Lower abdominal pain: causes of pain in men and women

If you have a pain in the lower abdomen, this is more a subjective perception than an objective sensation, therefore, the examination of patients with such a complaint is difficult.

If you have a lower abdominal pain, you need to understand that the causes of pain in this area of the epigastrium are great, and they can be divided conditionally, so to speak, by sex - typical male symptoms and signs of painful sensations characteristic only of the female body. In addition, there are common symptoms inherent in both men and women, and the elderly, and children.

[1]

Lower abdominal pain, causes of pain in men

Representatives of the stronger sex also suffer from pain in the lower abdomen, however, somewhat less frequently than women, for whom they may sometimes be monthly. If a man has very low abdominal pain, most often they courageously suffer pain in the lower abdomen, despite the possible serious dangers that lie behind this symptom. And the causes of lower abdominal pain may be as follows: 

• Inflammatory processes in the gastrointestinal tract, gastric or duodenal ulcer. The pain is usually aching in chronic diseases and acute, cramping during exacerbation of the disease. 
• Inflammation of the appendix - the appendix, which is localized in the lower right part of the abdomen, near the colon. The pain can be varied in nature, epigastrium does not always manifest itself in the right zone. One of the characteristic signs of appendicitis is a sharp pain in the lower abdomen, nausea, vomiting and fever. 
• Diverticulitis, in which pain in the lower abdomen can be localized in the left lower abdomen. In addition to pain, the inflammation of the diverticulum is accompanied by nausea, low-grade fever. 
• An inguinal hernia, which is a rather serious pathology, can be infringed and cause severe pain in the lower abdomen, nausea, vomiting, and even loss of consciousness. This condition requires urgent surgical care. 
• The inflammatory process in the kidneys, pyelonephritis or stones are also a provoking factor causing lower abdominal pain in men. 
• The inflammatory process in the testicles (orchitis) or appendages can also provoke painful sensations in the groin. 

Fortunately, the oncologic process in the intestine is a rare cause of pain in the lower abdomen. The pain can manifest itself at a late stage of the disease, when the tumor reaches a large size and puts pressure on nearby organs.

The lower abdomen hurts in men and because of chronic, often asymptomatic at the initial stage of development, diseases of the genitourinary system. If it is chronic cystitis, then the first signal is a violation of urination, which gradually enters the acute stage until the urine retention. An overflowing inflamed bladder causes dull at first, and then severe pain in the lower abdomen. In addition to cystitis, the cause of the lower abdomen pain in men may be prostatitis. The inflammatory process in the prostate gland develops, as a rule, slowly, often without obvious symptoms. When clinical signs appear, it can be said that prostatitis goes into an exacerbation stage. The pain usually begins with a pulling sensation that the man tries to endure patiently. If prostatitis is not treated, pain in the lower abdomen becomes more pronounced, gives the groin and testicles, especially severe pain accompanies urination. In addition to the fact that a man’s health condition can hardly be called good, he is tormented by constant pain in the lower abdomen, and his sexual activity is also disturbed. Prostatitis, which was not detected in a timely manner, may aggravate the course of another serious disease, prostate adenoma. Pain in the lower abdomen with adenoma is characteristic, it appears due to strong contraction and squeezing of the urethra, as a rule, the painful sensations are permanent and provoke the urge to night and daytime urination. Adenoma is accompanied by a significant deterioration in the patient's condition, urinary retention often leads to renal pathologies, and sexual function decreases.

All conditions that cause persistent chronic pain or sharp, sharp pain, accompanied by nausea, pressure drop, require medical care, often urgent.

[2]

Why does the lower abdomen hurt women?

Common physiological reasons for the fair sex are premenstrual pain, a painful menstrual cycle, pressure from the uterus on the bladder, which can also be overfilled. The lower abdomen often hurts during menstruation - this is the most frequent complaint of lower abdominal pain in gynecological practice. Family troubles, physical and sexual abuse, alcohol, drug abuse and other stressful effects can also be realized in the form of painful sensations. Among the factors that cause pain in the lower abdomen, include large intestine overflow and diverticulosis, spasms of a hungry stomach, the first three months of carrying a child when the muscles and ligaments of the abdomen stretch. Also, the pain in the lower abdomen in women can be caused by the causes of a pathological nature, among which the most common are the following: 

Inflammatory process, acute or chronic, in the female genital organs - the ovaries, the body of the uterus, the vagina or the fallopian tubes. Often, a woman has a sore and pulling lower abdomen due to an ovarian cyst that has grown to a large size or due to chronic adnexitis, pain can cause colpitis or adhesions, endometriosis or a benign formation in the myometrium of the uterus - fibroids. Most often, except for pain, these diseases are accompanied by fever, secretions, weakness. Analytical studies of blood serum show an increased level of white blood cells, confirming the inflammatory process. 

Why hurt the lower abdomen in women, if the cause is clearly not gynecological in nature? Factors causing pain in the lower abdomen can be various inflammatory processes of the urinary organs, such as cystitis, pyelonephritis, or kidney stones. Blood tests also show an increase in leukocyte levels, and leukocytes and red blood cells are found in the urine, the urine itself darkens, becomes turbid, often with patches of purulent elements. In addition to lower abdominal pain, the above diseases can cause fever, pain during urination, severe swelling. 

