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Digestive Disorders > Symptoms

Lower abdominal pain – What could be behind pain in the lower abdomen?

Dr. med. André Sommer

Dr. med. André Sommer

Most people have had abdominal pain before. It can have a variety of causes, most of which are harmless in nature and not a matter of concern. Lower abdominal pain can be caused by many different acute or chronic illnesses.

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The region below the belly button is called the lower abdomen. For example, the lower abdomen can be further divided into right and left parts (quadrants).

When can lower abdominal pain be particularly dangerous?

First of all, it is important for the doctor to differentiate between threatening diseases and functional complaints.

Immediate, emergency clarification is required for the following:

  • Very severe abdominal pain
  • Defense tension (involuntary tensing of the abdominal wall when touched), hard stomach
  • Lower abdominal pain accompanied by circulatory disorders
  • Rapid pain development followed by vomiting, a heavily bloated stomach, stool and wind behavior
  • Vomiting blood, tarry stools, bloody stools
  • Lower abdominal pain during pregnancy
  • Lower abdominal pain with urinary retention

If the following symptoms appear in connection with lower abdominal pain, this can also indicate a serious illness:

  • Fever
  • Jaundice
  • Unwanted weight loss
  • Change in stool habits
  • Diarrhea lasting more than 14 days

What are functional symptoms?

Functional disorders are characterized by the fact that disrupted organ functions cannot be explained by any physical findings. Around one in four patients with such a problem presents themselves at the doctor. The disturbed organ functions present themselves to a large extent as pain disorders, whereby here again the abdominal region is very often affected.

Not all pain is the same. Whether it occurs suddenly or insidiously and whether there is a trigger or soothing factors can indicate the cause of the pain. In addition, the pain localization offers initial indications due to the location of the organs.

If you take a look at the organs directly under the abdominal wall, you only see the intestine. A distinction is made between the small and large intestines, which together are several meters long. The large intestine surrounds the long loops of the small intestine like a frame.

In the right lower abdomen is the transition between the small and large intestine. The so-called ileum of the small intestine located closer to the mouth opens into the well-known appendix of the large intestine.

Pain in the right abdomen


A "classic" among the causes of pain in the lower abdomen is appendicitis. In fact, it is not the entire appendix, but only its appendage, the Vermiform appendix, that is inflamed here. A typical pain characteristic can appear with appendicitis: First the pain is perceived diffusely around the navel, later the pain migrates into the right lower abdomen and is described as a rather piercing, "light" pain. In addition, nausea and vomiting as well as wind and bowel movements and loss of appetite can occur. Subfebrile temperatures or fever are also typical. Nevertheless, appendicitis is often not easy to diagnose. Especially in children, the elderly or pregnant women, the typical symptoms may be missing or different.

Inflammatory bowel disease

Another disease that can cause right-sided pelvic pain, similar to appendicitis, is Crohn's disease.

This is an inflammatory bowel disease of unknown origin, which usually also affects young adults and children. Inflammation can affect the entire digestive tract, but it usually affects the last part of the small intestine and the colon that immediately follows. If you want to differentiate between these two diseases, accompanying symptoms help. In over 70 percent of all patients with Crohn's disease recurrent diarrhea is in the foreground along with pain.

If you follow the course of the large intestine, you reach the descending part of the large intestine in the left lower abdomen via two bends.

Pain in the lower abdomen


In the descending part, there are often protuberances of the intestinal wall, so-called diverticula. The prevalence of diverticulosis is very high in industrialized countries, occuring in 60 percent of the population over 70 years of age. However, diverticulosis is almost always symptom-free. However, around 20 percent develop an acute inflammation (Diverticulitis) if, for example, stool is stuck in the protrusions. Then the disease is also called "left-sided appendicitis". Those affected are mostly older patients between the ages of 60 and 80. Various factors such as obesity, high meat consumption, chronic constipation and age-related weak connective tissue can lead to diverticulosis.

Colon cancer

The last section of the colon is the location of the most common type of colon cancer - the colorectal cancer. Many patients only have symptoms at an advanced stage, with little pelvic pain. Therefore colorectal cancer screening tests are recommended from the age of 50.

Inflammatory bowel disease

The rectum is also affected with ulcerative colitis. It is another inflammatory bowel disease in addition to Crohn's disease (see above). Here, too, there is pain in the lower abdomen, but this is more on the left side. In contrast to Crohn's disease, diarrhea with ulcerative colitis is bloody and slimy. Also typical are so-called tenesmus - cramp-like pains before or immediately after bowel movements.

Pain in the middle or entire lower abdomen

Often you cannot clearly assign the lower abdominal pain to one side. If there is more diffuse pain in the lower abdomen or the entire abdominal region, the small intestine or the entire intestine can be the cause.

Bowel obstruction and narrowing

This can be, for example, an intestinal obstruction (ileus), an intestinal narrowing (stenosis), an intestinal breakthrough (perforation) or circulatory disorders in the intestine. In these cases there is an acute, severe clinical picture with the warning symptoms mentioned at the beginning. These are absent in the case of harmless flatulence - which can also lead to severe, cramping pain.


Another acute, but less threatening and very common disease of the small intestine are gastrointestinal infections. Depending on the pathogen, in addition to acute diarrhea and vomiting, pelvic pain occurs in the case of infectious mucous membrane inflammation of the stomach and small intestine. In general, such infections are usually self-correcting within one day. With all diarrhea, the fluid and electrolyte balance must be kept in mind.

Irritable bowel syndrome

In contrast, there are chronic complaints, such as those that show up in irritable bowel syndrome. The clinical picture in irritable bowel syndrome is very diverse and can be indicated by various symptoms such as abdominal pain, diarrhea or constipation. To diagnose the syndrome, the symptoms must last longer than 3 months and other diseases that could cause the symptoms must be excluded. Irritable bowel syndrome is a functional syndrome.

