Lower abdominal pain can have numerous causes. This makes the diagnosis all the more difficult. For this reason, in addition to the exact character of the pain, its localization and accompanying symptoms, the timing of the pain is also of great importance.
Causes
Especially at the beginning of a pregnancy pain can occur due to a change in the body. These are caused by stretching of the various ligaments of the uterus, which adapts to the new situation. In addition, especially at the beginning of a pregnancy, the pregnancy hormones (ß- HCG) are often not yet sufficiently present and the uterus tends to contract, which can cause pain in the abdomen.
In later stages of pregnancy, kicks or an unfavorable position of the child can also cause pain. However, exercise contractions are also normal in the last trimester and are only used by the uterus to prepare for birth. However, these exercise contractions have no effect on the cervix and do not serve to induce labor. For this reason, they must be distinguished from birth-relevant preliminary contractions, which can induce birth and cause premature birth.
Symptoms
A slight pulling in the abdomen, similar to that during menstruation, without bleeding is usually harmless and merely a sign of changes in the uterus. Nevertheless, this should also be confirmed by a doctor to avoid abortion. Especially a too small amount of pregnancy hormones can cause contractions of the uterus and possibly lead to a miscarriage.
If pain occurs in the later stages of pregnancy, a distinction must usually be made between child movements, exercise contractions and premature labor. Kicks of the child against the abdominal wall or an unfavorable position of the child can be very painful, especially if the space in the abdomen is significantly reduced. However, by changing the position of the mother, or encouraging the child to reposition itself, the pain usually stops.
This type of pain is also different from contractions, as the pain does not occur regularly and can last much shorter or be ended by repositioning the child. Exercising contractions are normal, especially in the third part of pregnancy, and are used to prepare the uterus for delivery. However, they are not relevant to childbirth and do not lead to the opening of the cervix.
Just like real birth pangs, these are contractions which are accompanied by a hardening of the abdomen. They differ from birth-relevant contractions in that they only last a maximum of 45 seconds and do not occur more than 3 times per hour. A CTG can be taken at the gynaecologist or in hospital to make an exact distinction.
This shows both the contractions and the heart activity of the childPain in the left lower abdomen often occurs in adult patients and can be a sign of intestinal diverticulosis. These are benign bulges of the intestinal wall which often occur in the context of chronic constipation and a weakened intestinal wall. The reason for this is probably the increased pressure in the intestine caused by the chronic constipation and the weakened intestinal wall.
For this reason older patients are often affected. The pain can also be felt as a burning sensation in the abdomen. In most cases, these diverticula do not cause any symptoms.
However, the diverticula can become inflamed and then cause severe pain in the left lower abdomen. These often occur suddenly and severely affect the patient. In addition, in many cases the pain is accompanied by fever and general symptoms such as tiredness, exhaustion and headache and aching limbs.
If there is only inflammation of the diverticula without any indication of a breakthrough into the free abdominal cavity, there is no indication for surgery. This article could also be of further help to you: Abscess in the intestineThe pain can be treated with painkillers and antispasmodic drugs. Antibiotics are also used to treat the inflammation.
The intake of food should be avoided at first to protect and calm the intestine. The patients are then temporarily fed through the vein. The pain should subside within a few days.
If the inflammation has led to a breakthrough into the free abdominal cavity, surgery must be performed immediately. This is the only way to prevent a life-threatening peritonitis. During the operation, the S-shaped part of the colon (sigmoid colon) is usually removed, and the remaining part of the colon is connected to the rectum.
Thus, no artificial bowel outlet needs to be created.This therapy is also preferred in case of recurrent inflammation of the diverticula, to prevent an imminent rupture of the diverticula. Likewise, an ectopic pregnancy in women of childbearing age can lead to pain in the left lower abdomen. These are accompanied by similar symptoms as a diverticular rupture.
The pain is acute and very severe. They are often accompanied by fever, a severely weakened general condition and possibly vaginal bleeding. Since this is also an inflammatory cause with breakthrough into the free peritoneal cavity and the great danger of peritonitis, the ectopic pregnancy must be operated on immediately.
