Causes of Lower Abdominal Pain and How to Treat It

The lower abdomen is the area between your belly button and pelvic bone. Lower abdominal pain is commonly caused by trapped gas or indigestion. Less commonly, lower abdominal pain can be a symptom of a more serious issue, like a kidney infection or a twisted bowel.

Lower abdominal pain is a symptom, not a condition. If you are experiencing it, pay close attention to any other symptoms you may have. For example, if you have lower abdominal pain in addition to another red flag symptom like blood in your stool or vomit, then you need to get medical attention right away.

This article describes 12 possible causes of abdominal pain along with the symptoms of those conditions. It also explains how each condition is diagnosed and treated.

Appendicitis

Appendicitis is a serious condition that requires emergency attention. When the appendix becomes infected and inflamed, prompt treatment is necessary to prevent the organ from rupturing.

People between the ages of 10 and 30 are most likely to get appendicitis. It can happen at any age, though.

Symptoms

Most people with appendicitis have pain that:

• Starts suddenly on the right side of the lower abdomen
• Starts suddenly around the navel, then shifts to the lower right abdomen
• Is relieved by putting pressure on the site but comes back when the pressure is removed
• Gets worse when you move, breathe deeply, cough, or sneeze
• Comes on before other symptoms and gets worse over the next few hours
• Is severe and may have a different quality than you've felt before

Other possible symptoms include:

• Nausea and vomiting
• Abdominal swelling
• Diarrhea or constipation
• Mild fever
• Loss of appetite
• Being unable to pass gas 

When the appendix ruptures, it usually alleviates the pain for a while. However, the burst organ spills infection out into your abdomen, where it can spread throughout your body. That leads to sepsis, which is life-threatening.

Causes

Common causes of appendicitis include:

• Viral, bacterial, or parasitic infections in your digestive tract
• A blockage of calcified feces in the appendix (appendicloth)
• Tumors of the appendix or intestines

Treatments

The most common treatment for appendicitis in which the appendix has not burst (uncomplicated appendicitis) is a surgical procedure called laparoscopic appendectomy to remove the appendix. This is considered a relatively safe procedure with a low risk of complications.

In some cases, uncomplicated appendicitis may be treated with a 10-day course of broad-spectrum antibiotics. However, there is a 15% to 40% chance that the appendicitis will recur within one year. Antibiotic treatment is a potential option for people who have very mild appendicitis without an appendicloth.

In people with a burst appendix (complicated appendicitis), appendicloth, or people who are severely ill, surgical removal of the appendix (open appendectomy) is required. If the appendix has burst, the surgeon may place a small tube to drain infectious fluids from the belly. The tube will be removed a few days later. The recovery period may also involve a course of antibiotics.

Colitis

Colitis is a chronic disease characterized by inflammation of the large intestine (colon). It is considered a form of inflammatory bowel disease (IBD).

Symptoms

Abdominal pain due to colitis may begin suddenly or gradually and become constant or come and go. The pain is often described as a cramping sensation in the lower left side of the abdomen.

Most people with colitis experience periods of severe pain and other colitis symptoms. These flare-ups are typically followed by longer periods of remission, during which time the pain may be more mild.

Other possible symptoms of colitis include:

• Blood in the stool
• Bloating
• Frequent urge to have a bowel movement (tenesmus)
• Diarrhea
• Dehydration 
• Fever 

Causes

Possible causes of colitis include:

• Colon infections caused by a virus or parasite
• Food poisoning due to bacteria
• Crohn disease
• Ulcerative colitis
• Ischemic colitis, in which there is a lack of blood flow to the colon
• Radiation colitis caused by past radiation to the colon
• Necrotizing enterocolitis (in newborns)

The exact cause of colitis is unknown in approximately 5% to 15% of cases. However, researchers agree there tends to be a combination of dietary, environmental, and genetic factors at play.

Treatments

The first-line treatment for mild to moderate colitis is a class of drugs called aminosalicylates. The use of these drugs can induce and maintain colitis remission by reducing colonic inflammation.

Oral corticosteroid treatment may also be prescribed to reduce inflammation and induce remission, but they should not be used long-term as they are associated with a higher risk of side effects. Corticosteroids are not effective for maintaining colitis remission, either.

Approximately 70% of people with colitis respond well to anti-inflammatory medications and go into remission. If remission is not possible from medications alone, the next option is surgery.

The first surgical option for treating colitis is called a total proctocolectomy with Brooke ileostomy. The surgery, which is done under general anesthesia, involves removing the entire colon and rectum through the abdomen. An ostomy bag is then fitted to the body to collect waste. The bag may be temporary or permanent.

