Lower Abdominal Pain

Lower Abdominal Pain can have many causes. The more difficult the diagnosis is. For this reason, in addition to the precise Lower abdominal pain character, the localization and the accompanying symptoms and the temporal occurrence of pain is of great importance.

Especially at the beginning of a pregnancy, a change in the body can cause pain. These are caused by strains of the various bands of the womb ( uterus ), which adapts to the new situation. In addition, especially at the beginning often the pregnancy hormones ( ß- HCG ) are not yet sufficiently available and the uterus is prone to contractions , which can cause Lower abdominal pain.

Lower Abdominal Pain

In later stages of pregnancy, even kicks or an unfavorable position of the child can lead to pain. But also labor pains are normal in the last trimester and only serve the uterus to prepare for the birth. However, these practice pains have no influence on the cervix and are not intended to initiate childbirth. For this reason, they must be distinguished from birth-relevant forerunners, which can initiate the birth and cause premature birth .

symptoms

A slight tugging in the abdomen , similar to that during menstruation , without bleeding, is usually harmless and merely signs of changes in the uterus. Nevertheless, this should also be confirmed by a doctor to avoid abortion . In particular, too little amount of pregnancy hormones can cause contractions of the uterus and possibly lead to a miscarriage.

If pain occurs in the later part of the pregnancy, child movements, exercise labor and premature labor usually have to occurbe differentiated. Kicking the child against the abdominal wall or an unfavorable position of the child, especially if the space in the abdomen is significantly lower, can be very painful. However, by changing the position of the mother, or animating the child into a rearrangement, the pain usually ceases.

This type of pain also differs from contractions, as the pain does not occur regularly, and can be significantly shorter or stopped by rearrangement.

Exercise labor is normal especially in the third part of pregnancy and is used to prepare the uterus for childbirth. However, they are not relevant to birth and do not lead to the opening of the maternal. Just like real birth pains, these are contractions that go along with a hard stomach. They differ from birth-related labor, as they only last a maximum of 45 seconds and do not occur more often than 3 times an hour.

For a clear distinction, a CTG can be applied to the gynecologist or the hospital. This shows both the labor activity and the heart activity of the child.

Localization of the lower abdominal pain

Lower abdominal pain is common in adult patients and may be a sign of intestinal diverticulosis . These are benign bulges of the intestinal wall which oftenarisein the context of a chronic constipation and a weakened intestinal wall.
The reason for this is probably theincreased pressure in the intestinecaused by the chronic constipation , and the simultaneously weakened intestinal wall. For this reason, older patients are often affected. The pain can also befeltas a burning in the abdomen .

In most cases, these diverticula are not noticeable by any symptoms. The diverticula, however, can inflame and then bring severe Lower abdominal pain with it. These often occur suddenly and severely affect the patient.

In addition, the pain in many cases with fever and general symptoms, such as fatigue , fatigue and head and limb pain associated. If there is only inflammation of the diverticulumwithout any indication of a breakthrough into the free abdominal cavity, there is no indication for surgery.

The pain can be treated by analgesics and antispasmodic drugs. In addition, antibiotics are used to treat inflammation. The intake of food should first be avoided to protect the intestine and calm. The patients are then fed temporarily via the vein. The pain should go back within a few days.

If the inflammation has led to a breakthrough in the free abdominal cavity, this must be promptly treated surgically. Only then can perilous peritonitis be prevented.

As part of the operation, the sigmatic part of the large intestine (sigma) is usually removed and the remaining part of the large intestine is connected to the rectum. So no artificial gut exit must be created. This therapy is also preferred in the case of recurrent inflammation of the diverticulum in order to prevent an imminent breakthrough of the diverticulum.

Similarly, an abdominal cavity pregnancy in women of childbearing age may lead to Lower abdominal pain. These are associated with similar symptoms as a diverticula breakthrough. The pain is acute and very strong. They are also often accompanied by fever, severely weakened general condition and possibly vaginal bleeding.
Since it is also an inflammatory cause with breakthrough in the free abdominal cavity and the great risk of peritonitis , the abdominal cavity pregnancy must be promptly operated on.

Even a pinched inguinal hernia is associated with severe, sudden pain. In addition, the hernia in the fractured sac is often palpable in the area of ​​the groin. Inflammatory signs such as fever are missing in many cases. Since the inguinal hernia can lead to entrapment of the intestine, it must also be treated as soon as possible. In some cases, the hernia can be reduced manually.

Subsequently, the surgical closure of the inguinal hernia should be carried out promptly.
If the hernia can not be removed from the entrapment, it must also be operated on immediately to prevent death of the affected intestinal component. Also a testicular torsioncan cause sudden severe pain as it is a twisting of the spermatic cord with the supplying vessels and nerves. In most cases, testicular torsion can also be treated manually.

