Female Abdominal Pain

Causes, Diagnosis & Treatment Of Female Abdominal Pain 

What Is Female Abdominal Pain?

Pain in the abdomen occurs more in women than it does in men.

The presence of the uterus, ovaries, Fallopian tubes, cervix and vagina in a women means that females have more organs to worry about than their male counterparts.

Often, the cause of abdominal pain in a woman can be pinpointed with a good degree of accuracy, especially if it relates to causes like menstrual pain, pelvic inflammatory disease, irritable bowel syndrome or labour pain.

In some other cases, the cause of such pain in the abdomen will not be discovered, even after extensive investigations. Thankfully, conditions that cause pain in the abdomen for women is often not serious and do not lead to any long term health problems.

Common Causes Of Abdominal Pain In Women

Common causes of abdominal pain in a woman include:

As with any part of the body; injury, infection or cancer affecting an organ in that region or nearby region is what commonly leads to pain.

To fully understand what could be causing abdominal pain in a woman, we shall look at each of the four regions of the abdomen in a woman and describe the organs and structures that are there and why they could be causing pain. We will then briefly look at the top ten conditions that can cause female abdominal pain. 

Organs In The Female Abdomen

Women tend to suffer with conditions like gallstones, cholecystitis and irritable bowel syndrome and a few other non-female specific diseases more than their male counterparts despite both sexes having these organs. 

In addition to that, the unique reproductive organs found in women also brings additional causes of pain. Let us examine each of the four parts of the abdomen in a woman and see what can go wrong and bring pain in the abdomen. 

Right Upper Abdomen

Organs in the right upper abdomen that commonly cause pain in women include:

• Gallbladder. Infection or injury to this organ could lead to gallstone pain, cholecystitis, ruptured gallbladder, etc.
• Liver. Associated with hepatitis, liver cysts, amoebic liver infection, cirrhosis, Fitz Hugh Curtis Syndrome (following gonorrhoea infection) etc.
• Ribs. Leading to right sided costochondritis
• Skin. Can be affected by shingles
  

Right Lower Abdomen

Organs in the right lower abdomen that commonly cause pain in women include:

• Right Ovary. Twisted ovarian cyst, ruptured ovary, ovarian cancer or corpus luteum cyst.
• Endometriosis
• Right Fallopian Tube. Affected by salpingitis or PID, ectopic pregnancy
• Right Round Ligament
• Part of the Uterus may encroach here too
• Bowels. Appendicitis, constipation, IBS, Crohns, ulcerative colitis, coeliac, bowel cancer
  

Left Upper Abdomen

Organs in the left upper abdomen that would commonly cause pain in a woman include:

• Stomach. Causing gastritis, stomach ulcer
• Left end of the liver equally affected, with same condition as on the right.
  
• Spleen
• Pancreas. inflammation of this organ leads to pancreatitis
• Bowels, leading to constipation
  
• Ribs. Leading to costochondritis
• Skin. Can be affected by shingles.
  

Left Lower Abdomen

Organs in the left lower abdomen that commonly cause pain in women include:

• Left Ovary. Twisted ovarian cyst, ruptured ovary, ovarian cancer, corpus luteum cyst.
• Endometriosis
• Left Fallopian Tube. Affected by salpingitis or PID, ectopic pregnancy
• Bowels. Diverticulitis, colitis, crohns disease, irritable bowel syndrome, bowel cancer
  

Lower Central Abdomen (Below The Umbilicus)

• Womb or uterus (fibroid, adenomyosis, menstrual pain, miscarriage)
• Bladder (Cystitis, overactive bladder, bladder stones). 
• Central ends of the two fallopian tubes
• Cervix
• Upper part of the vagina
• Ends of the round ligaments
• Part of the usually mobile gut could also come to lie here.

Top Ten Causes Of Female Abdominal Pain

1. Menstrual Pain

Menstrual pain is also known as dysmenorrhoea, period pain or menstrual cramps.

Menstrual pain is the most common cause of abdominal pain in women of child bearing age (approximately between the ages of 11 to 55 years old). It causes a cramping and lower central abdominal pain below the umbilicus a day or two before the time of the period.

A recent report revealed that 1 in every 2 women have some degree of period pain around the time of their menses and in up to 1 in 10 women the pain could be so serious that it affects their daily life. 

To relieve the pain you can take pain killers and anti-inflammatory medications like ibuprofen or mefenamic acid to control the pain. 

In very severe cases, you may need to use a combined contraceptive pill to overcome the pain. It is important to discuss with your doctor about your suitability for such use. You can read more on menstrual pain here.