A second surgical option is restorative proctocolectomy with ileal pouch-anal anastomosis. It involves removing the entire colon and most of the rectum. A new rectum is then created from the small bowel. The procedure may be performed laparoscopically to ease recovery.

Diverticular Disease

Diverticular disease includes diverticulosis and diverticulitis. People with diverticulosis have bulging pouches that form on the inner wall of the large intestine or colon. When the pouches become irritated or infected, the condition is called diverticulitis. More than half of Americans over age 60 have diverticulitis.

Symptoms

Some people with diverticulosis have no symptoms at all. However, the bulging can cause abdominal bloating, cramping, and constipation. In diverticulitis, the most common symptom is sharp abdominal pain and tenderness in the lower left half of the abdomen.

Symptoms of diverticulitis often start suddenly and can be severe. In addition to abdominal pain, symptoms may include:

• Nausea and vomiting
• Lack of hunger
• Fever and chills

Although rare, some people with diverticulitis may notice blood in their stool or on toilet paper. If you notice this symptom, it's important to get medical attention right away.

Causes

The exact cause of diverticular disease is unknown, but several risk factors have been identified. In particular, eating a low-fiber diet made up of mostly processed food is thought to be a major contributing factor.

A lack of fiber in the diet makes stools harder and more difficult to pass. This results in straining, which increases pressure in the colon or intestines, potentially leading to the development of diverticular bulges. Diverticulitis then develops if the bulges become inflamed or infected.

Treatments

Treatment for diverticulitis depends on the severity of symptoms. In mild cases of diverticulitis, symptoms may be treated at home by:

• Resting in bed
• Using a heating pad on the belly
• Taking pain medications according to your healthcare provider's recommendation
• Drinking only fluids for a day or two, then progressing to thicker fluids, then foods

If you have diverticulitis with infection, your provider may prescribe a course of antibiotics.

Note that once diverticular bulges form, they will not go away, and there is a chance that diverticulitis will recur in the future. You can reduce your risk by introducing more fiber to your diet.

Kidney Infection

A kidney infection (pyelonephritis) is a type of urinary tract infection in which one or both kidneys get infected with a bacteria, virus, or rarely a fungus.

Symptoms

While you're likely to feel some back pain, you may also feel pain under your ribs, around the abdomen, and around your groin. Kidney infection pain is typically very severe.

Symptoms may include:

• Pain when urinating
• Frequent urge to urinate
• High fever with chills
• Nausea and vomiting

If you suspect you have a kidney infection, get immediate medical attention.

Causes

Pyelonephritis is a serious infection that often starts with an infection of the bladder (also called infectious cystitis). When cystitis due to a bacteria, virus, or fungus travels to the kidneys, it can cause a kidney infection.

Treatments

Kidney infections caused by bacteria are typically treated with a course of antibiotic, antifungal, or antiviral medication, depending on the type of infection you have. For pain, you may also use a painkiller like paracetamol as needed.

Acute Urinary Retention

If you have acute urinary retention, you're suddenly unable to pass urine. Urinary retention can also be chronic. This condition is more common in males, particularly after age 60. The condition begins suddenly.

Symptoms

Symptoms of acute urinary retention may include:

• Complete or partial inability to urinate
• Difficulty starting the flow of urine (urine hesitancy)
• Pain in the lower abdomen, which is often severe
• The urgent need to urinate, but without success
• Leaking urine without warning
• Swelling of the lower abdomen

Sometimes, urinary retention becomes a chronic condition that develops gradually over time. It may begin with urine hesitancy, a slow urine stream, or urine leakage, then progress to a complete inability to urinate. In some cases, people with chronic urinary retention have few or no symptoms, making the condition difficult to detect.

Causes

Urinary retention can occur for a variety of reasons. Most of the time, it is related to a blockage that partially or completely prevents urine from leaving the bladder or urethra. The blockage may be caused by:

• Enlarge prostate (benign prostatic hyperplasia)
• Bladder obstruction due to scar tissue
• Urinary tract stones, known as calculi
• Cancerous or noncancerous pelvic tumors, fibroids, polyps, or clots
• Tight pelvic floor muscles
• Urinary tract infections or sexually transmitted infections
• Prostate inflammation (prostatitis)
• Trauma to the pelvis, urethra, or penis

Other possible causes include:

• A neurological problem, such as Parkinson's disease, multiple sclerosis, or stroke, that weakens the bladder muscles resulting in underactive bladder
• Medications, including some antidepressants, opioids, and decongestants, that interfere with nerve signals required to urinate
• Weak bladder muscles due to aging, trauma, pregnancy, or childbirth
  

Treatments

Acute urinary retention requires an emergency room visit. At the ER, a healthcare provider will immediately drain the urine from your bladder using a catheter. This will ease your pain and prevent damage to the bladder and kidneys.

