Lower left abdominal pain can be concerning and confusing. The lower left area of the abdomen contains a number of important organs, including the tail end of the colon and intestines, the left ovary in women, and the tip of the bladder in both men and women. While there are many common and benign causes of lower left abdominal pain, some can be signs of serious medical issues that require prompt medical attention. This article will provide an overview of the possible causes of lower left abdominal pain and guidance on distinguishing benign pain from more worrisome, serious causes that warrant medical evaluation.
What organs are located in the lower left abdomen?
The lower left quadrant of the abdomen contains portions of the following organs:
- Large intestine (colon) – The descending colon runs down the left side of the abdomen.
- Small intestine – The end of the small intestine connects to the colon on the lower left side.
- Left ovary and fallopian tube (women) – The left ovary and fallopian tube sit in the lower abdomen.
- Left ureter – The ureter carries urine from the left kidney to the bladder.
- Bladder – The bottom left portion of the bladder extends into the lower abdomen.
- Left leg muscles – Abdominal wall muscles cover the lower left side.
Many abdominal organs can refer pain to the lower left side. For example, issues with the left kidney, which sits higher up, can radiate pain down to the lower abdomen.
Common causes of benign lower left abdominal pain
There are many common, benign causes of isolated lower left abdominal pain. These types of pain are usually mild to moderate, tend to come and go, and are not associated with other worrisome symptoms. Common causes include:
Gas pain or indigestion
Gas pain is one of the most common reasons for lower left abdominal discomfort. Gas pain may feel like cramps or aches, and may come and go. Things that can provoke gas or indigestion include:
- Eating foods that are fatty, greasy, or high in fiber
- Eating too much or too quickly
- Swallowing air when eating or drinking
- Drinking carbonated beverages
- Lactose intolerance
- Artificial sweeteners
Gas pain usually goes away once gas is passed or with antacids or over-the-counter medications that decrease gas production.
Constipation
Constipation, or difficulty emptying the bowels, can also cause lower left abdominal discomfort. This occurs because feces can build up in the descending colon on the left side. Straining to pass stool can provoke aching or cramping. Constipation is common with:
- Poor fiber intake
- Dehydration
- Medications like opioids, iron supplements
- Low thyroid hormone
- Poor mobility
Mild constipation pain will improve with passage of stool or with over-the-counter laxatives or stool softeners. Seek medical advice if constipation is severe or long-lasting.
Menstrual cramps
Many women experience lower abdominal cramps around the time of their menstrual period. Prostaglandins released during menstruation cause contraction of the uterus and blood vessels, leading to cramping and aches. Cramping is usually worst on the first day of bleeding and may switch sides from month to month. Using a heating pad and over-the-counter pain medication helps relieve this type of cramping.
Intense exercise
The abdominal muscles and intestinal wall muscles can be strained or overworked during intense exercise. activities like running, sit-ups, and strength training that engage the core muscles can provoke aches and cramps in the lower left side that resolve with rest. Staying hydrated and avoiding pushing through abdominal pain during workouts can prevent this.
Kidney stones
Kidney stones form as salt and mineral deposits in the kidneys and can cause sharp pain in the left side as they pass down the ureter towards the bladder. The pain often comes in waves, with intense cramping followed by periods of relief. It may radiate down the inner thigh or groin. Kidney stone attacks are often accompanied by nausea, vomiting, blood in the urine, and difficulty passing urine. Small stones may pass on their own, while larger ones may require urologic procedures.
When should you be concerned about lower left abdominal pain?
While most causes of lower left abdominal pain are benign, certain symptoms and characteristics warrant medical evaluation. Seek prompt medical care if lower left abdominal pain is accompanied by:
- Severe pain that comes on suddenly and intensely
- Fever of 101F (38.3C) or higher
- Vomiting, especially if vomiting blood or “coffee grounds” material
- Bloody or black/tarry stools
- Inability to pass gas or stool
- Severe constipation lasting over a week
- Burning with urination
- Blood in the urine
- Difficulty passing urine
- Heavy vaginal bleeding
- Severe pain with menstrual periods
- Abnormal vaginal discharge
- Pain with intercourse
- Significant unintentional weight loss
- Localized abdominal swelling
Seek emergency medical care for lower left abdominal pain if you experience:
- Fainting or feeling faint
- Chest pain or tightness
- Shortness of breath
- Confused, slurred speech
- Weakness or numbness
Serious causes of lower left abdominal pain
There are a number of disorders and medical emergencies that can cause lower left abdominal pain. These include:
Diverticulitis
Diverticula are small outpouchings in the colon wall that can become inflamed, known as diverticulitis. Diverticulitis classically causes intense, constant lower left abdominal pain, fevers, chills, and changes in bowel habits. It is more common in older adults and requires antibiotics and sometimes surgery for treatment.
Bowel obstruction
A blockage or obstruction prevents the normal passage of food and stool through the intestines. This causes abdominal swelling, cramping pain, vomiting, and an inability to pass gas or have bowel movements. Bowel obstructions are medical emergencies requiring hospitalization.
Inflammatory bowel disease
Chronic conditions like Crohn’s disease or ulcerative colitis can flare up and cause lower left abdominal pain, diarrhea, rectal bleeding, weight loss, fever, and anemia. IBD may lead to bowel obstructions or abscesses requiring hospitalization for intravenous medications, fluids, or surgery.
Irritable bowel syndrome (IBS)
IBS provokes recurrent abdominal pain associated with altered bowel habits. Pain may switch between the lower right and left sides. IBS does not lead to bleeding, weight loss, or bowel obstruction, so these symptoms would warrant further workup.
