Introduction
The term “lower abdomen” refers to the area of the abdomen which is located below the navel and is bordered by the pelvis. Pulling pain in the lower abdomen is not a rare condition and is often mistakenly dismissed as a banal “women’s complaint”, although there may be much more behind it. The complaints in the lower abdomen can generally be caused by a variety of factors. Accompanying symptoms can often help to identify the reason for the pulling in the lower abdomen.
Causes
In principle, all organs or parts of organs located in the lower abdomen can cause pulling lower abdominal pain. These organs include, in particular, parts of the intestine. A frequent cause of increasing, pulling to cramping severe lower abdominal pain in childhood is appendicitis.
Girls and boys are equally affected. Typical for appendicitis is that the pain begins in the upper abdomen and “migrates” to the right lower abdomen within a few hours. In addition, those affected often also suffer from fever, nausea with vomiting and stool irregularities ranging from diarrhea to constipation.
Appendicitis is counted among acute lower abdominal pain. Banal gastrointestinal infections (gastroenteritis) can also be the cause of acute and pulling lower abdominal pain. This is usually accompanied by diarrhoea, vomiting, occasional fever and general malaise.
Especially children and elderly people are affected by such gastroenteritis, which is usually caused by viruses. Other organs in the abdomen which can cause corresponding pain are the urine-forming and draining organs. The kidneys are among the urine-producing organs.
Inflammation of the renal pelvis is very painful for the affected person and is accompanied by fever and pain in the flanks, which, however, radiate into the lower abdomen and can be felt there as a pulling pain. Inflammation of the renal pelvis is usually the result of an ascending bacterial infection from the bladder or as a result of a kidney or ureteral stone that hinders the drainage of urine. Women, especially those with weakened immune systems, are more frequently affected.
The ureters and the bladder are among the urinary organs that drain urine. A stone that clogs the ureters and hinders the passage of urine causes severe wave-like pain, also known as colic pain. The cramping, pulling pain typically radiates into the lower abdomen, the labia in women and the testicles in men.
Young women are particularly affected by an inflammation of the bladder, as bacteria can ascend into the bladder and infect it more easily due to the much shorter urethra compared to the male sex. Due to the location of the organ, an inflammation of the bladder is also associated with pulling or cramping pains in the lower abdomen. Other causes of acute pulling lower abdominal pain in women are period pains, which are usually harmless, i.e. apart from the unpleasant pain they have no disease value.
Another serious disease is ovarian inflammation, which is usually associated with yellowish-greenish discharge from the vagina, nausea and vomiting. Inflammations of the fallopian tubes present themselves with similar symptoms. In case of sudden and strong pulling/spasmodic lower abdominal pain in women of childbearing age, one should always consider a possible pregnancy in which the embryo has falsely implanted itself in the abdominal cavity or the fallopian tube (ectopic pregnancy).
In this case, immediate action is required and termination of the pregnancy is inevitable. The cause of chronic pulling-cramping pain in the lower abdomen can be permanent inflammation of the intestines in the context of ulcerative colitis or Crohn’s disease. In both diseases the actual trigger is largely unknown, but an autoimmunological component is strongly suspected.
While in ulcerative colitis the intestinal mucosa of the rectum is mainly affected, in Crohn’s disease the entire digestive tract, i.e. from the mouth, esophagus, stomach to the small and large intestine, can be affected. Typical symptoms of Crohn’s disease are severe and frequent diarrhea, weight loss and occurrence. The disease usually occurs between the ages of 15 and 30.
Typical for ulcerative colitis are bloody diarrhea and its occurrence between the ages of 20 and 40.Crohn’s disease is the more common of the two. Persistent pulling to pressing abdominal pain with a maximum in the groin region may indicate an inguinal hernia. In extreme cases or in very slender people, the hernia can become visible as a bulge in the groin. Frequently, no local cause can be found for recurrent, pulling abdominal pain, either in men or women. Also mental illnesses, led by depressions, can express themselves with these symptoms.
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