Lower abdominal pain, the discomfort felt in the area between your belly button and pelvic bone, is a common complaint with a wide range of potential causes. While often benign, like trapped gas or indigestion, it can sometimes signal a more serious underlying medical condition. Understanding the possible reasons behind your lower abdominal pain is crucial for knowing when to seek medical attention and ensuring timely diagnosis and treatment.
It’s important to remember that lower abdominal pain is a symptom itself, not a disease. Paying close attention to accompanying symptoms can provide valuable clues. If you experience lower abdominal pain alongside red flag symptoms such as blood in your stool or vomit, seeking immediate medical help is crucial.
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Verywell / Jessica Olah
When Should You See a Healthcare Provider for Lower Abdominal Pain?
It’s advisable to consult a healthcare provider if your lower abdominal pain persists, worsens, or is accompanied by other concerning symptoms. These potentially serious symptoms include:
- Blood in your stool
- High fever
- Vomiting blood
- Lightheadedness
- Severe pain that doesn’t subside
Let’s explore some of the potential causes of lower abdominal pain, ranging from common to more serious conditions.
Appendicitis: A Medical Emergency
Appendicitis is a serious condition requiring immediate medical attention. It occurs when the appendix, a small pouch attached to your large intestine, becomes inflamed and infected. Prompt treatment is necessary to prevent rupture, a potentially life-threatening complication.
Appendicitis is most common between the ages of 10 and 30, but it can occur at any age.
Symptoms of Appendicitis
Recognizing the symptoms of appendicitis is crucial for timely intervention. These symptoms may include:
- Pain that worsens: Often starting suddenly in the lower right abdomen or around the navel and shifting to the lower right.
- Rebound tenderness: Pain that is relieved when pressure is applied to the abdomen but intensifies when the pressure is released.
- Pain aggravated by movement: Worsening pain when moving, breathing deeply, coughing, or sneezing.
- Gastrointestinal distress: Nausea and vomiting.
- Abdominal changes: Abdominal swelling.
- Changes in bowel habits: Diarrhea or constipation.
- Systemic symptoms: Mild fever, loss of appetite, and inability to pass gas.
A temporary relief of pain may occur if the appendix ruptures. However, this is a dangerous sign as it indicates the spread of infection into the abdomen, potentially leading to sepsis, a life-threatening condition.
Causes and Treatments for Appendicitis
Appendicitis can be triggered by several factors, including:
- Infections: Viral, bacterial, or parasitic infections in the digestive tract.
- Blockage: A blockage in the appendix, often due to calcified fecal matter (appendicolith).
- Tumors: Tumors of the appendix or intestines.
The standard treatment for uncomplicated appendicitis (before rupture) is a laparoscopic appendectomy, a minimally invasive surgical procedure to remove the appendix. In some mild cases without appendicolith, antibiotics may be considered, but recurrence is possible. Complicated appendicitis, ruptured appendix, or severe illness often necessitate open appendectomy and potentially drainage tubes and antibiotics for recovery.
Seek Emergency Treatment: If you suspect appendicitis or a ruptured appendix, call emergency services immediately or go to the nearest emergency room. Prompt surgery is almost always required to prevent serious complications.
Colitis: Inflammation of the Colon
Colitis is a chronic condition characterized by inflammation of the large intestine (colon). It falls under the umbrella of inflammatory bowel disease (IBD).
Symptoms of Colitis
Abdominal pain from colitis can develop gradually or suddenly and may be intermittent or constant. It’s frequently described as cramping, often located in the lower left abdomen. Colitis symptoms often fluctuate with flare-ups followed by periods of remission.
Other symptoms associated with colitis include:
- Rectal bleeding: Blood in the stool.
- Abdominal distention: Bloating.
- Urgency: Frequent urge to have a bowel movement (tenesmus).
- Bowel changes: Diarrhea.
- Dehydration: Due to fluid loss from diarrhea.
