Chronic Lower Abdominal Pain and Persistent Back Discomfort: What to Do?

I'm sorry to hear that you're feeling this way. It's important to talk to someone who

Long-term lower abdominal pain, combined with almost daily left and right lower back pain.
The sensation is not pressure, but I feel easily fatigued.
I have been diagnosed with irritable bowel syndrome (IBS) for over a year.
Even when I am not experiencing abdominal pain, I still have left and right lower back pain and a sensation of pressure.
The discomfort in my lower back occurs almost daily, and the pain and pressure in the left and right lower back started when the abdominal pain began.
The right lower back does not usually hurt as much; the discomfort is more pronounced on the left and right sides.
I have seen specialists in gynecology, urology, and orthopedics over the past year, and they found no issues.
In gastroenterology, I underwent an upper endoscopy, abdominal ultrasound, barium enema X-ray, and stool tests, all of which were normal.
My gastroenterologist diagnosed me with IBS.
When I asked my doctor about the intermittent lower abdominal pain and the persistent lower back pain and pressure, the doctor mentioned that abdominal pain can indeed cause back pain.
However, I experience daily lower back pain and pressure even when I am not having abdominal pain, which is very uncomfortable.

Doctor, what should I do?
1.
Initially, I experienced lower abdominal pain more frequently, with less discomfort in the lower back, but now I have daily left lower back pain, pressure, and fatigue.
What should I do?
2.
With long-term lower abdominal pain, bilateral lower back pain, and discomfort from pressure and cramping, which specialty should I consult next?

WW, 20~29 year old female. Ask Date: 2012/08/01

Dr. Xu Weikai reply Urology

Hello, based on the description, it seems there is no definitive diagnosis that can explain the symptoms.
Autonomic nervous system dysfunction could also be considered.
It may be beneficial to maintain a regular lifestyle and engage in daily exercise (to the point of sweating).
If you need to see a doctor, you might consider consulting a psychiatrist.
This does not imply that there is a mental health issue, but psychiatrists often use various neurological medications and have more experience with autonomic nervous system problems.
If there are any unclear aspects, feel free to ask again for further discussion and research.
Online responses should only serve as a reference; if necessary, it is important to seek medical attention at a healthcare facility.
This response is provided by Dr.
Hsu Wei-Kai, Chief of Urology, Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2012/08/01

More Info

Chronic lower abdominal pain combined with persistent back discomfort can be quite distressing and may significantly impact your quality of life. Given your history of irritable bowel syndrome (IBS) and the extensive evaluations you've undergone, it’s understandable that you are seeking further clarity and potential solutions.

1. Understanding the Connection Between Abdominal Pain and Back Pain: Your doctor’s assertion that abdominal pain can lead to back pain is well-founded. The body’s pain pathways are interconnected, and discomfort in one area can often manifest as pain in another. In your case, the chronic abdominal pain may be causing muscle tension and discomfort in the lower back, leading to a cycle of pain. Additionally, the muscles in the abdomen and back work together to support the spine; thus, any dysfunction in one area can affect the other.

2. Potential Causes of Your Symptoms: Given that you have been evaluated by various specialists without definitive findings, it’s crucial to consider other potential causes. Chronic pain syndromes, such as fibromyalgia, can present with widespread pain, including the abdomen and back. Stress and anxiety can also exacerbate physical symptoms, leading to muscle tension and pain. Furthermore, conditions like myofascial pain syndrome, where trigger points in the muscles can refer pain to other areas, might be contributing to your discomfort.

3. Recommended Next Steps:
- Consult a Pain Specialist: A pain management specialist can provide a comprehensive evaluation of your symptoms and may suggest treatments that target chronic pain, such as physical therapy, medication management, or alternative therapies like acupuncture.

- Physical Therapy: Engaging in physical therapy can help strengthen the muscles supporting your abdomen and back, improve flexibility, and teach you techniques to manage pain. A physical therapist can also provide tailored exercises that may alleviate discomfort.

- Psychological Support: Since you mentioned experiencing anxiety, it might be beneficial to explore cognitive-behavioral therapy (CBT) or other forms of psychological support. These therapies can help you develop coping strategies for managing chronic pain and anxiety, which may, in turn, reduce your physical symptoms.

- Lifestyle Modifications: Incorporating regular low-impact exercise, such as walking or swimming, can improve overall physical health and potentially alleviate some of your discomfort. Additionally, practicing relaxation techniques, such as yoga or mindfulness meditation, may help reduce stress and muscle tension.

4. Further Investigations: If your symptoms persist despite these interventions, consider discussing with your healthcare provider the possibility of further imaging studies, such as an MRI, to rule out any underlying structural issues that may have been missed. Conditions like herniated discs or spinal stenosis can sometimes present with similar symptoms.

5. Follow-Up with Specialists: Given your complex symptoms, it may be beneficial to revisit some of the specialists you have seen, such as a gastroenterologist or a neurologist, to ensure that all potential causes have been thoroughly investigated. A multidisciplinary approach, involving collaboration between different specialties, may yield better insights into your condition.

In summary, while chronic lower abdominal pain and persistent back discomfort can be challenging to manage, a comprehensive approach that includes medical evaluation, physical therapy, psychological support, and lifestyle modifications can help improve your symptoms and overall well-being. It’s essential to remain proactive in your healthcare journey and communicate openly with your healthcare providers about your ongoing concerns.

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