[56F] With severe lower abdominal pain for one month

Patient Description

A 56-year-old female has been experiencing severe, constant, sharp lower abdominal pain for the past month. The pain extends into her back and is so intense that it has her doubled over and makes it difficult to walk. She reports no relief from the pain. The patient denies fever, chills, nausea, vomiting, changes in bowel habits, urinary symptoms, or abnormal vaginal bleeding or discharge. Her appetite and weight have remained stable. She had a hysterectomy over 15 years ago. The patient uses tobacco daily and has a family history of gastrointestinal or gynecological conditions, though she is unsure of the specifics. She has lupus, diagnosed 8 years ago, and is allergic to Plaquenil. Current medications include Rabeprazole 20 mg daily, Azathioprine 50 mg daily, Amlodipine 5 mg daily, Sertraline 150 mg daily, Levothyroxine 0.3 mg daily, and Glycopyrrolate 2 mg daily, all taken for over 5 years. She also takes ibuprofen and a prebiotic vitamin.

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Arora's Assessment

What might be happening

Based on the information you've provided, there are a few potential causes for your severe lower abdominal pain:

  1. Gastrointestinal Issues:

    • Irritable Bowel Syndrome (IBS): IBS can cause chronic abdominal pain, often described as cramping or sharp pain. It can be associated with changes in bowel habits, but not always.
    • Diverticulitis: This condition involves inflammation or infection of small pouches in the digestive tract and can cause severe, constant pain, usually in the lower abdomen.
  2. Gynecological Issues:

    • Endometriosis: Even though you had a hysterectomy, endometriosis can still cause pain if there are remaining endometrial tissues.
    • Ovarian Cysts: These can cause sharp, severe pain in the lower abdomen and back.
  3. Musculoskeletal Issues:

    • Muscle Strain or Hernia: Given the location and severity of your pain, a muscle strain or hernia could be contributing to your symptoms.
  4. Autoimmune Flare-Up:

    • Lupus Flare: Since you have lupus, it's possible that your abdominal pain could be related to a flare-up of your condition, which can sometimes affect the gastrointestinal tract.

What you can do

Severe Lower Abdominal Pain:

  • Seek Immediate Medical Attention: Given the severity and duration of your pain, it's important to see a healthcare provider as soon as possible. They may perform imaging tests like an ultrasound or CT scan to determine the cause.
  • Pain Management: While waiting to see a doctor, you can take over-the-counter pain relievers like ibuprofen, but be cautious with the dosage and frequency.
  • Rest and Hydration: Ensure you are resting and staying hydrated. Sometimes, lying down in a comfortable position can help alleviate some pain.

General Tips:

  • Track Symptoms: Use MDandMe to journal your symptoms, track your progress, and share your notes with your healthcare provider. This can help in identifying patterns and potential triggers.
  • Avoid Triggers: If you notice certain foods or activities worsen your pain, try to avoid them until you can see a healthcare provider.

What you should look out for

Given the severity of your symptoms, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • Fever or Chills: These could indicate an infection.
  • Nausea or Vomiting: Persistent nausea or vomiting could be a sign of a more serious condition.
  • Changes in Bowel Habits: Any new onset of diarrhea, constipation, or blood in your stool should be evaluated.
  • Urinary Symptoms: Pain during urination, increased frequency, or urgency could indicate a urinary tract infection or other issues.
  • Severe Back Pain: If the pain in your back becomes more severe, it could indicate a more serious condition.

Remember, while I can provide some guidance, it's crucial to consult with a healthcare professional for a formal diagnosis and appropriate treatment. If you have any more questions or need further assistance, feel free to continue the conversation.

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5 mo ago


People Also Ask


Can a hysterectomy completely eliminate the risk of gynecological issues like endometriosis?

A hysterectomy, which involves the removal of the uterus, can reduce the risk of certain gynecological issues, but it does not completely eliminate the risk of endometriosis. Endometrial tissue can still exist outside the uterus and cause pain.


What are the common symptoms of a lupus flare-up that might affect the gastrointestinal tract?

A lupus flare-up affecting the gastrointestinal tract can cause symptoms such as abdominal pain, nausea, vomiting, and changes in bowel habits. It can also lead to inflammation in the intestines.


How can smoking affect gastrointestinal or gynecological health?

Smoking can exacerbate gastrointestinal issues by increasing acid production and reducing blood flow to the stomach lining, potentially leading to ulcers. It can also affect gynecological health by altering hormone levels and increasing the risk of certain cancers.


What are the potential side effects of long-term use of medications like Azathioprine and Rabeprazole?

Long-term use of Azathioprine can suppress the immune system, increasing the risk of infections and potentially leading to liver damage. Rabeprazole, a proton pump inhibitor, can lead to nutrient deficiencies, such as magnesium and vitamin B12, and increase the risk of bone fractures with prolonged use.

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