Digestive Disorders / Gastroenterology Expert Forum
Pain in lower right quadrant
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Pain in lower right quadrant

About three months ago I experienced a sharp pain on waking located  on the lower right side near or above the appendix. The incident happened after a party with lots of food and drink. I thought it was a reaction to the food or possibly an appendicitis. I have never experienced pain that intense. The pain subsided after a few hours. The pain came at the same time as I was having a bladder infection (sharp pain during urination) -- although at the time I didn't connect the two events (and still do not know if they are related).

The reason I am writing to this forum is that a faint echo of the pain is still there -- sometimes dull and sometimes sharp. It worries me occasionally and I would like to know what is going on.

To figure it out, so far I have had a full range of blood tests (all normal), ultrasound (no apparent kidney, gall bladder or other organ problems), urine and stool samples (all normal, no blood), and a barium x-ray of my colon (perfectly clean and healthy). The doctor I am visiting says he cannot find anything for me to worry about. I am 43 year old male in generally good health.

The pain is much reduced from the first onset at the end of  November. It now seems localized in my small intestine about two to three inches to the right of my navel. It does not appear to be directly related to eating. I notice it when I am both walking and sitting. It appears to be slightly aggravated by stress, alcohol (wine) and caffeine -- or it could simply be that I imagine it being worse after these things. Occasionally it radiates to my lower back. Sometimes it feels like a "gut pain" -- the stitch in the side you feel after running a long distance. I also have periods -- two or three hours at a time -- when the pain is completely gone. When I am experiencing the pain and I push in on my lower intestine, I hear gurgling and bubbling (like gas). Sometimes I think it is merely trapped gas -- the problem is that it has gone on so long. My bowel and urination habits a basically normal.

I would appreciate your advice. Has anyone had this specific symptom set. Which tests should I pursue further? Would you suspect intestinal irritation, possibly an ulcer or even something related to what appeared to be a bladder infection on onset? I do not have any nausea, vomiting or fever. Aside from this pain in my side, I feel basically fine. I thank you in advance. Mark
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Possibilites of abdominal pain in that area are the appendix, small bowel disease, inflammatory bowel disease or irritable bowel disease.

In addition to the tests you have already received, I would suggest an abomdinal CT scan (to evaluate the appendix or look for any organ masses), an upper GI series with small bowel series (to evaluate the small bowel), or a colonoscopy (both this test and the small bowel series can also look for inflammatory bowel disease).  

If every test is negative, you may want to consider irritable bowel disease, which can increase the sensitivity of the digestive tract to gas and give the feeling of increased bloating.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.
11 Comments
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Avatar_n_tn
I am 38 y old male, generally in good health and I am experiencing similar problems of late.

In late January I started experiencing some stomach problems, heartburn, and constant need to burp. About the same time I did a lot of snow cleaning and at one moment I felt a pinch like pain in my mid-left abdomen. I did not pay a lot attention to that pain since I attributed it to muscle strain. I went to my doctor and tested positive to HP bacteria. My upper X-Ray and abdominal ultrasound were negative, my blood and urine were OK. I was prescribed HP Pack that I finished in 7 days. Since I finished therapy I started having even more bad feeling in my abdomen.

I do not know if stress or worry can make it. The pain is not bad and constant pain. It is rather intermittent disturbing filling in my stomach. More often on the left side mid, low and even high left side. I can also feel it around my belly button or on the right side. For a few days I also had a burning sensation in my left groin but it is gone now. I usually feel the pain like pinching but can not determine how deep it is. I started some exercising (push-ups, sit-ups, curl-ups) and I can do them without the problem with high number of repetitions, but after few days I developed a lot of, what I hope is, muscular pain that is also not constant and can
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Avatar_n_tn
I would suggest having a small bowel follow through and possibly a colonoscopy (hoping to reach the connection of small and large bowel)  It would be great to rule out Crohn's disease.  I also started out just like you...in Nov.  Only diff was I had loss of apetite, fever, weight loss- finally in Jan diagnosed with Crohn's through colonoscopy.  Probably not an encouraging letter but if I had to describe my pain..very similar except I do notice that certain (almost all) food makes it worse.  I also don't suffer from diareah even though I have crohn's.  Take care and hopefully it is a strained muscle, gas, IBS (not that that is much fun either).  Take care
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Avatar_n_tn
Thanks for the feedback. I will pursue it. In the meantime I tried an over the counter enzyme ... I believe an enzyme that helps to break down fatty types of food ... and the pain is better. Does this give anyone any clues? Mark
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I'm a 36 yr old female with almost identical symptoms.  Same location, about 3 inches out from my navel on the right side.  The pain came on suddenly (in Dec) and has since decreased in intensity, but is still there all the time.  It hurts worse to sit or walk.  I had the blood tests, urinary tract tests, colonoscopy and blood work.  All normal.  I saw a surgeon who thought I might have a small hernia.  I posted here about a month ago (search on "RLQ" to see my post) and the surgeon suggested a small bowel issue or nerve impingement.  The only thing left for me is a small bowel xray (to look for Crohn's) or a laproscopy.  Hope that helps.
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I am a 24 year old male and am also experiencing pain in the lower area of my stomach. It is centralized to the right of my naval and is a sharp, pinching pain. So far, my physician has done an array of blood tests and CT scans. We have found no problems. As I explained to him, this pain sometimes affects my ability to walk minimal distances. My doctor has prescribed Pepcid to take as needed. I have noticed no relief from this medication as of yet. I am physically fit and have also been keeping a calendar of what I eat to see if this has any connection to the pain, none that I am aware of. The pain has been on and off for almost two years. When I press on the area with pain, it increases.

