Lower Abdominal Pain: Causes and When to Worry

What counts as lower abdominal pain

The lower abdomen contains the end of the small intestine, the appendix, the colon and rectum, the bladder and ureters, and in women the uterus, fallopian tubes and ovaries. Doctors divide the abdomen into areas: the right lower quadrant, the left lower quadrant, and the central suprapubic area above the pubic bone.

The type of pain also gives clues:

• Crampy, coming in waves: gut spasm, gas, constipation, period cramps or a kidney stone
• Constant and worsening: inflammation such as appendicitis or diverticulitis
• Sharp and sudden: a ruptured cyst, ovarian torsion or ectopic pregnancy
• Burning with urination: urinary tract infection

Lower right abdominal pain

Lower left abdominal pain

Central lower abdominal (suprapubic) pain

• Bladder infection: burning, frequent urination, urgency, cloudy urine. See urinary tract infection.
• Period cramps: start just before or at the start of the period.
• Urinary retention: a full, painful bladder and inability to pass urine, more common in older men.
• Pelvic inflammatory disease: pain on both sides, fever, abnormal discharge.
• Interstitial cystitis: chronic bladder pain with frequency.

Lower abdominal pain in women

The reproductive organs add several possible causes:

• Period pain (dysmenorrhea): cramping that starts with the period and lasts 1 to 3 days.
• Ovulation pain (mittelschmerz): a one-sided twinge midway through the cycle lasting hours.
• Ovarian cysts: dull ache or sudden sharp pain if one bursts.
• Ovarian torsion: sudden, severe one-sided pain with vomiting; a surgical emergency.
• Ectopic pregnancy: a pregnancy growing outside the womb, usually 5 to 10 weeks after the last period. Can cause life-threatening bleeding.
• Miscarriage: cramping with bleeding in early pregnancy.
• Endometriosis: pain with periods, sex and bowel movements that worsens over years.
• Fibroids: pressure, heavy periods and sometimes pain.
• Pelvic inflammatory disease: often from chlamydia or gonorrhea.

Anyone who could be pregnant and has lower abdominal pain should take a pregnancy test.

Lower abdominal pain in men

• Inguinal hernia: a groin bulge with discomfort on lifting or straining.
• Testicular torsion: sudden severe testicle pain that can spread to the lower belly; an emergency.
• Prostatitis: pain in the lower belly, perineum or back with urinary symptoms and sometimes fever.
• Urinary retention: from an enlarged prostate.
• Bladder infection: less common in men, so needs medical review.

Other common causes in anyone

• Gas and bloating
• Constipation
• Irritable bowel syndrome: recurrent pain linked to bowel movements, with diarrhea, constipation or both
• Gastroenteritis: cramping with diarrhea and vomiting
• Kidney stones
• Muscle strain of the abdominal wall
• Shingles: a burning one-sided pain before a rash appears

How doctors find the cause

Your doctor will ask where the pain started and where it is now, when it began, its character, and about bowel habits, urinary symptoms, periods, sexual health and pregnancy possibility. They will examine your abdomen for tenderness, guarding and hernias, and may do a pelvic or rectal exam.

Common tests:

• urine test for infection and blood
• pregnancy test
• blood tests: blood count, inflammation markers, kidney function
• swabs for sexually transmitted infections
• pelvic or abdominal ultrasound: first choice in women and children
• CT scan: for suspected appendicitis, diverticulitis or kidney stones in adults

Relief and treatment

Home care for mild pain

• Rest and apply a heating pad or hot water bottle.
• Sip water and eat light, plain food.
• For gas, walk around, and avoid fizzy drinks and beans for a day.
• For period pain, ibuprofen or naproxen work well, following the label dose.
• Acetaminophen (paracetamol) is a good option for general pain.

Avoid strong painkillers before a doctor has assessed severe or unexplained pain, and avoid laxatives if you might have a bowel obstruction.

Medical treatment

• UTIs and pelvic infections: antibiotics.
• Appendicitis: usually surgery to remove the appendix; some mild cases are treated with antibiotics.
• Diverticulitis: rest, fluids, and antibiotics for complicated cases.
• Ectopic pregnancy: medicine or surgery.
• Kidney stones: pain relief, fluids, and procedures for large stones.
• IBS: diet changes, fiber, antispasmodics and gut-brain therapies.

Frequently asked questions

What causes lower abdominal pain?

The most common causes are gas, constipation, period cramps, urinary tract infections, irritable bowel syndrome and gastroenteritis. More serious causes include appendicitis, diverticulitis, ectopic pregnancy, ovarian torsion, kidney stones and pelvic inflammatory disease.

When should I worry about lower abdominal pain?

Seek urgent care for severe or worsening pain, pain with fever, vomiting, blood in stool or urine, a rigid belly, fainting, or pain in early pregnancy. Pain that moves to the lower right side over several hours may be appendicitis.

What does lower right abdominal pain mean?

It may be appendicitis, especially if it started near the belly button and moved down to the right. Other causes include ovarian cysts, ectopic pregnancy, kidney stones, hernias, Crohn's disease, and gas or constipation. Worsening pain needs prompt assessment.

What causes lower abdominal pain in women?

Common causes are period cramps, ovulation pain, urinary tract infections, ovarian cysts and endometriosis. Serious causes include ectopic pregnancy, ovarian torsion and pelvic inflammatory disease. Any woman who could be pregnant should take a pregnancy test.

Can stress cause lower abdominal pain?

Yes. Stress affects the gut-brain connection and can trigger cramping, bloating and changes in bowel habit, particularly in irritable bowel syndrome. Stress-related pain should not come with fever, weight loss or bleeding, which need medical review.

How long should lower abdominal pain last before seeing a doctor?

See a doctor if mild pain lasts more than a few days, keeps coming back, or comes with changes in bowel habit, urinary symptoms or weight loss. Severe pain, or pain with fever, vomiting or bleeding, should be seen the same day.