Pain in the lower abdomen in women is most often found during menstruation, the physiological or pathological course of pregnancy, adnexitis. Also, pain syndrome develops with endometriosis and neoplasms of the genital organs, diseases of the urinary and digestive systems. To detect the cause of pain, a gynecological examination, ultrasound, endoscopic and radiological diagnostic methods are prescribed. For therapeutic purposes, analgesics, antispasmodics, antibiotics, hormones, sedatives are used. Some conditions require surgery.
With a normal gestation, women experience short-term, non-intense pain in the lower abdomen. They are caused by an increase in the size of the uterus, overstretching of the ligaments that support it. In the second or third trimesters, the enlarged uterus compresses neighboring organs, which also causes discomfort for the expectant mother. Pain can occur with swelling, which is often observed in pregnant women.
During the gestation period, acute pains in the lower abdomen indicate the development of complications. With spontaneous abortion in women, there is a sharp paroxysmal pain in the suprapubic and sacral zone. It appears suddenly, can be provoked by a blow to the stomach, lifting weights, a stressful situation. The pain syndrome is accompanied by bloody discharge from the genital tract, which indicates an abortion in progress.
Severe paroxysmal or aching dull pain in the lower abdomen, combined with bleeding, may indicate premature placental abruption. The lower abdomen becomes hard and tense; when probing this zone, the pain increases. Sometimes the pain syndrome is so intense that some women lose consciousness. The condition mostly develops after the 20th week of pregnancy.
Aching pains in the lower abdomen on the right or left occur in women with an ectopic pregnancy. They may be accompanied by engorgement of the mammary glands, a change in appetite, and a delay in menstruation. An interrupted tubal pregnancy is characterized by sharp pains in the lower abdominal cavity, which radiate to the perineum, lower back, and thigh. Bloody or brown spotting from the vagina is common.
It is the most common cause of lower abdominal pain in women of reproductive age. Soreness appears 12-24 hours before the onset of menstruation. In most women, the pains are pulling or aching in nature, have a moderate intensity, and are eliminated with the help of conventional analgesics or antispasmodics. The most intense cramps are observed on the first day of menstruation, then they decrease. Within 3-4 days, a slight discomfort in the lower abdomen may be felt.
With moderate and severe algomenorrhea, women experience severe cramps in the lower abdomen with irradiation to the lumbar region. Soreness becomes stronger when turning and tilting the body, coughing and sneezing, straining. Severe pain affects the ability to work and activity of women. In addition to the pain syndrome, psycho-emotional instability, weakness and dizziness, nausea and stool disorder are noted.
Pain in the lower abdomen in women
Pain above the pubis and in the lateral parts of the abdomen is characteristic of endometritis, adnexitis. In acute inflammation, women are concerned about intense persistent or paroxysmal pain, which is more pronounced on the side of inflammation. For acute endometritis, pain in the lower abdomen without a clear localization is typical. Against the background of pain, body temperature rises, general weakness increases, various vaginal discharges are possible.
In the chronic form of adnexitis, moderate aching pain in the lower abdomen is observed, and occasionally short-term spasms occur. Soreness increases after hypothermia, under the influence of stress, with concomitant viral or bacterial processes. In chronic endometritis, pulling pains are felt, accompanied by menstrual irregularities. A pathognomonic sign is a sharp increase in pain during intercourse.
Depending on the localization of endometriosis, pain in the lower abdomen has different characteristics. Most women complain of a vague pulling or aching sensation in the pelvis that gets worse before menstruation. The pain syndrome reaches its maximum intensity in the first 2-3 days of menstruation. Often, pain in the pubic zone is aggravated during intimate relationships.
The most common tumor formation of the genitals in women is uterine fibroids. Interstitial and subserous fibroids are characterized by persistent dull pain in the pelvic cavity. With submucosal fibroids, women suddenly feel severe spasms. A typical change in the intensity of the pain syndrome in different phases of the monthly cycle. Pain is accompanied by menorrhagia, acyclic uterine bleeding.
For malignant tumors of the uterus, constant pain in the lower abdomen is specific, which worsens as the neoplasm grows. Sometimes the pain radiates to the lower back, sacrum, rectum. With cancer of the body of the uterus, cramping pain occurs for no apparent reason. After a painful attack, as a rule, bloody or sanious vaginal discharge appears.
