Lower Abdominal Pain

Causes, Diagnosis & Treatment Of Lower Abdominal Pain 

What is Lower Abdominal Pain?

Lower abdominal pain is any discomfort or annoying sensation rising or occurring in the abdomen at a level below the belly button or umbilicus.

This could be:

• Lower right abdominal pain
• Lower left abdominal pain
• Lower central abdominal pain (just under the umbilicus or below the bikini line in the middle, also called suprapubic pain)
• Lower abdominal and back pain
  

Do you have pain here? Where exactly is your pain? The most important task now is to try and work out what is causing the pain and more importantly to exclude serious conditions of abdominal pain that require immediate medical attention.

To do so, let's take a look at the organs that are found in the lower abdomen and identify what can go wrong with these organs, the most common causes of abdominal pain in this region and how to identify them, as well as a list of other causes of pain in the lower abdomen.

Organs In The Lower Abdomen

The lower abdomen is where the small and large intestines are located including the appendix, cecum, sigmoid colon and rectum.

It is also the place where the following organs and structures are housed:

• Urine bladder
• Parts of the ureters
• Urethra 
• Ovaries
• Fallopian tubes
• Womb or uterus
• Ligaments that hold the uterus in place (broad and round ligaments)
• Prostate
• Spermatic tubes
• Muscles
• Bones
• Nerves
  
• Large, medium and small sized blood vessels like the abdominal aorta, iliac arteries and inferior epigastric artery respectively 
• Lymph nodes and a number of bones 

Below these but intimately connected to the lower abdomen are the scrotum, testicles and epididymis in men.

Any infection, inflammation or injury affecting any of these organs will result in pain and discomfort, often felt in the lower abdomen.

To aid our understanding of how to work out things that might be wrong in the lower abdomen, let's now re-arrange the organs in the abdomen, roughly as they would be naturally found in the abdomen. 

Organs In Central Lower Abdomen

• Loops of Small and Large Intestines
• The Urinary Bladder
• Uterus (in women)
• Rectum and Anus
• The Bones of the Lower Spine (Lumbar and sacral Vertebra)
• Lower part of the Abdominal aorta
  

Common Causes Of Lower Abdominal Pain

Appendicitis, bladder infection or cystitis, pelvic inflammatory disease, menstrual or period pain, ectopic pregnancy, miscarriage, irritable bowel syndrome, endometriosis, diverticulitis, urine tract infection, fibroid, poly-cystic ovarian syndrome, lower ureteric stones, and constipation are the most common causes of lower abdominal pain.

Other causes of pain in the lower abdomen include intestinal gas or trapped wind, celiac disease, ulcerative colitis, Crohn's disease, bowel polyps, bowel cancer, cancer of the womb or Fallopian tubes, premenstrual syndrome, pelvic congestion and pelvic pain syndrome.

The ten top common causes of lower abdominal pain in both men and women are:

1. Acute Appendicitis

Appendicitis is one of the most common causes of lower right abdominal pain in both men and women, old and young. Though appendicitis can occur at any age it is more common between the ages of 10 and 30.

Symptoms of acute appendicitis last for a few days (usually between 3 to 6 days) and if not diagnosed and treated it will get worse with complications. It is rare for it to get better on it's own. The pain from appendicitis will not go on-and-on for weeks or months.

The early symptoms of an acute appendicitis are:

• A colicky or cramping central abdominal pain around the umbilicus which moves down to the lower right abdomen in a day or two
• Continuous dull to severe pain in the lower right abdomen
• Pain made worse by coughing, laughing or pressing directly on the lower right abdomen
• Feeling generally unwell
• Nausea and perhaps vomiting once or twice once the pain starts
• Loss of appetite 
• A temperature (feeling feverish, hot and cold)
• There may be a mild episode of constipation (more in adults) and diarrhoea (more in common in children)

Does this sound like you? If you have more than half of the above symptoms, you are likely to be suffering from an appendicitis. Contact your doctor or go to your local Emergency Department.

Treatment is usually by removal of the diseased appendix by surgical operation. You can learn more about acute appendicitis here.

2. Urine Tract Infection (Cystitis)

Infection of the urinary tract is another very common of lower abdominal pain, especially in children and women. The urine tract starts from and includes the kidneys, ureters (the tube that connects the kidney to the bladder), the bladder (urinary bladder) and the urethra (the tube that connects the urinary bladder to the outside world.

A bladder infection is called cystitis. If it is not recognised and treated it could spread upwards to affect one or both of the kidneys. In extreme cases it can lead to a very serious infection which may require hospitalisation.

The symptoms of cystitis are:

• A dull lower central abdominal ache of gradual onset in the last day or two
• An increase in the number of times you pass urine. You may notice that you go to pass urine in small amounts every few hours and yet still feel like you need to do more
• Pain, stinging or burning sensation when passing urine
• Lower abdominal and back pain. The pain may even spread upward to the side of your back towards your kidney area
• Feeling more tired than usual
• Confusion and behaving irrationally (more likely in elderly people)
• Central abdominal pain and vomiting (more likely in children)
• Fever
• Blood in the urine or your urine becoming rose coloured
  

Does that sound like you or someone you care for? It's time to seek medical attention.