Pathological processes in the pelvic organs can also cause lower abdominal pain in women. It can be a different size of hernia, colon diverticulosis. Permanent constipation is a functional disease called megacolon, in which the walls of the large intestine are hypertrophied, and the intestine is constantly thickened. Besides the fact that the lower abdomen is very painful, often the diseases are accompanied by poor appetite, general fatigue, flatulence, hemorrhagic vein thrombosis of the rectal part of the digestive system. 

If the lower abdomen hurts, the causes can be more serious - these are cancers such as tumors - cancer of the body of the uterus and ovaries. 

All diseases that require urgent surgical assistance can also cause pain in the lower abdomen, although these conditions are most often accompanied by characteristic signs, which in surgical practice are called "acute stomach". It is appendicitis, protrusion of the wall (diverticulum) of the ileum - Meckel's syndrome, which, in addition to pain, is manifested by vomiting and blood in fecal masses. It often hurts the lower abdomen of a woman and because of the twisting of the sigmoid colon, torsion of the legs of the ovarian cyst, rupture of the cyst, perforation of the ulcer and ectopic, tubal pregnancy, torsion of the subperitoneal uterine fibroids. Each of these serious diseases can end in disrepair if timely medical care is not provided. In addition, the temperature rises, there is a sharp pain in the abdomen, these conditions are characterized by a sharp drop in blood pressure, nausea, severe weakness before loss of consciousness. 

Among the causes may be infectious diseases, including intoxication. In addition to the painful sensations in the epigastric region, women often have diarrhea, vomiting, fever.

Abdominal pain may be caused by extragenital factors, but most often a painful symptom is a sign of gynecological disorders, among which the following are the most common: 

• Apoplexy, ovarian rupture. This may be bleeding into the peritoneum or rupture of the capsule without hemorrhage, but both types of apoplexy are accompanied by strong painful sensations. 
• Congenital pathology that interferes with the normal development of the genital organs and interferes with the outflow of blood. 
• Primary or secondary menalgia or algodysmenorrhea - severe pain during the menstrual cycle. 
• Pathological inflammatory processes in the pelvic organs, passing into the acute stage. 
• Torsion of the legs of various types of cysts or appendages of the uterus. 
• Rupture of purulent or simple large cyst.
• Ovarian hyperstimulation due to hormonal drugs. 
• Interruption of ectopic, tubal pregnancy is a condition requiring emergency surgical care. 
• Uterine fibroids, which increases in size. 
• Inflammation of the endometrium, adnexitis, parametritis. 
• Necrosis of myoma tissue or its torsion is related to fibroids growing in the direction of the peritoneum (subserous formations). 
• The development of fibroids growing in the submucosal tissue in the direction of the uterus - submucous formation. 
• The threat of miscarriage in early or late terms of carrying a child. 
• Mechanical injuries of the peritoneum and the walls of the uterus (blow, fall, accident, and so on). 
• Iatrogenic injury with minor surgery, including uterine perforation during abortion - abortion. 
• Tuberculosis of the pelvic organs. 
• Spikes. 
• Accretion of the cervical canal and violation of blood outflow during menstruation - atresia. 
• The accumulation of fluid secretion in the abdominal cavity, cyst - serozotsele. 
• Intrauterine device, installed incorrectly, causing pain. 
• Varicose veins, pathological expansion of the pelvic venous system.

Also, a woman's lower abdomen hurts severely when there is diverticulitis, perforation of a stomach or intestinal ulcer, and an irreducible hernia is injured. In addition, pain in the lower abdomen may be associated with advanced cystitis, pyelonephritis in the acute stage, granulomatous enteritis (Crohn's disease), and an oncologic process.

If the lower abdomen hurts?

Regardless of who suffers from pain, man or woman, there are common signs of emergency conditions and rules of conduct in such cases.

It hurts lower abdomen, what needs to be done and what can not be done in any case.

A condition that in clinical practice is characterized as “acute abdomen” is a serious threat not only to health, but also to life, accompanied by the following symptoms and signs: 

• Acute, intolerable pain that lasts for an hour. 
• Significant increase in pain at the slightest tension or cough, when turning over or any movement. 
• Pain in the lower abdomen, which does not change its intensity with a change in posture or position of the patient. 
• If before the appearance of pain during the day there was no bowel movement, the abdomen is tense and swollen, this may indicate an acute intestinal obstruction. 
• The stomach does not just hurt much, it is tense. 
• Lower abdominal pain is accompanied by increased heart rate, sweating, pale skin, a decrease in blood pressure and even fainting, loss of consciousness. 
• If the pain is accompanied by a bowel movement, in which there are blood clots in the feces (black or uncharacteristic feces).

In any case, it is almost impossible to independently diagnose and differentiate a serious, threatening disease from others that do not require emergency care. Therefore, with severe pain, persistent for an hour, fever, weak pulse, nausea and vomiting, you need to call an ambulance.

