Persistent Right Lower Abdomen Discomfort: Which Specialist to Consult?

Right lower abdominal discomfort?

I have been experiencing dull abdominal pain for the past two weeks.
The pain is intermittent and of moderate intensity, located near the right pelvic area.
When lying flat, I notice a pulsating sensation to the right of my navel.
However, a gynecological examination showed normal results.
A gastroenterologist performed an X-ray and ordered urine and blood tests, which also returned normal results, except for some mild intestinal gas.
I took the gastrointestinal medication prescribed by the doctor, which reduced the pain somewhat, but I still feel discomfort and persistent dull pain in my abdomen.
Which specialist should I see next?

An, 20~29 year old female. Ask Date: 2015/07/27

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, seeing a gastroenterologist is indeed appropriate.
If there is no fever, it is likely due to gastrointestinal dysfunction or indigestion.
In addition to medication, it is recommended to choose a mild diet that is low in oil, dairy, irritants, and meat.
Sincerely, Dr.
Chi-Feng Chen, Attending Physician, Department of Gastroenterology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2015/07/27

More Info

If you have been experiencing persistent discomfort in your right lower abdomen for the past two weeks, it is essential to approach this issue systematically to identify the underlying cause. Given that you have already consulted both a gynecologist and a gastroenterologist, and the tests conducted (such as X-rays, urine tests, and blood tests) returned normal results, yet you still feel discomfort, it may be time to consider a few additional avenues.

1. Consult a General Surgeon: Since your symptoms are localized to the right lower abdomen, which is near the appendix, it would be prudent to consult a general surgeon. They can evaluate for conditions such as appendicitis, which may not always present with classic symptoms, especially in the early stages. A surgeon can also assess for other potential surgical issues, such as hernias or any complications related to previous surgeries if applicable.

2. Consider a Specialist in Pain Management: If the discomfort persists without a clear diagnosis, a pain management specialist may be able to help. They can provide insights into chronic pain syndromes and may suggest treatments that can alleviate your symptoms, even if the exact cause remains undetermined.

3. Explore a Consultation with a Urologist: Since the pain is near the pelvic region, it may also be beneficial to consult a urologist. They can evaluate for any urinary tract issues or kidney-related problems that might not have been considered in your previous evaluations.

4. Follow-Up with a Gastroenterologist: If your symptoms are gastrointestinal in nature, it may be worth returning to a gastroenterologist for further evaluation. They might consider additional diagnostic tests, such as an abdominal ultrasound or a CT scan, which can provide more detailed images of the abdominal organs and help identify issues that X-rays might miss.

5. Consider Functional Gastrointestinal Disorders: If all structural causes are ruled out, you might be dealing with a functional gastrointestinal disorder, such as irritable bowel syndrome (IBS). This condition can cause abdominal pain and discomfort without any identifiable structural abnormalities. A gastroenterologist can help you explore dietary changes, lifestyle modifications, and possibly medications that can help manage these symptoms.

6. Keep a Symptom Diary: Documenting your symptoms, including when they occur, their intensity, and any associated factors (such as food intake, stress levels, or physical activity) can provide valuable information to your healthcare providers. This diary can help identify patterns that may lead to a diagnosis.

7. Consider Psychological Factors: Sometimes, abdominal pain can be exacerbated or influenced by psychological factors such as stress or anxiety. If you feel that emotional or psychological stressors might be contributing to your discomfort, consulting a mental health professional could be beneficial.

In summary, while you have already seen a gynecologist and a gastroenterologist, it may be time to broaden your search for answers. Consulting a general surgeon, a urologist, or even revisiting a gastroenterologist for further evaluation could provide the insights needed to address your ongoing discomfort. Remember to communicate openly with your healthcare providers about your symptoms and any concerns you may have, as this will help them assist you more effectively.

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