- Fever.
Causes and Treatments for Colitis
The causes of colitis are diverse and can include:
- Infections: Viral or parasitic colon infections.
- Foodborne illness: Bacterial food poisoning.
- IBD: Crohn’s disease and ulcerative colitis.
- Ischemic colitis: Reduced blood flow to the colon.
- Radiation colitis: Damage from radiation therapy to the colon.
- Necrotizing enterocolitis: Primarily in newborns.
In a significant percentage of cases (5% to 15%), the exact cause of colitis remains unknown. However, a combination of dietary, environmental, and genetic factors is believed to play a role.
Treatment for colitis varies depending on severity. Mild to moderate cases are often initially treated with aminosalicylates to reduce inflammation. Other treatment options include:
- Corticosteroids: Short-term oral corticosteroids to reduce inflammation and induce remission.
- Anti-inflammatory medications: Effective for remission in many individuals.
- Surgical interventions: Total proctocolectomy with Brooke ileostomy (removal of colon and rectum with a permanent ostomy bag) or proctocolectomy with ileal pouch-anal anastomosis (creation of a new rectum from the small bowel) may be necessary in severe cases.
Diverticular Disease: Pouches in the Colon
Diverticular disease encompasses diverticulosis and diverticulitis. Diverticulosis involves the formation of small bulging pouches (diverticula) on the inner wall of the large intestine or colon. Diverticulitis occurs when these pouches become inflamed or infected. Diverticular disease is common, particularly in individuals over 60.
Symptoms of Diverticular Disease
Many people with diverticulosis experience no symptoms. However, some may have abdominal bloating, cramping, and constipation. Diverticulitis symptoms tend to be sudden and can be severe, including:
- Localized pain: Sharp abdominal pain and tenderness, often in the lower left abdomen.
- Gastrointestinal upset: Nausea and vomiting.
- Appetite loss.
- Systemic symptoms: Fever and chills.
Although less common, diverticulitis can cause rectal bleeding. Any rectal bleeding warrants prompt medical evaluation.
Causes and Treatments for Diverticular Disease
The exact cause of diverticular disease is not fully understood, but a low-fiber diet is considered a major contributing factor. Lack of fiber leads to harder stools and increased straining during bowel movements, potentially increasing pressure in the colon and promoting diverticula formation. Once formed, diverticula are permanent, and diverticulitis can recur.
Treatment for diverticulitis depends on symptom severity and may include:
- Rest and supportive care: Bed rest and heating pads.
- Pain management: Pain medications as prescribed by a healthcare provider.
- Dietary modifications: Clear liquid diet initially, progressing to thicker fluids and then solid foods.
- Antibiotics: If infection is present.
Kidney Infection (Pyelonephritis): Infection of the Kidneys
A kidney infection, also known as pyelonephritis, is a type of urinary tract infection (UTI) that involves one or both kidneys. It’s usually caused by bacteria, but can sometimes be due to viruses or fungi.
Symptoms of Kidney Infection
Kidney infection pain is often severe and felt not only in the back but also under the ribs, around the abdomen, and in the groin area.
Other symptoms can include:
- Urinary symptoms: Painful urination and frequent urge to urinate.
- Systemic symptoms: High fever with chills, nausea, and vomiting.
Suspected kidney infection requires immediate medical attention.
Causes and Treatments for Kidney Infection
Kidney infections often originate as bladder infections (cystitis) that ascend to the kidneys. Bacteria, viruses, or fungi can cause these infections.
Bacterial kidney infections are typically treated with antibiotics. Antifungal or antiviral medications are used for other types of infections. Pain management may involve painkillers like acetaminophen.
Acute Urinary Retention: Sudden Inability to Urinate
Acute urinary retention is the sudden inability to pass urine. While it can be chronic, acute retention is characterized by its abrupt onset. It’s more common in males, especially after age 60.