Antibiotics like Trimethoprim 200mg Twice Daily; Nitrofurantoin 50mg Four Times A Day; Or Co-amoxiclav 625mg Three Times daily,  for up to 7 days, are frequently used in treating this condition in adults with excellent response. 

3. Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome which is often referred to as IBS can cause pain and discomfort in the lower abdomen. IBS is extremely common with approximately 5 in every 20 people suffering from this condition. It is two and a half times more common in women than in men and can occur at any age.

The symptoms of IBS are:

• Lower central or left sided abdominal pain or discomfort (more often on the lower left abdomen) that is relieved with defecation
• Bloating or feeling mild to moderate abdominal tightness 
• Change in the number of times you pass stools 
  
• Abdominal pain made worse from eating
• Passing of mucus or slime in stools (without blood)
• Constipation or diarrhoea
  
• Feeling tired and lethargic most of the time

Is that you? Have these symptoms been going on for about 6 months or more? Why not have talks with your doctor as you may be suffering with irritable bowel syndrome.

Treatment options for IBS include:

• Dietary changes (keep a log or diary of what makes your pain worse and avoid them)
• Exercise 
  
• Use of medications like mebeverine, alverine and peppermint oil
• Amitriptyline 
• Loperamide for those with diarrhoea
• Acupuncture and use of aloe vera capsules or tablets

IBS must only be diagnosed after every other possible causes of the type of pain that you have has been excluded. So it is important not to self diagnose and treat yourself for IBS, just in case it is something else. See your doctor.

4. Mesenteric Adenitis

Mesenteric adenitis, also referred to as non-specific mesenteric lymphadenitis, is another common cause of lower abdominal pain, especially in children.

It is a condition where the glands on the wall of the small bowels become inflamed, swollen and painful, usually following a sore throat or viral infection.

Typically, the complaints are:

• Lower right sided abdominal pain
• A fever, cough and cold which has lasted up to two weeks
• Sore throat, tonsillitis or ear pain
• Diarrhoea and or vomiting

This condition usually mimics acute appendicitis. The difference is often that the child or adult would still have a good appetite, while in appendicitis, the appetite becomes poor. The pain in mesenteric lymphadenitis could be fleeting. The pain could move around (as the small bowel floats around inside the abdomen) so it may not always be confined to the right lower abdomen as its often the case in appendicitis. Also the precedence of the pain by sore throat, cough and cold which is lasting a few weeks is unusual with appendicitis.

Treatment is with simple pain killers, lots of clear fluid intake and rest.

5. Endometriosis

Endometriosis is a condition where the normal tissue or cells that line the inner surface of the womb are found outside the womb.

These tissues then respond to the same hormonal stimulation that causes menstruation, leading to menstrual bleed into spaces outside the womb. The blood trapped in such abnormal site causes prolonged irritation, scarring and pain around the area they are deposited in.

They also cause the surface of organs and bowels nearby to stick together, leading to

• Chronic lower abdominal pain
• Heavy menses
• Pain during intercourse
• Excessive tiredness
• Infertility (in some cases)

Treatment is through pain killers, hormones, surgery and complementary medicine. You can read more on lower abdominal and back pain due to endometriosis here.

6. Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease also known as PID is another common cause of lower abdominal pain in women. It is an ascending infection of the female genital tract. The infection often involve the womb, Fallopian tube, ovaries and tissues surrounding the womb and ovaries.

This infection is caused by sexually transmitted diseases in about 95 percent of cases. It is an infection commonly seen in women between the ages of 16 and 30, although can occur in any woman who is sexually active and have more than one sexual partner.

If not diagnosed and treated in time, it could lead to severe infections, infertility and increased risk of ectopic pregnancy.

The symptoms of pelvic inflammatory disease or PID are:

• Mild, moderate to severe lower abdominal pain that may spread to the lower back
• Pain during intercourse (deep inside the pelvis or lower abdomen)
• Abnormal vaginal discharge (may be foul smelling)
• New onset vaginal bleed after intercourse
• Heavy menstrual bleed with a combination of the above symptoms
• Fever and generally feeling unwell
• Pain when passing urine
  

PID is best treated in the GUM clinic, though it can be treated by your doctor too. Treatment involve the initial taking of a swab specimen from inside the vagina and neck of the womb for testing for chlamydia, gonorrhoea and other possible infections (if you have a coil or IUCD or IUS fitted this would be removed). You will then be prescribed antibiotics.  Commonly used antibiotics include Doxycycline 100mg to be taken TWICE Daily for 14 days, plus Metronidazole 400mg Three Times Daily for 7 -14 days; or ofloxacin 400mg and Metronidazole (flagyl) 400mg, both Twice Daily for 14 days; or other types of antibiotics as per local choice.

You can read more on PID here.

7. Mid Cycle Pain (Mittleschmerz)

Mittleschmerz or mid cycle pain is pain associated with ovulation. It is very common in young women, especially within a few years of their menarche or first menstrual period. It is a common cause of lower abdominal pain.

