Intermittent Lower Abdominal Pain: Possible Causes and Solutions - Gastroenterology and Hepatology

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Intermittent lower abdominal pain can be a perplexing and distressing symptom, especially when it has persisted for several years without a clear diagnosis. Based on your description, it seems that you experience episodes of intense pain that can last from 20 to 40 minutes, and these episodes are triggered by physical pressure or movement, such as coughing, sneezing, or changing positions. Given that you have experienced this pain since high school and have had episodes severe enough to cause significant discomfort, it is understandable that you seek clarity on the potential causes and solutions.

There are several possible explanations for intermittent lower abdominal pain, and it is important to consider both gastrointestinal and non-gastrointestinal causes. Some common gastrointestinal issues that could lead to such pain include:
1. Irritable Bowel Syndrome (IBS): This functional gastrointestinal disorder can cause abdominal pain, bloating, and changes in bowel habits. The pain associated with IBS often improves after a bowel movement, but it can also occur independently of bowel activity.

2. Muscle Strain: Since you mentioned that the pain can be triggered by physical activity, it is possible that you may be experiencing muscle strain or spasms in the abdominal wall or pelvic floor muscles. This could be exacerbated by activities that put pressure on the abdomen.

3. Pelvic Floor Dysfunction: This condition involves the muscles of the pelvic floor not functioning properly, which can lead to pain in the lower abdomen and pelvic region. It may be associated with muscle tightness or spasms.

4. Ovarian Issues: In females, conditions such as ovarian cysts or endometriosis can cause intermittent lower abdominal pain. These conditions may not always present with regular menstrual symptoms, making them harder to diagnose.

5. Gastrointestinal Obstruction: Although less common, intermittent pain could indicate a partial obstruction in the intestines, which may not always present with other symptoms like vomiting or constipation.

6. Urinary Tract Issues: Conditions affecting the bladder or urethra, such as interstitial cystitis or urinary tract infections, can also lead to lower abdominal pain.

Given that you have consulted a family physician who suggested that the pain is not significant enough to warrant further investigation, it may be beneficial to seek a second opinion, particularly from a gastroenterologist or a specialist in pelvic pain. They can conduct a thorough evaluation, which may include imaging studies (like an ultrasound or CT scan), blood tests, or even a referral to a pelvic floor physical therapist if muscle dysfunction is suspected.

In terms of management, keeping a pain diary can be helpful. Documenting the frequency, duration, intensity, and any associated activities or dietary factors can provide valuable information for your healthcare provider. Additionally, lifestyle modifications such as stress management techniques, dietary adjustments, and regular physical activity may help alleviate symptoms.

If the pain becomes more frequent or severe, or if you experience additional symptoms such as changes in bowel habits, weight loss, or fever, it is crucial to seek medical attention promptly. Understanding the underlying cause of your intermittent lower abdominal pain is essential for effective management and improving your quality of life.