Urinary retention cannot be resolved until the underlying condition is addressed. For example, if it is caused by an enlarged prostate, you may be prescribed a 5-alpha reductase inhibitor like dutasteride or finasteride to shrink the prostate.

You may also be prescribed an alpha-blocker, such as alfuzosin or prazosin, to ease urination. An antibiotic may be prescribed in case of a bacterial infection.

Cystitis

Cystitis refers to inflammation of the bladder. It is common, and typically caused by a lower urinary tract infection. Cystitis affects females much more often than males. Menopause increases the risk of developing cystitis due to hormone changes.

Symptoms

Cystitis symptoms include:

• Painful urination
• A burning sensation while urinating
• Cramps or pressure in lower back or abdomen
• A frequent urge to urinate
• Involuntary loss of urine (urinary incontinence)
• Cloudy or dark-colored urine
• Blood in the urine
  
• Foul-smelling urine
• Pain during sexual intercourse
• Genital pain
• Low-grade fever
• Fatigue

Occasionally, older adults may have cystitis without any of symptoms listed above. In some cases, they may experience fever, confusion, or delirium instead.

Causes

The most common cause of cystitis is bacterial infection. Bacteria from feces and sexual intercourse are commonly found in and around the anus. Sometimes, that bacteria enters the urethra and spreads to the bladder, leading to infection.

Females are more prone to cystitis for a few reasons. The female urethra is shorter and closer to the anus than the male urethra. Also, the end of the female urethra is moister and therefore more hospitable for bacteria to grow.

Regardless of gender, having penetrative anal sex increases the risk of cystitis, as it exposes the end of the urethra to fecal matter. Other risk factors that affect males include having an uncircumcised penis and an enlarged prostrate.

Non-bacterial causes of cystitis include:

• Certain medications
• Radiation
• A foreign body in the lower urinary tract
• Interstitial cystitis
• Other medical conditions, like diabetes or kidney stones

Treatments

Cystitis caused by infection can usually be treated with a course of antibiotics. For pain and discomfort, your healthcare provider may prescribe a drug called phenazopyridine which targets pain in the urinary tract. A warm sitz bath may also be helpful for pain.

Cystitis that is caused by a blockage in the urethra or bladder may need to be treated with a surgical procedure to improve urine flow.

Nephrolithiasis (Kidney Stones)

Kidney stones are pebble-like masses that form in the kidneys. They develop when there are high levels of certain minerals and acids like calcium, oxalate, phosphorus, and uric acid, which stick together in urine. Most kidney stones are no larger than the size of a pea but rarely can be as large as a golf ball.

Symptoms

People with kidney stones may experience sharp pains in the back, side, lower abdomen, or groin. The pain may be constant or come and go.

Other possible symptoms of kidney stones include:

• Pink, red, or brown blood in your urine
• A constant urge to urinate
• Pain while urinating
• Difficulty urinating
• Cloudy or foul-smelling urine
• Nausea and vomiting
• Fever and chills

Any time you notice blood in your urine, be sure to get medical attention right away. This symptom can be a sign of a life-threatening condition, such as kidney or bladder cancer.

Causes

Kidney stones are common and often run in families. Why exactly they develop is not always clear, although some possible causes and risk factors include:

• Not drinking enough water
• Obesity
• Weight loss surgery
• Eating food with too much salt or sugar
• Consuming too much fructose

Treatments

Small kidney stones usually pass on their own. Drinking at least six to eight glasses of water per day can help them pass. For pain, you can take an over-the-counter pain reliever, such as ibuprofen or naproxen.

Your healthcare provider may ask you to give a urine sample to test the contents of the kidney stone. Once it's clear which minerals the kidney stones are made of, your provider will be able to determine a treatment. For example, uric acid stones are treated with a drug called allopurinol.

Other medications your provider may prescribe include:

• Diuretics (water pills)
• Sodium bicarbonate or sodium citrate
• Tamsulosin, a drug that relaxes the ureter to help the stone(s) pass

In some cases, a non-invasive procedure called lithotripsy can be used to break up the stones using sound or shock waves, making it easier to pass.

Less commonly, surgery is needed to remove kidney stones. The procedure is done under general anesthesia and involves making a small surgical cut on your back to remove the stone from your kidney or ureter. You may need surgery if:

• The stone is too large to pass.
• The stone is growing.
• The stone is blocking urine flow.
• The pain cannot be controlled with medication.
  

