Right Lower Abdominal Pain: Causes and Concerns - Gastroenterology and Hepatology

Q: Right Lower Abdominal Pain: Causes and Concerns

Hello： Right lower abdominal pain is often associated with colonic disorders. <br>It is recommended to undergo a colon examination. <br>Best regards, Dr. <br>Chen Qifeng, Taoyuan General Hospital, Department of Health.

Right lower abdominal pain?

Dear Doctor,
I may have written a bit too much, but I hope you can patiently read through my previous symptoms.
About two to three weeks ago, I started experiencing diarrhea (three to four times a day), often feeling a dull ache and bloating in my lower abdomen, as if my belt was too tight.
I even had blood in my stool after diarrhea (the stool came first, followed by blood, and due to the diarrhea, the blood was often accompanied by intestinal mucus, bright red in color).
I would know about the bleeding a few minutes beforehand because it usually happens all at once.
After that, I had a regular occurrence of bloody stools about once a week, which made me extremely anxious every time I saw blood, and my stomach hurt even more (I used to have blood in my stool, but it was only once every few months).
I have seen a gastroenterologist two to three times, and after an ultrasound, I was told I have irritable bowel syndrome.
Last week, I even consulted a colorectal surgeon, who performed a flexible sigmoidoscopy (a shorter scope) and said my intestines looked beautiful.
The bleeding was due to skin tears in my rectum, and he advised me not to clean my bottom too thoroughly.
Current situation: Over the past week, after my consultation and taking medication, my bowel movements have improved, and I have been running every day.
Now I have a bowel movement every morning, which is formed, thick, averaging twice a day, but if I eat too much greasy food or get anxious, I still experience diarrhea.
However, I have developed a frequent dull pain in my lower right abdomen, which feels more pronounced when walking.
Sometimes the pain radiates to my lower back on the right side, approximately above the right hip bone (not yet at the level of the navel).
Other symptoms: Before eating, I experience pain in my upper right abdomen (below the right rib cage).

Additional information: It is difficult to pinpoint the pain in my lower right abdomen; it is not severe pain, just a dull ache.
The right side of my lower back also aches, especially when I lift my thigh while walking or twist my waist.
This has been ongoing for over a week.
There has been no weight loss, fever, or other symptoms.
The symptoms become more pronounced in the evening.
When I tap my right abdomen, it sounds hollow.
There are no significant changes in urination, but I notice that when I hold my urine or have gas, the dull ache in my lower right abdomen becomes more pronounced.
1.
I would like to ask the doctor, based on my description, what could be the cause of the dull pain in my lower right abdomen? (Appendicitis, ascending colon issues, or could it be related to the small intestine or duodenum?)
2.
If there is something abnormal or inflammation in the ascending colon, would the blood in the stool also be bright red, and would the blood be separate from the stool?
3.
If it is a duodenal ulcer or inflammation, would the pain radiate to the lower abdomen or the side of the waist?

Xiao Yin, 20~29 year old female. Ask Date: 2012/11/25

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello: Right lower abdominal pain is often associated with colonic disorders.
It is recommended to undergo a colon examination.
Best regards, Dr.
Chen Qifeng, Taoyuan General Hospital, Department of Health.

Reply Date: 2012/11/25

More Info

Dear Patient,
Thank you for your detailed description of your symptoms. It’s clear that you have been experiencing significant discomfort, and I appreciate your patience in seeking clarity on your condition. Based on your account, let’s break down your concerns regarding right lower abdominal pain and its potential causes.

1. Possible Causes of Right Lower Abdominal Pain
The right lower abdominal pain you are experiencing could stem from several conditions. Given your symptoms of diarrhea, the presence of blood in your stool, and the sensation of pressure or pain in the lower abdomen, the following conditions are worth considering:
- Appendicitis: This is an inflammation of the appendix, typically presenting with sharp pain in the right lower abdomen, often accompanied by nausea and vomiting. However, your symptoms of diarrhea and blood in the stool may not align perfectly with this diagnosis.

- Irritable Bowel Syndrome (IBS): Since you have been diagnosed with IBS, this condition can cause abdominal pain, bloating, and changes in bowel habits, including diarrhea. Stress and anxiety can exacerbate IBS symptoms, which might explain the fluctuations in your bowel movements and abdominal discomfort.

- Diverticulitis: This condition involves inflammation or infection of small pouches (diverticula) that can form in the walls of the colon. It can cause localized pain, often in the lower left abdomen, but can also present with right-sided pain, especially if the diverticula are located in the right colon.

- Colorectal Issues: Given your history of blood in the stool, it’s essential to consider other colorectal issues, such as hemorrhoids or fissures, which can cause bleeding and discomfort, particularly after bowel movements.

- Gynecological Issues: In females, conditions such as ovarian cysts or ectopic pregnancy can cause pain in the lower abdomen. However, these would typically present with additional symptoms.

2. Blood in Stool and Its Characteristics
Regarding your question about blood in the stool, if there is bleeding from the ascending colon (which includes the cecum and appendix), the blood may appear bright red and can be mixed with stool or separate from it. The presence of bright red blood often indicates that the bleeding is occurring in the lower gastrointestinal tract. If the blood is darker or mixed with stool, it may suggest bleeding from higher up in the digestive tract.

3. Pain from Duodenal Ulcers
If you are concerned about a duodenal ulcer, the pain can indeed radiate to the lower abdomen or back, especially if the ulcer is causing irritation or inflammation in surrounding tissues. Symptoms of duodenal ulcers often include a burning sensation in the stomach, which may improve with eating but can worsen after meals.

Recommendations
Given the complexity of your symptoms, I recommend the following steps:
- Follow-Up with Your Gastroenterologist: Since you have already seen specialists, it’s crucial to continue monitoring your symptoms. If your pain persists or worsens, further imaging studies (like a CT scan) or additional endoscopic evaluations may be warranted.

- Dietary Adjustments: Pay attention to your diet, as certain foods can exacerbate IBS symptoms. Keeping a food diary may help identify triggers.

- Manage Stress and Anxiety: Since you mentioned anxiety, consider techniques such as mindfulness, yoga, or counseling, which can help manage stress and potentially alleviate some gastrointestinal symptoms.

- Monitor Symptoms: Keep track of any changes in your bowel habits, pain intensity, and any new symptoms. This information will be valuable for your healthcare provider.

In conclusion, while there are several potential causes for your right lower abdominal pain, it is essential to work closely with your healthcare providers to determine the exact cause and appropriate treatment. Please don’t hesitate to reach out for further evaluation if your symptoms change or worsen.

Wishing you good health,
Doctor Q&A Teams

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