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Abdominal Pain (lower)

My 15 year old daughter has complained of lower abdominal pain on her right side for two years on and off, and lately it seems to have become more of a problem. We had ultrasounds done but they show everything is fine. What should we be looking for? Her doctor doesn't have too many ideas what it could be. Please give us some suggestions.

Recurrent lower abdominal pain that has persisted for two years should not be anything acute and immediately worrisome (like appendicitis). There are so many organs in the abdomen that it is often hard to sort out what it could be. An ultrasound would have ruled out an abscess, a tumor, a fluid collection and dilated kidneys, but would not always be able to be helpful. Regarding the bowel, it is important to assess that she is having regular bowel movements, to rule out constipation, and to check the stool for blood. Her kidney and urinary tract system could (less likely) be involved, and screening her urine for a chronic urinary tract infection should be done. Finally, her genital system could be involved. I will assume by her age that she has already started menstruation. There is a recurrent abdominal pain that occurs during ovulation (called mittelschmerz) that some women feel; if she is regular this would occur about two weeks after her period started. Ovarian cysts can present with abdominal pain, although an ultrasound should have ruled this out. A pelvic exam should be performed to rule out infection or ovarian mass. This would be the minimal general workup I would recommend. If it persists, potentially she should see a gynecologist or gastroenterologist.

TK 7-13-10



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