Before the arrival of specialists, the following independent actions are allowed: 

• The patient needs - complete rest, silence, ventilated room and horizontal position. 
• You can put a cold water heater with ice, a cooled water bottle, a cold compress on the abdominal area. The cold can not be kept more than 20-25 minutes, cold compresses should be changed in order to avoid warming the abdomen. 
• Of the medicaments, let us accept a No-shpy, no more than two tablets. All other drugs can be prescribed only by a doctor after an examination and a preliminary diagnosis. 
• If there are signs of internal bleeding - fainting, bluish complexion, increased heart rate, and there is a health worker next to it, you can put an intravenous drip of sodium chloride solution.

It hurts lower abdomen, the following actions are unacceptable: 

• You cannot choose and take painkillers yourself. At a minimum, this “lubricates” the clinical picture and makes it difficult to make a correct diagnosis, as a maximum - it provokes an even greater exacerbation of the underlying disease. 
• You can not warm the stomach in order to avoid the development of extensive sepsis, let's say only cold. 
• You can not take medications from a number of laxatives, enemas are unacceptable. 
• You can not take food or drink. With a strong dry mouth, it is acceptable to wet the tongue and lips.

This is a recommendation that applies to both men and women, especially you need to be attentive to the painful symptoms in children who still do not know how to properly describe their feelings. At the slightest warning signs of malaise in a child, you should immediately seek medical help.

[3], [4]

It hurts lower abdomen during menstruation

Such pain is most common in young women, whose hormonal system has not yet stabilized. Menstruation itself is not a disease, it is a natural physiological condition that ensures the fertility of a woman. If all the organs and systems of a woman work flawlessly, then the menstrual cycle should not cause discomfort. Some pain may occur in the first two or three days of the cycle, and then pass. The lower abdomen hurts during menstruation, usually because of dissonance between different types of sex hormones - prostaglandins and progesterone. The uterus produces substances that provide its contractile function - prostaglandins. If there are too many of them, the contractions become intense, the pain increases accordingly. Also, an excess of prostaglandins can provoke headaches, nausea and even vomiting. Elevated levels of contractile hormones are characteristic of young women who have not yet given birth. If the lower abdomen hurts during menstruation in women who have given birth, this may be evidence of more serious pathologies - endometriosis, uterine fibroids, adnexitis, inflammation in the ovaries, in the fallopian tubes and many other diseases. In addition, poorly selected intrauterine device can also provoke painful sensations during menstruation. Abdominal pain may be accompanied by other signs, among which the most common are: 

• Pain radiating to the lumbar region. 
• Heaviness and pain in the legs. 
• Nausea, vomiting. 
• Impaired bowel movements, diarrhea or constipation. 
• General weakness. 
• Irritability, tearfulness, often increased aggressiveness.

Emergency medical care is necessary for pain during menstruation, if the following symptoms appear: 

• The pain becomes intense with increased bleeding. The dough is a sanitary pad that overflows in one hour. 
• In addition to pain, the woman feels fever, fever, sweating. 
• The pain is accompanied by severe aching in the joints. 
• Abdominal pain accompanied by dizziness and loss of consciousness.

[5], [6], [7]

After monthly pain in lower abdomen

This is typical for conditions caused by excessive levels of prostaglandins, which are responsible for the contractile function of the uterus. During the cycle, the uterus must contract to remove blood clots; after the cycle ends, the contractions become less active. However, if a woman’s hormonal system works with disorders, there is an imbalance of hormones in it, there may be pain even after the menstrual cycle. Often in women 30-35 years old there is an increase in estrogen production, which leads to lower abdominal pain during the cycle, which can also change and stray. As a compensatory response, the uterus begins to intensively produce prostaglandins, which continue to contract the organ even after the end of menstruation. Postmenstrual pain in the lower abdomen is often caused by stress or depression. As a result, a hard flowing cycle disrupts the functioning of the thyroid gland, which controls hormonal balance. It turns out a kind of vicious circle in which one pathological factor provokes another. In addition, after menstruation, lower abdomen often hurts because of a congenital anomaly of the uterus - underdevelopment or its wrong position. Any inflammatory process - adnexitis, salpingitis can cause long postmenstrual pain. The intrauterine device, irritating walls, uterus cavity can also interfere with normal uterine contraction. In situations where the pain after the cycle does not stop for two or three days, do not worry, it is most likely the usual physiological hormonal "jump". If, after menstruation, the lower abdomen hurts for four or more days, especially if there is a discharge and increased body temperature, you should consult a doctor to rule out a serious inflammatory process in the pelvic organs.

[8]

After ovulation lower abdomen hurts

It is also a common phenomenon in gynecological practice, women often complain of lower abdominal pain during the period of follicle maturation and uterine contraction. Surprisingly, even women who gave birth sometimes do not know what ovulation is and how the fertilization process is associated with it.