An incarcerated inguinal hernia is also accompanied by severe, sudden pain. In addition, the hernia is often palpable in the hernia sac in the region of the groin. Inflammatory signs such as fever are absent in many cases.
Since the inguinal hernia can lead to an entrapment of the intestine, it must also be treated as quickly as possible. In some cases the hernia can be reduced manually. Subsequently, the surgical closure of the inguinal hernia should be performed promptly.
If the hernia cannot be released from the incarceration, surgery must also be performed immediately to prevent the affected part of the intestine from dying off. A torsion of the testis can also lead to sudden severe pain because of a twisting of the spermatic cord with the supplying vessels and nerves. In most cases the torsion of the testis can also be treated manually.
Ureteral stones, if they are too large to pass through the ureter, can lead to colicky pain in the lower abdomen. In most cases a pain and spasm relieving therapy is sufficient and the stone is transported into the bladder by itself and then excreted. If this is not the case, the stone must be dissolved by ultrasound-guided waves or stone-dissolving medication.
In exceptional cases, surgical removal of the stone is necessary. Right-sided lower abdominal pain can occur as on the left side due to an ectopic pregnancy, an incarcerated inguinal hernia, a ureteral stone or a torsion of the horn. Again, the pain may be felt more as a burning sensation.
However, appendicitis is specific to the right lower abdominal pain because it is located in the right lower abdomen. The pain of an appendicitis often starts in the middle abdomen around the navel and then moves slowly to the right lower abdomen. The reason for this is the progressive inflammation of the appendix with increasingly exactly localizable pain.
The pain is often accompanied by slight fever, nausea, vomiting and constipation. The pain tends to be dull and persistent and increases in intensity. If the appendix bursts, the pain may initially subside.
However, as the peritoneum becomes more inflamed, the pain in the lower abdomen becomes much stronger and can ultimately affect the entire abdomen. Since such an inflammation of the peritoneum can be life-threatening, it is important to recognize an appendicitis at an early stage and to operate if necessary. Appendicitis can often be detected by ultrasound examination and the elevated inflammation parameters in the blood.
As long as the inflammation is limited to the appendix, the operation can often be performed laparoscopically. Only three small incisions are necessary to insert the camera into the abdomen. The remaining scars are very small and hardly visible in the long run.
Since appendectomy is a routine procedure, complications are very rare and the risks are low. In addition to appendicitis, the appendages (adnexa) of the woman can also become inflamed. In women, the appendages are the fallopian tubes (tuba uterina) and ovaries (ovaries).
Adnexitis can occur on one or both sides and thus, strictly speaking, also on the left side. For unknown reasons, however, right-sided pelvic inflammatory disease seems to occur more frequently. An acute inflammation of the appendages is accompanied by sudden severe pain in the area of the right lower abdomen.
If the inflammation is not treated correctly and does not heal completely, scarring and adhesions in the area of the fallopian tube or ovary can occur, so that complaints persist for years. The pathogens causing pelvic inflammatory disease are manifold. In 40% of cases, however, chlamydia can be detected.
The pain often occurs laterally after menstruation or during ovulation. If the cervix or uterus is also affected in addition to the appendages, discharge and spotting may also occur.Severe infections can also cause vomiting, fever and nausea. If the inflammation leads to a rupture of the fallopian tube or the ovary, an acute abdomen can also occur as in the case of appendicitis.
Diagnostically, a gynecological examination with palpation of the uterus should be performed. This examination causes pain in case of inflammation. Also by means of speculum examination the inflammation of the uterus is visible by a strong redness and oedema.
In the course of this examination a microbiological smear should be taken. The ultrasound can reveal abscesses, swellings or secretions in the area of the fallopian tube and ovary. If the diagnosis cannot be confirmed, a laparoscopic examination must also be performed in this case.
In addition, elevated inflammation parameters can be detected in the blood count. As a rule, the pelvic inflammatory disease is treated with antibiotics after taking the microbiological smear. Since in most cases chlamydia is responsible for the inflammation, treatment is with tetracyclines or fluoroquinolone for at least 10 days.
