Lower Abdominal Pain

Overview

Stomach pain is the most common symptom which could mean anything from a temporary cause such as constipation to a more troublesome form a stomachache such as an irritable bowel syndrome.

Pain at a particular site of the abdomen points towards pain from organs underlying in that region. For example, a pain in the right lower abdomen could indicate an inflamed appendix. Pain can also occur as a referred pain from an organ due to the stimulation of the nerve.

Pain in the abdomen could be central, epigastric or pain below the chest area, pain all around the abdomen, sides of the abdomen or a lower abdominal pain.² 

In this article, we will discuss lower abdominal pain, its causes, symptoms associated with it and how it can be managed.

The lower abdomen consists of various organs such as small intestine, colon, appendix, ovaries, uterus, ureters, bladder, and peritoneum.¹ Numerous medical disorders can affect both men and women and result in lower abdomen pain. 

Among other things, constipation, diverticulitis, colitis, and problems with the reproductive system can all result in left-side pain.⁵

Among other things, appendicitis, kidney stones, and ovarian cysts can all result in right-side pain.⁴ There are many distinct types of pain. It can be twisting, stabbing, dull, sharp, or any number of other things. We will now discuss the potential causes of lower stomachache.

Causes of lower abdominal pain

Lower abdominal pain could commonly mean that a person is suffering from a stomach bug that may cause them diarrhoea. Excessive wind trapped in the bowels could also result in abdominal pain and flatulence.³ Women of reproductive age may also experience lower abdominal pain or stomach cramps during their regular menstrual cycles.⁸ However, there are many causes of lower abdominal pain that are mentioned below.^4,5,1

1. Appendicitis

An appendix is a small, pouch-like organ attached to the large intestine and when an appendix is inflamed it causes a sharp pain in the lower right abdomen.

2. Peritonitis

Peritoneum is the organ that acts as a cover for internal organs in abdominal cavities like kidneys, liver, and bowel. When this lining gets infected it could lead to damage to all organs it protects. It is caused by a burst in peptic ulcer, an appendix, or inflammation of the diverticulum, pancreas, stomach or liver or Pelvic inflammatory disease.

3. UTI

An infection in the urinary system that includes bladder infection(cystitis), urethra(urethritis) and kidneys (kidneys infection) that leads to pain and discomfort in the lower abdomen.

4. Ovarian cyst

Fluid-filled sacs form on the ovaries, causing abdominal pain or discomfort, especially during menstruation.

5. Endometriosis

The tissue lining the uterus grows outside of it, resulting in pain and inflammation, including in the lower abdomen.

6. Pelvic inflammatory disease (PID)

An infection that affects the female reproductive organs, causing lower abdominal pain, pelvic pain, and abnormal vaginal discharge.

7. Uterine fibroids

Non-cancerous tumours found in or on a uterus.

8. Irritable bowel syndrome (IBS)

A chronic disorder that affects the large intestine, resulting in symptoms such as abdominal pain, bloating, and changes in bowel movements.

9. Hernia

An organ or tissue protrudes through a weak area in the abdominal wall, often causing pain or discomfort.

10. Diverticulitis of the colon

Small pouch that form in the colon causing diverticulosis, getting infected and causing left lower abdominal pain.

11. Twisted bowel

Lower abdominal pain can be an initial symptom of twisted abdominal pain known as volvulus.

12. Ectopic pregnancy

Pregnancy occurring outside the womb indicates ectopic pregnancy. A lower abdominal pain on one side of the stomach along with pain at the shoulder tip, vaginal bleeding and missed periods could suggest that it is an ectopic pregnancy. One of the most important complications of an ectopic pregnancy is a sudden and intense pain in the tummy that could indicate a rupture and medical advice is recommended.¹⁰

Signs and symptoms of lower abdominal pain

There are several signs and symptoms associated with lower abdominal pain. The different types of lower abdominal pain include dull discomfort, cramp-like pain, colicky pain or severe or sharp pain. 

A dull discomfort could be suggestive of trapped wind or flatulence, Stomach bug or gastroenteritis, Constipation, and indigestion. 

A dull ache on the right could indicate a gallstone, whereas a dull ache on the left could indicate a kidney stone. 

Secondly, a cramp-like pain in the lower abdomen could also indicate flatulence as well as diarrhoea, constipation or bloating. 

For the female sex, it can be indicative of menstrual pain, miscarriage, or problems with reproductive organs. 

Next, colicky pain is an on-and-off pain occurring abruptly due to intestinal obstruction, or when a hollow organ such as the intestines, gallbladder, kidney, or ureters contract.⁹ 

The pain could last for a few hours, which increases in intensity and then gradually subsides. There could be more than one episode of colicky pain. 

Lastly, a sharp pain could be an indication of an infection such as appendicitis, ovarian cysts, ulcerative colitis or Chron’s disease.²

The type of lower tummy pain could support a diagnosis, however associated symptoms along with stomach-ache could make a diagnosis of clearer.

Symptoms associated with lower tummy pain.^1,2,3

• Altered bowel habit: this includes diarrhoea, constipation, or both
• Bloating: Excessive wind produced due to swallowing air, and consuming food high in fat that alters bowel movement and stress. It can give a sense of fullness and the stomach may appear enlarged
• Nausea and vomiting along with lower abdominal pain could point towards diverticulitis, hernias, torsion of testicles, bladder infection, pancreatitis, or endometriosis. If these symptoms are accompanied by fever, urgent medical advice should be sought
• Urinary symptoms such as an increase in urinary frequency or burning in urine with smelly urine could be a result of a urinary tract infection
• Menstrual irregularities can be due to ectopic pregnancy, uterine fibroids, ovarian cysts or failure, uterine fibroids, and cervical ectropion with or without pelvic pain or abnormal vaginal discharge.⁷
• Fever or chills indicate inflammation or infection in various organs in the abdomen¹

Management and treatment for lower abdominal pain

As mentioned above in causes and symptoms, a lower abdominal pain could indicate several medical conditions and treatment depends on the cause. Diagnosing a medical condition that causes tummy pain requires a physical examination performed by a physician.⁶ Depending on the cause a treatment could be suggested.

