Right Lower Abdominal Pain: Causes and When to Seek Help - Gastroenterology and Hepatology

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Right lower abdominal pain can be a complex issue with various potential causes, especially considering your symptoms of persistent discomfort, pressure sensations, and the associated gastrointestinal issues like constipation and bloating. Given that you have already consulted a gynecologist and ruled out gynecological problems, it may be beneficial to explore other possible causes related to the gastrointestinal system or even musculoskeletal issues.


Possible Causes of Right Lower Abdominal Pain
1. Irritable Bowel Syndrome (IBS): Your symptoms of bloating, constipation, and abdominal pain could suggest IBS, a common gastrointestinal disorder characterized by a combination of abdominal pain and altered bowel habits. Stress and anxiety can exacerbate IBS symptoms, leading to increased abdominal discomfort.

2. Appendicitis: Although typically associated with acute pain, early appendicitis can present as vague discomfort in the right lower abdomen. If the pain worsens or is accompanied by fever, nausea, or vomiting, immediate medical attention is necessary.

3. Diverticulitis: This condition occurs when diverticula (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 lower quadrant, especially in individuals with a history of constipation.

4. Musculoskeletal Issues: Given your description of pain upon pressure and the potential for referred pain from the lower back or pelvic region, musculoskeletal problems such as muscle strain or even issues related to the spine could be contributing to your discomfort.

5. Chronic Constipation: Your history of habitual constipation can lead to significant abdominal discomfort and pain. Straining during bowel movements can cause pain in the lower abdomen and may even lead to rectal discomfort.

6. Hernia: An inguinal or femoral hernia could also present with localized pain and discomfort, particularly when straining or lifting.


When to Seek Help
You should seek medical attention if:
- The pain worsens or becomes severe.

- You experience fever, chills, or vomiting.

- There is blood in your stool or urine.

- You have significant changes in bowel habits or unexplained weight loss.


Recommended Medical Consultations
Given your symptoms and the fact that you have already seen a gynecologist, it would be prudent to consult a gastroenterologist. They can perform a thorough evaluation, which may include:
- Colonoscopy: This procedure allows for direct visualization of the colon and can help identify issues such as diverticulitis, polyps, or other abnormalities.

- Imaging Studies: An abdominal ultrasound or CT scan can help visualize the organs in the abdomen and identify any structural issues.


Potential for Laparoscopy
If non-invasive tests do not provide a clear diagnosis, a diagnostic laparoscopy may be considered. This minimally invasive procedure allows the physician to directly visualize the abdominal cavity and assess for conditions such as appendicitis, hernias, or other intra-abdominal pathology.


Conclusion
In summary, your ongoing right lower abdominal pain, coupled with gastrointestinal symptoms, warrants further investigation. Consulting a gastroenterologist is a logical next step, as they can provide a comprehensive evaluation and determine the most appropriate diagnostic tests. Managing your constipation and any associated anxiety may also help alleviate some of your symptoms. Remember to keep track of your symptoms and any changes, as this information will be valuable for your healthcare provider in determining the best course of action.