Introduction
Pulling in the abdomen or also lower stomach-pains often were seen as “female-suffering” earlier. These complaints are often associated with the female sexual organs. For example, they can be cycle-dependent or occur during pregnancy, or they can be an indication of gynecological diseases, such as inflammation of the ovaries and fallopian tubes (pelvic inflammatory disease) or ovarian cysts.
However, pain or pulling in the abdomen is also increasingly common in men. The causes can be inguinal hernias, torsion of the testis (a dangerous rotation of the testis) or inflammation of the prostate. Generally speaking, however, pulling in the lower abdomen can also occur due to constipation, urinary stones, urinary tract infections, appendicitis or sigmoid diverticulitis. However, a slight pulling in the lower abdomen without accompanying symptoms is usually harmless and should not be a cause for concern. However, if you experience fever, severe pain, malaise or bleeding, a doctor should be consulted in any case.
Symptoms
Pulling in the abdomen is itself only one symptom and can have many causes. For further clarification it is therefore important to know when the pulling started, whether it is cycle-dependent (in women), whether it is accompanied by altered vaginal fluorine (discharge) or fever (suspected inflammation of the genitals), whether an intact pregnancy is present or whether it is a miscarriage or an ectopic pregnancy. It is also important whether the pulling occurred suddenly (ovarian cyst), whether nausea or vomiting, diarrhoea or stool retention is present (suspected intestinal problems).
In men, the testicles and the prostate should be examined. A pulling alone in the lower abdomen, without accompanying symptoms, is usually harmless and should be treated with local warmth and rest. However, if any of the other symptoms mentioned above are present, a doctor should definitely be consulted.
Causes
One cause of pulling in the abdomen in women can be cycle-dependent changes in the body, for example as a result of ovulation, menstrual cramps or endometriosis. Cycle-independent causes are, for example, large ovarian cysts, which are not dangerous in themselves, but can cause severe pain in the event of stem rotation and require emergency surgery. Other causes of pulling in the abdomen can be pregnancy, as well as an imminent miscarriage or an ectopic pregnancy.
A miscarriage is usually accompanied by severe pain and bleeding. An ectopic pregnancy also manifests itself mainly through severe abdominal pain. One cause of pulling in the lower abdomen in men can be testicular torsion, i.e. a torsion of the testicles.
This is an absolute emergency and must be operated as soon as possible. But also an inflammation of the prostate or an inguinal hernia can become noticeable as pulling in the lower abdomen. Other general causes of pulling and pain in the lower abdomen can be constipation or kidney stones.
Also appendicitis or sigmoid diverticulitis (inflammation of protrusions of the intestinal mucosa) can become noticeable as a pulling in the lower abdomen. Some women notice a slight pulling in the lower abdomen in the middle of their cycle, at the time of ovulation, on the side of the active ovary. Other women experience ovulation as a sudden, short-lasting colicky pain, while other women do not feel their ovulation at all.
Menstrual cramps can also be felt as a pulling in the lower abdomen. They usually start shortly before the next period, increase during the first two days of the period and then subside again. Menstrual cramps usually last until menopause, but are usually harmless.
Menstrual pain is triggered by an increased release of prostaglandins (tissue hormones), which cause the spiral arteries in the uterus to contract, leading to the rejection of the built-up uterine lining. Increased secretion of these substances increases the contraction and the rejection of the uterine lining is perceived as painful. Stress and mental strain can intensify these symptoms.
Pain during ovulation Endometriosis is to be distinguished from normal menstrual problems. It can also cause menstrual pain and pulling in the lower abdomen.Endometriosis is a disease in which there is an abnormal metastasis of the lining of the uterus into the small pelvis, the ovaries and fallopian tubes or into the abdominal cavity. With each cycle, there is then a painful bleeding of the endometrium, which can manifest itself as pulling in the abdomen and even pain in the abdomen and back.
Among other things, it can also lead to pain when urinating, defecation or sexual intercourse. Therapeutically, taking painkillers and the progestins often contained in the contraceptive pill can help here. A pulling in the lower abdomen can also be an indication of pregnancy.
In combination with a feeling of tension in the breasts, dark coloring of the nipples, fatigue, dizziness and weakness, it is considered an uncertain sign of early pregnancy (pregnancy symptoms). The pulling in the abdomen is usually due to hormonal changes, the loosening of ligaments and tissue and the increase in size of the uterus. Pulling in the lower abdomen can also increase during pregnancy.
This is mainly due to the growth of the uterus, which now pulls more and more on the ligaments it is attached to. In the later course of the pregnancy, pulling in the lower abdomen can also be caused by the movements of the child, and towards the end of the pregnancy can often be a sign of incipient contractions. Pulling in the lower abdomen during pregnancy is usually harmless and should not be a cause for concern.