Trapped Gas

The average person produces anywhere from 1 to 4 pints of gas per day. Most people pass gas 14 to 23 times per day, but sometimes extra gas gets trapped in the digestive tract and causes uncomfortable symptoms.

Symptoms

Gas in the digestive tract commonly causes abdominal pain and discomfort. Other symptoms it can cause include:

• Burping
• Bloating
• Abdominal pain
• Flatulence

The abdominal pain from trapped gas depends on where it is. Left-side gas may feel like heart-related pain, while right-side gas may feel similar to appendicitis.

Causes

Gas can end up in the digestive tract when you swallow air or eat certain foods that cause gas. Some foods contain substances that can make you feel gassy, such as:

• Soluble fiber, like beans
• Insoluble fiber, like vegetables
• Fructose, like onions or bananas
• Raffinose, in cabbage and other cruciferous vegetables
• Starch, like potatoes and noodles
• Lactose, found in dairy products

Some people are more likely to have gas in the digestive tract, including people who are lactose intolerant or have digestive disorders.

Treatments

While it can be quite uncomfortable, trapped gas is not cause for concern and usually resolves on its own. Allowing yourself to burp and pass gas helps.

The following methods can help release some trapped gas:

• Drink peppermint or chamomile tea to relax the bowel.
• Drink a tablespoon of apple cider vinegar diluted in a cup of water to ease digestion.
• Take deep breaths to relax the body and aid in digestion.
• Do light physical activities, like walking or yoga.

There are also some things you can do to avoid gas pain:

• Don't drink with a straw.
• Avoid carbonated drinks.
• Avoid chewing gum.
• Switch up your diet to avoid gas-causing foods.

If you have taken steps to reduce gas and bloating but are still experiencing symptoms, call your healthcare provider to rule out food sensitivities or digestive problems.

Twisted Bowel

Lower abdominal pain can also be an early sign of twisted bowel. Also known as volvulus, twisted bowel happens when part of your intestine twists around the tissues that hold it in place. The twisting can result in a loss of blood supply (bowel obstruction).

Symptoms

Abdominal pain from a twisted bowel is often described as a cramping sensation that may be constant or come and go.

Other symptoms of a twisted bowel include:

• Bloating
• Constipation
• Nausea and vomiting

A twisted bowel can become life-threatening if infection, bowel obstruction, or other complications develop. Signs of complications include:

• Symptoms of infection, like fever
• Symptoms of shock, such as confusion, loss of consciousness, fast heart rate, sweating, and pale skin

Get immediate medical attention if you develop any of these symptoms.

Causes

A twisted bowel is caused by differences in the structure of the intestines and surrounding tissues. These differences may be congenital (present at birth), and may include:

• A sigmoid colon (the end of the large intestine) that is longer than average
• Looser tissues around the sigmoid colon, which allow the sigmoid colon to move more than usual
• A cecum (the beginning of the large intestine) that is not properly fixed in place

Also, volvulus affecting the sigmoid colon (sigmoid volvulus) is more prevalent in older adults who live in nursing homes or other long-term care facilities, as these individuals tend to spend long periods of time lying down in bed.

Treatments

A twisted bowel is an emergency condition that requires immediate medical care. This condition is most often treated with emergency surgery.

First, the healthcare provider will using imaging tests to check for signs of colon damage. If there are no signs of colon damage, a surgical procedure known as a flexible sigmoidoscopy can be done to untwist the volvulus.

But, if this procedure doesn't work, or there are signs of colon damage, surgery to remove the affected part of the colon will likely be done right away.

Menstrual Cramps

Cramping during menstruation happens due to uterine contractions. More than half of menstruating people experience some pain for at least one to two days each month.

Symptoms

Menstrual pain can be mild or severe, and dull or throbbing. It is typically continuous for a few days in a row. You may experience lower back pain in addition to lower abdominal pain.

Other symptoms that may accompany menstrual cramps include:

• Fatigue
• Weakness
• Diarrhea
• Nausea and vomiting 
• Headaches

Causes

Mild to moderate pain and cramping are a normal part of menstruation.

However, some people experience menstrual cramps due to another disorder or infection. This is called secondary dysmenorrhea. This abnormal cramping can happen for several reasons, including:

• Endometriosis
• Pelvic inflammatory disease
• Uterine fibroids

Treatments

The first-line treatment for menstrual pain is pain-relieving medication. You can take an NSAID, such as aspirin, ibuprofen, or acetaminophen to reduce pain as needed.