Symptoms of Acute Urinary Retention
Symptoms of acute urinary retention can include:
- Urinary inability: Complete or partial inability to urinate.
- Hesitancy: Difficulty starting urination.
- Lower abdominal pain: Often severe.
- Urgency without result: Urgent need to urinate without success.
- Incontinence: Leaking urine without warning.
- Abdominal swelling: Swelling in the lower abdomen.
Chronic urinary retention develops gradually with symptoms like hesitancy, slow urine stream, or leakage, potentially progressing to complete retention. Some individuals with chronic retention may experience minimal or no noticeable symptoms.
Causes and Treatments for Urinary Retention
Urinary retention often stems from a blockage in the bladder or urethra, preventing urine outflow. This blockage can be caused by:
- Prostate issues: Enlarged prostate (benign prostatic hyperplasia – BPH) or prostate inflammation (prostatitis).
- Obstructions: Bladder obstruction due to scar tissue or urinary tract stones.
- Growths: Pelvic tumors, fibroids, polyps, or clots (cancerous or noncancerous).
- Pelvic floor dysfunction: Tight pelvic floor muscles.
- Infections: UTIs or sexually transmitted infections (STIs).
- Trauma: Pelvic, urethral, or penile trauma.
- Neurological conditions: Parkinson’s disease, multiple sclerosis, or stroke affecting bladder muscle function.
- Medications: Certain antidepressants, opioids, and decongestants.
- Weak bladder muscles: Due to aging, trauma, pregnancy, or childbirth.
Acute urinary retention requires emergency room treatment. A catheter is used to immediately drain urine, relieving pain and preventing bladder and kidney damage. Addressing the underlying cause is essential for long-term resolution. Treatments vary depending on the cause, ranging from medications for prostate enlargement to antibiotics for infections.
Cystitis: Bladder Inflammation
Cystitis is inflammation of the bladder, commonly caused by a lower urinary tract infection. It’s significantly more frequent in females, with menopause increasing risk due to hormonal changes.
Symptoms of Cystitis
Cystitis symptoms include:
- Painful urination.
- Burning sensation during urination.
- Lower abdominal or back cramps or pressure.
- Urinary frequency.
- Urinary incontinence.
- Cloudy or dark urine.
- Blood in urine.
- Foul-smelling urine.
- Pain during intercourse.
- Genital pain.
- Low-grade fever.
- Fatigue.
In older adults, cystitis may present atypically with fever, confusion, or delirium instead of typical urinary symptoms.
Causes and Treatments for Cystitis
Bacterial infection is the most common cause of cystitis. Bacteria from feces or sexual activity can enter the urethra and reach the bladder. Females are more susceptible due to anatomy. Anal sex and factors like uncircumcised penis or enlarged prostate in males also increase risk.
Non-bacterial cystitis can be caused by medications, radiation, foreign bodies, interstitial cystitis, or other medical conditions like diabetes or kidney stones.
Infectious cystitis is typically treated with antibiotics. Pain relievers targeting the urinary tract, like phenazopyridine, and warm sitz baths can help manage discomfort. Cystitis due to blockages may require surgical intervention to improve urine flow.
Nephrolithiasis (Kidney Stones): Mineral Deposits in the Kidneys
Kidney stones are solid masses that form in the kidneys when high levels of certain minerals and acids in urine, such as calcium, oxalate, phosphorus, and uric acid, crystallize and clump together. They vary in size, from pea-sized to, rarely, golf ball-sized.
Symptoms of Kidney Stones
Kidney stones can cause intense pain in the back, side, lower abdomen, or groin. The pain may be constant or intermittent.
Other symptoms can include:
- Hematuria: Pink, red, or brown blood in urine.
- Urinary urgency.
- Dysuria: Painful urination.
- Difficulty urinating.
- Cloudy or foul-smelling urine.
- Nausea and vomiting.
- Fever and chills.
