Chronic Abdominal / Pelvic Pain

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

โ€ข Irritable Bowel Syndrome (IBS)
โ€ข Dyspepsia
โ€ข Muscle Strain (of abdominal wall)
โ€ข Anxiety / Depression

Most Common Causes of Chronic Pelvic Pain (Females)

โ€ข Endometriosis
โ€ข Fibroids
โ€ข Adenomyosis
โ€ข Chronic Pelvic Pain

NOTEย  —ย  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
  • Significant amount of blood in stool / black, tarry stools (“melena”)
  • Regular nausea, vomiting, diarrhea
  • Weight Loss
  • Foot swelling (that we see for ourselves), which hides weight loss
  • Age >50 y.o. when symptoms began
  • Heavy alcohol history
  • Prominent “other symptoms” pointing to specific diseases
  • Abnormal findings on physical exam (e.g. large liver, tumor, tender uterus, etc.)

2.ย ย  If any Red Flags above are present, we order basic lab tests:

2a. If No Red Flags, may order some of the above tests anyway

3.ย  Return in 3 weeks.ย  Check for weight loss.ย  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 (โ€œmelenaโ€) 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 ย โ†’ย  try treating for Dyspepsia
  • Constipation or Diarrhea prominent ย โ†’ try treating for Irritable Bowel Syndrome
  • Pain relates to Menstrual Cycle ย โ†’ might treat for Endometriosis
  • Pain is Pelvic ย โ†’ย  try treating for Chronic Pelvic Pain
  • None of Above ย โ†’ย  try treating for Dyspepsia
  • Inquire about Stress, and symptoms of Anxiety or Depression ย โ†’ If significant, obtain thorough mental health history, treat seriously with medication and/or psychotherapy

5.ย  Still no better (& no Red Flags)ย 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

Seeย Chronic Abdominal / Pelvic Pain โ€” Full Textย for more in-depth explanations and discussions.

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