Lower Abdominal Pain

1 Lower Abdominal Pain Summary

Abdominal pain is a very common symptom of many different conditions. The intensity and location of pain may differ with the condition. In some cases, it is dull and crampy, while in some others it is severe and periodic.

The duration of pain may depend on the underlying cause of the symptom. Abdominal pain may be generalized or localized. Generalized pain is usually an indicator of a mild illness, while localized pain indicates a more serious condition which requires attention.

Lower abdominal pain is a pain that occurs below the belly button. The pain may be localized to the right or left of the lower abdominal area. The pain may be accompanied by other symptoms like nausea, gas, and loss of appetite.

Medical attention is warranted if the pain lasts for few days and is severe. Lower abdominal pain is seen both in men and women.

Pain in the lower left part of the abdomen may be caused by constipation, diverticulitis, pseudomembranous colitis, appendicitis, issues with reproductive organs, muscle and skin disorders, and volvulus.

Chronic pain on the left side results from constipation, diverticulosis, chronic colitis, colorectal cancer and polycystic ovarian syndrome (PCOS).

Pain in the right side of the lower abdomen is caused by conditions like appendicitis, constipation, infection of right kidney, kidney stones, Crohn’s disease, ectopic pregnancy, ovulation, and ovarian cysts.

In men, the pain may originate from any of the internal organs in the abdomen. Apart from others testicular torsion and hernia may also result in lower abdominal pain.

Abdominal pain is of concern if it is accompanied by: 

  • Fever
  • Dehydration
  • Severe vomiting
  • Inability to pass stool
  • Tenderness in abdomen
  • Painful urination
  • Pain lasting for longer duration
  • Vomiting blood
  • Black tarry colored stools
  • Breathlessness

As the causes of lower abdominal pain are many, physical examination, evaluation of symptoms, and medical history will help the physician to find the most probable causes of this symptom.

The doctor may collect information on the intensity, duration, onset, type and location of pain. Further tests and investigations are based on the probable cause of the condition.

Blood tests, urine analysis, stool tests, and imaging techniques are commonly suggested for diagnosing the underlying cause of abdominal pain. Endoscopy, ultrasound scan, and CT scan are also used in some specific causes.

Treatment of lower abdominal pain depends on the cause of the symptom. It can range from medications, simple home treatment or surgery. Lower abdominal pain can be prevented by keeping low-stress levels, healthy diet, hydration and regular exercise.

2 Causes

Abdominal pain can be generalized or localized, and location of pain gives a clue about the cause of the condition.

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Generalized pain that is felt both in the lower and upper part of the abdomen may be caused by:

The pain felt in the lower abdominal region may be caused by appendicitis, intestinal obstruction, and ectopic pregnancy.

Some of the common causes of acute pain in the lower left region of the abdomen are: 

  • Constipation – the pain may be felt as cramps in the lower left part of the abdomen.
  • Diverticulitis – this condition is characterized by the bulging or inflammation of the diverticulum at the end of the colon. The pain may have a sudden or gradual onset and is often accompanied by bloating in the lower left part of the abdomen. Fever and diarrhea can also be seen along with other symptoms.
  • Pseudomembranous colitis – this condition is caused by long-term use of antibiotics that kills the normal flora of the intestine. The pain is usually felt on the left side along with high fever and diarrhea.
  • Volvulus – volvulus is the twisting of the end part of the colon and is a rare condition. It is characterized by pain and tenderness in the lower left part of the abdomen. Vomiting, constipation and presence of mucus in stool are the other accompanying symptoms.
  • Appendicitis – in some rare cases appendicitis may result in pain in the lower abdominal region.
  • Muscle and skin disorders – conditions like a herpes and inguinal hernia can cause pain in the lower abdominal part.
  • Kidney stones – excess crystals in the urine may form stones that move through the urinary system. These stones may be large or small and cause pain in the lower abdomen accompanied by nausea and blood in urine.

Chronic pain in the lower abdominal region may be caused by chronic colitis like Crohn’s disease and ulcerative colitis. Pain in the abdomen may be accompanied by diarrhea, blood in stool, and an urgency for a bowel movement.

Colorectal cancer is another cause of chronic pain in the lower abdomen. This is characterized by pain and presence of blood in stool, nausea, poor appetite and weight loss. Polycystic ovarian syndrome is another cause of pain in the lower abdominal region, mostly on the left side.

