Lower Abdominal Pain: Causes and Symptoms

What is in the lower abdomen?

Where does the abdomen begin?

Simple answer:

From above, it is bounded by the rib cage, specifically the processus xiphoideus, i.e. the sword-shaped process of the sternum called the xiphoid process, and the area below the ribs. Part of the lower ribs also protects the abdominal organs, such as the liver or pancreas.

In the lower region, it is located in the pelvic region, between the hip bones, spine and sacrum.

The division of the abdomen into three main areas:

1. epigastrium is the upper central region of the abdomen, directly under the process of the sternum
   • central part below the process, i.e. the regio epigastrica
   • lateral part, i.e. the left and right halves or hypochondria
2. mesogastrium is the middle region and the area around the navel
   • has right and left sides
   • umbilical area, i.e. around the navel
3. hypogastrium,i.e. the region of the abdomen located below the umbilical region
   • below the navel 
   • right and left side of the lumbar region, inguinal part, regio inguinalis
   • middle part above the pubic bone, regio pubica

Of course, in addition to the organs of the abdominal cavity, the skin, muscles, tendons, bones, joints, spine, nerves and blood vessels or the lymphatic system are also found in this area.

Therefore, the question regarding pain in the lower abdomen extends to different organ systems, parts and diverse problems. Pain arises as a result of disease, inflammation or injury.

Table: parts of the lower abdomen with organs

Typical problems with pain on the right side of the hypogastrium

The lower abdomen on the right side mainly contains the intestine, more precisely the terminal part of the small intestine and the beginning of the large intestine and its ascending part.

Apendicitis

The appendix, or the vermiform process, is a finger-like, blind-ended tube at the beginning of the cecum which is considered to be the beginning of the large intestine.

In appendicitis, it can be an acute inflammation that sets in quickly. Typically, pain in the early stages occurs around the navel and only later moves to the right lower abdomen.

The inflamed part of the intestine can cause sharp stabbing pain and other general symptoms such as fever. Almost always, this form ends in surgery.

Read also: How to recognise appendicitis?

The second form is chronic appendicitis. The latter has a milder course, however, the difficulties recur, returning after some time.

Pain in the right lower abdomen signal and intestinal disorders

This symptom occurs in various abdominal diseases.

Examples:

• Crohn's disease
• Ulcerative colitis
• disruption of the normal propulsive ability of the intestine, i.e. ileus
• Omental torsion
  • omentum is a thin structure
  • covers the abdominal organs
  • it is divided into a small and a large omentum
• inflammation of Meckel's diverticulum
• intestinal tuberculosis
• colon cancer, cecal cancer
• constipation
• diarrhea

Read also:
Stool - what should we know about it?
Diet during diarrhoea
Summer diarrhoea

Other causes of pain in the right lower abdomen

Another intestinal cause of pain in this location may be acute gastroenteritis. In translation, this is an inflammation of the lining of the stomach and intestine. This problem is most often associated with an unsuitable diet.

During the year, we often encounter infectious inflammation, which can be caused by a virus, bacteria or other microorganism. The problem is mainly a disturbance of the intestinal microflora.

Dysbacteriosis is an alteration of the intestinal microflora that puts a strain on digestion, immunity or overall metabolism.
Read the article about probiotics, which help in maintaining proper intestinal microflora.

Dysbacteriosis, or also dysbiosis, also occurs after treatment with antibiotics, laxatives, after the intake of certain substances used in the food industry. It occurs with insufficient fibre intake, as a consequence of other diseases, such as Crohn's disease, celiac disease, food allergy or intolerance, excessive physical or psychological stress.

Referred pain from the upper abdominal region

The gallbladder can be a lot of trouble. Pain in this area occurs in cases of an acute cholecystitis, i.e. inflammation of the gallbladder, provided that the gallbladder is located in a lower area.

Similarly, pain from the upper abdominal cavity is transmitted to the lower abdomen, for example, in gastroduodenal perforation - rupture of a gastric ulcer.

The pain arises suddenly, is localized in the epigastrium, and the cause of transmission is irritation of the peritoneum. In addition to sharp, intense to severe pain, there is abdominal muscle stiffening. It can be felt during palpation of the abdomen.

This phenomenon is called muscular defense - a reflex of the abdominal muscles to contract upon mechanical force to the abdomen, and serves as protection.

Common complaints of pain on the left side of the hypogastrium

Typically, pain in this area is caused by diverticulitis. It is characterized by colicky pain in the left lower abdomen, which is accompanied by diarrhea, mucousy stools and even an admixture of blood. Body temperature rises and so does CRP.

Similarly, non-specific intestinal inflammation, referred to as IBD, i.e. Inflammatory Bowel Disease.

Read also: the article on diverticulosis and diverticulitis

Another cause may be, for example, intestinal obstruction, which is technically referred to as ileus. In older age, pain in this area may signal colon cancer, more specifically rectosigmoid carcinoma.

Ileus occurs in different forms:

• obstructive ileus, mechanical, strangulating (with strangulation of the intestine)
• neurogenic ileus, paralytic, spastic
• vascular ileus, as a consequence of intestinal haemorrhage, in embolism or thrombosis of blood vessels

Intestinal obstruction is classified as an event of an acute abdomen. 

