Lower abdominal pain. What to do?

February 24, 2011 2:19 PM

Lower abdominal pain and tenderness. What do do?

YANMD, I know.

I am male, 29, never had something like this happen before.

Starting yesterday morning, I had a pretty sudden onset of a pain directly in the middle of my lower abdomen, between my belly button and hip. It comes and goes, at its worst it's like a really bad gas pain. In addition, this same area of my abdomen is extremely tender, hurts when I sit down, lay down, stand up, or move in pretty much any way that involves the area. I went to my doctor yesterday afternoon, he checked me out, gave me a urinalysis, and scheduled an ultrasound on Monday.

Dr. called today to say that the urinalysis indicated no blood or sign of infection.

I've had no nausea or vomiting. I don't actively feel like eating, but I can eat. Last night I spiked a fever of about 102-102.5f, it broke sometime this morning. Now I am back up to about 100.5f. I can pee, I can poop, I can pass gas. When I belch, it sets off a temporary flare in the pain. Coughing hurts a LOT. The right side does not hurt more or differently than the center or left.

My doctor doesn't seem overly concerned about what would happen to me between now and Monday, but increasingly I am as it seems that most lower abdominal stuff is "ER- NOW" territory.

posted by rollbiz to health & fitness (24 answers total)

Call your doctor's office again and bug them; if they can't help, you might want to go to the ER.
posted by infinitywaltz at 2:20 PM on February 24, 2011 [1 favorite]

Go to the ER. Do not fuck around.
posted by L'Estrange Fruit at 2:20 PM on February 24, 2011

Yeah so general rule of thumb; if your body is saying "take me to the ER" you should let it call the shots.
posted by mckenney at 2:22 PM on February 24, 2011 [1 favorite]

Fever + abdominal pain? Yeah, call your doctor's office. If they aren't helpful, head to the ER.
posted by zug at 2:23 PM on February 24, 2011 [2 favorites]

You had a fever. You have pain. It could be any number of things, some of them serious.

My advice is to go to the ER, unless your doctor can see you again right away. Definitely do NOT wait until Monday for the ultrasound.
posted by lydhre at 2:24 PM on February 24, 2011

More motivation if you need any: tl;dr -- go to the damn doctor; you're worth it.
posted by L'Estrange Fruit at 2:29 PM on February 24, 2011 [1 favorite]

Is it too painful to sleep? I'm not a doctor, but if I were you, I would sleep on it and see how you feel in the morning. If you're really anxious, you should go to urgent care first and see if they recommend going on to the ER. Don't mention that you already saw your doctor though or they might tell you to follow his instructions.

Most lower abdominal stuff isn't "ER now" territory, but I may be biased because I'm a woman and I sometimes have cramps from hell accompanied by migraines when it's about to be my time of the month (and during).
posted by anniecat at 2:36 PM on February 24, 2011

I had a weird viral thing a couple of weeks ago - it was horrible and kept me up 2 or 3 nights in a row - barely ate - tons of abdominal pain. I went to the doctor and she didn't have much to say. I was sure it was appendicitis or something from all of my internet sleuthing. The doctor didn't seem to think so, and it turns out she was right.

Probably not super helpful for you, but there's just another data point, I guess.
posted by soplerfo at 2:42 PM on February 24, 2011

Fever plus abdominal pain is a bad sign. Call your dr's office and ask to speak to the on-call doc, and tell them you have a fever plus worsening abdominal pain. Follow their recommendation. If you do get nausea or vomiting, go to the ER or an urgent care facility pronto.
posted by KathrynT at 2:43 PM on February 24, 2011

Most patients with appendicitis have a normal urinalysis. FWIW your symptoms exactly mirror mine; a GP was convinced I was fine because I didn't have the standard abdominal tap reaction and my urine was fine. My symptoms were not severe enough to transfer me to the ER until my appendix ruptured and put me on her floor.

I would go, for sure.
posted by DarlingBri at 2:43 PM on February 24, 2011 [6 favorites]

If you saw your GP, you probably have insurance that should also make an ER visit no worry. Yeah, it might just be a virus, but fever plus ab pain is a BAD combo and you could be really ill. It's worth checking out.
posted by maudlin at 2:46 PM on February 24, 2011

Are you insured?
YES --
ER (if you have a decent one) or an urgent care clinic.
NO --
1. Go to an urgent care clinic as you can be seen immediately but not get stuck with the astronomical ER bill. As anniecat said, just handle it as having not been seen by anyone.
2. If you can't find an urgent care clinic or you're not happy with how they handled your visit, get at 7 or 8 am and go through the phone book listings for doctors. Offer to show up in an hour and see if they can fit you in. Again, if asked, you don't have a regular doctor.
3. If no dice or you get worse after an urgent care clinic visit or a doctor visit, then go to the ER.

And switch doctors... you have abdominal pain and fever, and he wants to run some tests next week? Holy cow.
posted by crapmatic at 2:55 PM on February 24, 2011 [3 favorites]

Also, if you decide to wait and you don't have a partner or roommate who lives with you, make sure one of your friends is going to check in on you in the morning, in case you get worse during the night and can't get to the phone.
posted by anniecat at 3:10 PM on February 24, 2011

IANAD but this certainly sounds like appendicitis so listen to everyone else and go to the damn ER.
posted by awesomebrad at 3:20 PM on February 24, 2011 [1 favorite]

Call your doctor. Tell answering service it's urgent. They should get back to you within the hour. If you don't feel like eating, don't.

