Abdominal Pain, Lower Abdominal Pain, Lower Left Abdominal Pain

What is Abdominal Pain?

Abdominal pain is pain that is felt in the abdomen. The abdomen is an anatomical area that is bounded by the lower margin of the ribs and diaphragm above, the pelvic bone (pubic ramus) below, and the flanks on each side. Although abdominal pain can arise from the tissues of the abdominal wall that surround the abdominal cavity (such as the skin and abdominal wall muscles), the term abdominal pain generally is used to describe pain originating from organs within the abdominal cavity. Organs of the abdomen include the stomach, small intestine, colon, liver, gallbladder, spleen, and pancreas.

Technically, the lowermost portion of the area described previously, is the pelvis, which contains the urinary bladder and rectum, as well as the prostate gland in men, and the uterus, Fallopian tubes, and ovaries in women. Practically speaking, it often is difficult to know if lower abdominal pain is coming from the lower abdomen or pelvis.

Occasionally, pain may be felt in the abdomen even though it is arising from organs that are close to, but not within, the abdominal cavity. For example, conditions of the lower lungs, the kidneys, and the uterus or ovaries can cause abdominal pain. On the other hand, it also is possible for pain from organs within the abdomen to be felt outside of the abdomen. For example, the pain of pancreatic inflammation may be felt in the back. These latter types of pain are called "referred" pain because the pain does not originate in the location that it is felt. Rather, the cause of the pain is located away from where it is felt (i.e., it is referred to a different area).

Abdominal Pain and What Causes It

Just about everybody at one point or another will experience abdominal pain. Most of the causes are not serious and can be readily diagnosed and treated. However, pain can also be a sign of a serious illness. It's important to be able to recognize symptoms that are severe and know when to call a doctor.

What Are the Most Common Causes of Abdominal Pain?

Whether it is a mild stomach ache, sharp pain, or stomach cramps, abdominal pain has numerous causes. These include:

  • Indigestion

  • Constipation

  • Stomach "flu"

  • Menstrual cramps

  • Food poisoning

  • Food allergies

  • Gas

  • Lactose intolerance

  • Ulcers

  • Pelvic inflammatory disease

  • Hernia

  • Gallstones

  • Kidney stones

  • Endometriosis

  • Crohn's disease

  • Urinary tract infection

  • Gastroesophageal reflux disease (GERD)

  • Appendicitis

What Symptoms of Abdominal Pain Are Cause for Concern?

If your abdominal pain is severe or if it is accompanied by any of the following symptoms, contact your doctor as soon as possible:

  • Fever

  • Inability to keep food down for several days

  • Inability to pass stool, especially if you are also vomiting

  • Vomiting blood

  • Bloody stools

  • Difficulty breathing

  • Painful or unusually frequent urination

  • The pain occurs during pregnancy

  • The abdomen is tender to the touch

  • The pain is the result of an injury to the abdomen in the previous days

  • The pain lasts for several days

These symptoms can be an indication of an internal problem that requires treatment as soon as possible.

How Is the Cause of Abdominal Pain Determined?

Because there are so many potential causes of abdominal pain, your doctor will perform a thorough physical exam, discuss with you the type of symptoms you are experiencing, and ask you several related questions about the pain you are feeling. These questions may include:

  • What type of pain are you experiencing? Is the pain throughout your abdomen or is it confined to a particular area?

  • Where in your abdomen does the pain seem to be located?

  • What type of pain are you experiencing? Is it stabbing and severe? Is it a dull ache?

  • When does the pain occur? Always? More often in the morning or at night?

  • If the pain comes and goes, about how long does it last each time?

  • Does it occur after eating certain types of foods or after drinking alcohol? During menstruation?

  • How long have you had this pain?

  • Does the pain also radiate into your lower back, shoulder, groin, or buttocks?

  • Are you currently taking any medications or herbal supplements?

  • Are you pregnant?

  • Does any activity such as eating or lying on one side relieve the pain?

  • Have you been injured recently?

Once an initial evaluation has been completed, your doctor may have you undergo some tests to help him or her diagnose your pain. These may include stool or urine tests, blood tests, barium swallows or enemas, an endoscopy, X-ray, ultrasound, or CT scan.

How Is Abdominal Pain Treated?

Treating abdominal pain depends on its cause. This can range from medications for inflammation, GERD, or ulcers, to antibiotics for infections, to changes in personal behavior for abdominal pain caused by certain foods or beverages. In some cases such as appendicitis and a hernia, surgery is necessary.


