12 year old girl compaining of pain in left side

my 12 year old daughter ocassionally complains of pain in her left side up to her belly button area. she indicates the pain level is between 5 and 6 on a scale of 1 to 10. could you give me some idea of what may be causing her problem and pain

[J T Junig, MD PhD]

Thanks Jay-- I agree.  Then there are also the pains that seem to just come and go in teens-- what we refer to as 'growing pains'.  I think that those pains sometimes serve as attention getters during that confusing time in life when it is difficult for a child to directly ask for help.

A general approach to abdominal pain can be followed by realizing that pain affecting the intestines or stomach will be felt in the middle of the belly (not one one side or the other), UNLESS the pathology is causing irritation of the inside abdominal wall. That is why appendicitis, for example, generally starts as pain in the midline,, and then as the infected tissue irritates the inside wall of the peritoneal cavity, the pain is felt in the right lower quadrant.  Pelvic pain from the ovaries, uterus, etc is felt very low in the belly. Problems originating in the kidneys often cause pain in the flank;  the most common causes would be a kidney infection or a stone, both of which are quite painful.  The type of pain that this young lady describes, i.e. on the left of the abdomen, may also be coming from something in the wall of the abdomen such as a pulled muscle.  Pain not in the midline can also come from 'adhesions', or bits of scar tissue that can form between the intestines and the abdominal wall.

Another approach to diagnosis is more 'functional';  it would be unusual for a person to have significant abdominal pain coming from the GI system without the pain being accompanied by nausea, diarrhea, or constipation.  Pain related to GYN structures usually varies with the menstrual cycle.  Pain from the kidney or bladder will often cause blood in the urine and/or fever.  

One of the most important diagnostic factors is whether the pain is progressive, or whether is seems to stay the same as it comes and goes over weeks or months.  This latter pattern is consistent with the 'growing pains' that I mentioned first.

[Jaybay]

I'm not the doctor, but I'll chime in until he does.  If it isn't intestinal, it could be a gynecological.  Has she had a period yet?  Her hormones may be trying to kick in and it's just not quite enough to pop an egg out of the ovary.  That can result in a cysts that slowly drains and causes quite a bit of pain; or it bursts all at once and drops you to your knees.

There have also been rare cases of endometriosis that crop up in young girls - even before menarche.  That's a tough one to nail down because endo and it's associated adhesions (scar tissue) generally remains in hiding on imaging studies.  Making it tougher, many gynecologists won't even hear of the possibility of endo showing up in such a young lady; but it happens.

If she hasn't been to her famly doctor or pediatrician since these symptoms started, now would be a good time to go and get it checked out.  :-)

[bbaalbandit54]

Thank you for your insights into the possibilities that may be causing my daughter's pain.

[DantesMom]

From what you are describing it sounds very much like and ovarian cyst. You should have this checked out because there is nothing worse than having one burst and not knowing what it is. This happened to me at 13 when I was on vacation.