What's causing your lower abdominal pain?

Common causes of lower abdominal pain

Periods are the main cause of pelvic pain, particularly during the first couple of days when you may have menstrual cramps or dolori mestruali. You might also get pelvic pain around the middle of your cycle when you ovulate.

These pains vary in how much they hurt, but you should speak to your doctor if they last more than a few days, start before or after your period, or impact your life.

Endometriosi

Severe pelvic pain which is related to your menstrual cycle may be a symptom of endometriosi.

Endometriosis, where cells similar to those found in the womb (uterus) lining are found outside the womb, affects around 1 in 10 women according to Endometriosis-UK. It can cause severe period pain which can effect your day to day life.

It can also cause pain between periods, painful sex, bleeding between periods and problems getting pregnant. Getting diagnosed may take some time, as symptoms can be similar to other common conditions.

Dr Pandelis Athanasias, consultant gynaecologist at the London Women's Centre, says: "On average, endometriosis takes seven and a half years, or 11 visits to the GP, to diagnose."

However, it's important not to just put up with it - speak to your doctor or a gynaecologist about your symptoms and the impact they are having on your life.

Adenomyosis

Athanasias also highlights another condition called adenomyosis - where the tissue that normally lines the womb (endometrial tissue) grows into the womb's muscular wall - which often goes undiagnosed.

This can also cause pelvic pain due to prolonged menstrual cramps, as well as heavy bleeding and pain during sex.

Malattia infiammatoria pelvica

If your pelvic pain isn't related to your cycle and if it's the first time you've had this type of pain, it could be an infection such as malattia infiammatoria pelvica (PID). PID is an infection of a woman's reproductive organs affecting the womb, Fallopian tubes and ovaries.

You may have long lasting (chronic) pelvic pain and a discharge e fever.

Gravidanza

If you are - or could be - pregnant, you should be aware of the following causes of pelvic pain:

• Gravidanza ectopica - acute lower abdominal pain possibly accompanied by vaginal bleeding.

• Aborto spontaneo.

• Rupture of the corpus luteum - a normal cyst that grows on the ovary every month in women of childbearing age.

• Parto prematuro.

Vedi Pelvic Pain in Women per maggiori dettagli.

Other causes of lower abdominal pain

One of the issues with lower abdominal pain is that it can be multifactorial - meaning the pain may be due to several factors, not just one.

"Usually pain can be coming from the urinary tract, the gynaecological tract, the gastrointestinal tract or it could also be a musculoskeletal cause - so you have to look at everything," says Athanasias.

Other causes of lower abdominal pain include ovarian cysts, fibromi, sindrome dell'intestino irritabile (IBS), pelvic congestion syndrome, infezioni del tratto urinario, appendicite e inflammatory bowel diseases, come Crohn's e colite ulcerosa.

Lower abdominal pain can also be triggered by emotions such as stress, ansia e depressione. People who have suffered with disturbo da stress post-traumatico are often at a higher risk of developing chronic pain.

To find the cause of the pain, Gynacologist, Dr Karen Morton, says that she often performs a laparoscopia, a procedure to look inside the abdomen with a camera. She warns people beforehand that they need to prepare themselves to the fact that nothing physical might be found.

"We probably find nothing more often than we find something," says Dr Morton. "There are a number of women who come to the hospital recurrently with pelvic pain.

"Indeed, there's quite a lot of research¹ that shows issues such as sexual abuse can lead to women developing lower abdominal pain. And it isn't that it's not real for them, but that there's no identifiable underlying pathology. These women need a pain strategy, as well as psychological support," explains Dr Morton.

Firstly, women should seek an appointment with their GP for an initial evaluation and assessment of their condition, especially if the pain is chronic, has been present for three to six months, or if it is affecting their ability to carry out normal daily activities, says Dr Hemlata.

Judy Birch, co-founder of the Pelvic Pain Support Network, says that it's difficult to cope with any recurring pain.

"Treatments vary and will be individual, based on the condition and severity. It may involve medication, surgery, physiotherapy, nerve blocks, psychology, self-management, coping strategies and combinations of any of these at various points in time."

Birch suggests keeping a simple visual diary of when the pain occurs, how long it occurs for and what relieves it, if anything.

"Take this with you when you see a doctor if you're having difficulty getting a diagnosis or managing and coping with the pain. And ask about investigations, such as an ultrasound, and even to be referred to a specialist," she explains.