Ureteral stones , if too large to pass through the ureter, can cause colicky Lower abdominal pain. In most cases, a pain- and anticonvulsant therapy is sufficient and the stone is transported by itself into the bladder and then excreted. If this is not the case, the stone must be resolved by ultrasound-driven waves or stone-dissolving medications. In exceptional cases, an operative removal of the stone is necessary.

Lower abdominal pain right

Right- sided pelvic pain can occur as on the left side due to an abdominal cavity pregnancy, a pinched hernia , aureteral stone or a horseradish. Again, the pain can befeltas a burning sensation .

On the other hand, appendicitis is specific for the right lower abdominal pain , as it can be found in the right lower abdomen. The pains of appendicitis often begin in the mid abdomen around the navel and then slowly migrate into the right lower abdomen. The reason for this is the progressive inflammation of the cecum with increasingly precisely localized pain. Often the pain is accompanied by mild fever , nausea , vomiting and constipation .

The pain is more dull, persistent, and more intense. When the cecum breaks through, the pain may initially subside. With increasing Inflammation of the peritoneum , the Lower abdominal pain but significantly stronger and can ultimately affect the entire abdomen. Since such peritonitis can be life-threatening, it is important to detect appendicitis early and operate if necessary.

An appendicitis is often detectable by an ultrasound examination and the increased inflammatory parameters in the blood. As long as inflammation is limited to the cecum, surgery can often be performed laparoscopically. For this purpose, only three small incisions are necessary to introduce the camera into the abdomen. The remaining scars are very small and hardly visible in the long run.

Because cecal surgery is a routine procedure, complications are very rare and risks low.

In addition to appendicitis, the appendages (adnexa) of the woman can also ignite. The appendages indicate in the woman the fallopian tubes (tuba uterina) and ovaries (ovary). Adnexitis can occur on one or both sides and, strictly speaking, on the left side. However, for unknown reasons, right-sided pelvic inflammatory disease seems to be more common. An acute inflammation of the appendages is accompanied by sudden severe pain in the area of ​​the right lower abdomen.

If the inflammation is not treated correctly and does not heal completely, it can lead to scarring and adhesions around the fallopian tube or ovary , causing years of discomfort.

The causative agents of adnexitis are diverse. However, chlamydia can be detected in 40% of cases . The pain often occurs side-stressed after menstruation or during ovulation. If the cervix or the uterus are affected in addition to the appendages , may also cause discharge and spotting .

Vomiting, fever and nausea can also occur in severe infections. If the inflammation leads to a rupture of the fallopian tube or the ovaries, an acute abdomen can also occur as in appendicitis.

Diagnostically, a gynecological examination with palpation of the uterus should be performed. This examination causes pain in inflammation. By means of the speculum examination the inflammation of the uterus is also visible through a strong reddening and an edema . In this study, a microbiological smear should be taken.

Ultrasound can be abscesses , swelling or secretion behavior in the fallopian tube and ovary. If the diagnosis can not be confirmed, a laparoscopic examination must also be carried out in this case. In addition, increased inflammatory parameters are detectable in the blood picture. As a rule, pelvic inflammatory disease is treated with antibiotics after removal of the microbiological smear.

Since chlamydiae are responsible for inflammation in most cases , treatment with tetracycline or fluoroquinolone will take at least 10 days. If the therapy is not effective, the antibiosis should be switched to cephalosporins and metronidazole. If this therapy does not produce the desired results, it should be treated according to the microbiological result and the resistogram. If abscesses have arisen, they are usually treated in hospital and surgically relieved. For severe pain, pain medications canIbuprofen be used.

Lower abdominal pain in the middle

Lower abdominal pain in the middle abdomen arises in most cases due to nonspecific colonic complaints . First and foremost, this includes constipation . This may occur due to low fluid intake or through improper diet. In the case of simple constipation, there are strong, spasmodic and spasmodic Lower abdominal pain.

Through enemas or a short-term use of laxative drugs, the constipation can be solved. Prophylactically, you should eat a balanced and high-fiber diet and drink plenty of fluids. To diagnose the other causes of constipation are in many cases, further investigations such as a colonoscopy, an ultrasound or a computed tomography necessary.

In addition to the non-specific constipation, which can occur in the entire abdomen, the inflammation of the pancreas is considered a specific pain in the middle abdomen, which radiates belt-shaped around the abdomen. The pain is accompanied by nausea, vomiting and possibly acute intestinal obstruction (ileus).

