Chronic Lower Abdominal and Back Pain: Seeking Answers After Multiple Consultations

Chronic pain?

I have been experiencing long-term lower abdominal pain near the pubic bone, accompanied by almost daily soreness in my lower back and ribs.
The pressure sensation has persisted for over a year, and even when I am not experiencing abdominal pain, I still have soreness and pressure in my lower back and ribs.
This discomfort in my lower back and ribs began when the abdominal pain started.
Over the past year, I have consulted various gynecologists and undergone multiple pelvic examinations and ultrasounds, all of which showed no issues.
I also visited a urologist once, and everything was normal.
I consulted an allergist and immunologist, underwent numerous tests, and still found no problems.
Subsequently, I saw a gastroenterologist (who performed an endoscopy, abdominal ultrasound, barium enema X-ray, and stool tests, all of which were normal) and was diagnosed with irritable bowel syndrome (IBS).
When I asked my gastroenterologist about my intermittent lower abdominal pain and the persistent soreness and pressure in my lower back, the doctor mentioned that abdominal pain could indeed cause back pain.
However, I experience lower back soreness and pressure daily, even without abdominal pain, which is very uncomfortable.
I have been taking medication for IBS for over a year, but my abdominal pain and lower back discomfort have not improved.
I am feeling very distressed.
What should I do, doctor? I have seen many doctors already...
Please help me.

QQ, 20~29 year old female. Ask Date: 2012/08/26

Dr. Lin Wenbin reply Obstetrics and Gynecology

Such a description does not provide clear insights.
The combination of low back pain and abdominal pain has numerous potential causes, which cannot be detailed here.
Moreover, relying solely on written descriptions makes it difficult to assess your condition and answer questions accurately.
I hope you can visit a clinic to consult with other physicians, gather various opinions, and perhaps find an appropriate treatment direction.
Wishing you a speedy recovery.

Reply Date: 2012/08/26

More Info

Chronic lower abdominal pain accompanied by persistent back pain can be a complex issue, especially when multiple consultations and tests have yielded no definitive diagnosis. It is understandable that you feel frustrated and seek answers after a year of discomfort.
From your description, it seems that you have undergone a comprehensive evaluation, including consultations with gynecologists, urologists, and gastroenterologists, along with various imaging studies and tests. The diagnosis of irritable bowel syndrome (IBS) suggests that your symptoms may be related to gastrointestinal motility issues, which can indeed cause abdominal pain and may also lead to referred pain in the back.
IBS is characterized by a combination of abdominal pain and altered bowel habits, such as diarrhea or constipation. The pain can often be relieved by bowel movements, but in some cases, it can persist, leading to chronic discomfort. The connection between abdominal pain and back pain is well-documented; the nerves that supply the abdominal organs also innervate the lower back, which can lead to referred pain.
However, the fact that you continue to experience significant back pain even when your abdominal symptoms are not present raises some concerns. Chronic back pain can stem from various causes, including musculoskeletal issues, degenerative disc disease, or even conditions such as fibromyalgia, which can cause widespread pain and discomfort.
Given that you have seen multiple specialists without resolution, it may be beneficial to consider a multidisciplinary approach. Here are some suggestions for further evaluation and management:
1. Physical Therapy: Engaging in physical therapy can help address musculoskeletal issues that may be contributing to your back pain. A physical therapist can design a personalized exercise program to strengthen your core, improve flexibility, and alleviate pain.

2. Pain Management Specialist: Consulting with a pain management specialist may provide additional options for managing your chronic pain. They can offer treatments such as nerve blocks, epidural steroid injections, or other interventions that may help alleviate your symptoms.

3. Psychological Support: Chronic pain can often lead to anxiety and depression, which can exacerbate the perception of pain. Cognitive-behavioral therapy (CBT) or other forms of psychological support can be beneficial in managing the emotional aspects of chronic pain.

4. Re-evaluation of IBS Treatment: If you have been on medications for IBS without improvement, it may be worth discussing alternative treatments with your gastroenterologist. Sometimes, dietary changes, probiotics, or different medications can provide relief.

5. Further Imaging: If not already done, consider discussing the possibility of an MRI of the lumbar spine to evaluate for any structural issues that may not have been visible on previous imaging studies. Conditions such as herniated discs or spinal stenosis can sometimes cause chronic back pain.

6. Holistic Approaches: Some patients find relief through complementary therapies such as acupuncture, chiropractic care, or massage therapy. While these should not replace conventional medical treatment, they can be helpful adjuncts.

7. Lifestyle Modifications: Maintaining a healthy lifestyle, including regular exercise, a balanced diet, and stress management techniques, can also play a significant role in managing chronic pain.

In conclusion, while it is frustrating to deal with chronic pain without a clear diagnosis, a multidisciplinary approach that includes physical therapy, pain management, psychological support, and possibly further imaging may help you find relief. It is essential to continue advocating for your health and seeking out specialists who are willing to explore all avenues for diagnosis and treatment. Remember, chronic pain is a complex condition, and finding the right combination of therapies may take time.

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