With CPPS, women complain of pain sensations of various strength and nature that bother the patient for at least 6 months. Pain is localized in the lower abdomen, in the perineal and pubic region. Their irradiation to the hip joints, buttocks is possible. The pain syndrome is aggravated by physical exertion, hypothermia. Pain in the lower abdomen also appears during intercourse, vaginal examination.
A common cause of pain in the lower abdomen in women is cystitis. In acute inflammation, patients constantly experience pain in the suprapubic region, which has a different intensity - from slight discomfort to unbearable pain. There are frequent imperative urge to urinate, urine output is accompanied by increased pain in the lower abdomen. Sometimes women notice a sharp unpleasant odor and cloudy urine.
Dull pain above the pubis, worse at the end of urination, is typical of vesical polyps. With a malignant process in the bladder, there is constant severe pain above the pubis. Sometimes pain in the lower abdomen occurs with pyelonephritis, ureteritis. For these diseases, pain in the lower back is more characteristic, however, when urinating, a woman may feel discomfort in the suprapubic region.
Paroxysmal pain in the lower abdomen is typical for infections that occur with colitis syndrome. These include escherichiosis, shigellosis, yersiniosis and campylobacteriosis. Women are concerned about severe cutting pains, accompanied by painful urge to defecate. After a bowel movement, the pain syndrome subsides for a short time. Diarrhea develops 1 or more times a day, feces contain a large amount of mucus, sometimes streaks of blood.
Pain in the lower abdomen is observed in women with inguinal hernias, hernias of the white or Spigelian lines. Soreness occurs when straining, squeezing the abdominal organs with tight clothing or a belt. Over time, due to an increase in hernial protrusion, the pain becomes permanent. Acute pain in the area of the hernial sac and the inability to push it into the abdominal cavity indicate an incarcerated hernia.
Inflammation of the appendix is characterized by pain on the right in the iliac region, but sometimes pain is felt above the pubis. Localization of the pain syndrome depends on the location of the appendix in the abdominal cavity. With appendicitis, severe constant pain is disturbed, accompanied by muscle tension in the right iliac region. After the onset of pain, there may be one or two vomiting, diarrhea, or stool retention.
Establishing the root cause of pain in the lower abdomen in women is difficult even for an experienced doctor, since it is necessary to differentiate diseases of the reproductive, digestive, and urinary systems. The patient is examined by an obstetrician-gynecologist, a gastroenterologist, and other specialists are involved if necessary. The diagnostic plan includes laboratory and instrumental methods:
With pain in the lower abdomen, a woman is shown a consultation with a gynecologist
For pain in the abdomen associated with menstruation, non-drug methods are sufficient. Herbal teas with chamomile and mint are effective. You can put a warm (not hot!) heating pad on the lower abdomen and lie down with it in the “fetal position”, pulling your knees up to your body. To reduce menstrual cramps, it is advisable to give up strong tea and coffee, spicy and smoked foods. The psychological mood of a woman, the ability to calm down and relax is very important.
With a slight soreness that occurs in pregnant women, doctors recommend avoiding physical exertion and lifting weights, and rest more. It is necessary to exclude foods that increase gas formation from the diet, since flatulence is one of the main causes of abdominal pain during gestation. With increased pain, the appearance of protective tension in the abdominal muscles and bloody discharge from the vagina, you should seek medical help as soon as possible.
Treatment of women experiencing pain in the lower abdomen should be etiopathogenetic, so drugs are prescribed only after identifying the root causes of the pain syndrome. Drug therapy is supplemented with a sparing regimen, if indicated, bed or semi-bed, fortified diet with an adequate amount of liquid. Treatment regimens may include the following groups of medicines:
A number of obstetric pathologies require urgent surgical intervention. In case of an ectopic pregnancy, an operation is performed to remove the fallopian tube along with the fetal egg (tubectomy), and in an uncomplicated course, an organ-preserving operation, tubotomy, is possible. Complete premature detachment of the placenta is an indication for caesarean section, regardless of gestational age.
Gynecological diseases (ovarian apoplexy and torsion of the tumor pedicle) are treated surgically by oophorectomy, adnexectomy, wedge-shaped resection of the ovary. In severe forms of endometriosis, endometriotic lesions are excised. Surgical treatment is also required for abdominal pathology: appendicitis (appendectomy), hernias (hernioplasty).