Lower abdominal discomfort is one of the common complaints in gynecological outpatient clinics, and it is also a common complaint among the departments of gastroenterology, general surgery and gynecology. Of course, patients will not use \”dull pain\” when they complain, but \”abdominal pain\” or \”uncomfortable\” when they go to the hospital. Since this type of patients does not have the characteristics of an acute abdomen such as severe abdominal pain, nor is it a manifestation of an acute disease, “dull pain” is always used here to represent the demands of this group of people. The characteristic is that it hurts when I think about it, but not when I am busy; it does not hurt during the day but hurts at night; it does not hurt when I am working or nervous, but it hurts when I am quiet at night, etc. As for the pain, it can be said to be all kinds of strange, like pinpricks, pulling, and coming in waves. . . . . . To name a few.
There are various causes of chronic lower abdominal pain. For example, intra-abdominal adhesions can cause chronic abdominal pain. However, it is generally difficult to diagnose this problem before surgery. Most adhesions cause it. The pain was accidentally discovered and diagnosed during other surgeries. It is very rare for patients to undergo laparoscopy and surgery specifically because of dull lower abdominal pain.
There are many reasons for lower abdominal pain, the most common of which is adhesions caused after surgery. No matter what kind of surgery is done on the abdomen or pelvis, adhesions can form. The vast majority of adhesions appear as adhesions between the omentum, the abdominal wall, and the intestines. The omentum is highly stretchable, so it is not harmful to the body. Only in a small number of patients who seek medical attention due to intestinal obstruction or intestinal hernia causing severe pain, the problem is discovered and surgery is performed. No doctor would recommend surgery if you only have mild or tolerable lower abdominal pain. Because the surgery itself will cause adhesions, and no one knows how the next adhesion will stick and whether it will form a worse adhesion. Therefore, for this type of patients, in principle, we do not advocate surgery to find out the cause. .
Acute appendicitis is the most common reason for lower abdominal surgery, and adhesive pain after appendectomy accounts for a large proportion. However, the appendix surgery is performed in the right lower abdomen, and the pain in these patients usually also occurs in the right lower abdomen. This is also true for patients who have had surgery on their right fallopian tube and ovary. Adhesions after cesarean section are mostly in the middle of the lower abdomen, and the pain caused is mainly in the middle. Some people have chronic appendicitis. Although there is no history of surgery, the appendix is slightly congested and stiff, and there may be some adhesions between it and surrounding organs. It is also an important cause of chronic lower abdominal pain.
Left lower abdominal painAlthough the cause is also closely related to adhesion, there is generally no history of surgery, and most of it is caused by the adhesion of the sigmoid colon to the pelvic wall. Some people have thin adhesions between the sigmoid colon and the pelvic wall. Whenever they have a bowel movement or during intestinal peristalsis, they will feel pain in the lower abdomen, especially the left lower abdomen. Some patients even sweat profusely from the pain, but once the stool is completely eliminated, The pain disappears immediately. This type of pain is mostly related to adhesions in the sigmoid colon. However, in female patients, patients with left-sided salpingitis and endometriosis often have similar adhesions, leading to the same symptoms, and even a small fallopian tube ligation can cause the same lower abdominal pain.
In addition to adhesions, the second major cause of lower abdominal pain is the sequelae of inflammation of the pelvic organs. In women, such as salpingitis, after the inflammation in the acute phase disappears, the fallopian tubes -The inflammatory exudate from the ovary is absorbed, and adhesions easily form between the fallopian tubes, ovaries, uterus, and intestines. Once intestinal peristalsis occurs, it can cause lower abdominal pain. This type of pain is characterized by occurring on both the left and right sides, and the relationship with defecation is not so clear.
Endometriosis is an important cause of chronic lower abdominal pain. In addition to adhesions, pain from endometriosis can also occur in patients with peritoneal endometriosis, but the pain mechanism in these patients is still unclear. It may be related to the stimulation of local inflammatory factors in the pelvic cavity of such patients.
In addition, chronic abdominal pain can also occur after the gastrointestinal tract is subject to certain stimulation or after chronic gastroenteritis occurs.
There is currently no good way to diagnose chronic pelvic pain. Diagnosis is difficult with almost all imaging modalities. Although great progress has been made in imaging diagnosis such as CT and MR, there is still nothing that can be done about chronic pelvic pain. Some researchers used mini-laparoscopy (also called office laparoscopy) to diagnose patients under local anesthesia and found that nearly 1/3 of the patients had chronic appendicitis. Some of these people can tell a clear medical history, but more of them do not have a history of acute appendicitis, which may be related to the long duration of the patient\’s illness.
In about 1/3 of patients, even with laparoscopy, the cause cannot be discovered. For example, when patients were examined under local anesthesia, it was found that some people\’s pelvic peritoneum was simply hypersensitive to pain. A small stimulus could cause them pain, but there was no local disease. There is really no good solution for this kind of people at the moment.
Although chronic pelvic pain does not threaten people\’s lives, it seriously affects the patient\’s quality of life. Patients often run back and forth between internal medicine, surgery and gynecology, and even more A paradise for scammers selling all kinds of magical medicines. The real treatment focuses on analgesia. With appropriate distraction, after a period of time, the patient\’s feeling of pain will be \”numb\” (the pain range will rise), giving people the illusion of improvement. implies that there isSome people also have certain effects, which is why some placebo drugs are so popular.
If you have abdominal surgery, especially laparoscopic surgery, inform the doctor before the operation that you have such symptoms in the past, and let the doctor make a diagnosis during the operation. It is a better strategy to solve these problems by the way, such as appendicitis, appendicitis or adnexitis. However, if you perform a laparoscopy and surgery specifically to relieve the dull pain in your lower abdomen, it seems that the gain outweighs the gain. An occasional dull pain in the lower abdomen may not even make it necessary to go to the hospital. Only those with severe abdominal pain, or long-term chronic abdominal pain that affects work and school, are indications for laparoscopy.
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