Pain in the lower right part of the abdomen may be caused by: 

  • Appendicitis – this is one of the most common indicators of appendicitis. The pain is usually felt as a dull, aching one around the belly button. The area may become tender and the pain worsens with time. Other common symptoms include diarrhea, constipation, and low-grade fever.
  • Infection of right kidney – pain in the right lower part of the abdomen, back pain, and pain in the groin indicate an infection of the right kidney. Other symptoms include increased frequency of urination and blood in urine.
  • Kidney stones – kidney stones that block the urinary system may cause periodic pain that varies in intensity. Smelly urine, vomiting, chills and increased frequency of urination are also seen as other symptoms.
  • Carcinoid – it is a slowly growing tumor, mostly seen in elderly people. This is a rare condition but may cause pain when the growth is seen in appendix or cecum.
  • Ovulation – pain in the lower right quadrant of the abdomen is common during ovulation.

Pain may be caused by problems in the reproductive organs in both males and females. Thus disorders of testes, spermatic cord, testicular veins are the reproductive cause of the symptom. In females, ovulation, rupture of ovarian cyst, and ectopic pregnancy.

In an ectopic pregnancy, the fertilized egg gets implanted in the right ovary or fallopian tube. This may cause severe pain in the lower left or right side of the abdomen, depending on which ovary the implantation occurred.

3 Diagnosis and Treatment

The actual cause of abdominal pain is diagnosed based on physical examination, medical history, laboratory tests and imaging techniques.

Physical examination – during physical examination and medical history evaluation, the doctor may try to analyze the type of pain. Pain may be acute, intense, intermittent, chronic, progressing, crampy, sharp, dull, or steady.

Doctor tries to evaluate the same based on the response of the patient. Location of pain also is important in the diagnosis of the cause of pain. Radiating pain or pain localized to certain parts of the abdomen indicates specific causes.

Doctor also tries to assess whether the pain increases with activities, coughing, alcohol consumption, food, menstrual cycle, or just stress. Some types of stomach pain may be relieved by antacids, having more water, or eating certain foods.

Doctor analyzes these responses too to evaluate the actual cause of pain. Accompanying symptoms are also noted during the physical examination. During the examination, the doctor checks for tenderness and swelling by gently pressing on the abdomen.

Laboratory tests – complete blood test, liver function test, and urinalysis are the most common laboratory tests performed during the diagnosis of the condition. Inflammation or infection is indicated by an increase in the white blood cells. The level of red blood cells shows a sharp decrease with intestinal bleeding. The presence of white blood cells in the stool indicates diarrhea.

Imaging techniques – x-ray helps to detect an intestinal obstruction, ulcers, kidney stones, and pancreatitis. An abdominal ultrasound scan is used in identifying kidney stones, appendicitis, and ovarian cysts.

Computed tomography or CT scan, and MRI are useful in diagnosing cancer, appendicitis, and diverticulitis. Diseases of the arteries are also detected using imaging methods.

Capsule enteroscopy is a method in which a swallowed pill helps to take images of the small bowel and transmit the same to a receiver. Other imaging methods used in the diagnosis of the cause of stomach pain include colonoscopy, esophagogastroduodenoscopy (EGD), endoscopic ultrasound and balloon enteroscopy.

Treatment for abdominal pain depends on the actual cause. It is often individualized based on the health of the patient, age, and severity of pain. Any treatment plan focuses on the underlying cause and tries to minimize the pain and discomfort. It also tries to decrease the risk of complications of the underlying disease.

If the pain is caused by self-limiting conditions like viral infection or indigestion, adequate hydration and restricting diet are the most common recommended treatment method. The treatment of choice in most of the cases is the medication that helps to control the underlying disease.

For example, antibiotics are prescribed for bacterial infections. More serious causes of stomach pain like intestinal obstruction and appendicitis may need hospitalization. Surgery is recommended for some specific causes like a hernia and appendicitis.

Lifestyle choices can also help in reducing pain. Many types of abdominal pain can be controlled by having a healthy diet and avoiding excess alcohol and smoking.

One can minimize the risk of abdominal pain with adequate hydration, regular exercise, and by having smaller meals at regular intervals. Some diseases like Crohn’s disease requires the person to follow a strict diet.

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