Lower abdominal pain

The symptoms, causes and treatment of lower abdominal pain.

By Miss Louise Hayes MBBS (Lond.) FRCOG
Consultant in Gynaecology & Women’s Health
Published April 24th 2023

Lower abdominal pain in women can be caused by different conditions, from minor infections to reproductive system infections. There are many reasons why women of all ages experience abdominal pain. Generally, it’s very common and easy to manage if you know the cause. Often, lower abdominal pain in women isn’t a sign of a serious condition, but occasionally there can be something that needs investigating.

When to see a doctor

Occasional lower abdominal pain isn’t unusual for women, and period pain is a particularly common cause. Most of the time, this type of pain can be easily managed at home with pain relief, hot water bottles, rest or gentle exercise depending on the cause. Severe, unexplained or unmanageable pain, with other worrying symptoms, should be checked by a doctor urgently.

Dr Louise Hayes, Consultant Gynaecologist at Chrissie Yu Gynaecology & Women’s Health

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What causes lower abdominal pain?

Lower abdominal pain in women can be caused by different conditions, ranging from small infections to intestinal disorders, including:

  • Period pain
  • Urinary tract infection (UTI)
  • Pelvic pain
  • Reproductive system infections
  • Muscular pain
  • Pregnancy
  • Ectopic pregnancy
  • Sexual activity
  • intestinal disorders

Period pain

Symptoms of period pain

Period pain is usually a crampy, dull or tight pain in the middle of the lower abdomen, sometimes spreading further into the lower back. It can be very uncomfortable.

Causes of period pain

Period pain happens when the muscular wall of the womb tightens or contracts. Mild contractions continually occur in your womb, but they’re usually so mild that most women don’t notice them.

During your period, the wall of the womb starts to contract more vigorously to help the womb lining shed as part of your period. When the wall of the womb contracts, it compresses the blood vessels lining your womb. This temporarily cuts off the blood supply – and oxygen supply – to your womb. Without oxygen, the tissues in your womb release chemicals that trigger pain.

While your body is releasing these pain-triggering chemicals, it’s also producing other chemicals called prostaglandins. These encourage the womb muscles to contract more, further increasing the level of pain.
It’s not known why some women have more period pain than others. It may be that some women have a build-up of prostaglandins, which means they experience stronger contractions.

Period pain caused by a medical condition

In some women, period pain can be caused by an underlying medical condition.
Period pain that’s linked to an underlying medical condition tends to affect older women between 30 – 45 years old.

Medical conditions that cause period pain include:

  • Endometriosis. Where cells that normally line the womb grow in other places, such as in the fallopian tubes and ovaries; these cells can cause intense pain when they shed.
  • Fibroids. When non-cancerous tumours grow in or around the womb and can make your periods heavy and painful.
  • Pelvic inflammatory disease. When your womb, fallopian tubes and ovaries become infected with bacteria, causing them to become severely inflamed.
  • Adenomyosis. When the tissue that lines your womb starts to grow within the muscular womb wall, making your periods particularly painful.

Period pain caused by contraceptive devices.

An intrauterine device (IUD) is a type of contraception made from copper and plastic that fits inside the womb. It can also sometimes cause period pain, particularly during the first few months after it’s inserted. You may notice a change in your normal period pain if your period pain is linked to a medical condition or a contraceptive IUD. The pain may be more severe, or it may last much longer than normal.

Treatment of period pain

The majority of women are able to manage period pain with a hot water bottle and painkillers like paracetamol and ibuprofen. IN severe cases of period pain, it may be necessary to see a doctor.

Urinary tract infection (UTI)

Symptoms of a urinary tract infection

Symptoms include lower abdominal pain in women, and symptoms like burning when you pee, or needing to go to the toilet more often or urgently.

Causes of a urinary tract infection

UTIs are a key reason why doctors tell women to wipe from front to back after using the toilet. The urethra – the tube that takes pee from the bladder to the outside of the body – is close to the anus. Bacteria from the large intestine can sometimes get passed from your anus and into your urethra. From there, they can travel up to your bladder and, if the infection isn’t treated, can continue on to infect your kidneys.

Women’s urethras are shorter than men’s which makes it easier for bacteria to get to their bladders. Having frequent sex can introduce bacteria into your urinary tract, too.

Some women are more likely to get UTIs because of their genes. The shape of their urinary tracts makes others more likely to be infected. Women with diabetes may be at higher risk because their weakened immune systems make them less able to fight off infections. Other conditions that can boost your risk include hormone changes, multiple sclerosis, and anything that affects urine flow, such as kidney stones, a stroke, or spinal injury.

Treatment of a urinary tract infection

Mild urinary tract infections like cystitis often clear up on their own if you drink plenty of fluids, but more persistent UTIs might need a short course of antibiotics, which a doctor can prescribe. More severe UTIs can affect the kidneys, and might cause lower back pain on one or both sides, and make you feel generally unwell, sometimes with flu-like symptoms.

It’s important to see a doctor as soon as possible if your symptoms are more severe or if you UTI symptoms are recurring.

