Is It Chronic Appendicitis? Right Lower Abdominal Pain

Is this chronic appendicitis?

During the Lunar New Year period, I experienced pain in my lower right abdomen, but the sensation lasted only about a minute.
I also felt pain when performing larger movements, but again, the pain was not persistent.
I visited a nearby clinic, and the doctor mentioned that the area corresponds to the appendix, so I was referred to the emergency department of a larger hospital.
They conducted blood tests, urine tests, and X-rays, but the doctor found nothing abnormal; everything appeared normal.
When the doctor palpated my lower right abdomen, there was only mild tenderness.
The doctor suggested that it could be chronic appendicitis, noting that sometimes blood tests do not reveal this condition.
The doctor then asked me to stand and bend over, and I felt fine without significant pain.
After reviewing my medical history, the doctor speculated that I might be experiencing ovulation pain (my last menstrual period was at the end of January, and I did notice increased discharge during that time, indicating my ovulation phase).
The doctor advised me to monitor my symptoms and seek medical attention if the pain persisted.
Recently, I have occasionally felt mild pain in my lower right abdomen, but it does not last long, typically around a minute.
However, I no longer feel pain during larger activities, such as going up and down stairs (I tend to go down stairs quickly).
When I press on my abdomen, I only occasionally feel something unusual, but it is not painful.
I have researched online and found that I have some symptoms, but not all.
I tried jumping on my right foot, but it didn't elicit any significant sensation, although sometimes I do experience mild pain in my lower right abdomen.
What could this situation indicate? Is it really chronic appendicitis? Additionally, in the past couple of days, I have been able to feel my intestines moving when I place my hand on my abdomen, often accompanied by gurgling sounds, which seem quite normal.
Sometimes, my family members nearby can hear the sounds; is this normal?

Miss Zhu, 20~29 year old female. Ask Date: 2016/02/19

Dr. Xu Kaixi reply Surgery

It is recommended that you visit the surgical outpatient department of the hospital in person to arrange for an abdominal CT scan to confirm whether there is appendicitis.

Reply Date: 2016/02/19

More Info

Chronic appendicitis is a condition that can be challenging to diagnose, especially when symptoms are intermittent and mild. Based on your description, it seems that you have experienced right lower abdominal pain that lasts for about a minute and occurs during physical activity. You have also undergone various tests, including blood tests, urine tests, and X-rays, which returned normal results. The physician you consulted suggested the possibility of chronic appendicitis or ovulation pain, given your menstrual cycle timing.

Chronic appendicitis is characterized by recurrent abdominal pain in the right lower quadrant, which may not always present with the classic symptoms of acute appendicitis, such as fever or significant tenderness. In cases of chronic appendicitis, the inflammation may be less severe, leading to symptoms that can be easily overlooked or attributed to other causes. The intermittent nature of your pain, along with the lack of severe symptoms, could indeed suggest chronic appendicitis, but it is essential to consider other potential causes as well.

One possibility is that your pain could be related to ovulation, especially since you mentioned that your last menstrual period was at the end of January and that you experienced increased discharge during your ovulation period. Ovulation pain, also known as mittelschmerz, can occur when the ovary releases an egg, causing temporary discomfort in the lower abdomen. This pain typically lasts from a few minutes to a few hours and is often accompanied by other symptoms such as changes in vaginal discharge.

Additionally, the sounds you are hearing from your abdomen, often referred to as borborygmi, are normal intestinal sounds that occur as gas and fluids move through the intestines. These sounds can be more pronounced when you are hungry or after eating, and they are generally not a cause for concern unless accompanied by significant pain, bloating, or changes in bowel habits.

Given that your symptoms are mild and intermittent, it may be reasonable to continue monitoring your condition. However, if you experience any worsening of symptoms, such as increased pain, fever, or changes in bowel habits, it would be prudent to seek further medical evaluation.
In terms of next steps, consider the following recommendations:
1. Keep a Symptom Diary: Document when the pain occurs, its duration, any associated activities, and other symptoms. This information can be helpful for your healthcare provider in making a diagnosis.

2. Follow Up with Your Doctor: If your symptoms persist or worsen, return to your healthcare provider for further evaluation. They may consider additional imaging studies, such as an abdominal ultrasound or a CT scan, to assess the appendix and surrounding structures more thoroughly.

3. Consider a Specialist Consultation: If your primary care physician is unable to provide a definitive diagnosis, you may want to consult a gastroenterologist or a surgeon specializing in abdominal conditions. They can offer more specialized insights into your symptoms and potential treatment options.

4. Monitor for Other Symptoms: Be vigilant for any new symptoms, such as fever, significant changes in appetite, or gastrointestinal disturbances, which could indicate a more serious condition requiring immediate attention.

In conclusion, while chronic appendicitis is a possibility, your symptoms could also be attributed to ovulation pain or other benign causes. Continuous monitoring and open communication with your healthcare provider will be key in managing your condition effectively.

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