Chronic Lower Abdominal Pain: Seeking Answers After Multiple Doctor Visits

I've been troubled for a long time~~

I have been experiencing lower abdominal pain and back pain, which sometimes extends to the upper abdomen.
The lower abdominal pain started over a year ago, and I have also noticed an increase in vaginal discharge, which is thin, yellowish, and milky in appearance.
I have visited many gynecologists and received multiple treatments, including medications, but the pain persists.
I have seen doctors who have not been able to help me.
I consulted a urologist who performed urine tests and bladder and kidney ultrasounds, all of which came back normal.
The doctor then referred me back to gynecology.
After multiple visits and treatments, I was told everything was fine and was advised to see a gastroenterologist.
The gastroenterologist conducted tests, including stool analysis, gastroscopy, colon X-rays, and liver and gallbladder ultrasounds, all of which showed no issues.
Consequently, the gastroenterologist prescribed medication for irritable bowel syndrome, but after a year of treatment, there has been no improvement, and I still experience pain.
I informed the doctor that the medication has not been effective, yet they continue to prescribe it.
I have been suffering from lower abdominal pain for so long, and despite spending a significant amount of money on consultations, there has been no improvement.
What should I do?

NI, 20~29 year old female. Ask Date: 2012/06/11

Dr. Liu Yuhong reply Obstetrics and Gynecology

1.
There is a common condition among women known as chronic pelvic pain, which refers to pain in the pelvic region lasting more than six months.

2.
According to your description: "Lower abdominal pain and back pain sometimes accompanied by upper abdominal pain," "The pain has persisted for over a year...
I've seen doctors but haven't found relief..." your situation falls under chronic pelvic pain.

3.
"I consulted a urologist and underwent urinalysis and bladder and kidney ultrasound, all of which were normal," "I've seen many gynecologists and tried numerous medications, but there were no issues," "I had gastrointestinal evaluations, including stool tests, endoscopy, colon X-rays, and liver and gallbladder ultrasounds, all of which were normal." Unfortunately, chronic pelvic pain often has no identifiable cause (about two-thirds of cases), but the absence of a diagnosis does not mean the pain cannot be treated!
4.
"The gastroenterologist prescribed medication for irritable bowel syndrome, but after a year, it still hasn't helped and I'm still in pain." This is because the organs in the body can communicate with each other (cross-talk).
For example, if the pain originates from the uterus and remains untreated, nearby organs like the intestines and bladder may also start to react, leading to symptoms of irritable bowel syndrome, frequent urination, and painful urination.

5.
"I've had lower abdominal pain for so long, I've seen so many doctors and spent thousands, but there's been no improvement." The process of searching for a cause of chronic pelvic pain can be discouraging.
However, not finding a cause does not mean the pain cannot be treated! In addition to traditional anti-inflammatory and pain-relieving medications, there are many other treatments available, including medications, localized therapies, physical therapy, or surgery to address chronic pelvic pain.
I understand that your pain is distressing, but I believe your condition can improve; it just requires some time.
I recommend you seek another gynecologist who is willing to patiently listen to your entire pain history, the tests you've undergone, and the medications you've tried.
However, you must also be patient with this physician as they work to treat your condition.
Wishing you good health.

Reply Date: 2012/06/11

More Info

Chronic lower abdominal pain can be a frustrating and debilitating condition, especially when multiple medical consultations and tests yield no clear answers. It appears that you have already seen various specialists, including gynecologists, urologists, and gastroenterologists, and have undergone numerous tests such as ultrasounds, endoscopies, and lab work, all of which have returned normal results. This situation can understandably lead to feelings of helplessness and confusion.

Given the complexity of your symptoms, it is essential to consider a few potential avenues for further investigation and management. First, it is important to recognize that chronic pain can sometimes stem from conditions that are not easily identifiable through standard imaging or laboratory tests. For instance, conditions such as endometriosis, interstitial cystitis, or pelvic floor dysfunction may not always show up on imaging studies but can cause significant pain and discomfort.

Possible Conditions to Consider
1. Endometriosis: This condition occurs when tissue similar to the lining of the uterus grows outside of it, often leading to chronic pelvic pain, painful periods, and sometimes gastrointestinal symptoms. A laparoscopy, a surgical procedure, may be necessary to diagnose endometriosis definitively.

2. Interstitial Cystitis: This is a chronic condition characterized by bladder pressure, bladder pain, and sometimes pelvic pain. It can mimic urinary tract infections but does not respond to typical treatments for infections.

3. Pelvic Floor Dysfunction: This condition involves a group of disorders that affect the pelvic floor muscles, leading to pain and discomfort. Physical therapy focusing on pelvic floor rehabilitation may be beneficial.

4. Irritable Bowel Syndrome (IBS): Although you mentioned being prescribed medication for IBS without improvement, it may be worth revisiting this diagnosis. IBS can present with chronic abdominal pain and changes in bowel habits, and sometimes dietary modifications or alternative therapies can provide relief.

5. Psychosomatic Factors: Chronic pain can also be influenced by psychological factors such as anxiety and stress. Cognitive-behavioral therapy (CBT) or other forms of psychological support may help in managing the pain.

Next Steps
1. Seek a Multidisciplinary Approach: Given the complexity of your symptoms, consider consulting a pain management specialist or a multidisciplinary clinic that focuses on chronic pain. These specialists can offer a more holistic approach, combining medical, physical, and psychological therapies.

2. Consider Further Testing: If you have not yet undergone a pelvic MRI or a laparoscopy, these may be valuable next steps. An MRI can provide detailed images of soft tissues, which may help identify conditions like endometriosis.

3. Keep a Symptom Diary: Documenting your symptoms, including their frequency, intensity, and any potential triggers, can provide valuable information for your healthcare providers and may help in identifying patterns or correlations.

4. Explore Alternative Therapies: Some patients find relief through acupuncture, chiropractic care, or physical therapy focused on the pelvic region. These therapies can sometimes alleviate pain when traditional medical treatments have not been effective.

5. Advocate for Yourself: If you feel that your concerns are not being adequately addressed, do not hesitate to seek a second opinion or ask for referrals to specialists who have experience with chronic pain conditions.

Conclusion
Chronic lower abdominal pain can be a multifaceted issue that requires a comprehensive approach to diagnosis and treatment. It is crucial to continue advocating for your health and exploring various avenues for relief. Engaging with a multidisciplinary team may provide you with the support and solutions you need to manage your symptoms effectively. Remember, you are not alone in this journey, and there are healthcare professionals dedicated to helping you find answers and improve your quality of life.

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