Diverticulosis, chronic inflammatory bowel diseases Crohn's disease and ulcerative colitis, colorectal cancer and food intolerance are among the most important differential diagnoses for irritable bowel complaints. Our team of therapists specializes in bowel diseases. Find out more information here.

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With a food intolerance, the body has problems digesting certain substances. Examples include fructose, lactose or wheat. The absorption of these nutrients then leads to abdominal pain, bloating and diarrhea. Finding the cause of such non-specific abdominal discomfort is not always easy. We have therefore developed a nutritional therapy program in which you can explore your specific causes together with your personal nutritionist. Arrange a free initial consultation here and find out whether the therapy is suitable for you.

Diseases of the urinary organs

Behind the small and large intestine are the urinary organs, which include the kidney, ureter, bladder and urethra.

A common urinary tract disease in affluent societies like ours is urinary stones. They are not always symptomatic. When kidney stones move the ureter, there can be a strong colic-like, that is, swelling and declining pain in the lower abdomen or the groin or flank region. From a clinical point of view, this is characteristic of the motor restlessness of a colic-afflicted patient who wants to relieve their pain by constantly changing his position.

In extreme cases, a stone can make it impossible for those affected to empty the bladder. Doctors call this a urinary retention. Especially in acute cases, this is accompanied by severe abdominal pain. For a majority of the patients, stones are not the cause, but rather an existing chronic bladder emptying disorder, for example due to an enlarged prostate in men.

Frequent visits to the toilet are typical for cystitis. A dull pain can appear over the symphysis here. Inflammation of the bladder is usually easy to recognize by the burning pain when urinating and the unpleasant urge to urinate. It is much more common in women than in men.

In general, abdominal pain is often perceived as a typical female condition. It is true that there are some diseases that only occur in men or only in women, since the internal genital organs are also in the pelvis.

Pain in the lower abdomen in women

Menstrual cramps and endometriosis

Menstrual pains are not uncommon in women. Sometimes gynecological diseases such as endometriosis can also be behind cycle-dependent pelvic pain. With endometriosis, the endometrium is also outside the uterus. 2-10 percent of all women are said to be affected. These and other gynecological disorders that cause pelvic pain are usually accompanied by other symptoms such as irregular cycle and bleeding disorders.

Ectopic pregnancy

Sudden onset of abdominal pain with no bleeding at the same time can indicate rupture of the fallopian tubes during pregnancy of the abdominal cavity (ectopic pregnancy). Ectopic pregnancy refers to pregnancy outside the uterus. A pregnancy test is therefore positive.

Ovarian torsion

Another gynecological emergency is ovarian torsion. Here, too, right or left pelvic pain begins acute, but often after abrupt movement. With an ovarian torsion, the ovary or a large ovarian cyst rotates around its own axis and thus hinders blood flow to the ovary. With a high degree of probability, the ovarian torsion can easily be recognized by a simple sonographic examination.

Lower abdominal pain on the right or left side can also be caused by inflammation of the fallopian tube and ovary (adnexitis). It is an important differential diagnosis for suspected appendicitis in women. Adnexitis is an inflammation of the fallopian tubes, ovaries and the surrounding tissue. This usually arises via ascending infections from the vagina and uterus, e.g. after transmission of gonococci or chlamydia in sexually active women.

Tip: Abdominal pain is often caused by a bloated stomach. Unfortunately, especially women are affected by this due to hormones. Nutritional therapy can consciously reduce this flatulence.

Pain in the lower abdomen in men

Testicular torsion

In men, diseases of the genital organs can also cause lower abdominal pain. Sudden onset pain in the lower abdomen and testicles in children and young adolescents in particular can be signs of testicular torsion. Testicular torsion is an acute twisting of the testicles and spermatic cord and is an emergency.

Prostate and testicular inflammation

Inflammation of the prostate (prostatitis), testicular inflammation (orchitis) or epididymis (epididymitis) are less sudden, but also uncomfortable.** **At the same time, problems with urination, local signs of inflammation and general signs of infection such as fever and chills often occur.

Bladder infection

If you have problems urinating and have pain above the pubic bone, you should also consider that it may be a bladder infection. Because while in many cases an uncomplicated urinary tract infection can be assumed for women, a thorough investigation must be carried out for a male patient. This is because the woman's shorter urethra anatomically favors an infection in the immediate region of the anus, but cystitis is rare in men and is therefore definitely worth clarifying.

Inguinal hernia

Due to the anatomical conditions, men are predisposed for another disease, which can occur in both sexes: inguinal hernia. Bulging in the groin area is characteristic of inguinal hernia. Under certain circumstances, however pulling groin pain (especially when moving) may be the only symptom.

Lower abdominal pain and back pain

Sometimes pain caused by abdominal organs radiates to other parts of the body. Organs that have a close relationship to the back are the kidneys and the pancreas in particular. But diseases of the urinary tract and genital organs can also cause back pain.

Back pain can not only be the result of an abdominal disease - the spine can also cause lower abdominal pain. Degenerative changes in the spine such as herniated discs could be the cause here.

In general, both abdominal pain and back pain are very common complaints, so that they do not necessarily have to be related even if they occur at the same time.

Herold, G. (2011). Innere Medizin 2011. Cologne: Selbstverl.

AMBOSS. (2018). AMBOSS. [online] Available at: [Accessed 5 Mar. 2018].

Seiderer-Nack, J. (2012). Anamnese und körperliche Untersuchung. Berlin: Lehmanns Media.

Dr. med. André Sommer

Dr. med. André Sommer

I’m André, a medical doctor from Berlin. Together with a team of medical doctors, nutritionists and data scientists we empower people to understand digestive issues with our app Cara Care.

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