If the therapy does not work, the antibiotics should be switched to cephalosporins and metronidazole. If even this therapy does not bring the desired success, treatment should be based on the microbiological result and resistogram. If abscesses have developed, they are usually treated as inpatients and relieved surgically.
If the pain is severe, painkillers such as ibuprofen can be used. Lower abdominal pain in the middle abdomen is usually caused by non-specific colon pain. This primarily includes constipation.
This can occur due to insufficient fluid intake or incorrect nutrition. In the case of simple constipation, there is severe, intermittent and cramp-like pain in the lower abdomen. The constipation can be relieved by enemas or a short-term application of laxative medication.
As a prophylactic measure, one should always follow a balanced diet rich in fiber and drink enough fluids. To diagnose the other causes of constipation, in many cases further examinations such as a colonoscopy, an ultrasound or a computer tomography are necessary. In addition to the non-specific constipation, which can occur throughout the entire abdomen, the inflammation of the pancreas is considered to be a specific pain in the middle abdomen, which radiates around the abdomen in a belt shape.
The pain is accompanied by nausea, vomiting and possibly an acute intestinal obstruction (ileus). Pancreatitis can be both acute and chronic and is usually the result of severe or long-term alcohol abuse. The diagnosis is made based on the patient’s medical history (anamnesis), physical examination, an ultrasound and various laboratory tests.
Acute pancreatitis must be treated in hospital. Patients are not allowed to eat anything until the symptoms and laboratory values have improved significantly. This serves to immobilize the pancreas.
During this time, the patient receives a lot of fluid as well as electrolytes, nutrients and vitamins through the vein. Painkillers serve to alleviate the symptoms. Once the symptoms have subsided, the patient slowly starts to eat more.
The therapy of chronic pancreatitis is often much more complicated, as the cause is often unclear or no longer treatable. In some cases surgery may be necessary for both forms. Another cause of middle abdominal pain can be an umbilical hernia.
There is a prolapse of intestinal loops in the region of the navel through the obliterated umbilicalis annulus. This represents a part of the umbilical cord in the prenatal period and closes after birth. This part of the umbilical cord can be a predilection site for an umbilical hernia and then contains parts of the peritoneum and possibly intestinal parts.
If the hernial sac contains only parts of the peritoneum, or if it is very small, no symptoms often occur. However, if the hernia gap is large enough, or if parts of the intestine are trapped, localized pain in the umbilical region occurs. The navel is often swollen and possibly reddened as a sign of an intestinal protrusion under the skin.
Predisposing factors for such an umbilical hernia are overweight (obesity), heavy physical exertion and a significant increase in pressure in the abdominal cavity (for example, pregnancy). Women are also more frequently affected by an umbilical hernia. If the umbilical hernia is accompanied by clear symptoms, it is treated surgically.
The hernia sac is removed and the hernia gap is closed with a double suture.In some cases a net can be sewn in to strengthen the abdominal wall. Another life-threatening cause of middle abdominal pain can be abdominal aortic aneurysm. This is an aneurysm of the vascular wall of the abdominal aorta.
Such an aneurysm is often initially inconspicuous. In some cases, patients experience dull abdominal pain and back pain, which can also radiate into the legs. The actual symptomatology, however, only occurs when the aneurysm tears.
At this moment, a strong, stabbing and destructive pain in the middle abdomen occurs. Due to the massive blood loss, a life-threatening shock symptomatology occurs afterwards. Due to this very acute and life-threatening situation, an operation must be performed within a very short time.
The diagnosis is made by an orienting ultrasound examination and the immediate opening of the abdominal cavity to stop the bleeding. A bladder infection can also manifest itself in lower abdominal pain. As a rule, the first symptoms are a burning sensation when urinating and a constant feeling of urgency.
If the cystitis is not treated, abdominal pain in the middle lower abdomen and fever can also occur. The diagnosis can often be made by means of a urine test and the clinical symptoms. A cystitis should be treated by drinking plenty of fluids and possibly by a drug therapy with antibiotics.
