OpenHealth Q&A

Intensifying Abdominal/Pelvic Discomfort for Over Two Months

I am a 28-year-old individual assigned female at birth, standing 5 feet 6 inches tall and weighing 125 pounds. For over two months, I have been experiencing persistent discomfort in my lower left abdomen and pelvic region, which occasionally radiates down my thigh or into my back. The pain is progressively worsening and fluctuates throughout the day, generally registering between 3 and 7 on the pain scale. At times, the sensation can be described as pressure or fullness, while during more painful episodes, it presents as a pulling or throbbing feeling. This distress is unaffected by movement or food intake, tends to be milder in the morning, and often intensifies by nightfall. Additionally, the left side of my abdomen feels slightly tender, and I frequently notice a bloated appearance. I am also experiencing fatigue, likely due to sleep disturbances caused by the discomfort. Concerned about the possibility of an ovarian cyst, I consulted my gynecologist, who conducted pelvic and transvaginal ultrasounds. These tests returned clear results, showing only a minor amount of free fluid. Subsequently, my primary care physician eliminated the possibility of a urinary tract infection and performed a normal lumbosacral x-ray. She suspected an inguinal hernia and recommended urgent care when the pain escalated. At urgent care, they conducted blood tests (CMP and CBC with differential) and a CT scan with contrast, both of which yielded normal findings. Despite five days of muscle relaxants and laxatives prescribed by the urgent care physician, the pain has not improved. Bowel movements have remained regular apart from instances of diarrhea linked to the laxatives. Recently, I have been sensing a pronounced pulse in the painful area, to the extent that the urgent care doctor took note of it; however, the CT scan excluded the possibility of an abdominal aortic aneurysm. In terms of my medical history, I manage depression and anxiety effectively and have not undergone any surgeries. I consume 2 to 3 alcoholic drinks monthly and do not smoke or use drugs. My family history includes severe endometriosis on my mother’s side. I am currently taking the following medications: Duloxetine 60mg, Portia (a hormonal contraceptive), and a multivitamin. CT Scan Findings: - LOWER CHEST: No acute abnormalities present. - HEPATOBILIARY: The liver appears within normal size and contours, with a 9 mm irregular lesion in the right hepatic lobe deemed indeterminate. The gallbladder is normal, with no biliary duct dilation. - SPLEEN: Normal size and no focal lesions detected. - PANCREAS: Free of mass, ductal dilation, or surrounding inflammation. - ADRENAL GLANDS: Normal. - KIDNEYS/URETERS/BLADDER: No suspicious renal masses or hydronephrosis detected; urinary bladder deemed normal. - STOMACH/BOWEL: Stomach appears normal, with no obstruction, free air, or unusual bowel wall thickening; moderate fecal retention in the colon with a normal appendix. - REPRODUCTIVE: Uterus and adnexal regions show normal findings without any suspicious masses. - VASCULAR/LYMPHATIC: No signs of abdominal aortic aneurysm or significant vascular issues; lymph nodes are not pathologically enlarged. - OTHER: No ascites. - MUSCULOSKELETAL: No acute abnormalities noted in bones. I seek advice on the following: What conditions might be causing this pain? If it is related to my colon, why am I not experiencing typical digestive symptoms? Conversely, if it is endometriosis, why is it localized, and why does it not worsen during menstruation? What steps should I take next? My primary care doctor is quite supportive, while my gynecologist has not been as helpful. I appreciate any insights as this discomfort is significantly affecting my work and mental well-being, and I am eager to find a resolution promptly.

Answers (1)

4/1/2025, 3:01:09 AM

OpenHealth AI

I understand that you’ve been experiencing significant abdominal and pelvic discomfort for over two months, which has not improved despite various evaluations and treatments. This prolonged pain can be frustrating and concerning, especially when clear causes have not been identified. Let's explore potential explanations for your symptoms and outline actionable next steps.

Possible Conditions Causing Your Pain

1. Endometriosis: Given your family history, this remains a strong possibility. Even with clear imaging, endometriosis can sometimes be elusive, localized, and not always tied to menstruation patterns. It is known for causing chronic pelvic pain, and feelings of pressure or fullness can accompany it.

2. Ovarian Factors: Although your ultrasounds were clear, other ovarian issues (e.g., micromorphological cysts) might not be visible but can still cause pain.

3. Musculoskeletal Issues: Your symptoms, especially the radiating nature of the pain and the sensation of a pulse, could be related to muscular or ligamentous strains or issues around the pelvis.

4. Gastrointestinal Issues: Sometimes, issues like irritable bowel syndrome (IBS) or functional gastrointestinal disorders can cause abdominal pain without overt digestive symptoms like diarrhea or constipation. The moderate fecal retention noted during the CT scan could suggest less frequent but not atypical bowel movements.

5. Nerve Entrapment or referred pain: Conditions that affect nerves in the lower abdomen or pelvic area can lead to localized pain without broader gastrointestinal symptoms.

Next Steps to Consider

1. Symptom Tracking: Keep a detailed diary of your pain, including its intensity, nature (e.g., dull, throbbing), triggers, and any associated symptoms (like bowel changes). Specifically note if it correlates with activities, time of day, or stress levels.

2. Follow up with a Specialist: Consider seeing a specialist in endometriosis or a gastroenterologist to discuss your symptoms in more detail. A second opinion or further testing related to endometriosis or gastrointestinal functionality may be beneficial.

3. Pain Management Techniques: Since you've had some persistent discomfort, exploring non-pharmacological pain management options could be valuable. Techniques such as physical therapy focused on the pelvic floor or abdominal areas, relaxation techniques, or cognitive behavioral therapy (CBT) for pain management can have a positive impact.

4. Review Current Medications: Since you are on Duloxetine (which can help with both pain and anxiety), discuss with your primary care doctor if adjusting doses or trying additional medications for pain relief may be appropriate.

5. Lifestyle Adjustments: Gentle exercises like yoga or pilates may help alleviate tension in the pelvic area. Additionally, maintaining a balanced diet and hydration can also help with gastrointestinal health.

6. Reevaluate with Your Providers: If symptoms worsen or new symptoms appear, promptly communicate with your primary care physician or gynecologist. Ensure they are aware of all changes in your condition, as ongoing evaluations may be needed.

Acknowledging that persistent pain can impact both your physical and mental well-being, it's important to remain engaged with your healthcare team. Your experiences and concerns are valid, and pursuing clarity on the underlying cause of your discomfort will help you find more effective management strategies. Please feel free to reach out if you need more specific advice or support.