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Pelvic pain

Pelvic pain is felt in the lower part of your tummy. The type of pain varies, and it may be sudden and severe (acute pelvic pain) or last 6 months or longer (chronic pelvic pain).

Symptoms of pelvic pain

Pelvic pain varies. It may affect a small area around your pelvis (your lower tummy) or the whole area.
Types of pelvic pain include:

  • Sudden, sharp, stabbing or burning pain.
  • Pain that comes on slowly but doesn’t go away.
  • Dull or heavy ache, or feeling of pressure.
  • Twisted or knotted feeling.
  • Cramping or throbbing pain, which may come and go.
  • Pain only when you’re doing something, like exercising, having sex, or peeing.

Common causes of pelvic pain

Pelvic pain might be caused by an infection or a condition affecting one of the organs in the pelvic area, such as the bowel or bladder. Common causes include:

  • Constipation or irritable bowel syndrome.
  • Urinary tract infections (UTIs).
  • Sexually transmitted infections (STIs).
  • Sexual activity.
  • Periods.
  • Conditions affecting female reproductive organs, such as an ovarian cyst or endometriosis.
  • Pregnancy.

Very occasionally, the cause of pelvic pain could be something more serious, like an ectopic pregnancy, womb cancer or ovarian cancer.

Treatment of pelvic pain

The treatment of pelvic depends on the specific cause. It’s important to see a doctor as soon as possible if your symptoms are more severe or if your symptoms are recurring.

Reproductive system infections

Infections in the reproductive system can affect the uterus, fallopian tubes and ovaries. An untreated infection in one of the reproductive areas can become very serious and lead to long-term problems, so needs to be treated by a doctor.

Causes of reproductive system infections

These kinds of infections are often caused by an underlying sexually transmitted infection (STI), so if you’re sexually active, make sure you have regular sexual health screening.

Symptoms of reproductive system infections

Lower abdominal pain, pain during sex, spotting, or discoloured, smelly discharge can be other symptoms of an STI, or infection of the reproductive system.

Treatment of reproductive system infections

The treatment of pelvic depends on the specific cause and may include medication. It’s important to see a doctor as soon as possible if your symptoms are more severe or if your symptoms are recurring.

Muscular pain

Muscular pain can account for some cases of lower abdominal pain.

Causes of lower abdominal muscular pain

A strained or torn muscle from exercise or an injury can be very painful, affect one or both sides, or be more generalised across the lower abdomen.

Symptoms of lower abdominal muscular pain

These can include:

  • Soreness or tenderness.
  • Pain or discomfort when touching the abdomen.
  • Swelling.
  • Bruising.
  • Muscle spasms.
  • Difficulty stretching the muscle.
  • Pain when moving or stretching.
  • Pain after an injury or excessive exercise.

Treatment of lower abdominal muscular pain

Sometimes it’s possible to work out how or when muscular pain started, and this makes it more manageable with regular painkillers, topical treatments and lots of rest. Occasionally, in the event of a muscular strain or a sprain, physiotherapy may be required.

Pregnancy

Pregnancy causes major changes in a female’s body shape and places a huge amount of strain on the organs and muscles of the lower abdomen.

As well as general discomfort in this area, women often experience pain from Braxton Hicks contractions during the later stages of pregnancy, as the muscles prepare for childbirth.

If you have any worries about your pregnancy, you can always speak to a midwife or your local antenatal team as there are some less-common causes of lower abdominal pain in pregnancy that can be more serious. If you experience any severe, sudden or unexplained pain, or pain alongside unusual vaginal discharge or bleeding, go to your nearest A&E for urgent medical advice.

Dr Chrissie Yu, Consultant Obstetrician at Chrissie Yu Private Pregnancy Care

Ectopic pregnancy

In the UK, around 1 in every 90 pregnancies is ectopic. Ectopic pregnancies affect around 11,000 women in the UK every year. They occur when a fertilised egg implants itself outside the womb, usually in one of the fallopian tubes.

Fallopian tubes are the tubes that connect the ovaries to the womb. If an egg gets stuck in them, it won’t develop into a baby and your health may be at risk if the pregnancy continues.

Symptoms of ectopic pregnancy

If you do have symptoms, they tend to develop between the 4th and 12th week of pregnancy. Women affected can have problems with one ovary or fallopian tube that leads to complications and lower abdominal pain either in one or both sides. which is usually very severe. However, an ectopic pregnancy doesn’t always cause symptoms. They are often only detected routine pregnancy scans.

Symptoms can include one, or a combination, of:

  • Missed period and other signs of pregnancy.
  • Tummy pain low down on one side.
  • Vaginal bleeding or a brown watery discharge.
  • Pain in the tip of your shoulder.
  • Discomfort when peeing or pooing.

But these symptoms aren’t necessarily a sign of a serious problem.

Pain during or after sex

When to see a doctor

Occasional lower abdominal pain isn’t unusual for women, and period pain is a particularly common cause. Most of the time, this type of pain can be easily managed at home with pain relief, hot water bottles, rest or gentle exercise depending on the cause. Severe, unexplained or unmanageable pain, with other concerning symptoms, should be checked by a doctor urgently.