Lower abdominal pain in women

Health and Nutrition > Diseases > A Reviewed by Dr Philip Owen, consultant obstetrician and gynaecologist

What causes lower abdominal or pelvic pain?

All women feel discomfort or pain in the lower abdomen below the navel from time to time, for instance, before or during menstruation.

In many cases it can be difficult to identify the cause of the pain, but noting certain features will help you and your doctor come to a likely diagnosis.

The most common causes are a urinary disorder such as a bladder or kidney problem, a bowel problem or a condition involving the reproductive system - the uterus, Fallopian tubes and ovaries.

Type of pain arising from the urinary system

Pain from the urinary system can indicate such conditions as cystitis (inflammation of the bladder), inflammation of the collecting system of one or both kidneys (pyelonephritis), kidney stones or uncommonly tumours.

Typical symptoms of infections are a burning sensation when passing urine and a need to empty the bladder more frequently. In addition, pain travelling from the back and around to the front might suggest a kidney infection or kidney stone.

The pain associated with kidney stones may be particularly severe. The presence of blood in the urine raises the possibilities of infection, kidney or bladder stones or even a bladder or kidney tumour. Both benign and malignant tumours can first make themselves noticed in this way. The presence of blood in the urine always requires further investigation and should be reported to your doctor.

The duration of the pain will further help you and your doctor to make the correct diagnosis.

Type of pain arising from conditions of the intestines

The bowel can give rise to a wide variety of symptoms including pain.

Constipation and diarrhoea can be painful in themselves, and the change in bowel habit usually identifies the pain as coming from the bowel. Pain from the bowel is often described as colicky in nature. This means that the pain or discomfort comes in waves with little or no discomfort in between the pain.

Bloating or swelling of the lower abdomen may be present in many intestinal (bowel) conditions including irritable bowel syndrome.

The passing of fresh blood or altered blood (black motions) from the back passage should be reported to your doctor as investigation is usually necessary.

Type of pain arising from conditions of the reproductive organs

Pain might originate from the uterus (womb), Fallopian tubes or ovaries. It is usually felt in the middle of the lower abdomen, above the line of pubic hair as far up as the navel. Occasionally, the pain is more to one side, which is more typical of a pain coming from an ovary.

There might be discomfort or even pain during intercourse (called dyspareunia) felt deep within the pelvis.

Pain originating from the uterus is usually worse at the time of a woman's period (dysmenorrhoea).

Examples of conditions of the reproductive organs giving rise to pain include endometriosis, pelvic inflammatory disease, ovarian cysts, fibroids and problems related to the early stages of pregnancy such as miscarriage and ectopic pregnancy.

In any case of sudden, severe, unexplained abdominal pain your doctor should be contacted.

What will the doctor do?

. Acute and sudden pains are always worrying but chronic pain can also have serious implications and a doctor should be consulted.

The doctor will ask about periods, passing of urine and bowel movements. They might also ask if there have been episodes of nausea, vomiting, or fever. If appropriate, they may ask questions concerning the person's emotional life - family, friends, work - and their sex life.

The doctor will want to examine you. This will involve feeling your abdomen and, in addition, an internal examination (vaginal,rectal or sometimes both) may be necessary.

Further investigations or treatment will be based upon the description of the pain and the findings of the doctor's examination.

Typically, a urine sample will be requested and tested for any signs of infection.

If a kidney problem is suspected than an ultrasound scan of the kidneys and bladder will be arranged.

If a problem with the womb or ovaries is suspected, swabs from the vagina looking for any infection might be performed and an ultrasound scan of the womb and ovaries is commonly performed.

If a bowel problem is suspected, a sample of the motion is often investigated for signs of infection and you may be recommended to have a telescopic examination of the bowel called an endoscopy.

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