Internal Medicine

Abdominal pain in the lower abdomen

introduction

Abdominal pain in the lower abdomen can have different causes. Generally speaking, the pain can still be in left-sided and right-sided Lower abdominal pain can be distinguished, each of which can have certain causes. Also the Quality of pain (cramping, pressing, or stabbing) can provide an indication of the underlying cause.

Lower abdominal pain on the left side

Lower abdominal pain on the left side can have different causes. Here are some possible reasons:

Diverticulitis: Diverticulitis is one inflammation small bulges in the intestinal wall. These bulges (Diverticulum) are mainly found in older people (approx. 65% of those over 85) and arise from weakened connective tissue in the intestinal wall. Almost always it is Sigmoid colon (Sigmoid) affected, i.e. the section of the large intestine that lies in the left lower abdomen. In the diverticulum can become Store the chair. This can be on the Mucous membrane press and secondary to inflammation, which typically spreads through Pain and pressure in the lower abdomen, sometimes too fever, nausea, Vomit and Indigestion can express. The doctor can often feel a hard roller in the left lower abdomen. Diverticulitis can cause it to too Problems urinating or one Relocation of the intestine (Ileus / subileus) come.

Diverticulitis is diagnosed using Ultrasonic or Computed Tomography. As a rule, various types of therapy are used Antibiotics used. If diverticulitis occurs repeatedly in the same section of the intestine, it is advisable to resect this part of the intestine when there is no inflammation. This alone can then cure and prevent the recurrent disease.

Ulcerative colitis: Ulcerative colitis belongs to the group of inflammatory bowel disease. It mainly affects the rectum and colon. Ulcerative colitis often affects young people between the ages of 20 and 40, although the exact cause of the disease is not known. A genetic influence is discussed, as several genes could be identified that occur more frequently in sick people. stress and certain environmental factors promote relapses and a more aggressive course of ulcerative colitis. The typical symptoms of the disease during an acute flare-up are bloody diarrhea in conjunction with strong, often cramping pain in the lower abdomen (often emphasized on the left). The patients suffer from very frequent urge to stoolwhich can occur up to 40 times in 24 hours.

The disease is caused by a Colonoscopy with sampling diagnosed. For therapy mainly eanti-inflammatory drugs and Immunosuppressants are used, which significantly improve the symptoms and can suppress new flare-ups. In very severe cases, a Resection of the entire colon The small intestine is then connected directly to the anus so that patients can continue to have normal bowel movements. This is generally the case with ulcerative colitis after a long period of illness Colon cancer risk increasedso that regular checks must be carried out in this regard.

Right lower abdominal pain

Right lower abdominal pain can have different causes. Some possible causes are listed below:

Appendicitis (appendicitis): The popularly so-called appendicitis typically goes with it stabbing, right-sided lower abdominal pain hand in hand. Actually, however, this is not the case appendix himself (Caecum), but only its appendage, the Appendix (appendix), inflamed. Typically, pain begins in the upper abdomen and over time migrates to the right lower abdomen. Additionally can fever, nausea and Vomit occur. The diagnosis can include a Ultrasound examination be asked. However, the inflammation is not always clearly recognizable.

During the clinical examination, various tests can help diagnose appendicitis. There are e.g. two points in the right lower abdomen (McBurney and Lanz point), which can be very painful when pressure is applied. Also the contralateral pain of letting go (Blumberg sign) can be positive in appendicitis. To do this, the doctor presses in the left lower abdomen and then suddenly lets go, which causes pain in the right lower abdomen in the case of appendicitis. Furthermore, the colon can be stroked from end to beginning, which can also cause pain (Rovsing sign). Bending and rotating the right leg, as well as lifting the right leg against resistance, can be painful (Obturator and psoastest).

At a acute appendicitis needs the appendix early surgically removed become. Otherwise it can lead to a breakthrough (perforation) the appendix with emptying of intestinal contents come into the free abdominal cavity, whereby a Inflammation of the peritoneum (Peritonitis) and possibly a Blood poisoning (sepsis) can arise. The operation is now one of the Routine interventions and is generally considered to be low-risk.

Crohn's disease: Like ulcerative colitis, Crohn's disease belongs to the group of inflammatory bowel disease. In Crohn's disease, however, the lower small intestine and the large intestine are particularly affected. The inflammation also progresses discontinuously, i.e. Healthy bowel sections can lie between inflamed sections of the bowel. In contrast, ulcerative colitis progresses continuously. Crohn's disease mainly develops in young people between the ages of 15 and 35, as well as in older people over 60 years of age. The disease is caused by a genetic predisposition conditional, as it often occurs in families. Further influences that favor the disease are discussed. Overall, Crohn's disease is considered to be Autoimmune disease. Typical symptoms of the disease are pain in the right lower abdomen, especially after eating or before a bowel movement, as well fever, Loss of appetite, Weight loss, nausea and Vomit. Sometimes it happens too bloody diarrhea. Often the patients develop Fissures and Fistulas, also in the anal area, as well Abscesseswhich often have to be removed surgically. The therapy takes place among other things with anti-inflammatory drugs, as well Immunosuppressantsintended to suppress the destructive activity of the immune system against the intestines.

Pain in the lower abdomen on both sides

Abdominal pain in the lower abdomen can have a wide variety of causes, depending on the location and pain.

Some diseases can both left and right lower abdominal pain cause the corresponding organsthat come into question as the cause, are created in pairs and can be affected either only on one side or on both sides.

Gynecological diseases: In women who complain of left-sided or right-sided lower abdominal pain, a gynecological cause of the symptoms must always be considered. A Inflammation of the lining of the womb (Endometritis), or their Appendage (Inflammation of the ovaries or fallopian tubes (Adnexitis)) can cause similar complaints. The pain is usually acute and one-sided, but can also occur on both sides. Often they start after Menstruation or at the time of Ovulation. The Endometritis and Adnexitis mostly by pathogens caused by the vagina in the uterus ascend (e.g. Chlamydia) and trigger an inflammatory reaction there. From the uterus they can then continue the Fallopian tubes climb up.

In addition, pelvic pain can occur on both the right and left sides as part of normal menstrual bleeding. The symptoms are triggered by the contraction of the uterus and subside at the latest when the menstrual period ends. Some women also experience pulling in their active ovaries during ovulation.

Urological diseases: Left and right lower abdominal pain can also be caused by urological symptoms. E.g. Kidney or ureter stones trigger these symptoms. Kidney stones can have different causes. Insoluble salts or crystals precipitate, for example due to metabolic disorders or an excessively salty diet. The stones can remain asymptomatic if they are small. However, if they are larger or migrate into the ureter (Ureteral stone) can cause severe pain. Small stones up to 6mm in size can come off without discomfort. Larger stones may lead to an obstruction of the ureter. This begins to contract spasmodically, which triggers colic-like pain in the lower abdomen (depending on the position of the stone). Often there are also sweats, nausea, vomiting or fever. There is often blood in the urine. If the stones are not too large, you can first try to drive out the stone by increasing the fluid intake. If this does not succeed, a medicinal treatment can be tried. Sometimes a relaxing pain medication is enough, which allows the stone to pass by relaxing the ureter. Stones up to 2.5cm in size can be shattered by ultrasonic wave radiation, so that the smaller fragments are then spontaneously washed out through the urine. If none of these measures are successful, surgical removal of the stones is indicated. Otherwise, the congestion of the urinary system can lead to a congestion of urine in the kidneys, resulting in inflammation of the pelvis (Pyelonephritis) and possibly blood poisoning (Urosepsis) come.

Irritable bowel syndrome: No other cause for their symptoms can be found in patients suffering from irritable bowel syndrome. Those affected complain of recurring abdominal pain, excessive conduction, diarrhea or constipation and flatulence. Frequently, irritable bowel syndrome is triggered by stress; many of those affected suffer from mental health problems. In general, the disease is not associated with a reduced life expectancy, as it is not based on a serious cause, but the quality of life of those affected is often severely limited. The therapy is tried in different ways, one uses, for example, antispasmodic medication, peppermint oil and a diet rich in fiber.

Invaginations and hernias: Invaginations and hernias can also cause pelvic pain. In the case of intussusception, part of the intestine invades into another. This can lead to partial or complete relocation of this section of the intestine (mechanical ileus). The bowel reacts with spasmodic contractions, which can be expressed as severe pain in the affected area. Intussusception occurs primarily in previously completely healthy toddlers and can develop again even after being resolved. In contrast, hernias are also more common in adults. Loops of the intestine emerge through a weak point in the abdominal wall and become visible and palpable as a hernial sac. There are different types of hernias, which can cause different symptoms depending on their location, e.g. inguinal hernias, diaphragmatic hernias, umbilical hernias.

Malignant diseases: Tumors of the small and large intestines can in principle also lead to pain in the lower abdomen. Depending on the location of the tumor, the symptoms appear on the left or right. However, in the early stages, colon cancer usually does not cause specific symptoms. First of all, there are unspecific complaints, such as Weakness, loss of appetite, night sweats, weight loss and which are later replaced by symptoms such as blood in the stool, diarrhea and constipation, and abdominal pain. A doctor should definitely be consulted if the stool changes with blood. In addition, a colonoscopy (Colonoscopy) recommended from the age of 55 for colon cancer screening, which should be repeated every ten years if the colon is normal.

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