Any blood in the urine requires immediate medical evaluation to rule out serious conditions like kidney or bladder cancer.
Causes and Treatments for Kidney Stones
Kidney stones are common and often have a familial tendency. Dehydration, obesity, weight loss surgery, diets high in salt, sugar, or fructose are risk factors. The exact cause is not always clear.
Small kidney stones often pass spontaneously with increased fluid intake (6-8 glasses of water daily) and over-the-counter pain relievers like ibuprofen or naproxen. Other treatments include diuretics, allopurinol, sodium bicarbonate/citrate, tamsulosin (to relax ureter), and lithotripsy (using sound waves to break stones). Surgery is rarely needed.
Trapped Gas: Air or Gas Accumulation in the Digestive Tract
The average person produces a significant amount of gas daily. Trapped gas occurs when excess gas accumulates in the digestive tract, leading to discomfort.
Symptoms of Trapped Gas
Gas in the digestive tract commonly causes abdominal pain and discomfort, along with:
- Burping.
- Bloating.
- Flatulence.
The location of gas can influence pain perception. Left-sided gas pain might mimic heart pain, while right-sided gas pain can resemble appendicitis.
Causes and Treatments for Trapped Gas
Swallowing air and consuming gas-producing foods contribute to gas accumulation. Gas-inducing foods include:
- Fiber: Soluble fiber (beans) and insoluble fiber (vegetables).
- Fructose: Onions, bananas.
- Raffinose: Cabbage, cruciferous vegetables.
- Starch: Potatoes, noodles.
- Lactose: Dairy products.
Lactose intolerance and digestive disorders can increase gas susceptibility.
Trapped gas is usually benign and resolves on its own. Burping and passing gas are helpful. Relief measures include:
- Herbal teas: Peppermint or chamomile tea.
- Apple cider vinegar: Diluted in water.
- Deep breathing.
- Light physical activity: Walking, yoga.
Persistent gas symptoms despite self-care warrant medical consultation to rule out food sensitivities or digestive issues.
Twisted Bowel (Volvulus): Intestinal Twisting
Lower abdominal pain can be an early symptom of a twisted bowel, also known as volvulus. This occurs when part of the intestine twists, potentially obstructing blood supply (bowel obstruction).
Symptoms of Twisted Bowel
Twisted bowel pain is often cramping, intermittent or constant. Other symptoms include:
- Bloating.
- Constipation.
- Nausea and vomiting.
Twisted bowel is a serious condition requiring immediate medical attention due to potential complications like infection and bowel obstruction. Seek immediate medical help for these symptoms:
- Infection signs: Fever.
- Shock symptoms: Confusion, loss of consciousness, rapid heart rate, sweating, pale skin.
Causes and Treatments for Twisted Bowel
Twisted bowel can be caused by congenital structural variations in the intestines or surrounding tissues, such as:
- Elongated sigmoid colon.
- Loose tissues around the sigmoid colon.
- Improperly fixed cecum.
Sigmoid volvulus is more common in older adults in long-term care facilities due to prolonged bed rest.
Twisted bowel is a medical emergency. Treatment typically involves emergency surgery. In some cases without colon damage, a flexible sigmoidoscopy can untwist the bowel. Surgery to remove the affected colon segment may be necessary if sigmoidoscopy fails or colon damage exists.
Menstrual Cramps (Dysmenorrhea): Uterine Contractions
Menstrual cramps are caused by uterine contractions during menstruation. Most menstruating individuals experience some pain for a day or two each month.
Symptoms of Menstrual Cramps
Menstrual pain can range from mild to severe, dull to throbbing, and is typically continuous for a few days. Lower back pain may accompany lower abdominal pain.
Other symptoms include:
- Fatigue.
- Weakness.
- Diarrhea.
- Nausea and vomiting.
- Headaches.
Causes and Treatments for Menstrual Cramps
Mild to moderate menstrual cramps are normal. Secondary dysmenorrhea refers to abnormal cramping due to underlying disorders or infections.