Other option: check back of your insurance card, call #, ask for a nurse. They will be helpful and your insurance won't give you guff about going to the ER if they recommend it. They're quite conservative and will send you to the ER if there's any chance you need it.

Third option: google "NHS symptom checker" and see what it says. Can't link, sorry.

Good luck!
posted by the young rope-rider at 4:29 PM on February 24, 2011

Call the ER, ask what they recommend, and on the basis of that, call your insurer to make sure you're approved for coverage. Write down the first and last names and times of both people you talk to.
posted by A Terrible Llama at 4:32 PM on February 24, 2011

Appendicitis doesn't always hurt where it's supposed to. Sometimes you get pain from another organ after the infection spread from your diseased appendix elsewhere. Ask me how I know this.

The problem is, doctors get confused when your appendicitis doesn't present itself with typical symptoms, which include pain in a specific area. My doctor made me wait several weeks, and it's only when I got fed up of being sick that I went to the ER at another hospital -- and was operated on the same day.

I don't say this lightly: Go to the ER or an urgent care centre ASAP. If you're not satisfied with the answers, find another doctor/centre/ER. You obviously aren't happy with your doctor, since you're asking strangers on the internet for medical advice, so get another opinion (and maybe a third for good measure). If you're not insured, you'll just have to find a way to suck up the costs, but it'll be cheaper than possibly having to undergo several weeks of intravenous antibiotics in order to kill the infection spreading in your body.
posted by Simon Barclay at 5:36 PM on February 24, 2011

It definitely sounds as though it could be appendicitis... I suggest you go to an urgent care clinic.
posted by with the singing green stars as our guide at 5:47 PM on February 24, 2011

If you haven't already, head to the ER or Urgent Care. As others have said, appendicitis doesn't always present the same way in everybody and even if it isn't appendicitis, there are other things it could be that shouldn't be waited out for days.

I had similar symptoms awhile back--the only difference being I had a temp running from normal to low grade fever. I waited out an evening of pain, went to see my doctor the next morning and he sent me off to the ER because my level of tenderness was "cause for concern" and waiting for a normal, scheduled ultrasound or CAT scan might not be the wisest course of action. He said most of the time doctors, himself included, think that it is just some sort of gastroenteritis that people freak out about and assume is appendicitis, but when there is that kind of pain/tenderness, it is only smart to make sure there isn't something else going on--and I wasn't presenting a temperature like you have and he still wanted me checked out right away. Thank goodness he was so conscientious--turns out I was having an attack of diverticulitis for which I had to be admitted. If he or I had waited to see how things worked out, treating it would have taken much longer/been more complicated.

Go. The sooner you get it checked out, the sooner you can get treatment you might need AND some peace of mind. Feel better!
posted by HonoriaGlossop at 6:10 PM on February 24, 2011

I am a critical care doctor. If I had the kind of pain and fevers you are describing, I'd be writing this post from the Emergency Department.
posted by drpynchon at 7:18 PM on February 24, 2011 [3 favorites]

Abdominal pain is always a "go to the doctor's immediately" situation. Especially if there's a fever on top of it.

Go. Even if all that happens when you get there is that you find out that it was just a weird case of gas, at least you'll know that. Go.
posted by EmpressCallipygos at 5:37 AM on February 25, 2011

Update: I went to the ER about an hour after making this post. Went through a battery of tests, including a CT scan of the area. It turned out to be colitis caused by some sort of infection in my colon, not far off the mark from what Honoriaglossup mentioned. They wound up admitting me to the hospital, and told me I'd be there for a few days of IV antibiotics and morphine for pain-management. I'm happy to report that I actually just got out of the hospital a day before their best case scenario date, because strong antibiotics were exactly what I needed and today I was able to demonstrate that I can eat and keep myself hydrated on my own without my digestive system betraying me.

I'm definitely not all the way better yet, and I have another nine days of antibiotic regimen, bed rest/restricted diet, and follow-up exams to go, but the difference between how I feel right now and how I felt 24 hours ago is astounding. In addition, I now have the ease-of-mind that what is making me feel like this isn't going to kill me, which is...you know...huge.

Thank you to everyone who weighed in here, you all really did serve as the final tipping point and I am so glad I'm not still sitting here doubled over in pain and freaking out because I don't know why. I most likely would've wound up in the ER anyway, but after much more suffering and a much larger infection. A special thanks to scrump who dropped me an email with advice and followed up to see how I was doing.

And yes, I am lucky enough to have what would be considered decent insurance in the US. Our co-pays for major events are pretty high, so this has all cost me almost a grand thus far, but it could've been a lot worse.

Sorry if this is disjointed, but I'm on painkillers and I don't think super-well on those. Anyway, the point is: Thank you everyone!
posted by rollbiz at 7:05 PM on February 25, 2011 [2 favorites]

Glad to hear the (relatively) good news. Now call your doctor, tell him the story, and to go fuck himself 'cause you're finding a new doc.
posted by Simon Barclay at 4:55 PM on February 27, 2011 [1 favorite]

I'm glad to hear you're feeling better and on the mend, but btw:

My doctor doesn't seem overly concerned about what would happen to me between now and Monday

You might want to think about a new doctor.

Lie around, watch a lot of TV, feel better.
posted by A Terrible Llama at 2:50 PM on February 28, 2011