Right Lower Abdominal Pain: Causes and Next Steps - Gastroenterology and Hepatology

Right lower abdominal pain?

Hello Doctor, since December of last year, I have been experiencing persistent abdominal pain following an episode of gastroenteritis.
Currently, the pain is primarily located in the lower right abdomen, characterized by sharp, bloating, and cramping sensations.
I often feel as if there is something in the lower right abdomen, and sometimes bending over causes a pinching pain in that area.
The pain generally remains in the lower right abdomen but occasionally radiates to the upper right abdomen, middle lower abdomen, and even to the right lower back.
There are rare instances when I feel pain in the lower left abdomen, and sometimes I experience discomfort in the testicular area or pain that radiates down to the right thigh.
It's quite strange.
Occasionally, I also have stomach pain and changes in bowel movements, with stool appearing dark green at times and yellow at others.
The stool is consistently soft, thin, and has mucus, often sticking together rather than forming a smooth, complete shape.
Recently, I have also been feeling very fatigued, with poor sleep quality and light sleep, often waking up around 5 AM to urinate.
I underwent an upper endoscopy last December, followed by two colonoscopies and an abdominal ultrasound.
Aside from some gastroesophageal reflux noted in my stomach, all other tests were normal.
I would like to ask the doctor how I should proceed.
Should I continue seeking medical attention, or are there any additional tests I should consider?

Mr. Song, 20~29 year old female. Ask Date: 2015/06/23

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, aside from the pain radiating to the thigh, the other symptoms are a result of gastroenteritis causing irritable bowel syndrome.
It is recommended to follow a low-fat, low-meat, low-dairy, and low-irritant diet.
If necessary, digestive enzymes and even antidiarrheal medications may be administered...
this should lead to improvement.
Wishing you safety and health.
Sincerely, Dr.
Chi-Feng Chen, Attending Physician, Department of Gastroenterology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2015/06/23

More Info

Right lower abdominal pain can be a complex symptom with various potential causes, especially considering your history of gastrointestinal issues since December. The symptoms you describe—sharp pain, bloating, cramping, and the sensation of something being present in your abdomen—are concerning and warrant further investigation.

Potential Causes
1. Appendicitis: This is one of the most common causes of right lower abdominal pain. Although you have had previous gastrointestinal issues, appendicitis can occur independently and may present with pain that can radiate to other areas, including the back and groin.

2. Irritable Bowel Syndrome (IBS): Given your history of gastrointestinal distress, IBS could be a possibility. It often presents with abdominal pain, changes in bowel habits, and can cause bloating and discomfort.

3. Diverticulitis: This condition occurs when small pouches in the colon become inflamed or infected. It can cause localized pain, often in the lower left abdomen, but can sometimes present in the right side, especially if the right colon is involved.

4. Hernia: A hernia in the groin or abdominal wall can cause pain that radiates to the lower abdomen and may be exacerbated by certain movements or positions.

5. Kidney Stones or Ureteral Stones: Pain from kidney stones can radiate to the lower abdomen and groin, and may be accompanied by changes in urination.

6. Gynecological Issues: In males, testicular pain can sometimes refer to the abdomen. In females, conditions such as ovarian cysts or ectopic pregnancy can cause similar symptoms.

7. Musculoskeletal Issues: Given your description of pain that worsens with movement or bending, a muscle strain or other musculoskeletal issue could be contributing to your discomfort.

Next Steps
Given the complexity of your symptoms and the fact that you have already undergone several diagnostic tests (endoscopy, colonoscopy, and ultrasound), it is essential to follow up with your healthcare provider. Here are some recommendations:
1. Consult a Specialist: If you haven't already, consider seeing a gastroenterologist who specializes in functional gastrointestinal disorders. They can provide a more in-depth evaluation of your symptoms and may suggest additional tests or treatments.

2. Pain Management: Discuss your pain management options with your doctor. Sometimes, medications such as antispasmodics or specific dietary changes can help alleviate symptoms.

3. Dietary Modifications: Keeping a food diary to track what you eat and how it affects your symptoms can be beneficial. Certain foods may exacerbate your symptoms, and identifying these can help in managing your condition.

4. Further Imaging: If your symptoms persist, your doctor may recommend further imaging studies, such as a CT scan, to rule out conditions like appendicitis or diverticulitis that may not have been evident in previous tests.

5. Mental Health Considerations: Given your mention of fatigue and poor sleep quality, consider discussing your mental health with your doctor. Stress and anxiety can exacerbate gastrointestinal symptoms, and addressing these can be an essential part of your treatment plan.

6. Follow-Up: Regular follow-ups with your healthcare provider are crucial. If your symptoms worsen or new symptoms arise, seek medical attention promptly.

Conclusion
In summary, right lower abdominal pain can stem from various causes, and your ongoing symptoms since your initial gastrointestinal episode warrant further evaluation. It is crucial to maintain open communication with your healthcare provider and advocate for your health. By exploring these potential causes and following the recommended steps, you can work towards finding relief and improving your overall well-being.

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