First-line treatment for menstrual pain is pain-relieving medication, such as NSAIDs (aspirin, ibuprofen, acetaminophen). Other options include oral contraceptives, progesterone, exercise, heating pads, and warm baths/showers.
Constipation: Infrequent Bowel Movements
Constipation, characterized by infrequent bowel movements (fewer than three per week), is a common and uncomfortable condition.
Symptoms of Constipation
Constipation symptoms vary but can include:
- Inability to have bowel movements.
- Painful bowel movements.
- Bloating and discomfort.
- Sluggishness.
- Abdominal pain.
Causes and Treatments for Constipation
Constipation occurs when the colon absorbs excessive water, leading to hard, dry stools. Common causes include:
- Lack of exercise.
- Dehydration.
- Low-fiber diet.
- Pregnancy.
- Older age.
- Laxative abuse.
Underlying conditions like irritable bowel syndrome or medication side effects can also cause constipation.
Increasing fiber intake and fluid consumption are often sufficient to treat constipation. Prunes or figs can help. Laxatives or magnesium supplements may be used for more severe cases. Preventing constipation involves a high-fiber diet (20-35 grams daily) and limiting low-fiber foods like processed foods, meat, cheese, and ice cream.
Irritable Bowel Syndrome (IBS): Functional Bowel Disorder
Irritable bowel syndrome (IBS) is a functional bowel disorder, not a disease, affecting a significant portion of the population.
Symptoms of IBS
IBS causes a range of gastrointestinal symptoms, including:
- Abdominal pain.
- Changes in bowel habits: Diarrhea, constipation, or mixed patterns.
- Bloating.
- Mucus in stool.
- Incomplete bowel movement sensation.
Symptoms are typically mild but can be severe. IBS is diagnosed if symptoms occur at least three days per month for three months or more.
Causes and Treatments for IBS
The exact cause of IBS is often unclear. Post-infectious IBS can develop after bacterial or parasitic infections. Stress is also a common trigger.
Diet and lifestyle changes are the initial recommendations for IBS, such as avoiding trigger foods, eating slowly, smaller meals, and increasing fiber. Medications for more severe cases include anticholinergics, loperamide (for IBS-D), lubiprostone (for IBS-C), low-dose tricyclic antidepressants, and psychological therapy for stress-related IBS.
Diagnosis of Lower Abdominal Pain
If your lower abdominal pain persists, worsens, or is not related to simple indigestion, seek medical attention.
Diagnosis often involves a physical exam, detailed symptom history, and potentially tests to rule out underlying causes. Expect questions about pain location and character. Gynecological or rectal exams may be performed.
Diagnostic tests may include:
- Blood tests: Complete blood count to check for infection or blood loss.
- Pregnancy test.
- Imaging tests: CT scan to visualize abdominal organs. Ultrasound is preferred for pregnant individuals.
Causes of Pelvic Pain Mistaken for Lower Abdominal Pain
Pelvic pain can sometimes be confused with lower abdominal pain. Conditions causing pelvic pain include:
- Pelvic inflammatory disease (PID).
- Ruptured ovarian cyst.
- Leiomyomas (fibroids).
- Endometriosis.
- Ovarian torsion.
- Ectopic pregnancy.
- Ovarian hyperstimulation.
- Ovarian cancer.
Summary: Understanding Your Lower Abdominal Pain
Lower abdominal pain can be acute or chronic and can be a symptom of both minor and serious conditions, ranging from gas and indigestion to appendicitis, colitis, diverticular disease, and gynecologic issues like menstrual cramps or pregnancy. Kidney stones and urinary tract infections are also potential causes.
Treatment is determined by the underlying cause and can range from over-the-counter remedies to emergency surgery. Understanding the possible causes and associated symptoms is key to knowing when to seek appropriate medical care for your lower abdominal pain.
