Pain in the lower abdomen in women is an unpleasant sensation that often signals a harmful effect on the genital organs, their damage, or the occurrence of a condition dangerous to health. They can occur even in the absence of traumatic factors. However, discomfort affects the psycho-emotional sphere of a person’s life and limits his mobility.
According to the World Health Organization, many diseases are accompanied by this symptom. Therefore, if women experience pain in the lower abdomen, they should make an appointment with a doctor. He will correctly determine the reason for their appearance. To do this, you will undergo an examination and a comprehensive examination, which may include laboratory, visual, endoscopic and other diagnostic methods. Based on the results obtained and medical history, the doctor decides on treatment tactics - conservative and/or surgical.
Lower abdominal pain. Causes: gynecological diseases
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Pain in the lower abdomen during menstruation
Dysmenorrhea is one of the most common pathologies that causes pain in the lower abdomen. Dysmenorrhea can be a primary cause, or secondary when diseases of the female genital organs already exist.
In severe cases of dysmenorrhea, in addition to abdominal pain, vegetative symptoms appear, such as:
- nausea;
- vomit;
- headache;
- general weakness;
- nervousness.
Endometriosis is a cause of pain in the lower abdomen
Endometriosis is a disease characterized by the appearance of the lining of the uterus outside the organ itself. The mucous membrane grows and undergoes the same changes as the uterine mucosa during the menstrual cycle.
Endometriosis
Monthly bleeding of endometriotic tissue very often causes pain in the lower abdomen. Abdominal pain usually begins a few days before the start of menstruation.
Other symptoms of endometriosis include:
- painful sexual intercourse;
- lack of pregnancy (infertility);
- dysmenorrhea.
Why does my lower abdomen hurt?
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In most clinical cases, the manifestation of pain in the lower abdomen is a consequence of impaired functioning of the urinary and digestive organs. But there are other serious diseases that manifest themselves with similar symptoms. Regardless of gender, doctors identify the following causes of such pain in women and men:
- Appendicitis. Sharp pain appears in the right iliac region. If the internal organs are abnormally located, the syndrome may also appear on the left side. If the cause of discomfort is appendicitis, a person, in addition to abdominal pain, experiences high fever, nausea and vomiting. If a patient is diagnosed with chronic appendicitis, the pain in the lower abdomen will not be sharp, but weak, often aching.
- Diverticulitis . When a protrusion perforates on the wall of the sigmoid colon, pain appears similar to the sensations of appendicitis. But with diverticulitis, pain spreads to the entire lower abdomen.
- Inflammation of the bladder mucosa . This pathology is characterized by a gradual increase in pain: a person is bothered by a stabbing sensation in the lower abdomen. Against the background of the pathology, high temperature and frequent urination appear.
- Acute urinary retention . The pathology is characterized by the appearance of a mechanical obstruction to the outflow of urine: stones in the bladder or neoplasms in the urinary system. Sharp pain is clearly localized 2 fingers below the navel. A person feels a full bladder well, but when going to the toilet, urine does not come out of it. The condition requires immediate medical attention, as there is a possibility of rupture of this organ.
- Cystitis. The clinical picture of this disease is characterized by localization of pain over the pubic region, its nature is usually acute, and the syndrome can radiate to other areas of the abdomen.
- Chronic urethritis. Discomfort in this case is described as increasing, but not severe.
- Inguinal hernia strangulation. The pain syndrome in this case develops quickly, usually after unusual physical activity of a person - lifting an object that is too heavy, performing exercises without prior preparation, etc. The pain syndrome is quite sharp, but at the same time its location is blurred, so the patient cannot always accurately point to the location of the pain. The strangulation is accompanied by diarrhea, which after a few hours turns into vomiting.
- Inflammatory kidney damage . Against the background of severe pain in the lower abdomen, a person develops an elevated temperature, chills, and may develop a fever.
- Acute intestinal obstruction . The pain appears suddenly, the patient suffers from constipation and increased gas formation, in which the gases do not pass away and cause intestinal colic, and weakness develops.
- Irritable bowel syndrome. This is a chronic disease in which a person is often bothered by pain in the lower abdomen, bowel behavior disorders (unreasonable diarrhea or constipation) and flatulence.
- Colon pathologies of inflammatory nature: ulcerative colitis, Crohn's disease. The nature of the pain in this case is pronounced, appears against the background of elevated temperature, and is often accompanied by disruption of the gastrointestinal tract.
- Adhesive disease . This condition develops after operations in the peritoneum or pelvis. Pain in the lower abdomen becomes chronic and difficult to treat.
- Malignant tumors in the urinary system , intestines or abdominal area. Pain is an indicator of the transition of the disease to a severe stage. The syndrome can also spread to those areas where metastases appear - groin, lower back, spine, etc.