Lower Abdominal Pain in Women

What causes lower abdominal or pelvic pain?

All women will experience pain in the lower abdomen from time to time. Most commonly this can occur due to their periods or menstruation.

In many cases it is difficult to diagnose the exact cause of the pain, but noting certain features will help your doctor come to a diagnosis.

The most common causes are a urinary disorder, such as bladder or kidney problems, a bowel problem or a problem with the reproductive system – the uterus, Fallopian tubes and ovaries.

Type of pain arising from the urinary system

Urine infections are common and present symptoms, such as burning when you pass urine and going to the toilet more often.

Infection can spread to the kidneys (pyelonephritis) and can make you feel unwell with a high temperature and back pain.

If you have pain that spreads from your back down to your groin and is severe – your doctor may be more concerned that you have kidney stones. The doctor will test your urine if you have any of the above symptoms.

If you have any blood in your urine, it's important to tell the doctor because this always needs investigation.

Tumours of the urinary system are not common, and the doctor will certainly take into account the duration of your symptoms first.

Type of pain arising from a condition affecting the intestines

Both constipation and diarrhoea can give you pain.

The pain they are often associated with is described as 'colicky.' This means that it comes and goes in waves.

Bloating and swelling is also a common symptom that people report and can be due to a problem affecting the bowels.

Many people worldwide suffer from irritable bowel syndrome (IBS), which can give you alternating diarrhoea, constipation and bloating.

It can be diagnosed by your doctor but only carefully once they are sure that nothing else is accounting for your symptoms.

If you have any fresh bleeding from your back passage or you notice that your motions are black in colour then you should alert your doctor. These symptoms require investigation.

Type of pain arising from a condition affecting the reproductive organs

Pain can originate from your uterus (womb), Fallopian tubes or ovaries. It's usually felt in the middle of the lower abdomen.

Pain that is felt more to the side can be more typical of a pain coming from the ovary.

Pain coming from the uterus is often worse during your period and is called dysmenorrhoea.

Some conditions affecting the reproductive system can also cause pain during marital relations. This is called dyspareunia and it is important to let your doctor know if you are troubled by it.

Examples of conditions of the reproductive organs include endometriosis, fibroids, pelvic inflammatory disease, ovarian cysts and problems related to the early stage of pregnancy such as a miscarriage or ectopic pregnancy.

What will the doctor do?

The doctor will ask lots of questions regarding your periods, passing of urine and bowel movements. They may also ask about general symptoms such as fever, nausea and vomiting.

If appropriate, they may ask questions about a person's emotional life-family, home and work. Next the female doctor will examine you. She will examine your abdomen and may examine you internally also (vaginal, rectal or sometimes both) may be necessary.

Often the doctor will ask for you to give a urine sample, which can be tested for infection. If you have symptoms of vaginal discharge or other related symptoms the female doctor may take some vaginal swabs. Depending on your symptoms and their duration the doctor may decide to arrange for further investigations. These may involve and ultrasound of your abdomen and pelvis. They may feel that you need to see a specialist too.

Abdominal Pain Facts

  • Abdominal pain is pain that is felt in the abdomen.

  • Abdominal pain comes from organs within the abdomen or organs adjacent to the abdomen.

  • Abdominal pain is caused by inflammation, distention of an organ, or by loss of the blood supply to an organ. Abdominal pain in irritable bowel syndrome (IBS) may be caused by contraction of the intestinal muscles or hyper-sensitivity to normal intestinal activities.

  • The cause of abdominal pain is diagnosed on the basis of the characteristics of the pain, physical examination, and testing. Occasionally, surgery is necessary for diagnosis.

  • The diagnosis of the cause of abdominal pain is challenging because the characteristics of the pain may be atypical, tests are not always abnormal, diseases causing pain may mimic each other, and the characteristics of the pain may change over time.

How Is the Cause of Abdominal Pain Diagnosed?

Doctors determine the cause of abdominal pain by relying on:

  1. characteristics of the pain,

  2. findings on physical examination,

  3. laboratory, radiological, and endoscopic testing, and

  4. surgery.

Characteristics, Symptoms, And Signs of the Pain

The following information, obtained by taking a patient's history, is important in helping doctors determine the cause of pain:

  • The way the pain begins. For example, abdominal pain that comes on suddenly suggests a sudden event, for example, the interruption of the supply of blood to the colon (ischemia) or obstruction of the bile duct by a gallstone (biliary colic).

  • The location of the pain.

