Chronic Abdominal / Pelvic Pain is pain going on at least a month, often much longer
- The longer the pain has been present, the less chance of serious illness
- If the pain isn’t daily, comes and goes, there’s much less chance of serious illness
Most Common Causes of Chronic Abdominal Pain
| โข Irritable Bowel Syndrome (IBS) โข Dyspepsia | โข Muscle Strain (of abdominal wall) โข Anxiety / Depression |
Most Common Causes of Chronic Pelvic Pain (Females)
| โข Endometriosis โข Fibroids | โข Adenomyosis โข Chronic Pelvic Pain |
NOTE — The above are not physically dangerous (see below to rule-out other conditions)
1. Basic Medical History & Physical Exam, seeking Red Flags suggesting that instead of the above, there may be a more serious condition:
- Getting progressively worse week by week / month by month
- Fevers or night sweats (see also Fever)
- Significant amount of blood in stool / black, tarry stools (“melena”)
- Regular nausea, vomiting, diarrhea (see also Nausea, Chronic Diarrhea)
- Weight Loss (see also Weight Loss)
- Foot swelling (that we see for ourselves), which may hide weight loss
- Age >50 y.o. when symptoms began
- Heavy alcohol history
- Prominent “other symptoms” pointing to specific diseases
- If prominent Urinary symptoms, see also Urinary Problems
- Abnormal findings on physical exam (e.g. large liver, tumor, tender uterus, etc.)
2. If any Red Flags above are present, we order basic lab tests:
- Complete Blood Count (for various types of Anemia)
- Erythrocyte Sedimentation Rate (ESR) / CRP (suggests Crohnโs Disease / Ulcerative Colitis)
- Comprehensive Metabolic Panel — for abnormalities of liver, kidney, sugar, calcium, etc…
- Blood tests for Ferritin and Iron Saturation (for iron loss without anemia yet)
- Tissue-Transglutaminase, IgA Antibody (tTG-IgA) (for Celiac Disease)
- Lipase (for chronic Pancreatitis)
- If constipation or diarrhea prominent, a TSH for Hypo- or Hyperthyroidism.
- Urinalysis for bladder / kidney diseases
- If tender uterus, STD Tests (Gonorrhea, Chlamydia)
- Pelvic Ultrasound in females for Fibroids, Pelvic Tumors
- Specific findings on History or Exam ย โ explore those as starting point for diagnosis
2a. If No Red Flags, may order some of the above tests anyway
3. Return in 3 weeks. Check for weight loss. Begin work-up if abnormalities:
Refer to Gastroenterologist for Endoscopy / Colonoscopy to rule-out Cancer & other diseases if:
- Signs of iron deficiency (anemia, low ferritin), unless the woman has heavy periods
- History of black stools (โmelenaโ) or frank blood in stool
- High ESR / CRP
- Weight Loss
- Age >50
- Also perhaps if tTG-IgA level elevated (= Celiac Disease)
Order an Abdominal / Pelvic CT Scan with Contrast (assuming kidney tests normal) if:
- Significantly abnormal WBC count
- Elevated ESR (or CRP)
- Elevated Lipase
- Weight Loss documented
- Pain is Pelvic (can order Pelvic Ultrasound instead of CT)
- Some providers might let Gastroenterologist order the CT Scan
4. If Tests all Normal, and NO Red Flags:
- Bloating is prominent โ try treating for Dyspepsia
- Constipation or Diarrhea prominent โ try treating for Irritable Bowel Syndrome
- Pain relates to Menstrual Cycle โ might treat for Endometriosis
- or refer to Gynecologist for possible laparoscopy
- Pain is Pelvic โ try treating for Chronic Pelvic Pain
- None of Above โ try treating for Dyspepsia
- Inquire about Stress, and symptoms of Anxiety or Depression โ If significant, obtain thorough mental health history, treat seriously with medication and/or psychotherapy
5. Still no better (& no Red Flags) โ refer to Gastroenterologist / Gynecologist
- To rule out a variety of really rare diseases; OR
- To reassure the patient that there’s nothing serious going on
See Chronic Abdominal / Pelvic Pain โ Full Text for more in-depth explanations and discussions.