OpenHealth Q&A

Persistent Pain in the Lower Right Abdomen

I'm a 24-year-old female, standing at 5 feet 6 inches tall and weighing 134 pounds. My lifestyle tends to be quite inactive, I’m not on any medication, and aside from a general anxiety condition, I don't have any chronic health issues. I've never smoked. For the past six months, I have been suffering from ongoing pain localized in the lower right part of my abdomen. It's noteworthy that my appendix was removed about 15 years ago. I've dealt with constipation for as long as I can remember, especially during stressful situations such as moving, starting a new job or school (I have a tendency to be quite sensitive emotionally). I don’t believe I have any allergies, but certain foods, such as onions, can lead to increased bloating. This abdominal discomfort began shortly after I commenced my new office position. That morning, in an effort to relieve fullness, I strained to have a bowel movement, which I typically do not do. Unexpectedly, this led to escalating pain that developed throughout my workday; by evening, it had intensified significantly. This discomfort, which felt like a stretching sensation in my lower right abdomen, persisted for about three days before subsiding. The pain returned the following week under circumstances I can’t clearly remember, but I suspect I might have been constipated, missing a day to relieve myself. Now, six months later, the pain has transformed into a persistent, dull sensation in the same area, located below the site of my appendix scar. It feels deep inside my lower right abdomen, almost near my pubic region, but I find it challenging to specify an exact point. Occasionally, I experience a milder ache that radiates to my lower back. This ongoing discomfort tends to worsen when I feel bloated or if I go a day without a bowel movement. I've also observed that it intensifies during coughing spells, following physical activities that engage my abdomen, or during squatting positions, although sometimes it flares up unexpectedly. When I do these activities, the pain can escalate alongside sharp, brief pinching sensations that occur sporadically. While I have described the pain as a dull, background sensation, it can intensify and manifest as a burning discomfort or a nagging muscle soreness. I have also recently started to experience sharp pangs, particularly when bloated or after consuming difficult-to-digest foods, which is a new development and mostly affects the right side. This discomfort can range from being barely perceptible to keeping me restless at night or radiating to my lower back while primarily residing in the lower right abdomen. In addition to this abdominal pain, I continue to struggle with constipation, which predates the onset of the discomfort. Often, I find it hard to achieve a complete bowel movement on the first attempt, and to my embarrassment, there have been instances where I've needed to assist myself manually. I make a conscious effort to stay hydrated, incorporate psyllium husk and other fibers into my diet, limit my intake of fried foods and sugars, and ensure I move around daily. As for seeking medical advice, no specific diagnosis has been provided yet. The physicians I've consulted suggested it might be irritable bowel syndrome (IBS) if other conditions are ruled out. Blood tests returned normal results, reproductive health checks were satisfactory, and imaging studies like CT scans and ultrasounds showed no abnormalities. A surgeon didn’t find any hernias, while one gastroenterologist recommended a colonoscopy, yet another believed I was too young for such a procedure. Currently, I am at a loss regarding the next steps in addressing these ongoing issues.

Answers (1)

6/30/2025, 10:20:57 AM

OpenHealth AI

It sounds like you're dealing with a complex situation involving persistent abdominal pain and constipation. Your symptoms might be due to a combination of factors, including stress, diet, and possibly irritable bowel syndrome (IBS). The good news is that you're already taking proactive steps to manage your situation, which is essential.

Explanation:

1. Pain Location: Since you’ve had your appendix removed and the pain has persisted, it’s crucial to recognize that there are many other structures in the abdomen that could contribute to your discomfort. The lower right abdomen houses parts of the intestines, muscles, and nerves, which can be affected by digestive issues, tension, or stress.

2. Constipation and Pain Relationship: Your ongoing constipation likely plays a significant role in the abdominal pain. When your bowel doesn’t move regularly, it can cause the intestines to become distended, leading to discomfort. Stress and diet also directly impact bowel habits; stress can exacerbate constipation and lead to increased muscle tension around the abdomen.

3. Irritable Bowel Syndrome (IBS): It seems plausible that your symptoms align with IBS, characterized by chronic abdominal pain and changes in bowel habits (constipation, in your case). IBS can often be triggered by diet, stress, and other lifestyle factors.

Prioritized Next Steps:

1. Dietary Adjustments: Continue to monitor your fiber intake, but consider focusing on soluble fiber sources (like oats, fruits, and legumes) as they may assist in easing bloating and pain. Avoid known irritants like onions and certain fats.

2. Hydration: Ensure you're drinking plenty of fluids throughout the day. Aim for about 8 cups (2 liters) of water daily. This may help facilitate easier bowel movements.

3. Regular Physical Activity: Try to increase your activity levels gradually, focusing on exercises that engage your core and promote digestion, like walking, yoga, or gentle stretching. Aim for at least 30 minutes of moderate activity most days of the week.

4. Stress Management: Since you mentioned that stress impacts your symptoms, consider integrating relaxation techniques into your routine (like mindfulness, meditation, or breathing exercises) to help manage anxiety and potentially improve bowel function.

5. Keep a Symptom Diary: Document your food intake, bowel habits, pain level, and any stressors. This information can help identify patterns or triggers that exacerbate your symptoms and could be useful if you consult with a healthcare provider again.

6. Follow-Up with Healthcare Providers: While you’ve received various opinions, it may be helpful to revisit a gastroenterologist with your symptom diary in hand. Discuss the possibility of IBS management options, including medications specifically targeted at reducing IBS symptoms.

7. Consider a Specialist: If your symptoms persist or worsen, seek further evaluation. A dietitian or a specialist in functional gastrointestinal disorders could provide additional support tailored to your specific needs.

It’s important to stay proactive in managing your symptoms and reach out for help if needed. It sounds like you’re doing a lot of the right things, and with continued adjustments, there’s potential for improvement. If you have any further questions or need clarification on any point, please feel free to ask!