Ovulation is the period in which a ripe follicle “releases” into the abdominal cavity a single egg cell ready for fertilization. This process begins with the first menstrual cycle and gradually fades out during menopause. If a couple plans to replenish the family, then ovulation days are the most favorable days for conceiving a baby. The period of ovulation for each woman is different and depends on the length of the monthly cycle. The boundaries of the ovulation period range from 22 to 33-35 days. Ovulation is often accompanied by painful symptoms, in addition, during this period, fertility (attraction) to the opposite sex increases significantly, which is proof of the natural predisposition of these days to conceive. Pain, both during ovulation and after it, is most often of moderate intensity and is an acceptable physiological norm. Rarely, the pain becomes severe, cramping, but, as a rule, it does not last long. If the pain is interspersed from the left side to the right side, this indicates maturation of the follicle in the left and right ovary. Pain after ovulation is very rare, and if they occur, it may indicate the following conditions: 

• Exacerbation of chronic, latent inflammation in the ovaries. 
• The accomplishment of conception. 
• Pregnancy, which may be associated with some inflammatory processes in the ovaries. 
• Pathological processes in the pelvic organs, not associated with the maturation of the follicles and the release of the egg.

[9], [10], [11]

Sore lower abdomen and discharge

This is a sign of the inflammatory process, which goes into an exacerbation stage. Often, pain in the lower abdomen, accompanied by secretions of a milky color, is a symptom of a common disease - thrush or candidiasis. In fact, it is also an inflammation of the vagina, but it is usually caused by Candida albicans - specific yeast-like organisms, fungi. The reasons for which the lower abdomen hurts and the discharge becomes abundant, characteristic of its curd consistency, are very diverse. Among the most common are the following: 

• Endocrine system pathology - hyperthyroidism, hypothyroidism. 
• Diabetes mellitus, in which high blood sugar levels, respectively, and vaginal secretions. The acidity of the secretion is reduced, which creates a favorable, comfortable environment for the reproduction of Candida albicans. 
• Metabolic disorders, obesity or anorexia. 
• Long-term use of medicines - antibiotics, hormonal drugs. 
• Physiological changes in the body - menopause. 
• Long-term use of contraceptive drugs. 
• Diseases of venereal etiology.
• Infectious diseases of the pelvic organs - mycoplasmosis, chlamydia, ureaplasmosis. 
• The consequence of surgical intervention in which the body undergoes the process of adaptation. 
• The change of the climatic zone, especially often provokes pain in the lower abdomen and the release of moving to hot countries. 
• A general decrease in the protective functions of the immune system. 
• Avitaminosis.

Thrush is not a threat to the health of the disease, but its chronic course can provoke an erosive process in the cervix, which is considered to be quite a serious pathology.

It is also a sign of the inflammatory process in the appendages. Inflammation of the appendages can be manifested by painful sensations on the left or on the right side, radiating to the thigh or sacral region of the loins. Excretions in inflammation mucous, often with pus. The body temperature may rise, a feverish state occurs, which indicates an exacerbation of the process.

Also, abdominal pain can be regular, but not pronounced, the allocation of scarce, but these symptoms also can not be ignored, to prevent exacerbations and more serious problems that may require emergency surgical care.

[12], [13], [14]

Sore lower belly after sex

This is evidence of pathological processes that may be hidden in the body, but often such pains are provoked by psychogenic factors.

The lower abdomen after sex hurts - it is also a symptom of standard gynecological problems requiring diagnostics and treatment. Pain in the lower abdomen after sexual contact may indicate ruptures of an ovarian cyst, ruptures of the ovary itself, or the threat of miscarriage in the early stages of childbearing. In addition, the cause of the pain can be purely mechanical, when sexual contact was too rough, intense and provoked injury to the vaginal wall, damaged the mucous membrane of the cervix. If the lower abdomen hurts after sex and discharge with blood, urgently seek medical help, especially if the bleeding is intense.

[15], [16], [17]

Week hurts lower abdomen

This constant abdominal pain is called chronic abdominal pain. Descriptions of sensations on the part of patients are very diverse - from a burning sensation to constant pressure and severity. Quite often, the reason that a lower abdomen hurts for a whole week is an elementary eating disorder, the gastrointestinal tract is simply unable to work rhythmically in normal mode. However, often chronic, persistent pain in the lower abdomen may indicate a developing gallstone disease, pancreatitis, an inflammatory process in the large intestine. The pain can be really constant, but it can also be cramping. As a rule, if a person suffers pain in the lower abdomen for a week, the pain is rather weak and does not differ in intensity. It is important to note how pain is associated with food intake, whether it occurs before or after meals. Also, chronic abdominal pain may be a symptom of a psychosomatic illness, more associated with neurology than with gastroenterology. In clinical practice, these pains are called neurotic.

