Left Lower Quadrant Pain - Common causes

Authored by Dr Jacqueline Payne, 08 Jul 2017

Patient is a certified member of
The Information Standard

Reviewed by:
Dr Helen Huins, 08 Jul 2017

The list of causes of left lower quadrant (LLQ) pain is almost endless but the following are some of the more common possibilities, not in order of how common they are:

All sorts of common and uncommon problems to do with your guts can give you pain in this area. For example:

Constipation

  • If your guts are full of poo (faeces) this can cause discomfort anywhere in your tummy (abdomen).
  • You will normally be aware that you are not opening your bowels as often as usual.
  • Your poo will be hard and pellet-like.

See separate leaflet called Constipation in Adults for more information.

Gastroenteritis and food poisoning

  • Cause diarrhoea.
  • May also make you sick (vomit).
  • Pain may be anywhere in the tummy (abdomen).
  • Pain may ease for a while each time some diarrhoea is passed.

See separate leaflets called Gastroenteritis in Adults and Food Poisoning in Adults for more information.

Irritable bowel syndrome (IBS)

  • Very common.
  • Tends to cause crampy tummy (abdominal) pains.
  • Often causes bloating.
  • It comes and goes and may be associated with diarrhoea and/or constipation.

See separate leaflet called Irritable Bowel Syndrome for more information.

Diverticulitis

  • This is an inflammation of a pouch or pouches which people who have diverticular disease have in their guts.
  • Diverticulitis in the last part of the large gut (sigmoid colon) is the most common cause of LLQ pain in adults.
  • Diverticulitis in other parts of the colon can also cause pain in the LLQ.
  • It usually comes with a temperature (fever) and a change in bowel habit (opening your bowels more or less often than usual for you).

See separate leaflet called Diverticula (including Diverticulosis, Diverticular Disease and Diverticulitis) for more information.

Colon cancer and rectal cancer

Severe LLQ pain, bloating, and not being able to open your bowels at all, not even to pass wind (flatus), are symptoms that suggest you may have a colon cancer that is blocking your bowel. You should seek urgent medical advice.
  • Colon cancer and rectal cancer (sometimes called colorectal cancer) are two of the most common cancers in the UK (in contrast, cancer of the small intestine is rare).
  • Although colon cancer can affect any part of the large bowel (colon), it commonly affects the last part (descending colon and sigmoid colon) which is on the left-hand side. Rectal cancer affects the very last part of the large bowel (rectum) just before it ends at the anus.
  • There is usually a change in how often you need to open your bowels and you may notice that you have lost weight, without trying.
  • You may get a feeling of not fully emptying your bottom (rectum) after opening your bowels.

See separate leaflet called Colon Cancer and Rectal Cancer for more information.

Trapped inguinal or femoral hernia

  • A left inguinal or femoral hernia happens when a piece of bowel or other tissue from inside the tummy pushes through a weakness in the muscles of the tummy (abdominal) wall near the left groin.
  • It can happen on either side.
  • If whatever has pushed through gets stuck and can't slide back inside the tummy, it is trapped (incarcerated).
  • If it happens on the left-hand side, there will be a tender swelling in the left groin.
  • It causes pain in the groin and in the tummy, usually on the side of the hernia but it may cause pain over the whole tummy.
  • It is common to be sick (vomit).

See separate leaflet called Hernia for more information.

Kidney infection

  • A kidney infection can cause pain anywhere along your urinary tract. So this could be anywhere from the loin in your back, round the side and down to the LLQ.
  • You may notice that it hurts when you pass urine and that you need to pass urine more often.
  • You may have a temperature (fever)

See separate leaflet called Kidney Infection (Pyelonephritis) for more information.

Mittelschmerz

  • Pain at the time that you release an egg (ovulation), which is usually about halfway between two periods.
  • Can be very severe and stop you short but usually eases over several minutes.
  • Will only be felt on one side but can be left or right.

Pelvic inflammatory disease

  • Pain is usually on both sides but may just be in the LLQ.
  • Pain is worse during sex.
  • There is abnormal bleeding, so bleeding not just at period time but in between periods and often after sex.
  • There is usually a vaginal discharge, which may be smelly.

See separate leaflet called Pelvic Inflammatory Disease for more information.

Twisted ovary

  • Twisted ovary (ovarian torsion) usually only occurs if a fluid-filled sac (cyst) has developed on the left ovary.
  • Pain can be constant or intermittent.

See separate leaflet called Ovarian Cyst for more information.

Endometriosis

  • Sometimes endometriosis can cause constant lower tummy pain, though usually it is worse just before, during and for a short while after a period.
  • Pain is usually across the lower part of the tummy but it can be just on the left side.

See separate leaflet called Endometriosis for more information.

Ectopic pregnancy

You should always see a doctor urgently if you think you might be pregnant and are experiencing left lower quadrant pain. You could have an ectopic pregnancy.

See section on causes in pregnancy.

Any pain coming from the left side of the scrotum can cause pain in the LLQ but usually the pain in the scrotum will be worse.

Torsion of the testicle

  • Torsion of the testicle (testis) causes severe pain in the scrotum and severe lower quadrant pain.
  • It most commonly affects teenage boys but young adult men can be affected.
  • It is unusual over the age of 25 years but can affect any man at any age.
  • The testicle is very tender.
  • You should seek urgent medical advice.

See separate leaflet called Torsion of the Testis for more information.

Epididymo-orchitis

  • Epididymo-orchitis is an inflammation of the testicle and/or the tubes surrounding it (epididymis).
  • It is caused by a germ (infection).
  • The affected side of the scrotum swells and goes very red and tender.

See separate leaflet called Epididymo-orchitis for more information.

Further reading and references

  • Cartwright SL, Knudson MP; Evaluation of acute abdominal pain in adults. Am Fam Physician. 2008 Apr 177(7):971-8.

  • Kim JS; Acute Abdominal Pain in Children. Pediatr Gastroenterol Hepatol Nutr. 2013 Dec16(4):219-224. Epub 2013 Dec 31.

  • Cartwright SL, Knudson MP; Diagnostic imaging of acute abdominal pain in adults. Am Fam Physician. 2015 Apr 191(7):452-9.

  • Manterola C, Vial M, Moraga J, et al; Analgesia in patients with acute abdominal pain. Cochrane Database Syst Rev. 2011 Jan 19(1):CD005660. doi: 10.1002/14651858.CD005660.pub3.

Hey so I’ve been in pain for about 6 months with this pain and ive gotten multiple ultra sounds, lots of blood work, colonoscopy, endoscopy, MRI, got tested for Celiac. they’ve done everything they...

brooke25707
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