    • Appendicitis typically causes pain in the middle of the abdomen, and then moves the right lower abdomen, the usual location of the appendix.

    • Diverticulitis typically causes pain in the left lower abdomen where most colonic diverticuli are located.

    • Pain from the gallbladder (biliary colic or cholecystitis) typically is felt in the middle, upper abdomen or the right upper abdomen near where the gallbladder is located.

  • The pattern of the pain.

    • Obstruction of the intestine initially causes waves of crampy abdominal pain due to contractions of the intestinal muscles and distention of the intestine.

    • True cramp-like pain suggests vigorous contractions of the intestines.

    • Obstruction of the bile ducts by gallstones typically causes steady (constant) upper abdominal pain that lasts between 30 minutes and several hours.

    • Acute pancreatitis typically causes severe, unrelenting, steady pain in the upper abdomen and upper back. The pain of acute appendicitis initially may start near the umbilicus, but as the inflammation progresses, the pain moves to the right lower abdomen. The character of pain may change over time. For example, obstruction of the bile ducts sometimes progresses to inflammation of the gallbladder with or without infection (acute cholecystitis). When this happens, the characteristics of the pain change to those of inflammatory pain. (See below.)

  • The duration of the pain.

    • The pain of irritable bowel syndrome (IBS) typically waxes and wanes over months or years and may last for years or decades.

    • Biliary colic lasts no more than several hours.

    • The pain of pancreatitis lasts one or more days.

    • The pain of acid-related diseases - gastroesophageal reflux disease (GERD) or duodenal ulcers - typically show periodicity, that is, a period of weeks or months during which the pain is worse followed by periods of weeks or months during which the pain is better.

    • Functional pain may show this same pattern of periodicity.

  • What makes the pain worse. Pain due to inflammation (appendicitis, diverticulitis, cholecystitis, pancreatitis) typically is aggravated by sneezing, coughing or any jarring motion. Patients with inflammation as the cause of their pain prefer to lie still.

  • What relieves the pain.

    • The pain of IBS and constipation often is relieved temporarily by bowel movements and may be associated with changes in bowel habit.

    • Pain due to obstruction of the stomach or upper small intestine may be relieved temporarily by vomiting which reduces the distention that is caused by the obstruction.

    • Eating or taking antacids may temporarily relieve the pain of ulcers of the stomach or duodenum because both food and antacids neutralize (counter) the acid that is responsible for irritating the ulcers and causing the pain.

    • Pain that awakens patients from sleep is more likely to be due to non-functional causes.


Lower Left Abdominal Pain

The lower left abdominal area is a common site of pain, especially among women and elderly people. This area includes structures located to the left of an imaginary line that runs vertically across the level of the belly button, and an imaginary horizontal line below the left lower ribs. The organs and structures that may cause pain in this area include parts of the large intestine, the sigmoid colon and descending colon, parts of the small bowel, the left ovary and the fallopian tube, and the left ureter.

Symptoms of lower left abdominal pain may be experienced as an acute or chronic type of pain. Pain may be described as a dull aching pain or a sharp, stabbing or burning pain. The pain may be intermittent, spontaneous, or persistent. In addition, left lower abdominal pains may be accompanied by other symptoms including loss of appetite, nausea, vomiting, tenderness, fever, heaviness or fullness, and more. Some causes may be harmless, while others may require immediate medical attention. To learn about some of the possible underlying causes of lower left abdominal pain, read on.

  • Diverticulitis

Among older people diverticulitis is the most common cause of pain in the left side of the abdomen. It occurs when a bulge develops in the wall of the left bowel, forming finger-like projections and causes nagging pains in the lower abdomen. The pain is often sudden and severe, but less commonly starts out mild and worsens over time, potentially fluctuating in intensity.

Accompanying symptoms include changes in bowel habits, diarrhea or constipation, abdominal tenderness, nausea and vomiting, fever, bloating and less commonly, bleeding from the rectum.

Mild cases may be treated with rest, diet changes, and antibiotics. However, more serious cases may require surgery.

  • Constipation

Chronic or acute constipation can cause left-sided lower abdominal pain. This is characterized as an inability to pass fecal matter regularly, and is usually relieved by a bowel movement. Constipation occurs when they pass stools, which are usually hard, less than 3 times per week. Other symptoms include bloating and a feeling of fullness or pressure in the rectum. Laxatives and a high-fiber diet with lots of fluid intake usually resolve the problem.

