Abdominal pain (pelvic pain) - causes and treatment

Abdominal pain (pelvic pain) - causes and treatment

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Abdominal pain symptoms and causes
Abdominal pain is more common in women than in men, but men are also affected. Such symptoms are typical for women before and during menstruation, typical for men for diseases of the prostate and testicles. Bowel problems and diseases of the urinary tract, however, as common triggers affect both genders. Abdominal pain can also have psychological causes.

The lower abdomen - what is it?

The abdomen is an antiquated term. Doctors speak of the lower abdomen. This includes the genitals of men and women, the bladder and urethra, as well as the lower part of the intestine and the pubic area. These are the organs on which pain occurs, which we call abdominal pain.


Abdominal pain can occur unilaterally or in the entire lower abdomen. The most common pain is stinging or pulling. The symptoms can be acute, chronic or cyclical. Typical cyclical pain is the monthly recurring pain before and during the period. Lower abdominal pain can appear colicky, dull, spastic, or sharp.

They may appear as a single symptom, but may be accompanied by diarrhea, constipation, nausea and vomiting, dizziness, exhaustion, drowsiness, fatigue, headache, chest pain, or leg pain. If there are serious underlying illnesses, a shock condition can even occur. Often, the form already gives pain, its exact location and the accompanying symptoms indicate the cause.

Overview of abdominal pain - the most important facts

On the one hand, women and men have gender-specific triggers for abdominal pain: in women, these are menstrual problems, pregnancies and the female genitals, in men, above all, prostate and testicular diseases.

Pain in the lower abdomen during pregnancy is normal, but severe and chronic pain can indicate an ectopic pregnancy, premature birth or miscarriage.

Abdominal pain can come from organs that all people have, for example, inflammation of the urinary tract, intestinal tract, kidney, urinary or bladder stones.

In the case of acute and severe pain, you should definitely consult a doctor. In an emergency, these are diseases that destroy their fertility.

Causes in both sexes

Men and women can suffer from tumors (e.g. in the intestine), an inguinal hernia, inflammation of the kidneys, urinary or kidney stones or, albeit rarely, inflammatory bowel diseases such as Crohn's disease or ulcerative colitis.

Causes of pelvic pain in women

Pain in the lower abdomen in women can either come from the intestine or from the organs that drain urine. In women, the trigger can also be due to the internal genital organs. This includes the uterus, ovaries and fallopian tubes.

Genital causes include inflamed ovaries and fallopian tubes as well as fallopian tube or abdominal pregnancies. Non-genital causes can be urinary tract infections, constipation or an inflamed appendix.

Menstrual pain

Pain before or during your period is the most common cause of pelvic pain in women. They appear as cramping discomfort in the abdomen and back during menstruation or in the week before.

If this pain is particularly severe, it can indicate endometriosis. With this disease, uterine lining is distributed outside the uterus, usually in the nearby lower abdomen, but also in the peritoneum and in the small pelvis. The lining of the uterus reacts to the monthly period and also bleeds outside the uterus, which leads to severe pain during menstruation and a stinging in the abdomen.

Ovarian cysts

Cysts on the ovaries are normal, and many women have such small cysts without noticing them. If a cyst constricts blood vessels because it twists, severe pain in the lower abdomen is often the result.

Ectopic pregnancy

Sometimes a fertilized egg does not nest in the uterus, but in the mucous membrane of the fallopian tubes. This is a serious illness. Extreme pain, infection and bleeding are typical of a ruptured fallopian tube.

Infections of the ovaries and fallopian tubes

Infection threatens if germs from the vagina migrate through the uterus to the ovaries. Most of these are chlamydia, less often gonococci. Such inflammation is shown by severe pain in the lower abdomen, which can be either one or both sides. Accompanying symptoms are discharge and spotting.

Uterine prolapse

The pain in the lower abdomen is associated with a feeling of pressure. There is also a feeling of fullness "as if the stomach is bursting". Back pain and urge to urinate are also typical.