There are several other terms for acute abdomen:
Acute abdominal pain syndrome

Surgical abdomen

Acute abdomen is defined as severe and sudden onset abdominal pain. It lasts less than 6 hours and has a rapid course. If treatment is neglected or delayed, it will become a threat to the person's health and life. It also occurs when the person is fully healthy. Generally, surgery is the only solution.

Other causes:

• Ulcerative colitis
• constipation
• bloating, flatulence

Other causes of pain in the left hypogastrium

Pain on the left side also occurs in cases like that of pain on the right. In inflammation of the mucous membrane of the intestine and as an associated symptom of dysbacteriosis.

Hernia

Hernia is familiar to almost everyone since it is often talked about.

It affects children, adults, and the elderly.

Generally, in medical lingo, herniation refers to the pathological dislocation or displacement of an organ or other structures from their natural location. We are familiar with disc herniation, which involves the vertebrae and intervertebral discs.

If we are talking about the abdomen, hernia is the situation where an abdominal organ is pushed through the weakened abdominal wall and muscles. An abdominal hernia is not really serious until there is a strangulation of the displaced part, for example, the intestine.

The part that is kinked at the herniated opening is not supplied with blood, oxygen and nutrients. If this ischemia (restricted blood supply) persists, the dislocated, kinked part dies off - i.e. necrosis occurs.

Complications are peritonitis and shock state.

In this case, immediate surgery is required.

Based on the location, hernia is classified as follows:

• inguinal hernia 
• umbilical hernia 
• epigastric, or supraumbilical hernia 
• incisional hernia, usually after abdominal surgery, a weakened part of the abdominal wall
•  hiatal hernia, is when abdominal organs, typically a part of the stomach, slip through the abdominal cavity into the middle compartment of the chest
  • it occurs at the point of passage of the oesophagus into the abdominal cavity
    • hiatus oesophageus

Irritable bowel syndrome

Irritable bowel syndrome is a chronic functional disease of the digestive tract. The cause is multifactorial. However, the exact cause is unknown.

It is a functional, not an organic disease.

That is, the intestine is not affected by a change in structure, structure, but its function is disturbed. The condition is also referred to as IBS.

Naming the syndrome because it is characterized by the presence of a variety of symptoms.

OUR TIP: read the article Irritable bowel syndrome

In addition to irritable bowel syndrome, other functional disorders of the digestive and enteric nervous systems can also affect the digestive system.

Gas retention can also cause a problem. The intestine is stretched which irritates the nerve cells.

What if the cause is outside the digestive tract?

Another cause indicates: a problem with the urinary tract.

Pain in this case is professionally referred to as renal colic. It arises in the right or left flank and renal region, further spreading longitudinally into the area of the ureters, i.e. to the right or left lower abdomen, groin, to the testicles or to the labia.

The pain is sharp, colicky and is considered one of the worst experiences among pains.

It is accompanied by pallor, haggardness, cold sweat, a feeling of nausea to vomiting, blood in the urine (hematuria). This pain is most often associated with a urinary stone or with inflammation of the urinary tract. At that time, increased body temperature and fever are also associated.

Pain in the middle of the lower abdomen very often occurs with inflammation of the bladder.

Women are at much higher risk than men.

Since women's urethra is shorter, pathogens can penetrate the bladder more easily, for example in cases of an inflammation of the urethra. Associated signs and symptoms are sharp, burning sensation when urinating, an urge to urinate frequently, bloody urine, haematuria.

It is referred to as cystitis.

Of the general symptoms, an increase in body temperature is present.

Several other causes:

• sciatic nerve inflammation, i.e. ischias
• lumbago, i.e. low back pain
  • pain in the lumbar spine, sacrum and lower abdomen
  • for example, after excessive physical stress on the spine
  • colds of the spine, muscles and tendons
  • radiating into the lower limbs or abdomen
  • stretching of the muscles around the lumbar spine
• disc herniation and pain transmitted due to peripheral nerve irritation
• herpes zoster
• poisoning, intoxication, chemicals, fungi
• after injury

In children, abdominal pain is sometimes difficult to pinpoint, which is why an early medical examination is so important.

Learn more:
Dangerous dehydration in childhood
Children and injuries

Lower abdominal pain in men

Men can be troubled by inflammation of the testicles and epididymis, when pain radiates to the lower abdomen. Another cause may be inflammation of the prostate gland. Of course, inflammation also affects other parts of the male reproductive system, such as the seminal vesicle or the fallopian tubes.

Sexually transmitted diseases are a particular risk.

In an enlarged prostate, it is associated with urinary retention, i.e. the inability to empty the bladder. This happens mainly in men of older age. In addition to inflammation, the prostate can be affected by benign prostatic hyperplasia (a non-malignant disease), but also by prostate cancer (a malignant disease).

What is the difference between a tumour and cancer?

Testicular torsion occurs when the spermatic cord twists. This rotation cuts off the blood supply to the testicle. The bleeding itself causes a lot of pain.

This problem requires urgent medical attention.

