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Lower Abdominal Pain and Rectal Pain
cajungal328 posted:
Let me apologize in advance for this being so long...
I have two types of pain, and I'm not sure if one is related to the other or not, if they are a gastro-intestinal problem or a GYN problem. The first I will discuss is the lower abdominal pain. Located in the center of my abdomen, right in the pelvic region, deep, not superficial. It's not even a pain really, more like an uncomfortable pressure. It never ceases, but at times its barely noticeable, and at other times, it's painful, but not sharp pain at all, but dull heavy almost-pain but isn't. Easy to endure, easy to ignore. Coughing and sneezing cause painful pressure. Sex is often painful somewhere deep inside, near my uterus. Almost never get constipation, usually have loose bowels and alot of painful gas...
I have regular periods, which are medium / heavy flow with alot of cramping and passing blood clots, sometimes as big as dimes. My cycles have always been regular, except 2 years ago. I was also 140 lbs overweight (topped the scales at 270 lbs. on home scale), I was working and going to school full time. My periods stopped for about 6 months. Later, when I back on a normal schedule, and lost some weight, periods went back to normal. I have since lost 70 lbs. I also believe myself to have a hormone imbalance of some sort, cause I grow facial hair (lip and chin, male pattern hair growth), and quite a lot of body hair as well. I have to shave facial hair daily. I don't know if this info has any relevance here, but I thought I'd throw it in anyway...

Now for the rectal pain. It comes about once every few months. The only way I can describe it is like this : it's like having a lightning bolt shoved straight up my butt! A bolt of white hot electricity shooting straight through my rectum... It is so painful, so intense, it has literally knocked me of my feet, I was walking and I fell on the floor in pain. It hit me while I was driving once, and I remember lifting my whole behind off the seat and arching my back, and my foot stomped down on the excellerator and I couldn't move my leg to stop. I can usually feel this pain about to happen, it gives a warning, and I have to brace myself before it happens, or else I will fall. It's what I would imagine it feels like to be electricuted. These intense pains last about 10 - 20 seconds, and then they're gone for months, like they never existed, forgotten about until months down the line when hit again.
cajungal328 responded:
Sorry, I told you my symptoms and forgot to ask my question. What do you suppose is wrong with me? Does this sound like its a gastro-intestinal issue, or a gynocological issue? Should I just go to the ER and let them discover what it is? I don't have a regular doctor, and I lack health insurance (soon my boss will have to offer us health insurance, but as of now, he hasn't yet). There is a hospital here that treats patients and billing goes by your income, so I'm thinking that may be my best option. I have ignored this problem for so long due to inability to pay.
Jane Harrison Hohner, RN, RNP responded:
Dear cajungal: Your initial sentence of the first post could have been written by an MD! You are so correct. The second most common cause for pelvic pain (GYN is first) is GI issues. The most common culprit for GI caused pelvic pain is irritable bowel syndrome.

In your specific case, the deep lower abdominal pain might be either GYN or GI in nature, so it may take an evaluation from a GYN first--followed by a GI specialist if needed. Here are some possible, GYN sources of the type you have described:
1.? Endometriosis (bits of uterine lining tissue growing on the bowel, bladder, ovaries, etc). The endometriosis implants go through the same cycle as uterine lining—they slough off and bleed monthly. Because there is no outflow for the bleeding, the body creates bands of filmy scar tissue ("adhesions") as a response to the inflammation of monthly bleeding into the abdomen. These adhesions can "glue" together organs in the abdomen.
2.? Adhesions can also be formed if a woman has had an abdominal surgery or a serious abdominal infection (eg PID or ruptured appendix).
3.? Adenomyosis is endometriosis that has grown into the muscular walls of the uterus. In addition to pain it can produce a uterus that is enlarged, tender, and boggy. Unfortunately, adenomyosis is usually diagnosed only after hysterectomy has been performed. One could have a suspicion for adenomyosis if the woman, or her family, has a history of endometriosis.
4.? Pelvic congestion syndrome is also more difficult condition to diagnosis. It involves varicose veins of the uterus or ovaries.
5.? Uterine prolapse can create a dragging, heavy pain. The supportive tissues become relaxed and the uterus drops down into the vaginal canal.
6.? Large uterine or ovarian masses. Even benign masses such as large external uterine fibroids, or large dermoid cysts, can put pressure on surrounding organs.