Other options for reducing menstrual pain include:

• Oral contraceptives to inhibit ovulation
• Progesterone (hormone treatment)
• Regular exercise
• Using a heating pad on the abdomen
• Hot baths and showers

For more severe pain, or as a more permanent solution for relieving menstrual pain, the following procedures may be considered:

• Endometrial ablation, a procedure that destroys the uterine lining
• Endometrial resection, a procedure to remove the uterine lining
• Hysterectomy, an irreversible procedure to remove the uterus

Constipation

Most people poop between three times per day and three times per week. At some point or another, however, most people develop constipation, an uncomfortable condition characterized by difficulty having a bowel movement. Constipation is generally defined as having fewer than three bowel movements in a week.

Symptoms

Symptoms of constipation can vary from person to person.

Common symptoms of constipation include:

• Inability to poop
• Painful bowel movements
• Feeling bloated and uncomfortable
• Feeling sluggish
• Abdominal pain

Causes

Constipation occurs when the colon absorbs too much water, resulting in hard and dry stools that are uneasy to pass.

Some of the most common causes of constipation are:

• Lack of exercise
• Not drinking enough liquids
• Not eating enough fiber
• Pregnancy
• Old age
• Abuse of laxatives
  

Constipation is sometimes due to an underlying condition, such as irritable bowel syndrome or a problem with intestinal function. It can also be caused by some medications, including antidepressants and opioids.

Treatment

Eating more fiber and drinking more clear liquids (like water and tea) is often enough to relieve constipation. A few cooked prunes or figs, which are high in fiber, can go a long way.

In more severe cases, taking a laxative medication can quickly put a stop to constipation. Another option is to use a magnesium supplement, such as magnesium oxide.

Eating 20 to 35 grams of fiber per day is the best way to prevent constipation. Limit foods like ice cream, cheese, meat, and processed foods, which contain little to no fiber, and instead consume more:

• Whole wheat bread
• Whole wheat cereal
• Fruits and vegetables
• Nuts
• Beans

Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome is considered a functional bowel disorder, not a disease. About 10% to 15% of people in the United States have symptoms of IBS, which can occur at any age. It is not the same as irritable bowel disease (IBD).

Symptoms

Irritable bowel syndrome causes various gastrointestinal symptoms, including:

• Abdominal pain
• Changes in bowel movements, including diarrhea, constipation, or a mix of both
• Bloating
• Mucus in stool
• A sensation of an unfinished bowel movement

Symptoms are usually mild but can become severe. The above symptoms are considered IBS if you have them at least three days per month for three months or more.

Causes

It's not always clear why IBS develops. In some cases, a person may develop IBS after having a bacterial or parasitic infection that affects the intestines (post-infectious IBS). Stress is also a common cause.

Treatments

Diet and lifestyle changes are typically the first recommendation for people with IBS. This may include:

• Avoiding food and drinks that stimulate the intestines, such as coffee, tea, cola, and other caffeinated drinks
• Eating slower
• Eating small meals
• Adding more fiber to your diet

More severe cases of IBS may be treated with the following medications:

• Anticholinergic medications to control intestinal muscle spasms
• Loperamide for IBS with diarrhea (IBS-D)
• Lubiprostone for IBS with constipation (IBS-C)
• Low doses of tricyclic antidepressants to relieve intestinal pain
• Psychological therapy or medication for IBS due to stress or anxiety

Diagnosis of Lower Abdominal Pain

If your abdominal pain doesn’t seem to be the result of indigestion and is getting worse or not going away, you should see a healthcare provider. 

They will likely perform a physical exam and ask about your symptoms in detail. They may also request tests to rule out possible causes of your abdominal pain.

Expect your provider to ask you about the exact location of the pain and to describe the sensation you’re feeling. They may perform a gynecological or rectal exam if you have lower abdominal pain.

Testing may include:

• Blood tests such as a complete blood count to check for infection or blood loss
• A pregnancy test
• Imaging tests such as a computed tomography (CT) scan to look at your abdominal organs

If you could be pregnant, an ultrasound is the preferred imaging method for evaluating unexplained abdominal pain.

When to See a Healthcare Provider

See a healthcare provider if your symptoms aren't going away or are getting worse, or if you have other potentially serious symptoms, such as:

• Blood in the stool
• High fever
• Vomiting blood
• Lightheadedness
• Severe pain that doesn't go away

Summary

Lower abdominal pain can be acute or chronic. It can be a symptom of minor or major digestive system conditions such as gas, indigestion, constipation, colitis, diverticular disease, or appendicitis.

Gynecologic conditions such as menstrual cramps or pregnancy may also be causes, as can kidney stones and urinary tract infections.

Treatment depends on the underlying cause. It may include anything from over-the-counter antacids to emergency surgery.