The stomach actually hurts, although there are no objective external or internal causes. This is due to the psycho-emotional factor, which may be unloved work, intense study and fear of exams, family troubles. Also the cause of persistent pain can be vegetative-vascular syndrome, which is also a neurological disease. One of the causes of chronic, recurrent pain is helminthic invasion. Chronic pains are diagnosed through a comprehensive examination, the more complete it is, the more accurate and effective the treatment will be. The standard diagnostic complex includes the following procedures: 

• Collection of anamnestic information, including family information. 
• Palpation of the abdominal area. 
• Fibroesophagogastroduodenoscopy - FGDs.
• A comprehensive clinical study of blood, including leukocyte formula. 
• Biochemical blood test, which determines the level of enzymatic activity of the liver, pancreas. 
• Ultrasound examination of the abdominal cavity. 
• Analysis for the determination of helminthic invasion, coprogram.

If lower abdomen hurts

However, there are conditions that require immediate medical care, it is all strong pain, persistent for an hour.

Severe pain in the lower abdomen is one of the most typical symptoms shown in gastroenterological and gynecological practice. The stomach hurts most often intensively, since there are thousands of nerve endings and pain receptors in the gastrointestinal tract. The nature of the pain can be different: pulling, sharp, aching, cutting and so on. The pain symptom in the abdominal area is not specific, since many diseases are accompanied by painful sensations.

Women have lower abdominal pain during the menstrual cycle; in men, lower abdominal pain can be a sign of urological pathology.

One of the main reasons that cause severe pain in women in the absence of signs of pregnancy are the following: 

• Ectopic pregnancy, in which the egg does not reach the uterus and begins to implant in the fallopian tube. Signs of pregnancy may be absent, but after three to four weeks, the egg begins to grow and destroy the tissue of the fallopian tube. This process is accompanied by severe pain, nausea, dizziness before losing consciousness. Such a condition requires immediate surgical intervention. 
• Apoplexy, ovarian rupture. The rupture can be caused by injury, intense physical exertion or sexual contact. Symptoms are very similar to signs of ectopic, tubal pregnancy. The pain may radiate to the lumbar region, accompanied by vomiting, weakness and loss of consciousness. The treatment is urgent, surgical. 
• Torsion and violation of the outflow of blood through the veins in the leg of an ovarian cyst. The cyst begins to grow rapidly, puts pressure on nearby organs, often merging with them. Abdominal pain is aching, quite strong, but transient and recurrent. Surgical treatment. 
• Inflammation of the appendages, which happens quite often after an abortive abortion, after childbirth. The pain is diffuse, strong, intermittent. If you do not make a timely diagnosis, the spread of infection can lead to peritonitis. In the acute stage, adnexitis produces severe pain in the lower abdomen with irradiation to the groin. The temperature is elevated, the abdominal muscles are very tense. Treatment in the initial stage of development of adnexitis medical, conservative, in the acute stage with the threat of peritonitis, surgical intervention is possible.

In addition, the lower abdomen hurts when ureaplasmosis, pathological diseases of the urinary system. In men, acute pain in the lower abdomen is a typical sign of inflammation of the urethra, the acute stage of prostatitis, hernia incarceration.

All conditions associated with severe pain require immediate medical attention.

[18]

Sore back and lower abdomen

This is a description of the so-called pelvic pains. Pelvic pain is considered all the pain in the lower abdominal part, accompanied by pain in the sacrum, lumbar region. Often such pains in men give (irradiate) to the rectum or vagina in women. The lower back and lower abdomen hurts - it is a nonspecific symptom that may indicate various diseases, both gynecological, proctological, and vascular or urological. By the nature of the pain is also different, they can be acute or chronic, prolonged.

Acute back pain is a sudden pain that lasts two to three hours, combined with fever, nausea, weakness and fever. So often acute conditions that require immediate surgical care manifest themselves - appendix inflammation, intestinal acute obstruction, an attack of cholecystitis, rupture of an ovarian cyst, purulent inflammation of the urethra, pyelonephritis and other diseases.

Chronic, prolonged pelvic pain is a recurring discomfort, sometimes lasting for months. Such pains indicate a developing latent pathology that does not yet manifest itself.

[19], [20]

Sore back and lower abdomen - causes and types of diseases

Gynecological causes:

• Endometriosis, which can take various forms: 
• Imbalance of the hormonal system, the disruption of the normal anatomical structure of the uterus, compaction of the walls and tissue deformation. 
• Vulvodynia (vaginal pain) caused by endometriosis. 
• Inflammatory process in the pelvic organs caused by endometriosis. 
• Neoplasms (uterus, ovaries) - benign and malignant.
• The omission of the walls of the vagina and uterus or the vet (prolapse of the pelvic organs).

Urological causes: 

• Interstitial cystitis is a disease of unknown etiology when bacterial studies do not identify the pathogen of the inflammatory process. 
• Infectious inflammation of the urinary tract. 
• Urolithiasis or urolithiasis. 
• Bladder cancer.
• Adhesive causes that often accompany surgery, as well as adhesive disease can develop and cause back pain as a result of a closed injury.

Proctological causes: 

• Hemorrhoids, which is manifested by chronic pelvic pain. 
• Inflammation of the mucous tissue of the rectum - proctitis. 
• Intestinal tumor.

Neurological causes: 

• IBS - irritable bowel syndrome. 
• Radiculopathy - inflammation of the spinal cord of the spinal cord or its infringement (sciatica). 
• Hernia, osteochondrosis or prolapse (prolapse) of the intervertebral disk.

