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What Could Cause Pain In The Right Pelvic Quadrant?
Question: My daughter has now had bloodwork, several sonograms (there was a cyst, but pain was actually worse once cyst had dissolved) , a colonoscopy, a laproscopy to rule out endomedtriosis (while there were questionable areas - all pathology was negative for endo), and most ercently an MRI - all showing nothing. She has pain in her right pelvic quadrant - appendix, gall bladder, liver, uterus, all coming up fine - which is great, but her pain persists - any other suggestions as to what it might be?
Brief Answer:
Please provide more details to help understand the problem better.
Detailed Answer:
Hello
Thanks for trusting us with your health concern.
Has she had any previous surgery ?
The pain could be because of adhesions - those are not always picked up on tests.
Are her periods regular ?
Could you elaborate on the details of her pain ?
Is it related to her menstrual cycle ?
Is it constant or intermittent ?
What were the findings of the laparoscopy that was done ?
Is there any history of injury ?
Does the pain happen or is triggered by any specific movement ?
Are her bowel and bladder habits normal?
Could you please upload details of the MRI / ultrasound scan ?
Looking forward to hearing from you.
Take care.
Please provide more details to help understand the problem better.
Detailed Answer:
Hello
Thanks for trusting us with your health concern.
Has she had any previous surgery ?
The pain could be because of adhesions - those are not always picked up on tests.
Are her periods regular ?
Could you elaborate on the details of her pain ?
Is it related to her menstrual cycle ?
Is it constant or intermittent ?
What were the findings of the laparoscopy that was done ?
Is there any history of injury ?
Does the pain happen or is triggered by any specific movement ?
Are her bowel and bladder habits normal?
Could you please upload details of the MRI / ultrasound scan ?
Looking forward to hearing from you.
Take care.
Above answer was peer-reviewed by :
Dr. Yogesh D
Sorry we were away for the weekend. I will have to get you what I have for MRI/Ultrasound - they are just reports, but wanted to answer your questions.
The only surgery she has every had is the laproscopy May 9th to look for endometriosis - I have the pics from the surgery if I can upload with reports I will. She also had the colonoscopy (not surgery, but a procedure) in April to rule out GI.
She has had regular periods, pretty much normal flow according to her not too light or heavy and last 4 - 5 days.
Before they put her on the BC pills she would indicate her pain was worse just before her period - which is why everyone was thinking ovarian cyst/endo - she did wind up having a cyst (2) then shrunk to (1) then when her pain was so dibilating she could almost not stand they did an emergency one and cyst was totally gone!?! The cyst was also on her left side, and pain on the right. Hence the laproscopy and colonoscopy.
Once on BC pills though her pain has been pretty consistent - and is constantly there - she cannot bend at the waist bc it hurts so bad. She can walk, but cannot run or participate in physical activity (missed her entire varsity softball season and now is missing her travel ball season). She is very frustrated (as are we) to say the least.
Laproscopy pathology showed no sign of endometriosis.
No history of injury to that area - and nothing really triggers it - its just always there. We tried eliminating/limiting different foods - dairy; gluten - nothing seemed to make it better/worse.
Bowel and bladder habits are normal.
This has been going on since January 15th. She has had bloodwork, countless sonograms, the colonoscopy, laproscopy, and most recently the MRI - while I thank God that it has all come back normal I am just at a loss (as is her gyn) as to what to do next.
The pain is on the right side - if you can imagine appendicitis pain that is what they all assumed she had at first when they examined her and sent us to the hospital. It is in that same quadrant area just more towards the ovaries then appendicitis - which is why when ultrasound was normal they were thinking small ovarian cyst...and so it went on.
At this point the doctor added a supplement of Evening Primrose Oil to her pills. She is going to go for Pelvic Wall Therapy to hopefully help with the not being able to bend and she is going to consult with an accupunturist.
I will look for scan results tonight and attempt to upload.
Thank you for getting back to me.
XXXXXXX XXXXXXX
The only surgery she has every had is the laproscopy May 9th to look for endometriosis - I have the pics from the surgery if I can upload with reports I will. She also had the colonoscopy (not surgery, but a procedure) in April to rule out GI.