Inflammation of the uterus

Endometritis arises when germs from the vagina infect the uterus. The pain in the abdomen is burning. There is also vaginal discharge, severe itching and bleeding outside the period.

Pelvic inflammation

Pelvic inflammatory disease (inflammation of the abdomen or pelvic inflammation) refers to inflammation of the uterus, fallopian tubes and ovaries. In addition to the severe pain, this can result in infertility.


Cancer in the vagina or cervix also causes pain.

Lower abdominal pain during pregnancy

Every woman has pain in her lower abdomen during pregnancy. Stretching pains are not dangerous in the first two thirds of pregnancy. These come from the fact that the fetus grows, the uterus expands, and thus strains the ligaments, muscles and veins. The tension pains at the end of pregnancy are also not a symptom of an illness. Cramp-like pain, the labor pains, initiate the birth.

In addition to an ectopic pregnancy, the causes of unusually severe pain during pregnancy can also be an impending miscarriage, a uterine rupture or a non-functioning placenta.

Normal and dangerous pain in the lower abdomen in pregnant women

If the pain in the lower abdomen remains short-term and does not leave any chronic problems, there is no need to worry. Such pain usually disappears when the pregnant woman is resting. There are signals of serious causes

  • Fever,
  • burning pain when peeing,
  • Chills,
  • strong discharge,
  • Bleeding,
  • Paleness,
  • persistent weakness,
  • Fatigue and dizziness,
  • Dizziness,
  • Eye flicker
  • and fainting.

In these cases, you should see a gynecologist immediately. If acute pain in the lower abdomen is accompanied by diffuse accompanying symptoms, it is a medical emergency. You should go to the hospital immediately: miscarriage or premature birth is possible.

Symptoms of impending miscarriage or premature birth

A premature birth up to the twelfth week of pregnancy is announced by cramps in the center of the lower abdomen and bleeding. The same applies to premature birth until the 23rd week, but the bleeding is more severe here. Between the 23rd and 37th week, the pain extends to the pelvis, lower abdomen and back and is often accompanied by diarrhea.

If such symptoms occur, regardless of the stage, please consult a doctor directly. Mostly it is not a premature or miscarriage, but you have no inhibitions about using the medicine "uselessly". It is better to go to the doctor too much than to lose your child. Today, many premature babies can be prevented by gynecology.

From the 37th week, the cramps and contractions in the lower abdomen are not a sign of premature or miscarriage, but of "normal" birth. Back pain is also part of it.

Prevent pregnancy pains

If you feel pain in the lower abdomen during your pregnancy, have a clarifying conversation with a gynecologist or gynecologist. Above all, this helps to reduce mental stress. Your body is changing now, and your body and psyche are closely linked biochemically. Just clarifying whether everything is OK with them makes it easier for many to deal with pregnancy.

Even the "normal" pain can be severe or very noticeable if you are sensitive to pain. Sometimes the doctor then prescribes magnesium supplements to relieve the cramps.

If everything is OK with them, you can keep the complaints under control with simple home remedies:

  • Bathe warm but not hot.
  • Lie in bed with a warming blanket or hot water bottle.
  • Treat yourself to rest. Lie down, even if you feel no pain, and put your legs up so that the blood flows into the body.

Abdominal pain in men

Certain abdominal pain only affects men because it originates from male organs. For example:

An inflamed prostate, the prostatits. Here bacteria infect the prostate gland. Pain does not only arise in the lower abdomen - typical is pain when urinating and ejaculating.

Inflammation of the testicles and epididymis, the symptoms of which resemble those of an inflamed bladder: there is blood in the urine, the people affected often have to go to the toilet.

Testicular torsion, which usually occurs in boys. Here a testicle twists on its own strand. Extreme testicular pain and pain in the lower abdomen are the symptom. It is a medical emergency. The sufferer must go to the hospital immediately, because the testicle can die after only a few hours.

