Right Lower Abdominal Pain: Causes and Specialist Guidance

Q: Right Lower Abdominal Pain: Causes and Specialist Guidance

Hello： You can arrange for an upper gastrointestinal series or a colonoscopy with the gastroenterology department. <br>If the results are normal, it would be classified as a functional disorder. <br>Wishing you peace and health. <br>Sincerely, Dr. <br>Chi-Feng Chen, Gastroenterol

Right lower abdominal pain?

I have been experiencing pain in my lower right abdomen (near the groin, which is the lowest part of the lower right abdomen).
The pain has woken me up at night, and I feel more discomfort after eating or when I am anxious.
This has been ongoing for quite some time.
I have undergone ultrasound examinations in both obstetrics and gynecology as well as general surgery (for hernia), and they reported no issues.
However, the general surgeon performed an X-ray and noted that my intestines are positioned lower than average, but the doctor mentioned it could also be a congenital condition.
Additionally, my bowel movements, which used to be normal at 1-2 times a day, have increased to 2-4 times a day, and when the frequency is higher, the stools become loose, even leading to diarrhea.
I have also been gradually losing weight (about 4 kg over the past three months).
What type of issue could this be? Which specialty should I seek help from?

Beibei, 30~39 year old female. Ask Date: 2015/02/28

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello: You can arrange for an upper gastrointestinal series or a colonoscopy with the gastroenterology department.
If the results are normal, it would be classified as a functional disorder.
Wishing you peace and health.
Sincerely, Dr.
Chi-Feng Chen, Gastroenterology Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2015/02/28

More Info

Right lower abdominal pain can be a complex issue with various potential causes, especially given the symptoms you've described, including the pain's intensity, its association with eating and stress, changes in bowel habits, and weight loss. It's essential to approach this systematically to identify the underlying issue.

Potential Causes of Right Lower Abdominal Pain
1. Appendicitis: This is a common cause of right lower abdominal pain, especially if the pain is sharp and worsens over time. However, you mentioned that previous imaging did not indicate any issues, which makes this less likely.

2. Irritable Bowel Syndrome (IBS): Given your change in bowel habits (increased frequency and loose stools), IBS could be a possibility. IBS is a functional gastrointestinal disorder characterized by abdominal pain associated with changes in bowel habits. Stress can exacerbate symptoms, leading to discomfort.

3. Gastrointestinal Issues: Conditions such as inflammatory bowel disease (IBD), including Crohn's disease or ulcerative colitis, can cause similar symptoms. These conditions often present with abdominal pain, changes in bowel habits, and weight loss.

4. Hernias: Although you have been evaluated for hernias, it's worth noting that they can sometimes be missed, especially if they are small or not currently incarcerated.

5. Gynecological Issues: In females, conditions such as ovarian cysts, endometriosis, or pelvic inflammatory disease can cause right lower abdominal pain. These conditions may not always be visible on ultrasound, especially if they are small or in a location that is difficult to visualize.

6. Musculoskeletal Pain: Sometimes, pain in the abdominal area can be referred from the lower back or pelvic region, especially if there is a history of muscle strain or injury.

Recommended Specialist Consultation
Given the complexity of your symptoms and the fact that you have already consulted with gynecologists and general surgeons without a definitive diagnosis, I recommend the following steps:
1. Gastroenterologist: Since your symptoms include changes in bowel habits and weight loss, a gastroenterologist would be well-suited to evaluate for conditions like IBS, IBD, or other gastrointestinal disorders. They may suggest further testing, such as a colonoscopy or additional imaging studies, to rule out any underlying pathology.

2. Pain Management Specialist: If your pain persists and is affecting your quality of life, consulting a pain management specialist may provide you with strategies to manage your pain effectively while you continue to seek a diagnosis.

3. Dietitian/Nutritionist: Given the weight loss and changes in bowel habits, working with a dietitian may help identify any dietary triggers that could be contributing to your symptoms.

Additional Considerations
- Stress Management: Since you noted that stress exacerbates your symptoms, incorporating stress management techniques such as mindfulness, yoga, or cognitive behavioral therapy may be beneficial.

- Monitoring Symptoms: Keep a detailed diary of your symptoms, including the timing, intensity, and any associated factors (like food intake or stress levels). This information can be invaluable for your healthcare providers in diagnosing your condition.

- Follow-Up: Regular follow-ups with your healthcare providers are crucial, especially if your symptoms change or worsen. Persistent symptoms warrant further investigation, even if initial tests have not revealed a clear cause.

In conclusion, while your symptoms may point to several potential issues, a thorough evaluation by a gastroenterologist seems warranted given the gastrointestinal symptoms and weight loss. It’s essential to advocate for your health and ensure that all potential causes are explored.

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