Vascular causes: 

• VRVMT - varicose venous system of the small pelvis. 
• Pelvic varicose veins - an increase in the length of the pelvic veins, their expansion.

Musculoskeletal causes: 

• Inflammatory processes in the joints. 
• Fibromyalgia is a muscle spasm that causes lower back pain.

Gastrointestinal causes: 

• Colitis 
• Retroperitoneal cancer process, tumors. 
• Intestinal obstruction.

Psychogenic causes - depressive disorders, violence, neurotic fear of sexual contact.

[21], [22], [23], [24], [25], [26]

Sore lower abdomen to the left

The lower abdomen can be divided into quadrants - right side, umbilical, left side, right and left inguinal area and pubic part. Localization of pain in a particular area is one of the important diagnostic symptoms that help to identify the cause of pain.

The lower abdominal pain on the left is a signal of possible problems in the organs located in this abdominal part: in the left part of the intestine, in the left kidney, in the internal reproductive organs. Also, pain in the left abdomen can be non-specific and identical in the diagnostic sense with pain in the right abdominal region, with the exception of inflammation of the appendix. If the lower abdomen is painful on the left, this may mean that the sigmoid colon has become inflamed, or urolithiasis, adnexitis or diverticulitis develops. In connection with the non-specificity of the left-sided pain symptom, the diagnosis includes a full examination of the abdominal organs, regardless of their location, on the right or on the left. A comprehensive study allows timely detection of diverticulitis, which is also called left-sided appendicitis. If this disease is not diagnosed on time, especially in elderly patients, it can lead to perforation of the lower part of the large intestine (sigmoid), which is an indication for urgent surgical intervention. Also, pain in the left quadrant of the abdomen can also manifest tubal pregnancy, besides, an ingress of inguinal hernia signals this way about itself. One of the causes of left-sided pain can be ulcerative colitis, granulomatous enteritis (Crohn's disease or terminal ileitis), and worm infestation. Often the kidney calculus, which is located in the left kidney, passing the path to the bladder, also causes severe pain in the left side of the peritoneum.

[27]

Sore lower right

Explicit localization of pain, in a sense, is a plus for diagnosing the disease, while diffuse (widespread) pain in the lower abdomen makes it difficult to make a diagnosis because of its non-specificity. The first thing that comes to mind with right-side abdominal pain is inflammation of the appendix. Indeed, the right-sided localization of painful sensations is a specific manifestation of appendicitis, but the lower abdomen hurts in the right way with other diseases. For example, an inflamed ureter or an attack of cholecystitis, an inflammation of the liver, or an acute stage of pyelonephritis can also be "responded" by right-sided painful sensations. It may also signal its development Crohn's disease - a complex inflammatory disease of unknown etiology. Terminal ileitis, also called Crohn's disease, is a pathological lesion of the walls of the entire digestive tract, starting from the iliac region, where the first symptoms appear. However, when ileitis develops, symptoms may move down the peritoneum. In addition, cystitis or urolithiasis, right ulcerative colitis, herpetic lesions of the intestinal walls can signal and manifest pain, localized in the lower right abdomen.

Since the abdomen is a container of a variety of organs and systems, right-sided pain may indicate an inflammatory process, pathology or a chronic course of the disease of the following organs located exactly in this part of the peritoneum: 

• Worm-like area of the cecum or appendix, inflammation of which is most often manifested by pain in the right side of the abdomen - the upper or lower quadrant. 
• Most of the intestinal tract, zones of which are often subjected to inflammation, including infectious nature, obstruction, and oncological process in the intestine is also possible. 
• In the right lower quadrant is the right ureter, which can be inflamed and manifest right-sided pain. 
• The right fallopian tube, which by the anatomical structure is slightly longer than the left. In the tube, inflammation may develop - salpingitis, endometrial polyp.

[28]

Sore lower stomach and fever

This is a signal that the pathological process in the peritoneal organs is already entering an acute stage. Hyperthermia is a characteristic symptom of an acute inflammatory disease, but this symptom often manifests itself at the stage when urgent medical care is needed. Even with gangrenous appendicitis, the patient may have a relatively low body temperature, and during perforation, it may even decrease. Also, hyperthermia itself cannot be a specific symptom of a viral or bacterial infection. Many severe ulcerative processes are not always accompanied by significant temperature fluctuations, for example, a perforated ulcer is often only painful in the first few hours.

Appendicitis, inflammation in the gallbladder (cholecystitis), diverticulitis, dysentery, adnexitis and pyelonephritis, many other diseases may be accompanied by painful sensations and slight hyperthermia. This applies to urological pathologies, gynecological and proctologic diseases, and even venereal diseases, since, for example, gonorrhea is also sometimes manifested by abdominal pain and hyperthermia. The combination of "low abdominal pain and temperature" in clinical practice is considered a serious signal of the acute period of the disease, and a high temperature that exceeds 38-39C is clear evidence of an septic lesion of the body, which can be caused by apoplexy of the ovarian cyst, rupture of the abdominal aorta, spleen infarction, peritonitis, rupture of the fallopian tube, infectious diseases of the kidneys or gall bladder. Both too high borderline temperatures and low temperatures — hypothermia — are bad signs in the prognostic sense. All conditions in the symptoms of which there is pain in the lower abdomen and temperature require medical help, and if the thermometer shows 34-35 or 38-40C, you need to call an ambulance, as this is a clear sign of sepsis and internal bleeding.