However, if colicky (cramping) pain, fever, nausea, vomiting, diarrhoea or bleeding are added, a doctor should be consulted urgently – to rule out inflammation. A pulling in the abdomen, accompanied by vaginal bleeding or back pain, can also be an indication of an imminent miscarriage. In this case, it is highly recommended to see a doctor and have an ultrasound examination to monitor the child’s heartbeat.
In the case of an imminent miscarriage, hospitalization should be considered. In the case of a miscarriage that has already occurred, the spontaneous release of the embryo can be waited for, or a scrape can be performed. Another condition that can be associated with abdominal traction and severe pain is ectopic pregnancy.
In this case, the doctor will check the blood values and urine, and perform an ultrasound scan. If the Beta-HCG, a hormone that proves a pregnancy, is elevated but no amniotic sac is visible in the ultrasound, an ectopic pregnancy is very likely and must be operated on as soon as possible. Right-sided pulling in the lower abdomen, in women, is most often cycle-related and can occur due to ovulation (in the right ovary), or as part of menstrual problems.
A large cyst in the right ovary can also be a pulling in the right lower abdomen on the right. If pain and fever occur in addition to the pulling in the lower abdomen, this may indicate an inflammation of the right ovary or renal pelvis. Kidney stones in the right kidney can also manifest themselves as pulling in the right lower abdomen.
Right-sided pulling in the lower abdomen accompanied by nausea and vomiting may indicate appendicitis and should be clarified by a physician. If the pulling in the lower abdomen occurs shortly after heavy lifting and is accompanied by swelling in the groin, it may be an indication of an inguinal hernia. Inguinal hernias can occur on both the right and left side.
Left-sided pulling in the lower abdomen in women can occur, as well as on the right, in the context of ovulation or menstrual problems if the left ovary is affected. Inflammation of the left ovary or renal pelvis may also manifest itself as pulling/pain in the left lower abdomen, accompanied by fever and malaise. In older patients, a pulling in the left lower abdomen can also be a sign of sigmoid diverticulitis – that is, an inflammation of intestinal diverticula (protrusions of intestinal mucosa).
Diverticula in the intestine are usually caused by a weakness of the connective tissue in the intestine and are favoured by a low-fibre diet, overweight and little exercise. They are usually harmless, but can become inflamed and can be accompanied by pulling in the lower abdomen, up to pain, fever and stool retention. Diverticulitis is treated in hospital with antibiotics.
Other possible causes can be found on our pages Abdominal pain in the right lower abdomen and Abdominal pain in the left lower abdomen.A pulling in the abdomen, especially when coughing, can be an indication of an inguinal hernia. In most cases a swelling in the groin is also noticeable. An inguinal hernia can be caused by too heavy lifting and a weakness of the abdominal muscles and is defined as a penetration of the internal organs through the abdominal wall into the inguinal canal.
In this case, the intestine can be pushed out through the hernial orifice and become trapped. By coughing, pressing or sneezing, the hernia can increase in size and the pulling in the lower abdomen can become stronger. An inguinal hernia should always be clarified by a doctor and treated surgically.
Other causes of pulling in the lower abdomen in women, independent of the cycle, can be large ovarian cysts, an inguinal hernia, or inflammation of the sexual organs (fallopian tubes, ovaries, the uterus). For further clarification, ultrasound and blood tests are used. Antibiotics can be used to treat inflammation or infection of the reproductive organs.
In the case of ovarian cysts, surgical removal may be considered, as the cysts may rotate their stems and cause sudden, very severe pain, which can be life-threatening. A hernia should also be treated surgically, as it can lead to a life-threatening entrapment of the intestine. Pulling in the abdomen in men can be an indication of an inflammation of the prostate and should always be clarified urologically.
It is usually accompanied by fever, pain when urinating, bloody urine, pain and a feeling of tension in the groin and perineum and pain when ejaculating. For further diagnosis, a digital rectal examination (palpation of the prostate with a finger through the anus), control of blood values and urine, ultrasound, and uroflowmetry are performed. If the suspected inflammation of the prostate is confirmed, it is treated with antibiotics.
Another cause of pulling in the abdomen in men is testicular torsion. This is a twisting of the testicle around the spermatic cord and is an absolute emergency that requires immediate surgery. It manifests itself as an initial pulling in the abdomen up to the strongest pain, accompanied by vegetative reactions like sweating, nausea, vomiting, up to shock. Very common in men can be an inguinal hernia, which manifests itself with pulling and pain in the lower abdomen and swelling in the groin. An inguinal hernia should be treated surgically.
