What's causing your lower abdominal pain?

Common causes of lower abdominal pain

Periods are the main cause of pelvic pain, particularly during the first couple of days when you may have menstrual cramps or period pain. You might also get pelvic pain around the middle of your cycle when you ovulate.

These pains vary in how much they hurt, but you should speak to your doctor if they last more than a few days, start before or after your period, or impact your life.

Endometriosis

Severe pelvic pain which is related to your menstrual cycle may be a symptom of endometriosis.

Endometriosis, where cells similar to those found in the womb (uterus) lining are found outside the womb, affects around 1 in 10 women according to Endometriosis-UK. It can cause severe period pain which can effect your day to day life.

It can also cause pain between periods, painful sex, bleeding between periods and problems getting pregnant. Getting diagnosed may take some time, as symptoms can be similar to other common conditions.

Dr Pandelis Athanasias, consultant gynaecologist at the London Women's Centre, says: "On average, endometriosis takes seven and a half years, or 11 visits to the GP, to diagnose."

However, it's important not to just put up with it - speak to your doctor or a gynaecologist about your symptoms and the impact they are having on your life.

Adenomyosis

Athanasias also highlights another condition called adenomyosis - where the tissue that normally lines the womb (endometrial tissue) grows into the womb's muscular wall - which often goes undiagnosed.

This can also cause pelvic pain due to prolonged menstrual cramps, as well as heavy bleeding and pain during sex.

Pelvic inflammatory disease

If your pelvic pain isn't related to your cycle and if it's the first time you've had this type of pain, it could be an infection such as pelvic inflammatory disease (PID). PID is an infection of a woman's reproductive organs affecting the womb, Fallopian tubes and ovaries.

You may have long lasting (chronic) pelvic pain and a discharge and fever.

Pregnancy

If you are - or could be - pregnant, you should be aware of the following causes of pelvic pain:

• Ectopic pregnancy - acute lower abdominal pain possibly accompanied by vaginal bleeding.

• Miscarriage.

• Rupture of the corpus luteum - a normal cyst that grows on the ovary every month in women of childbearing age.

• Premature labour.

See Pelvic Pain in Women for more details.

Other causes of lower abdominal pain

One of the issues with lower abdominal pain is that it can be multifactorial - meaning the pain may be due to several factors, not just one.

"Usually pain can be coming from the urinary tract, the gynaecological tract, the gastrointestinal tract or it could also be a musculoskeletal cause - so you have to look at everything," says Athanasias.

Other causes of lower abdominal pain include ovarian cysts, fibroids, irritable bowel syndrome (IBS), pelvic congestion syndrome, urinary tract infections, appendicitis and inflammatory bowel diseases, such as Crohn's and ulcerative colitis.

Can anxiety cause lower abdominal pain?

Lower abdominal pain can also be triggered by emotions such as stress, anxiety and depression. People who have suffered with post-traumatic stress disorder are often at a higher risk of developing chronic pain.

To find the cause of the pain, Gynacologist, Dr Karen Morton, says that she often performs a laparoscopy, a procedure to look inside the abdomen with a camera. She warns people beforehand that they need to prepare themselves to the fact that nothing physical might be found.

"We probably find nothing more often than we find something," says Dr Morton. "There are a number of women who come to the hospital recurrently with pelvic pain.

"Indeed, there's quite a lot of research¹ that shows issues such as sexual abuse can lead to women developing lower abdominal pain. And it isn't that it's not real for them, but that there's no identifiable underlying pathology. These women need a pain strategy, as well as psychological support," explains Dr Morton.

Patient picks for Other women's health problems

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What it’s like to have pelvic inflammatory disease

Pelvic inflammatory disease (PID), an infection of a woman's reproductive organs affecting the womb, Fallopian tubes and ovaries, is a devastating condition that can cause chronic pain and infertility. The common condition predominantly affects women who are sexually active between the ages of 15 and 24.

by Karen Gordon

Women's health

Pelvic organ prolapse

The organs inside a woman's pelvis include the womb (uterus), the bladder and the back passage (rectum). Normally, these are supported and held in position by certain structures including ligaments and the muscles at the bottom of the pelvis (pelvic floor muscles). Pelvic organ prolapse (also known as genitourinary prolapse) occurs when these normal support structures are weakened and are no longer effective. The result is that one (or more) of the organs inside the pelvis drops down (prolapses). The space available for the organ(s) to drop down into is the vagina. There can be different degrees of prolapse, depending on how much, or how far, the organ(s) might have dropped down into the vagina. Sometimes, the prolapse can be so much that it causes the walls of the vagina, or the uterus, or both, to protrude outside the opening of the vagina.

by Dr Toni Hazell

What should you do about lower abdominal pain?

Firstly, women should seek an appointment with their GP for an initial evaluation and assessment of their condition, especially if the pain is chronic, has been present for three to six months, or if it is affecting their ability to carry out normal daily activities, says Dr Hemlata.

Judy Birch, co-founder of the Pelvic Pain Support Network, says that it's difficult to cope with any recurring pain.

"Treatments vary and will be individual, based on the condition and severity. It may involve medication, surgery, physiotherapy, nerve blocks, psychology, self-management, coping strategies and combinations of any of these at various points in time."

Birch suggests keeping a simple visual diary of when the pain occurs, how long it occurs for and what relieves it, if anything.

"Take this with you when you see a doctor if you're having difficulty getting a diagnosis or managing and coping with the pain. And ask about investigations, such as an ultrasound, and even to be referred to a specialist," she explains.

Further reading

1. Van Tilburg: Unexplained gastrointestinal symptoms after abuse in a prospective study of children at risk of abuse and neglect.