[29], [30], [31]

Chronic lower abdominal pain

Chronic lower abdominal pain is a persistent pain that remains the main complaint that disrupts the ability to work for six months or more. The correlation between the severity of pain and the severity of abdominal pathology is usually insignificant. Chronic abdominal pain is often accompanied by mental disorders such as depression and sleep disorders. Chronic pain in the abdomen, not associated with diseases, most often occurs in women who have been sexually abused. There are also statistics that a third of women who underwent laparoscopy for chronic pain, could not find out the cause of the disease, which indicates the psychogenic cause of acute pain. 10-20% of hysterectomy in the United States annually conduct about chronic lower abdominal pain, provoked by purely mental factors. Hysterectomy is highly effective in reducing the severity of pain syndromes associated with a subconscious protest against sexual contact. This reduces sexual dysfunction, reduces the level of psychogenia and improves the quality of life for a woman, even if there is no pathology on the part of the uterus. There is no data on the conduct of hysterectomy for psychogenic pains in our countries, it is obvious that such operations are not in demand and necessary for our women so far. The pain may also be the result of a latent inflammatory process, infectious diseases such as chlamydia or mycoplasmosis. Any discomfort associated with sexual relations should be eliminated, perhaps not in such a radical way as practiced in the United States. Modern gynecology has more effective means to help identify the true cause of pain after sex and effectively eliminate it.

[32], [33], [34], [35], [36]

Chronic lower abdominal pain due to gynecological problems

Dysmenorrhea is the most common cause of chronic pain. Dysmenorrhea is a pain in the uterus that is cyclical in nature that occurs before or during menstruation. Primary dysmenorrhea is not believed to be associated with pathology of the pelvic organs, but with hyperproduction of prostaglandins in the uterus. Secondary dysmenorrhea is usually associated with the presence of acquired pathology (for example, endometriosis).

Endometriosis. The severity of pain in this disease varies from dysmenorrhea to intense non-inhibited chronic pain resulting in disability. The intensity of pain does not correlate with the severity of the pathology.

Adenomyosis is a common condition, most women are asymptomatic. Adenomyosis is characterized by an enlarged, softened uterus, slightly painful on palpation. However, adenomyosis is considered a pathological condition.

Fibromyoma is the most common benign tumor of the pelvic cavity in women. Fibromyoma pain is caused either by compression of adjacent organs, or by degenerative processes that occur in the tumor.

Preserved ovarian syndrome is characterized by recurrent pain in the uterine appendages after hysterectomy.

The prolapse of the genitals may be accompanied by a feeling of heaviness, pressure or dull pain.

Chronic inflammatory diseases of the pelvic organs are characterized by prolonged pain, usually due to the presence of hydrosalpinx, tubo-ovarian cyst or adhesions in the pelvic cavity.

[37], [38], [39], [40], [41], [42]

Chronic lower abdominal pain due to non-gynecological diseases

Adhesions after infections or surgeries can cause chronic abdominal pain, difficult to treat.

Pathology of the digestive tract, such as inflammatory diseases of the colon ( Crohn's disease,, ulcerative colitis ), irritable bowel syndrome, constipation, fecal blockages, may be accompanied by painful manifestations. Abdominal pain may worsen in the perimenstrual period.

Diseases of the musculoskeletal system, such as abnormal posture, muscle sprain and hernia between vertebral discs, can cause reflected pain.

[43], [44]

Acute pain in the lower abdomen

If you have acute pain in the lower abdomen, an active tactic is needed, as a life-threatening condition is possible.

[45], [46]

Abdominal pain as a result of gynecological diseases

Acute pain in the lower abdomen is divided into three categories: infections, tears and torsions.

Ectopic pregnancy. All women of reproductive age in the examination for acute pain in the lower abdomen first of all it is necessary to exclude the interrupted ectopic pregnancy

Acute inflammatory diseases of the pelvic organs - ascending bacterial infections, which are usually accompanied by the following symptoms: fever, pain in the lower abdomen and pain during movements of the cervix; more often occur in women who are sexually active.

Rupture ovarian cysts. Acute pain in the lower abdomen most often occurs in the following conditions: intra-abdominal tears of a follicular cyst, corpus luteum or endometrioma. Pain in the lower abdomen can be so acute and intense that it is sometimes accompanied by loss of consciousness. The condition usually tends to be self-limiting with stopping bleeding.

appendages usually occurs in adolescents and women of reproductive age. Twisting on the vascular pedicle, any volume formation of the uterus appendages (dermoid ovarian tumor, Morgagni hydatid) can cause acute, severe pain in the lower abdomen due to a sudden blood supply disorder. Often, in these conditions, pain in the lower abdomen either increases or decreases and is accompanied by nausea and vomiting.