The causes of this symptom can be various diseases associated with damage to many organs and systems. In addition to the listed pathologies, metabolic, hormonal, mental and many other disorders in the body can be a provoking factor for pain. Therefore, if such a pain syndrome occurs, it is recommended to consult a specialist and undergo a comprehensive diagnosis.
Inflammatory diseases of the pelvic organs
Pelvic inflammatory processes can be caused by numerous pathogenic microorganisms: bacteria, viruses, protozoa or fungi.
The main symptoms of inflammation of the female genital organs include:
- stomach ache;
- slight bleeding from the uterus and vagina;
- soreness of the uterus upon independent palpation of the abdomen.
When there is inflammation of the appendages on the right side, the pain that appears must be differentiated from acute inflammation of the appendix.
Treatment
Help before diagnosis
For abdominal pain associated with menstruation, non-drug methods are sufficient. Herbal teas with chamomile and mint are effective. You can put a warm (not hot!) heating pad on your lower abdomen and lie with it in the “fetal position”, pulling your knees towards your body. To reduce menstrual cramps, it is advisable to give up strong tea and coffee, spicy and smoked foods. A woman’s psychological mood, the ability to calm down and relax are very important.
For minor pain that occurs in pregnant women, doctors recommend avoiding physical activity and heavy lifting and getting plenty of rest. It is necessary to exclude from the diet foods that increase gas formation, since flatulence is one of the main causes of abdominal pain during gestation. If pain intensifies, protective tension in the abdominal muscles appears, and bloody discharge from the vagina occurs, you should seek medical help as soon as possible.
Conservative therapy
Treatment of women experiencing pain in the lower abdomen should be etiopathogenetic, so drugs are prescribed only after identifying the root causes of the pain syndrome. Drug therapy is supplemented with a gentle regimen, if indicated - bed or half-bed, a fortified diet with an adequate amount of fluid. Treatment regimens may include the following groups of medications:
- Painkillers
. Taking antispasmodics and analgesics is effective for all types of inflammatory diseases of the genitourinary system and algomenorrhea, accompanied by severe pain. Non-steroidal anti-inflammatory drugs are also used for inflammation. - Antibacterial drugs
. Antibiotics are indicated for adnexitis, endometritis, cystitis, intestinal infections, etc. More often drugs from the group of cephalosporins, fluoroquinolones, and macrolides are used. For uncomplicated urinary tract infections, uroseptics are appropriate. - Hormones
. For the treatment of severe algomenorrhea, combined oral contraceptives or natural progestins are recommended. A similar treatment regimen is selected for women suffering from endometriosis. - Sedatives
. Medicines are effective for chronic pelvic pain, algomenorrhea, especially if they are combined with severe neuropsychic symptoms.
Surgery
A number of obstetric pathologies require urgent surgical intervention. In case of an ectopic pregnancy, an operation is performed to remove the fallopian tube along with the fertilized egg (tubectomy), and in case of an uncomplicated pregnancy, an organ-preserving operation - tubotomy - is possible. Complete premature placental abruption is an indication for cesarean section, regardless of gestational age.
Gynecological diseases (ovarian apoplexy and torsion of the tumor stalk) are treated surgically by oophorectomy, adnexectomy, wedge resection of the ovary. In severe forms of endometriosis, endometrioid lesions are excised. Surgical treatment is also required for abdominal pathologies: appendicitis (appendectomy), hernias (hernioplasty).
Abdominal pain during pregnancy
An ectopic pregnancy is a pregnancy in which implantation of the embryo occurs outside the body of the uterus. The most common site of ectopic pregnancy is the fallopian (uterine) tube.
Risk factors for ectopic pregnancy include: in vitro fertilization, pelvic inflammatory disease and gynecological surgery.
To diagnose it, the level of human chorionic gonadotropin (hCG) is determined, ultrasound examination and laparoscopy are performed.
The main symptoms of an ectopic pregnancy include:
- delayed menstrual bleeding;
- irregular discharge mixed with blood from the uterus;
- severe pain in the abdominal cavity.
Types of ectopic pregnancies
Diagnostics
Establishing the root cause of pain in the lower abdomen in women is difficult even for an experienced doctor, since it is necessary to differentiate diseases of the reproductive, digestive, and urinary systems. The patient is examined by an obstetrician-gynecologist and a gastroenterologist, and other specialists are involved if necessary. The diagnostic plan includes laboratory and instrumental methods:
- Examination on the chair.
In a classic two-manual examination, the doctor assesses the size and consistency of the uterus, and identifies tenderness or enlargement of its appendages. A vaginal examination using speculum is needed to examine the mucous membrane of the vagina, cervix, and determine prolapse of the internal reproductive organs in women. - Ultrasonography.
An ultrasound scan examines the condition of the uterus and appendages, detecting signs of pregnancy, space-occupying formations, and an inflammatory process. Abdominal sonography is necessary to exclude appendicitis and pathology of the distal intestine. An ultrasound of the bladder is performed after preliminary preparation. - Endoscopic methods.
