Tuesday, 29 October 2013

Analysing The Abdominal And Other Pains

For a while now I have been commenting on the abdominal pains I have been suffering, at least this year. It didn't start then, though. As I described in an earlier post I have had abdominal pains from around the time when puberty would have started, with the initial one being very severe. After that it's been relatively mild, aside from regular stabbing pain in mostly the groin/inner thigh regions.

The past months it's become more severe, however, with the last two months being particularly bad. For months now the symptoms include a hypersensitivity of the skin in the aforementioned groin/inner thigh regions, particularly on the right side, as well as an uncomfortable, itching sensation in the area where the vagina would be located. The last two months there's been reappearance of the nauseating, debilitating pain in my lower abdomen which I remember having as a child. For some reason my right hip has started hurting like hell as well and the upper part of my right upper leg has experienced a change in sensitivity. Another symptom which I previously blamed on the event in 2011 whereby my right knee got injured is that of a hurting, uncomfortable sensation in my right knee. This seems to be also connected to the other symptoms.

The really interesting part about this all is that it happens in cycles. It'll get really bad for a while, then subside, to then return a few weeks later. The past months I have been able to determine that it's happening on a roughly monthly basis, specifically the latter part of the month. Two days ago the pain in my hip started again, as well as the burning, stabbing sensations in my abdomen and groin/thigh regions. Yesterday and today I am having trouble on multiple occasions to sit comfortably in my chair as it feels uncomfortable and burning down there. Moving and shifting around however does not help to alleviate the pain, instead seemingly making it worse.

The previous time I had this pain in my hip and the other assorted pains in such a strong fashion was late last month, which subsided early this month to then vanish for weeks until two days ago. Last month I also experienced the abdominal pain in a very strong fashion, with me nearly passing out from the pain on one occasion while lying in bed, reading a book. Palpating around the lower right abdomen with a gentle hand would result in excruciating pain being felt in exactly one spot.

What one can deduce from the above is that a number of nerve bundles are being affected here. It can not be nerve damage due to the cyclical nature, but has to involve some kind of entrapment or pressure on the nerves in question which vanishes by itself after some time. Based upon the symptoms we can consider the following nerve bundles to be affected, using text from [1]:

  • Ilioinguinal Nerve: Symptoms may include hyperesthesia or hypoesthesia of the skin along the inguinal ligament. The sensation may radiate to the lower abdomen. Pain may be localized to the medial groin, the labia majora or scrotum, and the inner thigh. The characteristics of the pain may vary considerably.
  • Genitofemoral Nerve: inguinal ligament, which is how it is distinguished from the iliohypogastric and ilioinguinal nerve. Groin pain is a common presentation of neuralgia from nerve injury or entrapment. The pain may be worse with internal or external rotation of the hip, prolonged walking, or even with light touch.
  • Lateral Femoral Cutaneous Nerve: Symptoms include anterior and lateral thigh burning, tingling, and/or numbness, that increase with standing, walking, or hip extension.
  • Femoral Nerve: The symptoms of a femoral neuropathy may include pain in the inguinal region that is partially relieved by flexion and external rotation of the hip, and dysesthesia over the anterior thigh and anteromedial leg. Patients complain of difficulty in walking and of knee buckling, depending on the severity of the injury.
  • Saphenous Nerve: Symptoms of entrapment may include a deep aching sensation in the thigh, knee pain, and paresthesias in the cutaneous distribution of the nerve in the leg and foot.

Entrapment of the above nerves would account for the external symptoms I'm experiencing, yet it seems to offer no explanation for the lower abdominal pains. It is conceivable to assume that these are a direct symptom of the cause behind this all. Some kind of growth which develops every month, entrapping these nerves and causing other symptoms, which then subsides after about a week, reducing or vanishing the symptoms.

What this 'growth' could be is anyone's guess. Since I started on the pill (progesterone) there should be no possibility of any kind of menstrual cycle occurring. That something like it happens regardless of the hormone therapy makes for a real puzzle. Best case it's a benign occurrence with nothing worse than these quite annoying symptoms occurring every month. Worst case it's serious enough to warrant a rapid response before things worsen to a potentially fatal conclusion.

Unfortunately there exists no interest in the Dutch medical community for investigating an issue like this. Any kind of vague pain will be responded to with the advice to just take an NSAID like ibuprofen until it gets better. Hopefully I'll have more luck in Germany, though I can not try my luck until after I have a) found a home there, b) have finished moving and c) have taken care of my German health insurance.

I can not wait for these pains to pass this month so that I at least have a few painful few weeks during which I can hopefully muster some energy to do something about the above action points.


[1] http://emedicine.medscape.com/article/1234809-overview (Nerve Entrapment Syndromes of the Lower Extremity)

No comments: