Pulling in the lower abdomen

introduction

Under the term "Lower abdomen“One understands the area of ​​the abdomen, which is below the navels and is surrounded by the basin. Pulling pains in the lower abdomen are not uncommon and are often mistakenly dismissed as banal "women's complaints", although there may be much more to it.
The symptoms in the lower abdomen can generally be caused by a variety of causes. Accompanying symptoms can often help to get the cause of the pulling in the lower abdomen on the jumps.

causes

In principle, all organs or parts of organs located in the lower abdomen can pulling pelvic pain cause.

These organs also include parts of the intestine. A common cause of increasing, pulling to cramping severe pelvic pain in childhood is one Appendicitis. Girls and boys are equally affected. It is typical of appendicitis that the pain begins in the upper abdomen and "migrates" to the right lower abdomen within a few hours. In addition, those affected often also suffer from fever, nausea With Vomit and stool irregularities from Diarrhea up to constipation. Appendicitis is counted as acute pain in the lower abdomen.

Even banal ones Gastrointestinal infections (gastroenteritis) can be the cause of acute and pulling pelvic pain. This is usually accompanied by diarrhea, vomiting, occasionally fever and general malaise. Especially children and the elderly are affected by gastroenteritis, which is usually caused by viruses.

Other organs in Abdomenwhich can cause corresponding pain are the urinary and urinary organs.
The kidneys are among the organs that produce urine. A Pelvic inflammation is very painful for those affected and is accompanied by fever and pain in the flanks, which, however, radiate into the lower abdomen and can be felt there as pulling pain.
Kidney infections are usually Follow an ascending bacterial infection from the bladder or as a result of a kidney or ureteral stone that hinders the drainage of urine. Women, especially those with weakened immune systems, are more likely to be affected.
The urinary organs include the ureter and the bladder.
A stone, which clogs the ureters and prevents the passage of urine, leads to strong wave-like painalso known as colic pain. The spasmodic pulling pains typically radiate into the lower abdomen, as well as into the labia in women and in the testicles in men.
From one Inflammation of the bladder Young women are particularly affected, as the urethra, which is much shorter than that of men, allows bacteria to ascend better into the bladder and infect it. Cystitis is also associated with pulling to cramping pelvic pain due to the location of the organ.

Other causes of acute pulling pelvic pain in women are Period painwhich are usually harmless, so apart from the unpleasant pain, have no disease value.
A disease to be taken seriously is another Ovarian inflammation, which is usually associated with yellowish-greenish discharge from the vagina, as well as nausea and vomiting. Inflammation of the fallopian tubes present themselves with similar symptoms.

In the case of sudden and severe pulling / spasmodic pelvic pain in women of childbearing age, a possible pregnancy should always be considered in which the embryo has falsely lodged in the abdominal cavity or the fallopian tube (Ectopic pregnancy). In this case, immediate action is required and an abortion is inevitable.

Cause for chronic pulling-spasmodic Lower abdominal pain, can be permanent Inflammation of the intestines as part of a Ulcerative colitis or one Crohn's disease be. The actual trigger for both diseases is largely unknown, but an autoimmunological component is strongly suspected.
While at the Ulcerative colitis The intestinal lining of the rectum in particular is affected Crohn's disease the entire digestive tract, i.e. the mouth, esophagus, stomach and small and large intestines can be affected.
Typical for Crohn's disease are violent and frequent diarrhea, Weight loss and the occurrence. The disease usually occurs between the ages of 15 and 30. Year of life. These are typical of ulcerative colitis bloody diarrhea and the occurrence between the 20th and 40th Age. Crohn's disease is the more common of the two diseases.

Permanent pulling to pressing abdominal pain with a maximum in the groin area can result in a Inguinal hernia Clues. In extreme cases or in very slim people, the break can become visible as a bulging of the groin.

Often no local cause can be found in recurrent, dragging abdominal pain in both men and women. Also mental illnessBeing led by depression can manifest itself with these symptoms.

Symptoms

In addition to the pulling in the lower abdomen, other symptoms can point to the actual cause of the symptoms.
Above all, the radiation of pain from pulling, for example in the upper abdomen, back or intimate area, contains important information about the cause.
In addition to pulling in the lower abdomen, accompanying symptoms such as fever, diarrhea or constipation, vomiting and, in women, discharge or bleeding from the genital area are possible with various diseases.

Furthermore, a distinction must be made between acute, usually severe pulling pain and chronic pelvic pain that has existed for more than half a year.
Chronic pelvic pain is usually not as intense as the acute pulling pain.
Acute pain is usually caused by infections, which can also spread to surrounding organs and the peritoneum. Inflammation of the intestine, ovaries or fallopian tubes and the urinary tract are typical triggers.
Acute infections are usually accompanied by symptoms such as fever, indigestion, nausea, and vomiting, depending on the cause.
Period pain, which plagues many women every month, also counts as acute-drawing abdominal pain, but is, besides the pain, harmless.

Chronic pulling pelvic pain is usually the result of permanent inflammation of the abdominal organs in the abdomen. The cause are often autoimmune diseases (see under "causes"). Relapsing pain, which can be accompanied by fever, nausea and digestive problems, is typical.
Pulling pains caused by growing tumors in the abdomen are also counted as chronic pelvic pain and are often a very late symptom of an advanced tumor disease.

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Drawing in the left lower abdomen

Drawing-burning pains in the left lower abdomen can sign a Diverticulitis be. Diverticula are small bulges in the intestinal wall that mainly form in the last sections of the intestine.
The reason for this localization is that the stool is already very thickened in these intestinal sections and is therefore able to provoke the formation of the pouches. The number of diverticula increases with age.
At first they have no disease value, so they are harmless. However, the small bulges become infected easily and then lead to the clinical picture of diverticulitis.
The illness resembles in their emergence and the pain to which one Inflammation of the appendix, which is located in the right lower abdomen and, unlike diverticulitis, tends to affect children and adolescents. Since the symptoms resemble those of classic appendicitis (Appendicites) are very similar, just mirrored, the diseases are also referred to by doctors as "left-side appendicites".
In addition to the sudden pulling pain in the left lower abdomen, those affected often also suffer from fever, nausea and Vomit.
Due to the inflammation it can be next Painful bowel movements also to Painful urination because the bladder is in the immediate vicinity of the infected sections of the intestine. If such inflammations occur frequently, consideration must be given to removing the affected section of the intestine in order to prevent the intestine from tearing if the inflammation recurs.

The paired ones Ovaries, one ovary on each side of the lower abdomen, can be left-sided inflammation can also be the reason for pulling pelvic pain. Usually the associated fallopian tube is also affected by the inflammation.
The cause is usually bacteria that are transmitted during unprotected sexual intercourse and can ascend via the uterus to the ovaries.

A chronic inflammatory bowel disease that can lead to drawing pain on the left side of the lower abdomen is the Ulcerative colitis. There is persistent inflammation of the intestinal mucosa, which worsens in stages. This inflammation begins in the anal area and, if left untreated, “migrates” up the large intestine over the years. Since the anal area and the final large intestine are on the left side of the body, a flare-up of inflammation classically leads to food-independent, excruciating pulling to tearing, as well as burning pain in the left-sided localization. In addition, those affected often suffer from bloody, mucous diarrhea, which is caused by the inflammation of the mucous membrane. In severe cases, a fever also occurs.

Pulling in the middle of the lower abdomen

A Inflammation of the urinary bladder can lead to drawing pain in the middle lower abdomen. Young women in particular are more frequently affected by this clinical picture, as the responsible bacteria usually get through the urethra into the bladder, which is anatomically much shorter in women than in men.
The pulling ones Pain amplify usually when urinating. In addition, there is an increased urge to urinate, so the feeling of never being able to properly "empty" the bladder. The urine can be smelly due to the bacterial colonization.

A Inflammation of the prostate can cause pulling pain in the middle lower abdomen in men.

The pulling pains that are known to many women, which occur in connection with the monthly menstrual period, also lead to frequent complaints in the middle lower abdomen.

Drawing in the right lower abdomen

Severe pain in the right lower abdomen, can be an indication of a Appendicitis be. This is often accompanied by a strong feeling of illness and fever. Those affected can suffer from both diarrhea and constipation. Especially in children, constipation can manifest itself with similar symptoms, but these improve suddenly as soon as the child has cleared the stool.

Since the ovaries in women are in pairs, i.e. one ovary and fallopian tubes on each side of the lower abdomen, one leads Inflammation of the right ovary to drawing, right-sided lower abdominal pain.

People who are under the inflammatory bowel disease Are sick with Crohn's disease, suffer in the context of various attacks of inflammation from the recurring, including pulling and severe pelvic pain with a maximum in the right lower abdomen. In addition to the dragging, those affected often suffer from abdominal cramps, diarrhea with weight loss, and fever.

Drawing in the lower abdomen from disease of the back

Lumbar spine diseasessuch as herniated discs, fractures of the lumbar vertebrae, among other things in the context of osteoporosis or the slipping away of a vertebral body, can lead to back pain in this area, which occasionally also in the Radiate the lower abdomen and can cause the pulling pains. Such a charisma is rare, however.
Conversely, pulling pains in the lower abdomen can also occur radiate in the back. This can often be observed, for example, in the context of very severe period pain.
Take a special case Inflammation of the renal pelvis or Kidney stones which consequently hinder the removal and excretion of the urine. Typical for this disease are pain in the area of ​​the flank, i.e. also in the area of ​​the back, as well as a radiation with pulling pelvic pain.

Drawing in the lower abdomen in men

Abdominal pain and Pulling in the lower abdomen are by far not the only complaints that women have to struggle with, even if they are proportionally more often affected.
One of the most common male-specific causes is one Inflammation of the prostate, which is technically referred to as prostatitis.
This gland produces much of the fluid that escapes when a man ejaculates. Colloquially it is known as the prostate gland.

Almost the Half of all men get sick at least once in their life from such inflammation.
In addition to pulling in the lower abdomen, it often also occurs Pain in the perineum areathat the prostate rests on.
Furthermore, urination problems can occur as part of the urethra passes through the prostate. This often manifests itself in pulling pelvic pain. The pain can also radiate to the back. Since the prostate also plays an important role in ejaculation, it can do so too Pain and in the course to Erectile dysfunction come.
The most common cause of prostatitis is bacteria. Usually these are bacteria that are also found in the intestine and first infect the urethra, rise in it and finally attack the prostate. The prostate gland swells, among other things due to the bacterial infection, but also due to the body's defense reaction and expands the capsule that surrounds it, which leads to the corresponding pain.
In addition to this acute prostatitis, the organ can also chronic ignited be. In the latter, a cause can very often not be found. If the acute prostatitis is of bacterial origin, antibiotic therapy should be sought. This must be done via the vein with the help of a dissolved antibiotic in the hospital, especially at the onset of the disease, so that the active ingredient arrives at the inflamed organ more quickly and in greater quantities.

Drawing in the lower abdomen in the woman

Most of the young women in particular regularly suffer from it pulling pains in the abdomen. The said Pain occur monthly as part of the Menstrual bleeding and are the result of the contractions of the uterus, which during this time pushes the uterine lining away.
Some women find it very strong, others hardly have any problems.
More regular Sport and exercise, which continues during menstruation, can help relieve the intensity of the pain through relaxation. Will be accordingly with Relaxation exercisesachieved very good pain-reducing results, especially through yoga. Warmth helps during your period, for example with the help of a Hot water bottle to relax the cramped lower abdomen and thereby relieve the pain.
If the pain is severe, anti-spasmodic drugs, such as Buscopan® can be used.
Modern contraceptives, such as the birth control pill, can often significantly reduce the pain in the abdomen associated with menstrual bleeding.

If the pulling pelvic pain is extremely severe and hardly bearable even with medication, a disease, especially the Endometriosis be considered. This disease is the Uterine lining not only in the uterus, as in healthy women, but also sprinkled in the body to other organs, especially to the Ovaries. In addition, the mucous membrane is often located within the uterine muscles.
The endometrial foci, like the normal uterine lining, are subject to the hormonal cycle of women and accordingly bleed once a month during menstruation.It is not yet fully understood why women with endometriosis suffer from extremely severe, often pulling pelvic pain that goes beyond the usual period pain.
In addition to the strongly spasmodic pulling pelvic pain, some women experience it Blood in urine and / or stool insofar as endometrial foci are in the bladder or intestine.
If there is no menstrual bleeding, those affected are symptom-free. This is the case, for example, during pregnancy or during or after the menopause. In addition, a long cycle with one pill, in consultation with the treating gynecologist, can help, since menstruation only occurs every 3 months.
Due to the misplaced uterine lining, especially those in the muscular uterine wall, it can, among other things, become Bonding and Scarring come. One of the most serious complications of endometriosis, including for these reasons, is one difficult ability to swingr to become, in extreme cases even one infertility. In these cases, it is advisable to have the endometrial foci removed as part of a small operation.

Inflammation of the female genital organswhich are located in the lower abdomen can also lead to severe, pulling pains in this area. In this case, the inflammation usually affects the ovaries and fallopian tubes. Often times are sexually transmitted pathogens, especially Chlamydia the cause of the so-called Adnexitis.
At the beginning, the vagina is usually affected by the bacterial inflammation, which many women find less bothersome. If left untreated, the bacteria ascend through the uterus to the fallopian tubes and ovaries and infect them, which leads to severe unilateral pelvic pain, including pulling.
In addition to the pain, there are often fever, foul-smelling vaginal discharge and nausea with vomiting. According to the cause, it is mainly young, sexually active women who are affected. Frequent partner changes and unprotected sex increase the likelihood of infection.
In most cases there is one Antibiotic therapy sensible and important, as the disease can lead to infertility if left untreated.

ovulation

About 20-40% of women are able to “feel” their ovulation. In these cases, this is often expressed as a one-sided pulling in the lower abdomen, which is colloquially referred to as middle pain.
The name median pain comes from the fact that the pain does not necessarily appear immediately with ovulation, but a few days later, usually in the middle of the menstrual cycle. This is when women who do not use contraception are most fertile.

Learn more about: Middle pain

The women feel the pulling, sometimes cramping pain in the lower abdomen on the side from which the as yet unfertilized egg has passed from the ovary into the fallopian tube after a month of maturation. The duration of the pulling pains varies from woman to woman and can last from minutes to two days.

It is not yet fully understood why ovulation causes pain. If the pulling lower abdominal pain is very severe, local heat, for example with a hot water bottle, can help.

Read more on the topic Ovulation pain

During pregnancy

Many women occasionally experience pulling pelvic pain during pregnancy. However, this is not automatically a bad sign.
A common cause is the growing uterus during pregnancy. As it grows, the uterine ligaments, to which the uterus is "attached" in the abdomen, are increasingly stretched, which can cause the pulling pain in this area. This pulling can occur throughout pregnancy, as the uterus grows steadily, especially in the first few months of pregnancy, and in some women it is aggravated by the increasing movements of the child and the associated additional stress on the uterine ligaments.
It is typical for this pain, however, that it does not last continuously over a long period of time or that its intensity does not increase significantly.
If one of the two points is the case and there are other symptoms in addition to the pulling pelvic pain, such as nausea with vomiting, diarrhea, abdominal cramps with or without bleeding and / or fever, a gynecologist should be consulted without hesitation to avoid a miscarriage or premature birth to risk.

Read more on the topic: Pain in the mother ligaments

If the pregnancy is not very advanced, such severe, unilateral and pulling pelvic pain, if the pregnancy test is positive and / or the menstrual period is missing, can be a sign of an ectopic pregnancy.
In this case, surgical removal of the misplaced fertilized egg is essential. Since the fallopian tube, unlike the uterus, does not grow with the embryo, it is very likely that it will tear in the course of the pregnancy, at the latest by the 8th week of pregnancy. This is a life-threatening complication for those affected due to the massive bleeding that follows into the abdomen. The fertilized egg and the resulting embryo cannot survive if implanted in the fallopian tube.

