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Unable to diagnose severe abdominal pain 11 weeks post-pregnancy

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After a textbook pregnancy and vaginal delivery 11 weeks ago, my wife has had a lot of pain in various places. Since, most of the pain has gone away except three areas of her abdomen which have instead increased in pain. One area is on her right side in sort of a "C" shape and is constant and sharp. The opposite side has a similar pain that comes and goes. Lastly, she has soreness all across the top of her bladder. A crude diagram is shown here: http://dl.dropbox.com/u/6830281/WhereItHur ts.jpg

Three weeks ago her OB prescribed her Hydrocodone 5/500mg and told her the pain would subside as the others did. Last Friday she was scheduled for a rectal CT scan since the pain still only increased and the Hydrocodone was having no apparent effect. Tuesday when she called for the results, her doctor informed her that nothing abnormal was found but to check in to the hospital so they can better address her pain.

The doctor initially said her blood test showed increased levels of sediment which could indicate infection so he put her on an IV antibiotic of Doxycycline and a Dilaudid PCA for the pain. That day she was fairly pain free and was able to sleep. The plan was to wait out the antibiotics and see if the pain subsided. Wednesday she was taken off the PCA and given Hydrocodone again. Her pain returned with full force and after many hours of frustration and begging for pain relief her doctor decided to put her back on the PCA, but with Morphine, and scheduled an exploratory laparoscopic surgery for Thursday but first wanted a second opinion from a colleague. That doctor examined her results and gently pushed on her abdomen before deciding that she didn’t want to subject my wife to any surgery just yet.

Since the regular doctor will be unavailable until Monday he had the OB doctor on call assess her. She said that both she and our regular doctor had discussed the case extensively and that clinically my wife is stable. They believe that the pain is being caused by a muscular problem in her still recovering abdomen. So, she was taken back off the PCA and instead given Hydrocodone 7.5/750mg and an abdominal binder pending consultation with a general surgeon, which we were told, would not be available until Monday.

The oral pain medicine still had no apparent effect and since she was told she would not be provided any stronger medication she decided she would rather suffer at home and schedule a general surgeon consultation ourselves. She was released last night with the Hydrocodone 7.5/750mg, Methocarbamol 500mb, and Metronidazole 500mg.
We live in a small town in Texas without many other options at this point in time. I will be scheduling the consultation first thing Monday morning and have told her we will travel to a larger city if he is unable to remedy the situation. Her doctor has 45+ years of experience and will be retiring in two weeks so this adds to the desperation.

If she does in fact have a muscular problem that will go away in time I fear the meantime. She has trouble sleeping and when she isn’t all she can do is cry, moan, and writhe on the bed. She’s afraid if the pain gets worse and we have to go to the ER they will still be unable to handle her pain. I am looking for any route to pursue in an effort to relieve my wife’s pain. Any advice will be much appreciated.
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replied June 8th, 2011
Hi. I had pain in similar areas to your wife 7 weeks after i had my son. the pain was unbearable. i was told several different things by diff docs an in the end i went to an out of hours doc at the hospital as the pain was soooo bad. she examined me and said i had an infection called endometriitis ( sorry dont know how to spell it) they gave me a course of strong pain killers and antibiotics and the infection had gone after a week and i was totally fine afterwards, maybe your wife has the same thing? might be worth researching. hope this helps and hope your wife gets better soon Smile
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replied June 8th, 2011
Hi. I had pain in similar areas to your wife 7 weeks after i had my son. the pain was unbearable. i was told several different things by diff docs an in the end i went to an out of hours doc at the hospital as the pain was soooo bad. she examined me and said i had an infection called endometriitis ( sorry dont know how to spell it) they gave me a course of strong pain killers and antibiotics and the infection had gone after a week and i was totally fine afterwards, maybe your wife has the same thing? might be worth researching. hope this helps and hope your wife gets better soon Smile
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replied June 8th, 2011
Especially eHealthy
I sorry, but endometriosis is not an infection. It is a condition seen in women, usually in their 30's to 40's, but can be seen in any women after menstration has begun. It is a condition where the uterine lining cells develop outside of the uterus. Most commonly, this is on the ovaries and abdominal organs. This tissue is sensitive to the hormones just like the lining of the uterus is. So, symptoms become worse during the period. It is more common in women who have had a c-section or uterine surgery. But, can be seen in any woman.