Hysteroscopy is necessary to examine the uterine cavity, find benign and malignant neoplasms, and chronic inflammation. In case of possible Crohn's disease or UC, the gastroenterologist prescribes a colonoscopy, which, if indicated, is supplemented with a biopsy. - X-ray diagnostics.
Hysterosalpingography is a method for assessing the patency of the fallopian tubes and identifying sclerotic changes in women that are specific to chronic adnexitis. To confirm or exclude pathology of the urinary organs, excretory urography is used. Irrigoscopy is used to visualize the intestinal mucosa. - Laboratory methods.
If algomenorrhea is suspected, it is necessary to determine the levels of estrogen and progesterone; for early diagnosis of pregnancy, the content of human chorionic gonadotropin is measured. If there are signs of inflammation, smears are taken from the urethra and vagina, in which the causative agent of the infection is determined using a microbiological method.
For pain in the lower abdomen, a woman should consult a gynecologist
Miscarriage
Miscarriage is the most common complication of pregnancy. This term refers to the expulsion of the fertilized egg from the uterus before 22 weeks of pregnancy. If three more miscarriages occur after the first one, this condition is called recurrent miscarriage.
The main symptoms of a miscarriage include bleeding and pain in the lower abdomen of varying severity. The most common causes are genetic, hormonal, anatomical and immunological pathologies. The risk of miscarriage is related to the age of the pregnant woman. Women who become pregnant after age 35 have a much higher risk of miscarriage.
Pelvic organ prolapse
With age or during pregnancy and childbirth, the pelvic floor muscles may weaken, causing the uterus, vagina and bladder to move downwards. This is not a dangerous condition, but it leads to a feeling of discomfort and makes sexual intercourse painful. Special Kegel exercises help strengthen the pelvic floor muscles.
Varicose veins of the pelvic veins
Varicose veins can occur not only on the legs. Dilatation of the pelvic veins leads to pain, which intensifies when the woman sits or stands. When lying down, symptoms decrease or disappear. Varicose veins of the pelvic veins are treated surgically.
Genital cancer – pain and discomfort in the lower abdomen
Malignant neoplasms of the genital organs are one of the most common tumors found in women. One of the most common types of cancer is endometrial cancer, and the most severe types with the poorest prognosis are ovarian tumors.
A woman is often not bothered by anything; signs of ovarian cancer are uncharacteristic, and their appearance begins in a late stage of development. Manifestations of ovarian cancer include: increased circumference, pain and discomfort in the lower abdomen. 20% of patients experience symptoms of diseases from the genital organs, gastrointestinal tract and bleeding from the vagina.
Other fairly rare causes of abdominal pain include:
- torsion of the uterine appendages;
- rupture of an ovarian cyst;
- acute degeneration of uterine fibroids.
These diseases are characterized by acute, sudden, very severe pain in the lower abdomen and require hospitalization and emergency medical care.
Prostate diseases
Pain in the lower abdomen in men can occur as a result of prostate disease. Prostate diseases that cause pain in the lower abdomen include:
- inflammation of the prostate gland;
- prostate hypertrophy;
- prostate cancer.
Stages of prostate cancer
Inflammation (prostatitis) in the absence of treatment becomes chronic, possible development of abscess and fistulas of the prostate gland, cystitis and pyelonephritis, infertility due to the formation of autoimmune antibodies.
Pathologies of the reproductive system
There are many causes of pain associated with gynecological problems. Among the most common:
- Endometritis. It is characterized by inflammation of the endometrium, which can occur acutely or chronically. Often accompanied by menstrual irregularities, spotting, uterine bleeding, and nagging pain.
- Adnexitis. Inflammation of the uterine appendages is one of the most common diseases in gynecological practice. In addition to painful sensations (can be in one side or spread to the entire lower abdomen), patients are faced with signs of intoxication and fever. The disease is caused by bacteria, viruses or fungi.
- Endometriosis. In this disease, the cells of the uterus grow and end up outside the uterus. Accompanied by pain during urination, defecation, sexual intercourse and simply with sudden movements, heavy bleeding during menstruation. Regardless of the cycle, brownish discharge is observed.
- Uterine fibroids, which are usually characterized by dull pain in the pelvic area. Cysts and other benign, as well as malignant formations can cause discomfort of varying intensity and spasms.
- Spikes. They may be the result of inflammation in the genital organs, varicose veins and other diseases. Complications during pregnancy. This may include spontaneous abortion, placental abruption and other pathologies. In such cases, the pain is sudden and sharp, accompanied by bleeding from the genitals.
Separately, it is worth focusing on sexually transmitted infections - mycoplasmosis, gonorrhea, chlamydia, trichomoniasis and other diseases. They affect the reproductive organs, causing pain, profuse vaginal discharge of a pathogenic nature, burning, itching and are fraught with complications if left untreated.
