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Ask Dr S.A.Alam Your Own Question
Dr  S.A.Alam
Dr S.A.Alam, Doctor
Category: Medical
Satisfied Customers: 4454
Experience:  MBBS/FCPS/MRCP(R) U.K
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Sharp pain below my belly button.

Customer Question

Sharp pain below my belly button. Hurts when i bend or move a certain way. Its very localized and more towards the right side. I have nausea and a temp of 99. I went to the doctor who told me it might be appendicitis. So, i went to ER and had a ct scan done (drank the dye and had it injected), blood work, and a urine test. All came back normal. I dont know what this pain can be. hurts really bad, very sharp and sudden between my belly button and pelvis) First noticed pain when going to the bathroom, i leaned forward. It seems like its getting worse (more things trigger it)
Submitted: 7 years ago.
Category: Medical
Expert:  Dr S.A.Alam replied 7 years ago.

Can you explain the point of pain exactly ?
are there any urinary problems ?
any menstrual problems ?
when this pain started ?
has it increased ?
is this pain continuous ?
is it severe ?
what is the character of pain ? stabbing ? burning ?
does it gets relieved by medicine ?
is there any bowel complaints like loose motions ?
any vaginal discharge ?

Customer: replied 7 years ago.

can you explain the point of pain exactly :
Right below my belly button. Putting finger in belly button, move down (right outside of it) and to the right about an inch.

are there any urinary problems ?
No urinary problems. been drinking lots of water today and urinating. Have been having constipation (small amounts/thin) Skin has been dry and lips chapped, so been drinking lots of water.

any menstrual problems ?
No menstrual problems

when this pain started ?
Pain started today around noon. Had a head ache and took an Advil. little bit later went to the bathroom and leaned forward and that's when the pain started. Felt like a sharp pinch.

has it increased ?
Wouldn't say the pain has increased but the frequency of it has. Was just when i bend forward, now its random based on my position. Laying down...bending forward..sometimes when i cough...

is this pain continuous ?
It is not, it feels like I'm pinching something kind of our of no where.

is it severe ?
Not severe but does catch me off guild and it does hurt. I don't fall to the ground and cry but i grab my stomach and stop moving.

what is the character of pain ? stabbing ? burning ?
Its sharp, pinch, burning real fast then goes away.

does it gets relieved by medicine ?
Have no taken any medicine since it.

is there any bowel complaints like loose motions ?
Said before, constipation.

any vaginal discharge ?
nothing abnormal

Expert:  Dr S.A.Alam replied 7 years ago.

Diagnosis of appendicitis is mostly based on clinical examination.

clinical features are fever, abdominal pain below umbilicus on the right side, pain on coughing and changing position can be seen in appendicitis.

Take a peek at this web address clinical features.

http://www.mayoclinic.com/health/appendicitis/DS00274/DSECTION=symptoms

in many cases inflammation in the appendix cannot be detected by lab tests.

other possibilities in your case can be

pelvic inflammatory disease,

peptic ulcer( although its pain occurs more in the upper abdomen but can be lower)

ovarian torsion,

Mittelschmerz, mid cycle pain.

these should be kept in the list of differentials in your case.

in many cases diagnosis of appendicitis in clinical and no other pathology may be detected.

if pain and other symptoms are severe then pain killers and admission in hospital should be offered.

in many cases even after admission no cause is found, but this should not be considered as a false admission. as 50% of appendisectomy done in female reveal normal appendix.

I hope answer was helpful.

Customer: replied 7 years ago.
I had a CT scan, so should that rule out appendacitis or any of those things things you listed? Had the drink and the IV. Is there any symptom i should be on the watch the list of other posabilites you gave me?
Expert:  Dr S.A.Alam replied 7 years ago.

As i have explained that in many cases all the tests can be normal including the CT scan and contrast tests.

So in this case we have to trust on clinical examination.

In such cases appendisectomy can be offered to the client if symptoms are severe.

Other important possibility in your case is PID (pelvic inflamamtory disease)

In his case there may be no other symptoms except fever and pelvic pain this requires tests like pelvic ultrasound, endometrial biopsy and laproscopy to reach at the diagnosis.

I hope answer was helpful.

Dr S.A.Alam and 6 other Medical Specialists are ready to help you
Customer: replied 7 years ago.
Someone told me it could be an internal hernia as there is no buldge. Is this a possability or based on symptoms and ct scan, can rule that out? Thank you
Expert:  Dr S.A.Alam replied 7 years ago.

Yes this can be, but normal CT scan/and gut contrast tests are against that possibility.