The pancreatitis can occur both acute and chronic and is usually the result of a strong, or long-term alcohol abuse. The diagnosis is based on the medical history (medical history), physical examination, an ultrasound and various laboratory tests. The acute pancreatitis must be treated in the hospital. Patients should not eat until significant improvement in symptoms and laboratory values. This serves to immobilize the pancreas.

During this time, the patient receives plenty of fluids, as well as electrolytes, nutrients and vitamins via the vein. Painkillers are used to relieve the symptoms. When the symptoms have subsided, the diet is slowed down.

The treatment of chronic pancreatitis is often much more complicated, as the cause is often unclear or untreatable. In some cases surgery may be necessary in both forms.

Another cause of middle abdominal discomfort may be an umbilical hernia . There is an episode of intestinal loops around the umbilicus due to the obliterated annulus umbilicalis. This represents in the prenatal period part of the umbilical cord and closes after birth. This part of the umbilical cord can be a predilection site for an umbilical hernia and then contains parts of the peritoneum and possibly intestinal parts. If only peritoneum fractions are contained in the fractured sac, or if it is very small, often no symptoms occur.

However, if the fracture gap is large enough, or entrapment of the intestine, localized pain in the umbilical region occurs. The navel is often swollen and may be red as a sign of bowel obstruction under the skin.

Predisposing to such an umbilical hernia are overweight (obesity), heavy physical exertion and significant increase in pressure in the abdomen (for example, a pregnancy ). In addition, women are more often affected by an umbilical hernia.
If the umbilical hernia is associated with significant symptoms, it is treated surgically. Here, the breakage bag is removed and the gap is closed with a double seam. In some cases, a mesh can be sewn in to firm the abdominal wall.

Another life threatening cause of middle abdominal discomfort may be the abdominal aortic aneurysm . This is an outgrowth of the vascular wall of the abdominal aorta. Such an aneurysm is initially often unremarkable. In some cases, patients feel dull abdominal pain and back pain , which can also radiate into the legs. The actual symptoms, however, only occur when a rupture of the Aussackung.

At that moment, there is a strong, stabbing and scathing pain in the middle abdomen. Due to the massive blood loss, life-threatening shock symptoms subsequently occur. Due to this very acute and life-threatening situation, surgery must be carried out within a very short time.

The diagnosis is made by an orienting ultrasound examination and the immediate opening of the abdominal cavity to stop the bleeding.

Also, a bladder infection can manifest itself in lower abdominal pain. As a rule, a burning sensation when urinating and a constant urge to urinate appear first .

If the bladder infection is not treated can also abdominal pain in the middle lower abdomen and fever occur. The diagnosis can often be made by means of a urine test and the clinical symptoms. Cystitis should be treated with plenty of fluids and possibly antibiotic drug therapy.

therapy

Most causes of abdominal pain do not require any form of therapy. Especially contractions at the beginning of a pregnancy are not well treatable, since this is an adaptation of the body to the new circumstances. Early labor, however, must be taken very seriously and may be treated in hospital.

Most of the mothers affected have to keep to a strict bed rest for the remainder of their pregnancy and are treated with medicines containing vapors . If the cervix has opened too early, it can be closed by means of a so-called cerclage on a trial basis to avoid an ascending infection of the child and a premature birth.

Type of lower abdominal pain

Lower abdominal pain after eating

Lower abdominal pain after eating are often indications of various food intolerances. If children or babies complain of abdominal pain after eating, this can be due to a variety of causes.

First and foremost, food intolerance, especially lactose intolerance , must be considered in older children . This is an intolerance of lactose, which is caused by a lactase deficiency. This enzyme is normally used to break up the milk sugar into galactose and glucose.

If there is an enzyme deficiency, osmotically effective amounts of lactose enter the colon and bind water there. First, the symptom diarrhea develops(Diarrhea). In addition, the water leads to an overall higher filling level of the intestine and thus to abdominal pain . Subsequently, the lactase is split by the bacteria of the intestine, causing gas and flatulence.

Diagnostically, an outlet trial of lactose-containing foods can first be undertaken. In many cases, this leads to a spontaneous cessation of the symptoms. If the diagnosis can not yet be ascertained in this way, a H2 breath test can be carried out.

The best therapy for confirmed and symptomatic lactose intolerance is the renunciation or reduction of the daily intake of lactose. Lactase tablets containing the enzyme may help to prevent travel or planned use of lactose.

In addition to lactose intolerance, other foods such as fish, nuts, shellfish or hen’s egg can lead to gastrointestinal discomfort, especially pain, diarrhea and flatulence. Differential diagnosis must be considered especially in infants with abdominal pain and flatulence to the 3-month colic.