The symptoms of Mid Cycle Pain are pain in the right or left lower abdomen for about 2 weeks or after your last menstrual period, for those who have a 28 days regular menstrual interval. The pain could come on suddenly, lasting between a few minutes up to 3 days. The pain could be sharp or dull, moderate but rarely severe. It happens once every month and could be on the right lower abdomen this month, and then the left lower abdomen the next month, or skips a few months before coming on again.

Most women can tolerate the pain once they understand what it is. There is often no other associated symptoms. A warm bath and the use of simple pain killers like paracetamol or Tylenol is all that may be required. You can read more about Mittleschmerz here.

8. Constipation

Yes. Constipation. This is a common cause of lower abdominal in children, men and women.

Constipation is the infrequent or difficulty with the passage of faeces. Most people open their bowel daily or every other day. A few would only open their bowel once or twice in a week. Has the number of times you pass stools recently reduced? Are you passing hard stools or perhaps even straining to let out faeces? If so, you may be constipated.

Other symptoms of constipation include:

• Dull or sharp lower abdominal pain. It could be on the left or right side or in the middle of abdomen
• Reduced appetite or avoiding meals until after your bowels are opened
  
• Farting more than usual
• Passage of very big stools
• Passage of small rabbit-droppings stools 
• Not going to toilet for days and then passing small frequent loose watery stools with an awful odour (especially in children and the elderly)
• Children walking on tipped toes
• Vomiting

In the majority of cases constipation is straight forward and treatable. But sometimes, it might be a sign of something more serious, including a sign of conditions like bowel obstruction or cancer. If you are having on going constipation, abdominal pain, you are vomiting and your abdomen is getting distended see your doctor as soon as possible. You should also visit the doctor if you are constipated on and off for months, losing weight and have a poor appetite.

Laxatives like Senna, Lactulose, Fybogel and Movicol are very good medicines in the treatment of constipation.

9. Ovarian Cyst Pain

Ovarian cyst pain is very common. It is a frequent cause of lower right or left abdominal pain.

The pain from an ovarian cyst could come in one of the following forms:

• Ruptured Corpus Luteum Cyst. This is certainly the commonest cause of ovarian cyst pain. After ovulation around the middle interval between your periods, eggs are released from follicles on your ovary. A number of days later or even up to a few days after your menstruation, blood could tract into the empty "shell" or follicle where the eggs are released from, distending the cyst and or bleed into the abdomen causing sharp irritating lower abdominal pain. Such pain are often experienced a few days up to a week after your menses. This condition will often resolve on its own, does not need treatment and would not cause you any harm.
• Twisted Ovarian Cyst. This is a cause of severe lower abdominal pain. Cysts can be attached to the ovary, like apples to their stalk. If the cyst twists on the stalk or pedicle, the blood flow to the cyst is cut off which causes a severe pain. This comes on as sudden onset of lower abdominal pain that goes to the hip, lower back and upper leg. The pain is always there and sometimes becomes even worse as the ovary is trying to un-twist itself. You may vomit with the pain. If this sounds like what you are suffering with you will need to seek urgent medical attention.
• Ruptured Ovarian Cyst. This is similar in nature to a ruptured corpus luteum, except that it is happening in a bigger ovarian cyst. The pain is more sever and spreads to the back and upper thigh. You will need urgent medical attention here as well.
  

10. Diverticulitis

Diverticulitis is a cause of lower abdominal pain, especially in middle-aged and elderly people. 

Diverticulitis is due to weakness in the wall of the large bowels, there could be out-pouching on the bowel wall, forming numerous finger-shaped pockets. As bowel contents move down, they could be trapped within these pockets. In large amounts, they lead to intermittent change in bowel habit - constipation alternating with diarrhoea. There could also be passage of mucus in stools. 

If these pockets of out-pouched bowel walls with trapped feces becomes infected due to excessive activities of bacteria inside them, it causes:

• Constipation followed by diarrhoea
  
• Blood (and mucus) in the stool
• Constant lower left abdominal pain (though sometimes, the diverticular changes could also involve the right side)
  
• Fever
• Pain in the lower left abdomen when touched

Increasing the bulk of fibre in your meal will help. If you suspect though that you have diverticulitis, you will need to go to the hospital as soon as possible to be seen by a doctor. You may need to be hospitalised and given intravenous antibiotics and drip.

Other Common Causes Of Pain In The Lower Abdomen

Other common causes of pain in the lower abdomen include:

Have you suffered with any other causes of lower abdominal pain not mentioned here? We would like to hear from you. Please use the box below to help add to the list of causes of lower abdominal pain. Remember to share the details of your experience with this condition.

References

Oxford Handbook Of Obstetrics And Gynaecology. 2nd Edition. Published 2011

Oxford Handbook Of Emergency Medicine. 3rd Edition. Published 2006

NetDoctor, Lower abdominal pain in women, http://www.netdoctor.co.uk/conditions/digestive-health/a11617/lower-abdominal-pain-in-women/ (Accessed: September 2016)

NHS Choices, Stomach ache and abdominal pain, http://www.nhs.uk/conditions/stomach-ache-abdominal-pain/Pages/Introduction.aspx (Accessed: September 2016)

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