Threatening, incomplete abortion and abortion in the course are often accompanied by painful sensations along the median line, usually spastic, of a periodic nature.

Disintegrating fibroids or ovarian tumors can cause piercing, cutting, or aching pain.

[47], [48]

Abdominal pain as a result of non-gynecological diseases

Appendicitis is the most frequent acute surgical pathology of the abdominal organs that occurs in all age groups. In classical cases, diffuse pain first occurs with the epicenter in the umbilical region, but then, after a few hours, the pain is localized in the right iliac region (McBarny point). Appendicitis is often accompanied by low fever, anorexia and leukocytosis.

Diverticulosis often develops in older women. The disease is characterized by pain in the left lower abdomen, bloody diarrhea, fever and leukocytosis.

Diseases of the urinary system (cystitis, pyelonephritis, urolithiasis) can cause acute or irradiating pain over the pubis, a feeling of pressure and / or dysuria.

Mesadenitis often occurs in girls after acute respiratory infection. Abdominal pain is usually more diffuse and less acute than appendicitis.

[49], [50], [51], [52]

It hurts lower abdomen: what to do?

When collecting history, find out the nature, intensity and prevalence of pain in the lower abdomen. However, for abnormal intra-abdominal processes is characterized by indefinite localization of pain

Physical examination should include a full gynecological examination. In this case, special attention should be paid to the reproduction of pain symptoms.

Bacteriological tests, biochemical analysis of blood, determination of electrolyte concentration, ultrasound or other imaging tests may be indicated.

Specialized diagnostic examinations are carried out taking into account the presumptive diagnosis, and other specialists (anesthesiologist, orthopedist, neurologist or gastroenterologist) may be required.

The action algorithm for painful sensations depends on the organic or physiological variety of causes. A physiological factor, such as the menstrual cycle, involves taking antispasmodics and monitoring by a physician in order to find appropriate ways that reduce pain as much as possible. The causes of organic nature suggest either outpatient conservative treatment or emergency surgery if the disease has gone too far. Orientation in the possible causes and actions when the stomach hurts, this table will help:

Description of lower abdominal pain	List of possible causes	Actions
Acute, sharp pain, nausea to vomiting.	Intestinal infection, Intoxication, Inflammation of the vermiform part of the cecum - appendix, Intestinal obstruction.	Emergency call.
Acute pain in right side, radiating up	Attack of cholecystitis, fit of biliary colic.	Call a doctor if the temperature rises to 38-39C, call an ambulance.
Acute pain radiating to the groin, vagina.	Renal colic.	Call an ambulance.
Increasing pain on the right or upper right quadrant.	Acute inflammation of the appendix.	Call a doctor or emergency room.
Severe pain in the lower abdomen, transient and subsiding after urination.	Inflammation of the ureter.	Call a doctor or visit a urologist on your own. Strict diet, the exclusion of physical activity.
Acute common pain subsiding after stool (often after diarrhea).	IBS - irritable bowel syndrome.	Independent visit to the gastroenterologist. Diet, the exclusion of physical activity.
Pain on the right or left, accompanied by diarrhea with blood clots.	Colitis (ulcerative), Crohn's disease.	Rest, diet, call a doctor at home.
Severe pain in the left lower abdomen, increase or decrease in body temperature, drop in blood pressure.	Possible thromboembolism (heart attack) of the spleen, rupture of the capsule of the spleen, attack of renal colic.	Reception No-shpy. Urgent emergency call.
Aching, chronic pain on the right or on the left.	Cholecystitis, Right-sided inflammation of the renal pelvis, left-sided pyelonephritis, Concrements, sand in the kidneys.	Independent visit to the doctor.
Pulling in the bottom of pain, dull right-sided or left-sided pain.	Salpingitis, Inflammation of the fallopian tubes, Inflammatory process in the ovaries - salpingo-orphitis, Inflammatory process in the bladder - cystitis, Urethritis (in men), Prostatitis (in men), Vesiculitis - inflammatory process in the seminal vesicles.	An independent visit to the doctor, a full examination.
Chronic pain in the lower abdomen and lower back.	Inflammation of the pelvis, kidney tissue (pyelonephritis), including purulent, Oncoprocess in the kidneys, Concrements in the kidneys, Varicose veins of the pelvic organs, Tumors of the pelvic organs, Adenoma (in men).	Self-referral to a doctor, full diagnostic complex, examination of the body.

Pain in the lower abdomen is easiest to eliminate in the first hours of its manifestation, however, there are not too many indications for independent action. The abdominal organs are very vulnerable and sensitive to various influences, both thermal and medicamental. An inept step, such as a hot water bottle on the abdomen, can trigger peritonitis and sepsis, so the first rule for abdominal pain is observation for an hour. If the pain does not subside, but increases, the temperature rises, nausea, vomiting, weakness appear, you should not hesitate, but call an ambulance.

[53]