pain can be identified, such as endometriosis or irritable bowel syndrome.
However, the absence of a clear cause for chronic pelvic pain does not imply that there is a rare disease or that the pain cannot be effectively treated.
I recommend that you consult with a gynecologist to confirm whether you have chronic pelvic pain.
Here is some information on chronic pelvic pain: http://www.mayoclinic.com/health/chronic-pelvic-pain/DS00571.
Wishing you good health.

Reply Date: 2012/06/05

More Info

Chronic lower abdominal pain can be a complex issue, especially when it persists despite multiple evaluations and tests. In your case, it seems that you have undergone extensive examinations in gynecology, gastroenterology, and urology, with no definitive diagnosis found. This can be frustrating, but it is important to consider several factors that could contribute to your symptoms.

Firstly, it is essential to understand that chronic abdominal pain can arise from various sources, including gynecological, gastrointestinal, urinary, and even musculoskeletal issues. Given your history of pain that intensifies before menstruation, it is crucial to consider conditions such as endometriosis, pelvic inflammatory disease, or even adhesions from previous surgeries. Although you have had ultrasounds and internal examinations that did not reveal any abnormalities, some conditions, like endometriosis, may not always be visible on imaging studies.

Endometriosis is a condition where tissue similar to the lining of the uterus grows outside of it, often causing significant pain, especially during menstruation. It can also lead to chronic pelvic pain, which may not be limited to the menstrual cycle. If endometriosis is suspected, a laparoscopy may be necessary for a definitive diagnosis, as it allows direct visualization of the pelvic organs and the possibility of biopsy.

Another possibility is that your symptoms could be related to functional gastrointestinal disorders, such as irritable bowel syndrome (IBS). IBS can cause abdominal pain, bloating, and changes in bowel habits, and it can sometimes be challenging to diagnose. The fact that you have been prescribed medication for IBS suggests that your gastroenterologist considered this possibility. However, if the treatment has not provided relief, it may be worth revisiting this diagnosis with your doctor.

Additionally, psychosomatic factors can play a significant role in chronic pain. Anxiety and stress can exacerbate physical symptoms, leading to a cycle of pain and anxiety. If you are prone to anxiety, it may be beneficial to explore this aspect with a mental health professional who can help you develop coping strategies and address any underlying issues.

Given that you have seen multiple specialists without a clear diagnosis, it might be helpful to consider a multidisciplinary approach. This could involve working with a pain management specialist who can help you explore various treatment options, including physical therapy, medication management, and possibly alternative therapies such as acupuncture or mindfulness-based stress reduction.

In summary, while it can be disheartening to experience chronic lower abdominal pain without a clear diagnosis, it is essential to continue seeking answers. Consider revisiting your gynecologist for further evaluation of potential conditions like endometriosis, and discuss the possibility of functional gastrointestinal disorders with your gastroenterologist. Additionally, exploring the psychological aspects of your pain may provide valuable insights and relief. Remember, you are your best advocate, and persistence in seeking answers is crucial in managing chronic pain.

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