To get the most accurate diagnosis you would likely need a thorough pelvic exam and an ultrasound. A GYN can also evaluate if elevated male hormones (eg PCOS) are the cause of the unwanted hair growth growth.

As for the sudden, searing anal pain I don't have the expertise of even make a good guess (?spasm, ?neurological). You can ask a GYN, but they may refer you to a GI MD for a diagnosis.


PS BIG congrats on your healthier new weight. That's no easy task!
cajungal328 replied to Jane Harrison Hohner, RN, RNP's response:
Hello Jane,
Thank you for your reply. Everything you said is what I was already thinking myself. Endometriosis and/or PCOS are probably most likely. I suspect polycystic ovaries, because they can cause pelvic pressure and pain, and I know that is usually the cause of women having elevated male hormones which cause facial hair growth. I was reading the symptoms, and most of them seem to fit. I was speaking to my cousin the other day (who has had many female issues herself), and she told me I may have endometriosis (she had both endometriosis and pcos). She said just what you said, that hard painful periods is one sign, but also endometrial tissue can form outside the uterus and cause GI trouble, it could all be related. My mother was never diagnosed with endometriosis or pcos, but she had hard periods, so hard her doctor gave her demerol for her pain, and she also has dense facial hair. She had to have a hysterectomy at 36, exactly my age.

Also, IBS has also crossed my mind, becuase I stay gassy and bloated and have loose bowels more often than not.

You spoke about surgical adhesions and scarring. I had a ruptured appendix in 1987 when I was 11 years old. The doctors didn't know what was wrong with me, so I was rushed into emergency exploritory surgery, where they found fragments of my exploded appendix and severe perotonitis infecting my whole perotoneal cavity. I almost died. But that was 25 years ago. Do you think that after all this time, that could have an effect now? That never crossed my mind at all.

i have a GYN appt in a few weeks at the free clinic (I have no insurance), for my annual pap, which is about a year or 2 overdue. Should I request being tested further for PCOS and endometriosis? Or should I go in with a list of symptoms and let them figure it out? They may not be as smart as you... LOL. I rarely go to doctors and they intimidate me a little, and they make me feel stupid. I really don't know how to talk to them, especially about things of a personal nature. Also, we all know doctors just LOOOVVVEE people who refer to Dr. Internet before them.
garcia44 responded:
OMG I have the very same thing even the hair and i'm losing my hair in the front of my head just like a man what is it from ?? it hurts so bad .
painsetmefree responded:
Hello the first thing I wanted to say is I did not know that there was others who have the same problems as I! I just got back from my doctors appointment from all the check ups and everything and still nothing I have done so many tests I am pretty much over been investigated for so long it's been going for 6 years now pretty over it! They have made me do all the tests you could think about and still nothing! I've been checked for endo came back clear've been checked for Pcos came back clear. Done keyhole had colonoscopy so many others. Started to think it was all in my head these pains but it's not! Also i anemic which they still can't find out why so doesn't help with me bleeding alot! I'm in so much pain and it's so draining! its been ongoing so long they basically have given my case to the hospital so now I am seeing mercy woman's hospital as I have had sharp abdominal pains since I was little and gradually gotten worse I have only gotten the return pains when I got older. I have had irregular period painful periods and bleeding non stop to the point of been put on the pill to regulate it which I stayed on it for 3 years then went off it as it did its work. Then started bleeding again constantly! So after all that they put me on the mirena and not to sure if that is helping either! Please if anyone has some thoughts on this please let me know!
painsetmefree replied to painsetmefree's response:
Also I feel like the pains had gotten worse since I started been sexual active...
oldtimer21 replied to painsetmefree's response:
I"m having similar situation. However, I had a hysterectomy in 2001. The sharp pain wake me from deep sleep. I have had several procedures done over the years. Gallbladder, hernia, sinus, ... So pretty tired of procedures right now.