All women will experience pain in the lower abdomen from time to time. Most commonly this can occur due to their periods or menstruation.
In many cases it is difficult to diagnose the exact cause of the pain, but noting certain features will help your doctor come to a diagnosis.
The most common causes are a urinary disorder, such as bladder or kidneyproblems, a bowel problem or a problem with the reproductive system – the uterus, Fallopian tubes and ovaries.
Abdominal pain arising from the urinary system
Urine infections are common and present symptoms, such as burning when you pass urine and going to the toilet more often.
Infection can spread to the kidneys (pyelonephritis) and can make you feel unwell with a high temperature and back pain.
If you have pain that spreads from your back down to your groin and is severe – your doctor may be more concerned that you have kidney stones. The doctor will test your urine if you have any of the above symptoms.
If you have any blood in your urine, it’s important to tell the doctor because this always needs investigation.
Tumours of the urinary system are not common, and the doctor will certainly take into account the duration of your symptoms first.
Abdominal pain arising from the digestive system
Pain arising from the large intestine is a particularly common cause of lower abdominal pain in both men and women. Features suggesting your pain may be to do with the bowel are:
- Pain associated with pooing
- A change in bowel habit
- Loss of blood when you poo
- Bloating with wind
Both constipation and diarrhoea can give you pain.
The pain they are often associated with is described as crampy or ‘colicky.’ This means that it comes and goes in waves. Large bowel pain is characteristically relieved on opening the bowels. Potential causes of pain arising from the bowel include irritable bowel syndrome (IBS), which can give you alternating diarrhoea, constipation and bloating. Other conditions include diverticular disease and it’s complications which are more frequent in older patients. Inflammatory bowel disease (ulcerative colitis or Crohn’s). A rare but important diagnosis is colorectal cancer.
Bloating and swelling is also a common symptom that people report and can be due to a problem affecting the bowels.
If you have any fresh bleeding from your back passage or you notice that your poo is black in colour then your should alert your doctor. These symptoms require investigation.
Abdominal pain arising from the reproductive organs
Pain can originate from your uterus (womb), Fallopian tubes or ovaries. It’s usually felt in the middle of the lower abdomen.
Pain that is felt more to the side can be more typical of a pain coming from the ovary.
Pain coming from the uterus is often worse during your period and is called dysmenorrhoea.
Some conditions affecting the reproductive system can also cause pain during intercourse. This is called dyspareunia and it is important to let your doctor know if you are troubled by it.
Examples of conditions of the reproductive organs include endometriosis, fibroids, pelvic inflammatory disease, ovarian cysts and problems related to the early stage of pregnancy such as a miscarriage or ectopic pregnancy.
What will the doctor do?
The doctor will ask lots of questions regarding your periods, passing of urine and bowel movements. They may also ask about general symptoms such as fever, nausea and vomiting.
If appropriate, they may ask questions about a person’s emotional life-family, home, work and sex life.
Next the doctor will examine you. They will examine your abdomen and may examine you internally also (vaginal, rectal or sometimes both) may be necessary.
Often the doctor will ask for you to give a urine sample, which can be tested for infection.
If you have symptoms of vaginal discharge or other related symptoms the doctor may take some vaginal swabs.
Depending on your symptoms and their duration the doctor may decide to arrange for further investigations.
These may include:
- Gynaecological causes may require vaginal swabs, cervical smears or pelvic ultrasound examination. Ultrasound may also be performed from within the vagina. Specialised blood test for ovarian cancer, CA-125, are usually performed. More invasive tests will depend upon the doctor’s suspicion of the cause of the pain.
- Urinary causes can be investigated by urine culture, ultrasound or CT scan.
- Colonic causes may require internal endoscopic examination of the bowel by Flexible Sigmoidoscopy or Colonoscopy.
- A CT (Computerised Tomography Scan) may be appropriate for all three major sites of pain.
To determine how far to investigate lower abdominal pain takes skill and judgement. Pain can even arise outside the abdomen, for example from the back. Depending on the exact symptoms and duration, possible referral to the appropriate specialist is often required.
Other people also read:
Irritable bowel syndrome (IBS): what are the symptoms of IBS?
Lumbago (lower back pain): what are the danger signs?
Vaginal discharge: what can the doctor do?
Based on a text by Dr Erik Fangel Poulsen, specialist