Read more too Abdominal pain in pregnancy

diagnosis

Often the doctor can already through a detailed discussion and a subsequent physical examination make a suspected diagnosis and treat accordingly.
To confirm the diagnosis, especially for assessing the lower abdomen, a Ultrasound examination on. With the help of this gentle method, not only the internal, female sexual organs, bladder and kidneys, but also the prostate, for example, can be examined using certain techniques.
In some cases, additional imaging procedures, such as a Computed or magnetic resonance imaging makes sense.
If a bacterial infection is suspected, various laboratory tests, including those of blood, but also of smears, are used to provide general evidence of the infection and the detection of pathogens so that targeted antibiotic therapy can be started.

therapy

The therapy depends on the triggering cause pulling pelvic pain.

In case of a Appendicitis surgical removal of the inflamed appendix is ​​sought. In contrast to previous procedures, the procedure can now be carried out using a minimally invasive method. This means that only a few and only a few centimeters long incisions are necessary and the appendix is ​​removed.

Especially in childhood Gastrointestinal infections usually caused by viruses. Because of this, the use of antibiotics is ineffective. In these cases it should be sufficient Fluid and electrolyte supply Be careful, because diarrhea and vomiting cause both to be lost. Preparations prepared for this purpose are available in the pharmacy. In very severe cases, the fluid balance must be "replenished" via the vein in a hospital.
If a bacterial cause is suspected, especially in the case of severe pain in the lower abdomen with severe diarrhea, a Antibiotic therapy be useful. However, this decision is incumbent on the attending physician and depends primarily on the current condition of the person concerned. Eating light meals during illness, regardless of the cause, makes recovery easier.

A Pelvic inflammation is mainly caused by rising bacteria and usually has to deal with a antibiotic be treated. Has the inflammation developed as a result of an obstruction of the urine flow, often from a Ureteral stone If possible, the obstruction to drainage is removed and the excess urine is drained off with the help of various catheters.

Ureteral stones Insofar as they are small on the right, they occasionally come out of the ureters with the urine by themselves. However, they are often sufficient Fluid intake, anticonvulsant medication how Buscopan® and the application of a ureteral splint is necessary to remove the stone from the ureter.
With a one-time Cystitis Immediate antibiotic administration may not always be necessary, but should be considered if pain occurs during urination. As with the other complaints listed, adequate hydration is important for recovery. Frequent urination gives the kidneys and urinary organs the opportunity to “cleanse” and “flush” themselves. However, if you have previous illnesses of the kidneys or the heart, the amount you drink should be discussed with a doctor.

At Menstrual cramps or pain during your period usually helps with local heat in the lower abdomen, for example with the help of a spelled pillow or a hot water bottle. Fast, pain-relieving results can also be achieved with the help of anticonvulsant drugs, which are now also available in combination with an analgesic. Light gymnastics or yoga help with relaxation and can also help to reduce pain in the long term.

The Inflammation of the ovary and fallopian tubes (Adnexitis) is often caused by certain sexually transmitted bacteria, the Chlamydia triggered. This can be easily treated with the help of antibiotics. If pus accumulates in the lower abdomen in an advanced infection or if the inflammation has spread to other organs in the area, a laparoscopy is usually necessary, i.e. a small operation in which the pus is removed and the abdomen is rinsed out and cleaned.

For inflammatory bowel disease There are specific protocols, primarily aimed at drug therapy, which are continuously adapted by the attending physician to the current state of health of the person concerned. In the case of pronounced courses, surgical removal of the inflamed section of the intestine can improve the situation.
Especially with Crohn's disease In the course of the recurring inflammation, the intestine may constrict. These narrowings are known as strictures. In the worst case, this results in an intestinal obstruction, which if left untreated can be fatal for the person concerned. To avoid this serious complication, the constrictions are also widened or removed using a small operation.