Right Lower Abdominal Pain: Causes and Next Steps

Right lower abdominal pain?

Hello Dr.
Jan: I previously visited the Veterans General Hospital and Chang Gung Memorial Hospital due to pain in my lower right abdomen (sometimes on the left side, but less frequently) and underwent gynecological examinations.
However, the ultrasound tests (both transvaginal and abdominal) did not reveal any cause.
The doctor at the Veterans General Hospital mentioned that it might be due to very mild endometrial issues, which is why it was undetectable (if I really wanted to know the cause, I would need to undergo a laparoscopic procedure).
Later, since the pain decreased, I did not pay much attention to it (though I still experienced some pain during sexual intercourse).
Recently, over the past few days, I have been experiencing severe pain in my lower right abdomen, which I suspect may be related to drinking slightly cool beverages.
Any movement (walking, standing up, or sitting down) triggers sharp pain in my abdomen, and I even feel it affecting my stomach, causing some nausea.
I would like to ask the doctor which specialty I should consult.
Also, is it possible that the so-called endometrial issue is a side effect of taking contraceptive pills (I happened to see a report on the Discovery Channel about this)?

Jan, 20~29 year old female. Ask Date: 2002/06/07

Dr. Zhan Deqin reply Obstetrics and Gynecology

1.
Ultrasound is not万能; it cannot detect all conditions.
2.
If you have undergone abdominal surgery (such as appendectomy, cesarean section, tubal ligation, or others) or have experienced severe pelvic inflammatory disease, you are more likely to develop adhesions that can cause abdominal pain.
3.
A small incision in the abdomen is used for laparoscopic examination.
4.
Birth control pills may lead to endometrial thickening, but they do not cause adhesions of abdominal organs.

Reply Date: 2002/06/07

More Info

Right lower abdominal pain can be a complex issue with various potential causes, particularly in women, where gynecological factors often play a significant role. Based on your description, it seems that you have already undergone some diagnostic tests, including ultrasounds, which did not reveal any significant abnormalities. However, the persistence of pain, especially during certain activities or after consuming cold beverages, suggests that further investigation may be warranted.

Potential Causes of Right Lower Abdominal Pain
1. Gynecological Issues: Conditions such as ovarian cysts, endometriosis, or pelvic inflammatory disease can cause localized pain. Even if ultrasounds did not show any abnormalities, some conditions may not be easily detectable through imaging. Endometriosis, for instance, can cause pain that fluctuates with the menstrual cycle and may not always be visible on an ultrasound.

2. Gastrointestinal Factors: Issues such as irritable bowel syndrome (IBS), appendicitis, or diverticulitis can also lead to right lower abdominal pain. The fact that you experience pain with movement and certain activities could suggest a gastrointestinal component, especially if the pain is associated with changes in bowel habits or dietary triggers.

3. Musculoskeletal Pain: Sometimes, pain in the abdominal area can be referred from the muscles or ligaments in the lower back or pelvis. If you have engaged in activities that strain these areas, it could lead to discomfort that feels like abdominal pain.

4. Urinary Tract Issues: Conditions such as urinary tract infections (UTIs) or kidney stones can cause pain in the lower abdomen and may also be associated with gastrointestinal symptoms like nausea.

5. Psychosomatic Factors: Anxiety and stress can manifest physically, leading to abdominal pain. If you have a history of anxiety, it may be worthwhile to consider whether stress could be exacerbating your symptoms.

Next Steps
Given the complexity of your symptoms, it would be advisable to take the following steps:
1. Consult a Specialist: Since your pain is localized and has persisted, it may be beneficial to consult a gynecologist if you haven't done so recently. They can perform a thorough examination and may suggest further tests, such as a laparoscopy, to investigate conditions like endometriosis or adhesions that may not be visible through standard imaging.

2. Gastroenterology Referral: If gynecological causes are ruled out, a referral to a gastroenterologist may be appropriate. They can evaluate for gastrointestinal disorders that could be contributing to your symptoms, including functional disorders like IBS.

3. Pain Management: Discussing pain management strategies with your healthcare provider can also be beneficial. This may include medications, physical therapy, or lifestyle modifications to help manage your symptoms.

4. Monitor Symptoms: Keep a detailed diary of your symptoms, including when they occur, their intensity, and any associated factors (like diet or activity level). This information can be invaluable for your healthcare provider in diagnosing the underlying cause.

Regarding the Use of Contraceptives
As for your question about whether the use of contraceptives could lead to uterine lining issues, it's important to note that hormonal contraceptives can affect the menstrual cycle and the endometrial lining. Some women may experience changes in their menstrual patterns, including lighter periods or amenorrhea, which can sometimes lead to confusion about underlying conditions. However, there is no direct evidence linking contraceptive use to the development of uterine lining problems that would cause pain.

In conclusion, while your previous tests have not revealed a clear cause for your right lower abdominal pain, it is crucial to continue seeking answers. A multidisciplinary approach involving gynecology and gastroenterology may provide the best chance of identifying the underlying issue and developing an effective treatment plan. Always communicate openly with your healthcare providers about your symptoms and concerns to ensure comprehensive care.

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