Right Side Abdominal pain for 2 1/2 years

by Melinda R
(Sanford, Colorado, USA)

My 16 year old daughter has suffered from pain in her lower right side for 2 1/2 years.

It is a dull pain that becomes sharper at times and makes her sick to her stomach. She didn't have a period until march of 2014 and then not another one until November of 2014.

In February her Dr. put her on birth control and that didn't help the pain. We went to a Gynecologist in July of this year and she sent her for physical therapy. She also gave her a shot of steroids in her side. This didn't help.

She continued her birth control and stopped her period for 3 months. Before the 3rd month was up she started bleeding. She is on her 4th week of bleeding now.

I went to another Dr. that the gynecologist referred me to last week, and he wants her to continue physical therapy because he thinks it is a pulled muscle in her pelvis.

They have done ultrasounds and cat scans and found nothing. They are sure it is not Endometriosis. We are frustrated and don't know what to do.

..........................................................

Dear Melinda R,

I can relate to your frustration with the lower right side abdominal pain that your dear daughter has been experiencing for 2 1/2 years now with no clear diagnosis insight, despite having had ultrasound scan, trial of oral contraceptive pills and even a steroid injection.

Answers to some questions may help shed more light on this pain that has been ongoing, like:

• Is her pain always there or does it comes on only at certain times?
  
• Does the pain spread from the lower abdomen to anywhere else
  
• Is there any particular action or movement or time of the month that this pain is exacerbated?
  
• Does she feel a sense of fullness in her lower abdomen?
  
• Is there anybody in the family known with endometriosis?
  
• Any weight loss or reduced appetite?

Has she had laparoscopy - endoscopic direct visualization of her abdomen and pelvis?

Common causes of pain in the lower abdomen in women lasting more than 6 months include:

• Nerve entrapment - Nerve damage from inflammation, scar tissue formation or infection may play a part in this type of pain.
  
• Adhesion and stretching of pelvic organs from any previous pelvic infection or endometriosis
  
• Endometriosis. There is a wrong misconception out there that endometriosis is not common in adolescents. This is not true. Unless a pelvic MRI or laparoscopy is done, endometriosis cannot be ruled out. Ultrasound scan is not very good at excluding endometriosis. ou can read more on endometriosis here.
  
• Irritable bowel syndrome
  
• Interstitial cystitis
  
• Pelvic myofascial trigger point pain
  
• Hernias
  
• Pulled muscle.

This is a sensitive sentence you are going to read now; and it is not suggested in anyway that this may be the cause of her pain in anyway. Some women who experience chronic lower abdominal pain have been victims of physical or sexual abuse as children. Such cases would require deep empathy, tact and sensitivity to draw out and diagnose. As a parent with a 16 year old daughter and someone who comes in contact with young women with chronic lower abdominal pain very frequently, all possibilities need to be explored with a desire to help any woman get relief from this disabling pain.

I would suggest that:

1. Your daughter arrange a consultation with a gynecologist with interest in chronic pelvic pain management
   
2. Right away, she should get a diary and keep a pain diary - when she gets the pain, what time of the day, things and activities that precedes the pain, severity, scoring it from zero, being no pain to 10 being the worst pain every
   
3. Discuss with your doctor about the possibility of trying some pain killers
   
4. If she could take walks for 30 minutes every day, get involved in brisk exercises and get unto some physiotherapy, these may help her with the pain management.

I hope this helps.

Please keep in touch and let us know if there is any other specific query or concerns you would want to be addressed.

We hope your daughter finds an answer to the cause of her pain soonest.

Dr Omatseye Edema MD MRCGP CCFP MSc DRCOG
Family Physician, Emergency Medicine Practitioner and WebMD
Abdopain.com.

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