Discussions By Condition: I cannot get a diagnosis.

Lower abdominal Pain - Female - Cannot get positive diagnosis

Posted In: I cannot get a diagnosis. 3 Replies
  • Posted By: Anonymous
  • July 1, 2009
  • 11:58 AM

My wife has been dealing with what she describes as severe lower abdominal pain for about a year. We have been to the emergency room, she has undergone exploratory laparoscopic surgery, been on almost every type of birth control that comes in a pill, all to no avail. Please help us! If you know of someone with the following symptoms who has been properly diagnosed and treated please, PLEASE post to this thread and let us know what you know!

Here's everything about her situation:

Female
Age 23
5'9"
195 lbs
Constant pain in lower abdomen worsening at time of menstrual cycle
Pain sometimes accompanied with nausea
Pain often spreading to inner thigh area
Pain subsides somewhat while laying flat
Increased discomfort when sitting up
Pain lessens when heat is applied
Some pain associated with bowel movements during flare-ups
Flare-ups last anywhere from a day to a week

No pain when urinating
Pain is not restricted to one side of the body

Laparoscopic surgery results were ordered to look for endometriosis. No signs of endometriosis were found. All organs observed seemed to be in healthy condition.

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3 Replies:

  • This is a case of chronic pelvic pain (CPP). Diagnosis can be challenging and the last resort when no cause is found is diagnostic laparoscopy. If diagnostic laparoscopy fails to demonstrate a cause, then really there is nothing to recommend other than pain control. In this situation, doctors generally recommend referral to a multidisciplinary pain clinic. Such clinics generally have doctors (e.g. gynecologists, anesthesiologists), psychologists, and sometimes acupuncturists working together to help manage pain. http://www.uptodate.com/patients/content/topic.do?topicKey=~777HbAIIypxfsO(Note: Link provided for medical information only. The author of this post is not affiliated with any web site.)
    m3dh31p 69 Replies Flag this Response
  • Clarification: I have been imprecise in my terminology. The correct term would be dysmenorrhea (since the pain is associated with the menstrual cycle). First line treatment is with NSAIDS, and second line with hormonal pills. About 10 percent of women will not respond to the above treatment. Many times, nonresponders are considered to have underlying pathology and undergo diagnostic laparoscopy to rule out secondary causes such as endometriosis. In the absence of underlying pathology, and non-respondance to primary therapy, alternative therapies may be used. These include TENS, laparoscopic presacral neuronectomy etc. Their efficacy varies. For example, earlier studies cite up to about about 90 percent effectiveness for neuronectomy, but more recent studies do not show long term efficacy. Surgical therapy, therefore, is not in common use. Possible drug treatments include salbutamol, transdermal nitroglycerine, nifedipine, or MDPA. Psychotherapy is useful in some cases. My final advice is as stated in the earlier post: the focus should be on pain control and this should be discussed with the physician/gynecologist. A multidisciplinary approach may also be considered. I am sorry I cannot give you a more precise diagnosis (which was your query) or more specific advice.
    m3dh31p 69 Replies Flag this Response
  • Thank you, we will probably pursue that option.
    Anonymous 42789 Replies Flag this Response
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