When lower abdominal pain is accompanied by red flag symptoms such as:³

1. Fever, diarrhoea, or persistent constipation
2. Blood in stools or vomit
3. Persistent nausea or vomiting
4. Severe tenderness, jaundice or swelling in the tummy region

In case you suffer from any of these symptoms, seeking medical attention is recommended.

Otherwise, there are numerous ways mentioned below by which lower abdominal pain can be relieved.

Use of an ice pack, a warm bath or shower, warm herbal tea, over-the-counter painkillers like Tylenol or nonsteroidal anti-inflammatories (NSAIDs) and cutting out gas-forming or acidic foods from your diet are some of the home remedies for lower abdominal pain. 

Bowel rest, water, and heat therapy are further choices. In addition, consuming more fluids, working out to reduce gas and bloating, and taking over-the-counter antacids may all assist. 

Over-the-counter analgesics like NSAIDs and acetaminophen can be used to manage milder pain at home, however, prescription analgesics like steroids or opioids may be needed to treat severe pain. Lower abdomen pain may also be relieved by routine examinations, dietary adjustments, and lifestyle modifications.¹

Diagnosis

Based on a physical examination, medical history, laboratory testing, and imaging procedures, the true cause of lower abdomen discomfort has been identified. Patients with lower abdomen and pelvic pain should have rectal pelvic examinations. Faecal impaction, a palpable mass, or occult blood in the stool can all be seen during a rectal examination. Your doctor will question you about your lower abdomen pain to determine your issue⁶ Such inquiries might cover:

• When did you initially experience lower abdominal pain?
• Have you ever experienced such pain?
• Do you experience any other ailments?
• What causes your symptoms to improve or deteriorate?

Imaging techniques to diagnose lower abdominal pain

Ultrasound

An ultrasound is usually required to assess abdominal pain in the right upper quadrant. It is also used to confirm appendicitis problems with ovaries or pelvic pain.

Abdominal X-ray

For an acute abdomen causing abdominal pain and or lower back pain along with nausea or vomiting, an X-ray could be indicated. It is used to show any object that could be swallowed, obstruction or a hole in the intestines. X-rays could be efficient and use small ionizing radiation to look inside of the abdominal cavity and evaluate various organs like stomach, spleen, and intestines and they can help to provide diagnosis for unexplained pain, nausea and vomiting.

CT Scan

CT scan is a non-invasive technique advised when a patient experiences right or left lower quadrant pain.

Unenhanced magnetic resonance imaging

It can be used for evaluating acute abdominal emergencies such as Choledocholithiasis i.e., gallstones in the common bile duct, acute cholecystitis, bowel inflammation in case of inflammatory bowel disease (Chron’s disease and ulcerative colitis) and appendicitis.⁹

Laparoscopic

It could be done to investigate undiagnosed lower stomach aches as well an investigation of choice in gynaecological problems.¹¹

FAQ's

How can I prevent lower abdominal pain?

You can avoid hot and fatty foods and maintain a healthy, well-balanced diet to prevent lower stomach pain. Drink a lot of water and avoid soda and alcohol. To avoid swallowing air, have smaller meals and chew thoroughly regular exercise and stress management.

When making food, frequently wash your hands and maintain good hygiene. If you have an intestinal condition, adhere to the diet prescribed by your doctor. If necessary, reduce pain with a hot water bottle, a warm bath, or over-the-counter drugs. By avoiding certain meals that could cause lower stomach pain and bloating, consumers can occasionally avoid these symptoms.

How common is lower abdominal pain?

Lower abdominal pain discomfort is typical. Due to the location of the reproductive organs in the lower abdomen and pelvis, several of the disorders that can cause it are more prevalent in women.

Who is at risk of lower abdominal pain?

Older age, previous abdominal surgery, history of bowel diseases, exposure to stomach virus, gynecologic conditions including menstrual cramps or pregnancy, kidney stones, and urinary tract infections are risk factors for developing lower abdomen pain. Genitourinary diseases, which can cause abdominal pain in women, constitute a concern.

What can I expect if I have lower abdominal pain?

Depending on the underlying reason for your lower abdomen discomfort, you can suffer several symptoms. Lower abdomen pain is frequently accompanied by several symptoms. Lower abdomen pain is frequently accompanied by a number of symptoms, including nausea, indigestion, appetite loss, fever, and increased vaginal discharge.

It’s crucial to pay attention to additional symptoms you have since they can include information about what is causing your pain. It is advised that you seek medical care if your discomfort is severe or persists for more than a few days.

When should I see a doctor?

If your lower abdomen pain is severe, persists for more than a few days, or is accompanied by additional symptoms like fever, nausea, vomiting, or changes in bowel habits, you should consult a doctor. Additionally, it's crucial to get medical help right away if you feel sudden, acute pain. If you have any worries about your health, it is always a good idea to speak with a medical expert.

Summary

Lower abdominal pain is a common symptom. It originates from organs present in the lower abdomen like ovaries, appendix, small and large intestine, bladder, uterus etc. The pain can range from a mild dull ache to severe intensity abdominal pain. The lower abdominal pain causes could be different from those of the upper abdomen. It is important to notice the red flag symptoms such as unexplained intense pain, blood in stool or vomit and not delay seeking medical attention. There are some remedies that can help in relieving abdominal pain at home.