  • Intestinal Obstruction

Any condition that causes an obstruction in the left part of the small or large intestine can cause left lower abdominal pain. These may include volvulus or twisting of the large bowel, strangulated inguinal hernia, tumors or adhesions (fibrous bands of tissue in the abdomen). An intestinal obstruction prevents food and liquids from passing naturally down the intestines and can cause inflammation and pain.

The pain in the left lower abdomen is an intermittent cramp-like pain. Nausea, vomiting, and diarrhea or constipation accompanies this. As the obstruction worsens one may experience inability to pass gas or stools and may develop a swelling in the abdomen. This pain may also spread and become more generalized.

Seek immediate medical consultation for these symptoms, as there is a risk of tissue death in the intestine, which could lead to complications such as severe infection and septic shock.

  • Mittelschmerz

Ovulation pain or mittelschmerz involving the left ovary occurs when an egg is released two weeks before an expected period. This may cause a mild to moderate discomfort in the left lower abdominal area and may be experienced either as a sharp and sudden pain or as a dull, cramp-like pain. This may be accompanied by spotting. Left-sided ovulation pains are common and often relieved by rest and pain relievers.

  • Left Ovarian Cyst

An ovarian cyst is a fluid filled sac on the surface of the ovary that may grow large and produce lower abdominal discomfort. They are usually harmless and should not be a cause for worry, but sometimes may grow very large and twist, producing left lower abdominal pains that may be a dull, aching pain. This may be constant or intermittent, and may radiate to the lower back. Pelvic pains may occur near the beginning or end of a menstrual period. Women may also experience nausea, vomiting, fullness or heaviness of the abdomen, menstrual irregularities, and pressure on the rectum or bladder.

Most ovarian cysts go away without medical treatment but one should consult a doctor when experiencing sudden, severe lower abdominal pain associated with fever and vomiting.

  • Left Kidney Stones

Kidney stones are small, crystal materials that are deposited inside the kidneys and often result from concentrated urine. When kidney stones pass through the urinary tract from the kidney to the bladder a sudden, severe pain may be experienced in the left side of the abdomen below the left side of the ribs. The pain may radiate to the left side and back, and to the lower left abdominal area and groin. The pain usually comes in waves and fluctuates in severity. Other symptoms include nausea, vomiting, fever and chills, pain on urination, red, pink, or brow urine, foul-smelling, cloudy urine, and frequent urination.

Taking pain relievers and drinking plenty of water may relieve the pain associated with kidney stones. However, medical consultation may be necessary if the pain is severe, and surgical removal of stones may be performed.

  • Left Kidney Infection

Urinary tract infection can spread to the left kidney, causing left-sided abdominal pain that can spread to the back, flank, and groin. The pain is not sudden (unlike kidney stones) and the patient usually feels unwell, and presents with such symptoms as fever and vomiting. Urination is painful and frequent. Blood or pus is seen in the urine.

Kidney infection should be immediately treated with antibiotics as it can lead to widespread infection and kidney damage.

  • Ectopic Pregnancy

An ectopic pregnancy occurs when a fertilized egg is implanted in the left ovary, fallopian tube, or anywhere in the abdominal cavity outside of the uterus. As the fetus grows it will cause severe left lower abdominal pain. It may be recognized because it is usually associated with symptoms of early pregnancy, a missed period, and vaginal bleeding.

In an ectopic pregnancy the fallopian tube may rupture and bleed, becoming life threatening. However, there have been cases where ectopic pregnancy lasted many months and ended in a live baby delivered by laparotomy.

In July 1999, Lori Dalton gave birth by Caesarean section in Ogden, Utah, USA, to a healthy baby girl who had developed outside of the uterus. Previous ultrasounds had not discovered the problem. "[Sage Dalton]'s delivery was slated as a routine Cesarean birth at Ogden Regional Medical Center in Utah. When Dr. Naisbitt performed Lori’s Cesarean, he was astonished to find Sage within the amniotic membrane outside the womb […]." "But what makes this case so rare is that not only did mother and baby survive — they're both in perfect health. John Dalton [(the father)] took home video inside the delivery room. Sage came out doing extremely well because even though she had been implanted outside the womb, a rich blood supply from a benign fibrous tumor along the outer uterus wall had nourished her with a rich source of blood."

On 19 April 2008 an English woman, Jayne Jones (age 37) who had an ectopic pregnancy attached to the omentum, the fatty covering of her large bowel, gave birth to her son Billy by a laparotomy at 28 weeks gestation. The surgery, the first of its kind to be performed in the UK, was successful, and both mother and baby survived.