I had taken Vicodin for a back injury for a few months, but discontinued it. The pain was there prior, during, and after taking it. I have pain on average of two
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Avatar_n_tn
I'll apologize in advance that this post is kind of long.  I'm new to this site and I guess I'm a little anxious to talk about this with people in similar situations.

I am a 27 y/o male, and I have experienced symptoms very similar to those mentioned above for over two years now.  After struggling to find the cause/source of these problems (blood tests, colonoscopy, upper GI w/ small bowel follow-through), I am meeting with a general surgeon tomorrow.  I have no idea what he's going to do, but I'm sure it won't be fun.

Basically, I have experienced fluctuating pain in the lower right abdomen area.  The pain has ranged from mild/annoying... to the point where I've been admitted to the ER because my family doctor was certain I had appendicitis.  At the ER, upon examination, and after considering my healthy appetite, lack of temperature, etc... appendicitis was ruled out immediately.

For the most part, the pain seems to be brought on by physical exertion -- particularly, straining of the abdominal muscles.  Some of the first (and worst) episodes I had were after relatively heavy weightlifting workouts.... specifically those targeting the abdominal muscles.

After taking almost a year off from weightlifting -- and pretty much any physical activity for that matter -- the episodes don't seem to occur as frequently.  However, I just had a pretty bad episode only a couple weeks ago... which is why I'm meeting with the general surgeon tomorrow.

Recently, I have experienced episodes after doing things like moving furniture... and I've begun to notice a particularly disturbing corrlation between the onset of pain and sexual activity.

These episodes are typically followed by bowel problems... often times leading to straining, which leads to bright red blood in stool (consistent with internal hemorrhoids, although nobody has every confirmed that internal hemorrhoids are the source of the blood).  Sometimes the blood is more present than others... and the blood seems to almost always come at the end of a bowel movement.  

Also of note... despite the aforementioned potential gastrointesinal problems, my appitite rarely, if ever, seems to subside.  I eat a regular and healthy diet -- rarely missing a meal -- but because these abdominal problems have prevented me from exercising, I have expereinced some weight gain (I'm an even 6 feet tall, and I've gone from about 190 pounds to around 215 pounds in this two-year span).

I am extremely frustrated by all of this.  I miss being athletic and just enjoying life in general.  The good news, I guess, is that most of the major things have been ruled out (Krohn's, cancer, polyps, etc.).  The bad news is that we still can't get "it" fixed.

Any advice, feedback or general thoughts would be very much appreciated.
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Hi stuck_buck,

I posted on this topic a month ago.

So far I had all tests negative. My abdominal pain now changed into something that you perfectly described in your post. Gets worst with intense physical activity especially with things involving abdominal muscles like excercising, snow cleaning, holding my spoiled 3YR old in my arms during the shopping and so on. Jogging does not seem to affect it at all. I also feel increased pain in area of my groins specially while sitting, and it even goes down my leg after few days of more intense sexual activities. I can not give exact location of pain since it seems to
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Avatar_n_tn
I met with the general surgeon today.  He performed a rectal exam, and basically said he didn't see any obvious signs of internal hemorrhoids (i.e. he didn't notice any masses, etc.), and he now thinks that internal hemorrhoids may not be the source of the blood afterall.

He mentioned Crohn's again, but said maybe it's in its initial stages... and told me that sometimes it takes a couple years to diagnose.

He also mentioned accute appendicitis, but said that's not very likely.

The other thing he mentioned was some type of muscle problem.  He made the analogy to a runner with a recurring hamstring problem.  I didn't think quickly enough to ask him whether or not blood in the stool would be consistent with this.  I'm obviously not a doctor, but this muscular problem has kind of been my gut feeling (no pun intended).  However, like I said, how does this explain the blood?

I'm now having a CT scan on abdomen/pelvis on Friday.

This is frustrating.
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Good luck and keep us posted.
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My symptoms are identical to everyone else's in the post.  After 4 months of testing (blood tests, CT scans, colonoscopy, urinary tests) I am having a diagnostic laparoscope and appendectomy next week.  My surgeon thinks that there is a good chance that it is chronic appendicitis.  (This controversial diagnosis has only gained acceptance by physicians in the last 10 years.)  It may also be a non-palpable hernia.  If the procedure does not help the pain, he is sending me to get nerve block injections with the assumption that it is abdominal cutaneous nerve entrapment syndrome (ACNES).  A google search on the term will lead you to an interesting article on the topic.  Hope that helps.
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I am 33 years of age female, my problem is that i urinate quite often at nights like about two to three times and it comes with a sharpe pain in my lower abdomen after urinating, not during just after urinating, i would like to know if this is a sign of urinary tract infection. As i was treated for this several time when i was pregnant with second child who is now 5 years old. And wonder if must not just check for UTI only but for kidney problems or bladder problems. shellice
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