Usually a with a physical exam by a gynecologist, along with a thorough history, the diagnosis can be made. Sometime is can be picked up on ultrasound or MRI, but a negative study does not rule it out.


Your wife has been on IV antibiotics. It's doubtful that this is an infection. Also, her abdominal exam was fairly benign by your description. She did not have rebound tenderness nor a rigid abdomen. These are the signs that would prompt a surgeon to do an exploratory surgery. Now days that can be done laproscopically, but it is still a surgical procedure, and not done is not medically necessary. Surgeons also do not like to prescribe a lot of hard core opioids, because they can mask a developing problem. Then a problem that could have been taken care of in the early stages, becomes a life threatening one.

It sound like she needs a second opinion from a gynecologist, rather than a general surgeon. A muscle problem should have gone away in three months. It doesn't sound like she has peritonitis or a surgical abdomen. She may yet come to a laproscope, just due to the unresolved pain, but in a large percentage of cases done for just pain, they are negative. Then you are back to square one, but now with scars.

Hope you find out what is going on. Good luck.
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replied June 9th, 2011
Just to clarify i sed endomitriTIS! NOT endomitri0SIS! they are 2 different things, wot i had IS an infection.
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replied June 9th, 2011
Especially eHealthy
MISK is absolutely correct.

Endometritis is inflammation of the endometrial lining of the uterus. In addition to the endometrium, inflammation may involve the myometrium and, occasionally, the parametrium. These are the different layers of the uterus. It can also involve inflammation of the fallopian tubes (salpingitis), ovaries (oophoritis), and pelvic peritoneum (pelvic peritonitis). This inflammation can be due to several causes, one thought to be microabscesses within the uterine lining.

A common name for endometritis, which patients may have heard of, is pelvic inflammatory disease (PID). The most common organisms, causing the infectious etiology this disorder, are Chlamydia trachomatis (chlamydia), Neisseria gonorrhoeae (gonorrhea), Streptococcus agalactiae (Group B Streptococcus), Mycoplasma hominis, tuberculosis, and various viruses.

The diagnosis of endometritis is usually based on clinical findings, such as fever and lower abdominal/pelvic pain. For most cases of endometritis following vaginal delivery, oral antibiotics in an outpatient setting may be adequate. For chronic cases, with established inflammation, or those after abortion, c-section, medical instrumentation of the uterus, or those that do not respond to oral antibiotics, a course of IV antibiotics may be required.



This may be another reason to see a gynecologist rather than, or addition to, a general surgeon. Though, to patients, it's a technicality, general surgeons operate in the abdomen and gynecologists operate in the pelvis. They are actually two different compartments. The two specialties do learn about the other in residency, but they usually defer to each other is cases outside of their specialty.


I hope your wife is feeling better. And they find out what is going on. It can be quiet frustrating. Abdominal pain is one of the worst pains, as you just can’t seem to get away from it.

I know how it is out in the great expanses of Texas, as having spent several rotations between Ft. Bliss in El Paso and Ft. Sam in San Antonio. There isn't much between towns, and it's a long way between towns that are there. I can remember trying to explain to Europeans how vast Texas is, as most of Western Europe would fit inside of it.

Again, hope your wife feels better soon and you find out what is going on. If possible, it would be great if you could tell us what they finally find. It would help others, as they try to find information, concerning their problems.

Have as good a weekend as possible.
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replied June 10th, 2011
Yeah i got mine after having my son, i think they said something about damage due to giving birth.
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