Prostate cancer with lower abdominal pain is a warning sign that luckily comes just in time, but is usually too late. This is the most common cancer in men and usually only shows up in the advanced stage through pain during urination and in the lower abdomen.

Other causes in men and women

Appendicitis appears with pain in the upper abdomen and stomach. These then migrate to the right side of the abdomen and are accompanied by nausea and a lack of appetite.

Inflamed mucous membranes in the large intestine report a stinging in the lower abdomen, in Crohn's disease and ulcerative colitis this stinging is cramp-like.

Intestinal tumors lead to blood in the stool and cramps in the lower abdomen in late stages.

A hernia indicates a pulling pain in the lower abdomen.

An intestinal obstruction triggers very severe stabbing pain in the lower abdomen, those affected cannot empty their intestines and have to vomit. This medical emergency must be resolved immediately.

Also a medical emergency are clogged arteries in the intestine that lead to severe pain in the intestinal section.

Pain in the urinary tract

Lower abdominal pain around the urinary tract also affects both genders. These can extend into the bladder. Typical here are pain when urinating, blood in the urine and a dull pain in the lower abdomen. Ureteral stones or bladder stones, on the other hand, trigger a sharp pain in the lower abdomen.

A renal colic reports cramp-like pain caused by the backflow of urine and it is typical for bladder cancer that blood appears in the urine first - without pain. The pain in the lower abdomen follows later.

The diagnosis

  1. First, there is a detailed discussion with the doctor. These ask about the duration of the pain - is it acute or chronic? Then according to the nature of the complaints. Is the pain stinging, pressing, pulling, dull or burning. Then about the location. Does it stretch over the entire abdomen, on the right lower abdomen, the left lower abdomen or does it concentrate on a specific area.
  2. After the conversation comes the physical exam. Doctors now feel the abdomen to feel hardening or swelling.
  3. In women, the genitals are examined by a gynecologist to identify possible diseases of the genital organs. A pregnancy test is added to women of childbearing potential.
  4. An ultrasound examination of the abdomen and genitals often provides information about the underlying disease.
  5. Blood tests, smears of the urethra of the man or the vagina of the woman show inflammation caused by bacteria.
  6. Examinations of urine and faeces show possible bacteria, but blood in the excretions is also an indication of the cause.
  7. If there is reasonable suspicion, a colonoscopy provides insight into diseases of the intestinal tract.

The treatment

Treatment depends on the cause. Acute pain soothes anticonvulsants and pain relievers. Bacterial infections are fought by medicines that kill these bacteria, viruses and fungi with antiviral and antifungal agents.

Urinary stones either loosen themselves with the help of medication, or the urologist removes them chemically or with focused energy waves.

Appendicitis, testicular torsion or an ectopic pregnancy must be operated on immediately. An operation is also announced in the event of a hernia. (Dr.Utz Anhalt)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.


  • David H. Barad: Pelvine Pain, MSD Manual, (accessed 08/28/2019), MSD
  • Thomas Gasser: Basic knowledge of urology, Springer Verlag, 6th edition, 2015
  • Guideline program oncology (German Cancer Society, German Cancer Aid, AWMF): Interdisciplinary guideline of quality S3 for early detection, diagnosis and therapy of the various stages of prostate cancer, long version 5.1, 2019, AWMF registration number: 043 / 022OL, (accessed 28.08.2019), AWMF
  • Gerald L. Andriole: Benign Prostatic Hyperplasia (BPH), MSD Manual, (accessed August 28, 2019), MSD
  • James H. Liu: Endometriosis, MSD Manual, (accessed August 28, 2019), MSD
  • R. Phillip Heine, Geeta K. Swamy: Lower abdominal pain in early pregnancy, MSD Manual, (accessed August 28, 2019), MSD

ICD codes for this disease: R10.3, N94ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.

Video: All About Pelvic Pain (December 2022).