She has had regular periods, pretty much normal flow according to her not too light or heavy and last 4 - 5 days.
Before they put her on the BC pills she would indicate her pain was worse just before her period - which is why everyone was thinking ovarian cyst/endo - she did wind up having a cyst (2) then shrunk to (1) then when her pain was so dibilating she could almost not stand they did an emergency one and cyst was totally gone!?! The cyst was also on her left side, and pain on the right. Hence the laproscopy and colonoscopy.
Once on BC pills though her pain has been pretty consistent - and is constantly there - she cannot bend at the waist bc it hurts so bad. She can walk, but cannot run or participate in physical activity (missed her entire varsity softball season and now is missing her travel ball season). She is very frustrated (as are we) to say the least.
Laproscopy pathology showed no sign of endometriosis.
No history of injury to that area - and nothing really triggers it - its just always there. We tried eliminating/limiting different foods - dairy; gluten - nothing seemed to make it better/worse.
Bowel and bladder habits are normal.
This has been going on since January 15th. She has had bloodwork, countless sonograms, the colonoscopy, laproscopy, and most recently the MRI - while I thank God that it has all come back normal I am just at a loss (as is her gyn) as to what to do next.
The pain is on the right side - if you can imagine appendicitis pain that is what they all assumed she had at first when they examined her and sent us to the hospital. It is in that same quadrant area just more towards the ovaries then appendicitis - which is why when ultrasound was normal they were thinking small ovarian cyst...and so it went on.
At this point the doctor added a supplement of Evening Primrose Oil to her pills. She is going to go for Pelvic Wall Therapy to hopefully help with the not being able to bend and she is going to consult with an accupunturist.
I will look for scan results tonight and attempt to upload.
Thank you for getting back to me.
XXXXXXX XXXXXXX
Brief Answer:
As below
Detailed Answer:
Dear XXXXXXX
Thank you for a most detailed update.
I totally empathize with the distressing situation she ( and you all ) are in.
It is baffling, with all normal investigations, as to what this could be.
The pain typically sounds like endometriosis, but the laparoscopy was negative , as you said, and laparoscopy is the gold standard for diagnosing endometriosis.
And even if it was subtle or early tissue - diagnosis endometriosis, the BC should have lessened the pain.
I would appreciate all the images that you could send - they might add to the clinical picture I am trying to have, with the significant shortcoming, that I cannot examine her.
Is she sexually active ?
Has a spinal or bony cause been ruled out with X rays of the back / ribs / chest ?
Is there any ominous history running in the family ?
Can she bend or be active if she wants despite the pain ( I mean is the pain holding her back ? ) or is it a problem with the muscles and nerves that actually make the movement impossible ?
In the absence of a specific etiology, I would diagnose it as CPP - Chronic Pelvic Pain.
Please go through just 2 links related to this -
https://www.ncbi.nlm.nih.gov/pubmed/0000
https://www.uptodate.com/contents/chronic-pelvic-pain-in-women-beyond-the-basics
Feel free to discuss further.
Take care, all of you.
As below
Detailed Answer:
Dear XXXXXXX
Thank you for a most detailed update.
I totally empathize with the distressing situation she ( and you all ) are in.
It is baffling, with all normal investigations, as to what this could be.
The pain typically sounds like endometriosis, but the laparoscopy was negative , as you said, and laparoscopy is the gold standard for diagnosing endometriosis.
And even if it was subtle or early tissue - diagnosis endometriosis, the BC should have lessened the pain.
I would appreciate all the images that you could send - they might add to the clinical picture I am trying to have, with the significant shortcoming, that I cannot examine her.
Is she sexually active ?
Has a spinal or bony cause been ruled out with X rays of the back / ribs / chest ?
Is there any ominous history running in the family ?
Can she bend or be active if she wants despite the pain ( I mean is the pain holding her back ? ) or is it a problem with the muscles and nerves that actually make the movement impossible ?
In the absence of a specific etiology, I would diagnose it as CPP - Chronic Pelvic Pain.
Please go through just 2 links related to this -
https://www.ncbi.nlm.nih.gov/pubmed/0000
https://www.uptodate.com/contents/chronic-pelvic-pain-in-women-beyond-the-basics
Feel free to discuss further.
Take care, all of you.
Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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