Intussusception
This condition occurs when one segment of bowel slides into an adjacent segment, obstructing the intestines. This causes intense pain, vomiting, and bloody stool (“currant jelly” stool). It requires emergency surgery and primarily affects infants and small children.
Appendicitis
Appendicitis refers to inflammation of the appendix, usually due to obstruction of the appendix opening. It manifests as constant lower right abdominal pain that later shifts to the lower left as the inflamed appendix rests on the left side. Other appendicitis symptoms are loss of appetite, nausea, vomiting, fever, and abdominal tenderness. Appendicitis is a surgical emergency.
Kidney disorders
Kidney infections, stones, and cysts can all manifest as left lower abdominal pain due to the position of the left kidney and ureter. There is usually fever, back pain, burning urination, and visible blood or pus in the urine.
Abdominal aortic aneurysm
An abdominal aortic aneurysm is swelling and weakening of the major abdominal artery. If it ruptures, it causes sudden, severe pain that often radiates to the back. It is a life-threatening emergency requiring immediate surgery.
Endometriosis
Endometrial tissue that grows outside of the uterus and ovaries can cause intense pain, especially around menstrual periods. There may also be painful bowel movements and urination. Other symptoms are heavy periods and infertility. Endometriosis requires treatment with hormonal medications or surgery.
Pelvic inflammatory disease
Bacterial infections of the uterus, ovaries or fallopian tubes lead to lower abdominal pain, abnormal vaginal discharge, pain with sex or urination, and fevers. PID can scar the female reproductive organs and cause infertility if left untreated.
Ectopic pregnancy
A pregnancy that implants outside of the uterus may occur in one of the fallopian tubes on the left side. This causes intense, constant, one-sided pain that can rupture the tube and lead to life-threatening internal bleeding.
Ovarian torsion
The ovary and fallopian tube can twist on its supporting ligaments, compromising its blood supply. Sudden, severe, one-sided lower abdominal pain with nausea and vomiting may indicate ovarian torsion requiring emergency surgery.
Ovarian cyst rupture
Ovarian cysts are fluid-filled sacs that can develop on the ovaries. If a large cyst ruptures, it causes severe pain that comes on suddenly on one side. Symptoms persist for several hours.
What tests help evaluate lower left abdominal pain?
If serious causes of lower left abdominal pain are suspected, your doctor may order tests like:
- Blood tests – Signs of infection, inflammation, or anemia
- Urinalysis – Detects signs of urine infection or kidney disorders
- Pregnancy test
- CT scan – Visualizes abdominal organs and tissues
- Ultrasound – Evaluates the reproductive organs in women
- Endoscopy – Views the interior of the colon with a flexible tube inserted through the rectum
Surgical evaluation with laparoscopy may be needed if the diagnosis remains unclear. This involves inserting a small camera through the abdominal wall to view the organs.
How is lower left abdominal pain treated?
Treatment depends on the underlying cause of the left lower abdominal pain:
- Self-care for gas, constipation, muscle strain, menstrual cramps – This includes rest, over-the-counter pain medication, heating pads, and laxatives
- Antibiotics for diverticulitis and PID – Oral or intravenous antibiotics treat bacterial infection
- Surgery for appendicitis, bowel obstruction, abdominal aneurysm – Urgent operative intervention is needed
- Endometriosis treatment – Hormonal birth control, GnRH agonists, or laparoscopic ablation can reduce endometriosis-associated pain
- Bowel rest, IV fluids, medications for IBD – Treatment aims to reduce inflammation during IBD flares
- Diet changes, antispasmodics, and antidiarrheals for IBS – This alleviates IBS abdominal pain and diarrhea
Lower left abdominal pain should completely resolve with appropriate treatment. Worsening or persistent pain despite treatment mandates repeat medical evaluation.
When to see a doctor
See your doctor for lower left abdominal pain that:
- Is severe or worsens
- Persists for over 1-2 days
- Is associated with fever, nausea/vomiting, blood in stool or urine
- Occurs with burning urination, vaginal discharge/bleeding
- Occurs with chest pain, fainting
Seek emergency care if pain is sudden and severe or you have signs of shock like fainting, confusion, or high heart rate.
How can you prevent lower left abdominal pain?
You may be able to reduce episodes of lower left abdominal pain by:
- Eating a high fiber diet with fruits, vegetables, and whole grains
- Drinking plenty of fluids to stay hydrated
- Exercising regularly to avoid constipation
- Practicing mindful eating habits
- Taking antacids or simethicone products for gas as needed
- Maintaining a healthy body weight
- Seeing your gynecologist for regular checkups and STI screening
- Using protection during sexual activity to prevent PID
When to see a doctor for lower left side pain
You should see a doctor for lower left abdominal pain if:
- The pain is severe or gets worse over time
- The pain does not go away after a few days
- The pain is accompanied by fever, vomiting, or abnormal vaginal bleeding
- You have symptoms of dehydration like dizziness or dark urine
- You have difficulty passing stool or gas
- There is blood in your stool or urine
- You have signs of shock like fainting or rapid heart rate
See a doctor promptly if you experience any of these red flag symptoms. Call 911 or go to the ER if you have sudden, severe abdominal pain.
Conclusion
Lower left abdominal pain has a wide range of potential causes. Most are benign conditions like gas, constipation, menstrual cramps or muscle strain. However, some serious medical disorders can also manifest as left lower quadrant pain. Red flag symptoms like fever, vomiting, bleeding or inability to pass stool signal the need for rapid medical evaluation. If you have any concerns about severe, persistent or worsening left side abdominal pain, do not hesitate to see a doctor or go to an emergency room to rule out dangerous conditions that require hospitalization for treatment. Catching serious causes early greatly improves outcomes. With an attentive doctor guiding appropriate testing and treatment, most causes of left lower abdominal discomfort can be successfully managed.