Chronic pelvic pain also affects men.
It is also referred to as chronic pelvic pain syndrome.

Women's health issues

Many women are familiar with premenstrual or menstrual pain, when pain in the lower abdomen can occur even a week before the actual menstrual cycle, or bleeding. It is also referred to as premenstrual syndrome (PMS).

Menstrual cycle disorders affect 30-50% of women.
The pain reaches an unpleasant intensity.

The pains are sharp, spasmodic, radiating. They are accompanied by weakness, nausea, vomiting, inappetence, headache.

In this part of the article, we can not omit the inflammation of the reproductive system, e.g. adnexitis, i.e. inflammation of the ovaries and fallopian tubes. According to the side of inflammation occurs, either pain on the right or on the left.

Associated difficulties:

• pain during sexual intercourse
• abdominal cramps
• increased body temperature to fever
• Fatigue
• Nausea
• purulent discharge that smells and is green, brown or yellow in colour, especially with sexually transmitted diseases
• bleeding outside the menstrual cycle
• painful menstruation

Other kinds of inflammations of the female reproductive system include, for example, inflammation of the uterus or the cervix. Of the sexually transmitted diseases, HPV infection, trichomoniasis or gonorrhoea are common examples.

A specific type is pelvic inflammatory disease. This designation includes inflammation affecting the internal genital organs in the small pelvis.

Another cause is, for example, ovarian torsion, i.e. when an ovary twists on its attachment to other structures. It is an acute condition that restricts the blood supply to the ovary. The ovary is not sufficiently, or at all, supplied with oxygen and nutrients. Which ultimately causes it to die.

In young girls, it also happens during sports activity, such as basketball or volleyball.

The opposite is a pathological state, i.e. a tumourous disease, or an ovarian cyst, which is a less severe conditon.

Endometriosis and inflammation of the uterus

Endometriosis is a condition in which the endometrium occurs in places other than the uterus. This disease is responsible for a variety of difficulties.

Learn more in a detailed article Endometriosis.

Endometritis, or inflammation of the uterus, is an infectious disease caused by a bacterium, known as chlamydial infection or various other mycoplasmas.

The causes are various, it often arises because of early sexual activity, promiscuity, and poor hygiene.

Learn more:
What causes an inflammation of the uterus?

Ectopic pregnancy and miscarriage

The sperm fertilizes the egg while still in the fallopian tube. The fertilised egg then travels to the uterus. Here it attaches to a pre-prepared layer and continues to grow into an embryo, later a fetus.

However, if the fertilized egg does not pass into the uterus, it remains in the fallopian tube - this condition is referred to as an ectopic pregnancy.

It threatens the woman's health and life.

Ectopic pregnancy = an egg that has not passed into the uterus after fertilization.

It is most commonly trapped in the fallopian tube, accounting for up to 95% of cases. The other percentages are due to the occurrence of a fertilized egg in the ovary or abdominal cavity.

A list of symptoms:

• pain
• skipping menstrual bleeding
• bleeding due to complications
• morning sickness
• vomiting
• breast tension

The risk increases after frequent pelvic inflammatory disease, sexually transmitted infection or after surgery. These and other factors cause obstruction of the fallopian tube.

Fallopian tubes, also called uterine tubes, salpinges (singular salpinx), or oviducts - the medical, i.e. Latin, term is tuba uterina.

Table - complications of ectopic pregnancy

Miscarriage

A miscarriage is the expulsion of an embryo or fetus before birth, resulting in the death of the fetus/embryo.

There are two conditions:

1. weight at birth is less than 500 grams
2. duration of pregnancy less than 22 weeks

A miscarriage also includes terminated ectopic pregnancies.

An abortion is an artificially induced event can be performed for a variety of reasons, for example on request of a pregnant woman, or for medical reasons, e.g. when the mother's life is endangered.

Pain in the lower abdomen during pregnancy

Women during pregnancy may suffer from the above-mentioned ailments, such as various inflammations of the intestines or urinary tract.

Pain in the lower abdomen in connection with pregnancy requires high attention and professional examination.

Constipation or flatulence and bloating are harmless but spinal pain is unpleasant.

So as the baby grows, the uterus expands and presses on its surroundings. This can cause pain.

Yes, contractions are typical of childbirth.

Premature birth is a risk.

Preterm birth refers to birth before 38 weeks of pregnancy. The baby may have a low birth weight, may not be sufficiently developed and mature. The earlier the birth, the higher the risk of complications.

Symptoms:

• uterine contractions
• shortened cervix
• mucous discharge
• leaking Amniotic Fluid
• bleeding

The risk of preterm birth is increased by factors such as:

• anatomical proportions of the uterus
• insufficiently closed cervix
• gynaecological inflammation during pregnancy - the risk is that it may spread to the child
• eclampsia
• gestosis
• injury
• excessive mental stress

Approximately 50% of preterm births have an unclear cause.

Abdominal pain during pregnancy can also be triggered by a serious condition in which the placenta separates from the wall of the uterus before birth - placental abruption. Bleeding and shock condition are especially risky. Back pain is also associated. This serious condition threatens the life of the woman.

It occurs mainly in eclampsia, but also after blunt trauma to the abdomen.