These lead to persistent cry attacks of the infants after meals, culminating around the 6th week of life. Most of the symptoms disappear at the end of the 3rd Month of life again. An exact cause for this is not yet known. It is believed that too large amounts of drinking, swallowing much air during the meal (aerophagia) and increased gas formation in the intestine leads to painful peristalsis (intestinal movement) and flatulence.

Therapy is not required. Celiac disease causes symptoms only when children start to eat cereals. In this case, abdominal pain and diarrhea may also occur, often accompanied by child malformations and failure to thrive. This is due to sensitivity of the small intestinal mucosa to gluten.

Since it comes due to the incompatibility to atrophy of the small intestinal mucosa, it is important to make the diagnosis as early as possible. Through a strict lifelong diet, the symptoms go back quickly and the intestinal lining can regenerate. In some patients, celiac disease may continue to be asymptomatic for many years and in these cases does not become noticeable until adulthood. The symptoms largely correspond to the symptoms in childhood. However, failure to thrive and bad mood do not occur.

Lower abdominal pain in men

Some causes, among other possible diseases, may specifically be responsible for the pelvic pain in men. Especially diseases of the male sex organs are mentioned here. Urological diseases such as testicular torsion can cause severe Lower abdominal pain. Here, the testicles revolve around its own axis until it comes to a lack of blood supply to the testicle. Both a genetic predisposition and accidents involving testicular involvement can lead to the occurrence of torsion.

Even sexually transmitted infections may be responsible for the symptoms. Does it come to a chronic inflammation, Enlargement or tumor of the prostate , this may also be associated with Lower abdominal pain.

Finally, it should always be remembered in men that the complaints can also be a hernia . These are more common in males than females and can lead to severe lower abdominal pain, especially if intestinal components are pinched in the suture bag.

Partial back pain can radiate through nerve irritation in the area of ​​the lower abdomen. Especially with concomitant back pain should be thought of this possibility.

Lower abdominal pain in pregnancy

Lower abdominal pain during pregnancy can have many causes. Even during pregnancy, all other causes, regardless of pregnancy, may be responsible for the Lower abdominal pain. In the context of pregnancy, most complaints are triggered by simple adaptation processes of the body to the new situation.

Due to the strong changes in the entire body that occur during pregnancy, the muscles and ligaments are heavily stressed. In addition, the growth of the uterus causes increased space in the abdomen, which can cause discomfort and abdominal cramps .

Lower abdominal pain often has a pulling character in the lower abdomen and are similar to menstrual cramps, Bleeding, fever or other symptoms do not occur. The therapy consists in relaxing measures, stress reduction and heat treatments. In addition to the harmless causes of the adaptation processes in the body, but the cause can also be different origin.

If the pain occurs along with bleeding at the beginning of pregnancy, a doctor should be consulted as in some cases the symptoms may be associated with abortion . Ultrasound often makes this diagnosis easy.

Lower abdominal pain during pregnancy is a common symptom, which often causes great anxiety. However, this is unfounded in most cases as mild abdominal pain in the Lower abdominal pain are not uncommon. The causes of the pain are very different and, despite everything, need to be clarified by a doctor.

Summary

Lower abdominal pain during pregnancy is a common and often harmless symptom, as a sign of adapting the body to the new situation. Depending on the week of pregnancy, the causes of Lower abdominal pain can be numerous and are in part completely harmless.

However, so that no serious danger to mother or child arises, a medical presentation is usually useful. Using simple methods such as ultrasound , CTG and laboratory , the doctor can easily determine whether or not it is pain requiring therapy.

Summary of pelvic pain

Lower abdominal pain is a nonspecific symptom with numerous diagnoses. For this reason, the exact history of pain and duration of pain is essential to make the right diagnosis. In which area of ​​the lower abdomen the pain occurs is also an important indication of the cause.

While appendicitis causes pain in the right lower abdomen, in most cases diverticulitis is found in the left lower abdomen. In the middle lower abdomen is the urinary bladder, causing bladder infection can cause pain in this area. Due to the variety of causes, however, a more extensive diagnosis by imaging techniques and a blood test is always necessary.

You may also experience Lower abdominal pain during pregnancy or after eating. Since in these cases other causes may be the reason for the pain, a pregnancy or a relation to food intake in the anamnesis should also be reported. Simple adjustment procedures can be associated with the pain in pregnancy, but also dangerous inflammatory diseases, which require rapid diagnosis and therapy.

After eating, especially in children pain and then should also be closely examined, since children often suffer from failure to thrive and developmental arrears, if they are suffering from a food allergy. But even in adult patients, the pain should be urgently diagnosed after eating, because the symptoms are often tormenting and even serious diseases as the cause in question.

Lower Abdominal Pain
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