2. Mid Cycle Pain

Mid Cycle Pain is also called mittleschmerz and is another very common cause of lower abdominal pain especially in young girls between the ages 11 to 30 years old. Some people refer to it as ovulation pain and it causes pain in the middle of the menstrual cycle (usually two weeks after a period). The pain may be on the right or left lower abdomen and be sharp or a dull ache which lasts for a few hours to a few days.  It usually resolves on its own and does not lead to any serious problems. Read more on this here.

3. Urine Infection

Because women have a very short urethra, they tend to suffer more with urine infections or cystitis than men.

The features of urine infection include:

• Lower abdominal pain below the umbilicus
  
• Increased frequency of passing urine
• A stinging or burning sensation in the vagina when passing urine
• Lower back or side pain
• Reduced appetite
• Fever
• Tiredness 
• Headaches

If you think you might be suffering with an urine infection it is best to see your doctor to get some antibiotics. Some women find that taking potassium citrate medicine bought from the chemist without a prescription helps. So too does drinking cranberry juice. Please read more on this here.

4. Constipation

Constipation is a common cause of abdominal pain in both men and women. A few days ago, a 34 year old lady came into the Emergency Department with a 5 day history of severe pain between her vagina and anus. She claimed to have been opening her bowel normally. She is however known to suffered with constipation in the past.

Examination of her abdomen revealed mild to moderate pain on pressing down on the tummy. An internal examination of the rectum with a gloved finger was met with a big bulky stool impaction. When she was told that her pain was due to constipation she insisted that it is not possible. As a precaution, a routine blood test was done on her just in case something was being missed. Her urine was also tested. Both of these came back normal. An abdominal x-ray showed a big shadow of faeces stuck in her lower rectum. She was astounded. You can read about symptoms and treatment of constipation here.

5. Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome or IBS is a common cause of abdominal pain in women and it affects 3 women for every man with this condition.

IBS causes:

• Abdominal pain with a feeling of bloating and usually constipation, but diarrhoea also occurs in some people
• Symptoms tends to be worse after eating certain kind of food and gets better after opening the bowel
• The pain could be on the left lower abdomen, right side or lower abdomen 
• For some, pain is the predominant symptom and for others it is constipation or diarrhoea
  
• For those with constipation they are able to pass small hard rabbit-like stools
• Mucus in the stool
  

It is not an illness that makes people unwell or lose weight but there could be bladder symptoms, including waking up at night to pass urine. You can read more about IBS here.

6. Pelvic Inflammatory Disease (PID)

Often referred to as PID, pelvic inflammatory disease is the infection of the womb and fallopian tubes usually due to a sexually transmitted disease from the vagina and cervix. Gonorrhoea and chlamydia are the most common causes of PID in people with multiple sexual partners.

It can also be caused by other infections spreading from the vagina, up through the cervix to the womb and not due to a sexually transmitted infection.

It is a very common cause of lower abdominal pain in a woman.

Symptoms of PID include:

• Lower abdominal pain below the umbilicus or bikini line
• Abnormal vaginal discharge (this could be foul smelling in odour)
• Pain deep inside the pelvis or abdomen during sexual intercourse 
• Abnormal vaginal spotting or bleeding in between the menstrual cycle
• Fever
  
• Upper right abdominal pain with any of the above symptoms

Diagnosis of pelvic inflammatory disease is made by examination and blood test. Vaginal swabs will also be taken and in some cases ultrasound scans will used.

Successful treatment is achieved using the right antibiotics like:

• Doxycycline and flagyl (metronidazole) taken together. Doxycycline 100mg three times a day for 14 to 21 days and flagyl tablets 400mg three times a day for 7 to 14 days, depending on the severity of infection
• You may also be given a shot of Ceftriaxone injection daily for 1 - 5 days or the tablet if the injection is not available, again depending on severity of infection

It is also important for your sexual partner to be treated to prevent re-infection. Contact your doctor if you suspect you may be suffering with PID. They need to test you to identify the specific bacteria responsible and then choose a matching antibiotic that will help clear the bug.

7. Endometriosis

Endometriosis is a condition where cells that normally line the uterus are found in other parts of the abdomen or body where they are not supposed to be. These abnormally situated uterine cells then behave like the normal uterus, producing menstrual bleed at the end of each month. But the blood gets trapped, accumulates and irritates the surrounding organs and bowels causing abdominal pain.

Excess amounts of blood accumulating in a confined space leads to pressure and pain. The blood could form clots and adhesion, binding other structures like the intestines together too, causing obstruction.

Symptoms of endometriosis include:

• Lower abdominal pain for many months worse around the time of your menstruation
• There may be lower back pain 
• Some women experience pain on defecation around the time of their period 
• Deep seated pain in the pelvis during sexual intercourse
• Bloating
  
• Increase in weight during the menstrual period.