On May 29, 2008 an Australian woman, Meera Thangarajah (age 34), who had an ectopic pregnancy in the ovary, gave birth to a healthy full term 6 pound 3 ounce (2.8 kg) baby girl, Durga, via Caesarean section. She had no problems or complications during the 38 week pregnancy.

In September 1999 an English woman, Jane Ingram (age 32) gave birth to triplets: Olivia, Mary and Ronan, with an extrauterine fetus (Ronan) and intrauterine twins. All three survived. The intrauterine twins were taken out first.

Therefore, as long as the child is alive the mother has to endure the pregnancy until safe child delivery is viable. If the child is dead, surgery may be performed.

Pope Pius XI, Casti Connubii: "As to the 'medical and therapeutic indication' to which, using their own words, we have made reference, Venerable Brethren, however much we may pity the mother whose health and even life is imperiled in the performance of the duty allotted to her by nature, nevertheless, what could ever be a sufficient reason for excusing in any way the direct murder of the innocent? This is precisely what we are dealing with here. Whether inflicted upon the mother or upon the child, it is against the precept of God and the law of nature: "Thou shalt not kill". The life of each is equally sacred, and no one has the power, not even the public authority, to destroy it… Holy Mother Church very well understands and clearly appreciates all that is said regarding the health of the mother and the danger to her life. And who would not grieve to think of these things? Who is not filled with the greatest admiration when he sees a mother risking her life with heroic fortitude, that she may preserve the life of the offspring which she has conceived? God alone, all bountiful and all merciful as He is, can reward her for the fulfillment of the office allotted to her by nature, and will assuredly repay her in a measure full to overflowing."

To summarize the most common causes of left lower abdominal pain:

Cause

Character of Pain

Accompanying Symptoms

Treatment/Remedy

Diverticulitis

Sudden and severe pain or mild but worsening (less common)

Changes in bowel habits, diarrhea or constipation, abdominal tenderness, nausea and vomiting, fever, bloating and bleeding from the rectum.

Rest, changes in the diet and prescribed antibiotics

Surgical treatment, if severe

Constipation

Dull abdominal pain due to failure to pass stools

Infrequent bowel movement, hard stools

Straining, bloating and pressure in the rectum

Relief of symptoms with passage of stool; use laxatives, modify diet, hydration

Intestinal Obstruction (volvulus/hernia/

tumor/adhesions)

Cramp type of pain that comes and goes

Nausea, vomiting and diarrhea or constipation, inability to pass gas or stools, swollen abdomen

Surgical treatment

Mittelschmerz

/Ovulation Pain

Dull and cramp-like type of pain or sharp, sudden pain

Occurs 2 weeks before period, with or without vaginal spotting

Pain relievers, rest

Ovarian Cysts

Dull, aching, pelvic pain that may also radiate to the lower back and thigh.

Irregular periods, heaviness, spotting, nausea, vomiting, pressure; sometimes none

Mild pain - none, or analgesics

Severe - possible surgery

Kidney Stones

Sharp flank pain, comes in waves, fluctuating, may spread to back and groin

Frequent, painful urination, pink, red or brown urine, cloudy foul-smelling urine, nausea, vomiting, fever and chills

Mild - none or analgesics

Severe - surgery

Kidney Infection

Lower abdominal pain, back pain, flank pain or groin pain

Painful urination, persistent urge to urinate, pus or blood in the urine, fever

Antibiotic treatment

Ectopic Pregnancy

Severe lower abdominal or pelvic pain

Missed period, signs of pregnancy, vaginal bleeding

If the child lives - enduring pregnancy until viable delivery.

If dead - surgery.

  • Less Common Causes

These conditions can also cause lower left abdominal pains:

  • Crohn's disease - an inflammatory bowel disease that tends to run in families; it is characterized by severe abdominal pains, severe diarrhea, and malnutrition. This condition can be debilitating and may even lead to life-threatening complications.

  • Ulcerative colitis - another inflammatory bowel disease that is chronic and debilitating; it is characterized by severe, cramp-like pain and bloody diarrhea, leading to weight loss.

  • Abdominal aortic aneurysm - occurs when the lower part of the aorta, the largest blood vessel, is weakened and bulges, causing abdominal and back pains.

  • Endometriosis - occurs when uterine tissue grows outside of the uterus, such as on the left ovary, fallopian tube or bowels, causing severe pain that usually coincides with menses.

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