Diagnosis of this condition is by means of ultrasound scan and laparoscopy. 

There are many treatment options, including the use of:

• Regular pain killers only
• Combined contraceptive pills
• Special hormones to suppress the activity of the abnormal cell linings
• Surgery to clear endometriosis deposits 
  

You can read more on endometriosis condition here.

8. Fibroid

Female abdominal pain due to fibroid is common especially amongst women of African and Asian descent, who tend to have fibroids  more than their Caucasian counterparts.

Fibroids are abnormal lumpy growths of the muscles of the uterus, causing a hard stone-like mass on the wall or inside of the womb. They are also called womb stones, leiomyoma, leiomyomata, or myoma.

Fibroids often do not cause any symptoms unless they are big enough to exhaust their blood supply or cause obstruction in the womb or outside the womb. Only about a third of women with fibroids develop symptoms.

Symptoms of fibroids include:

• Lower abdominal pain
• Severe lower abdominal pain during your menses
  
• Heavy menstrual flow or periods
  
• Irregular menses
• Lower abdominal pain during sexual intercourse
• Frequent urine infection due to fibroid obstructing free outflow of urine from the bladder
• You may notice that your abdomen looks bigger than expected, and may even be able to feel a lump or mass in your lower abdomen.
  
• Anaemic from the continuous blood loss
• Fibroids may lead to infertility, if they block off both fallopian tubes or even occupy the space in the uterus where babies are supposed to stay, causing repeated miscarriages.

An ultrasound scan of the abdomen is the surest way to diagnose fibroids.

Treatment options for fibroids depend on the number and size of the fibroid, as well as whether the woman still wants to be pregnant or not. Available options currently include:

• Use of Esmya (ulipristal acetate) tablets, 5mg, taken once daily for up to three months to help shrink the fibroid in women who still hope to get pregnant, or before a definitive surgical operation to remove the fibroid
• Blocking off the blood supply of part of the uterus where the fibroid are by means of an injection, leading to their shrinkage in what is called uterine embolisation
• Microwave ablation of the surface of the uterus is done for persistent bleeders.
• Myomectomy is an operation to directly remove the fibroid from the uterus, but is a very bloody operation. It is safe and worth the risk in good hands and where the woman still desires to have children. The problem with myomectomy is that the fibroid may re-occur again
• Removal of the whole womb in what is called hysterectomy is the definitive treatment for fibroids. This is especially most appropriate where the woman has completed her family. It is a less risky operation compared to myomectomy, and offers a cure.

See your doctor if you have any suspicion of a fibroid as a cause of female abdominal pain in you.

9. Ectopic Pregnancy

Ectopic pregnancy is the presence of a fertilized egg outside the womb. This is another common cause of lower abdominal pain in women of child-bearing age.

Symptoms of ectopic pregnancy include:

• Lower right or left sided abdominal pain in a woman who have a "delayed" menstrual period or within 4 to 8 weeks after her last menses
• This pain may be followed by vaginal bleeding
• In severe cases, you may also have shoulder tip pain with the abdominal pain and bleeding.

Diagnosis of ectopic pregnancy is made from the history, the findings on examination, blood and urine test to confirm pregnancy and an urgent ultrasound scan of the abdomen where possible.  Laparoscopy may be needed.

10. Ovarian Cyst Pain

Female abdominal pain due to ovarian cyst comes in many forms. This can be due to:

• Ruptured ovarian cyst
• Twisted ovarian cyst
• Corpus Luteum cyst or
  
• Cancer affecting the ovary. 

The first three causes of ovarian cyst pain are indeed much more common than pain due to cancer of the ovary.

Symptoms of ovarian cyst pain include:

• Lower right or left sided abdominal pain that starts suddenly (or could be gradual) that spreads to the lower back, one of the hips and upper thigh
• The pain may come and go in waves
• Typically in corpus luteum cyst pain, it tends to occur around two weeks after your period, or just around the time of the period in some cases
• There may be abdominal boating and tiredness
• Loss of appetite, weight loss and increased abdominal or waist gain with abdominal pain are features more seen in ovarian cancer.

If you have any worries or fears that your abdominal pain might be due to an ovarian cyst problem, please see your doctor as soon as you can.

References

Patient.info, Pelvic Pain in Women, http://patient.info/health/pelvic-pain-in-women (Accessed: September 2016)

WebMD, What Causes Pelvic Pain, http://www.webmd.com/women/ss/slideshow-pelvic-pain-causes (Accessed: September 2016)

NHS Direct, Self-Help, Female Abdominal Pain, http://www.nhs24.com/selfhelpguide/decisiontree/601/602/?ref=BodyMap (Accessed: September 2016)

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