Female Abdominal Pain

Abdominal pain in women is thus more common, than in men.

Often, the cause of abdominal pain in a woman can be pin pointed with good degree of accuracy, especially if relates to causes like menstrual pain, and labour pain. In other cases, the cause of such pain in the abdomen will not be discovered, even after extensive investigations.

Like in all cases abdominal pain, pain lasting more than an hour in any woman should be taken seriously, and investigated as may be necessary.

Common causes of abdominal pain in a woman include:

• Appendicitis
• Constipation
• Urinary Tract Infection
• Menstrual pain also called period pain
• Inter-menstrual pain also called mid-cycle pain or Mittleschmerz (especially in teenage girls)
• Miscarriage
• Labour pain
• False labour during middle and late pregnancy (Braxton Hicks)
• Pelvic Inflammatory Disease or PID
• Ectopic pregnancy
• Fibroids
• Endometrosis
• Endometritis
• Polycystic ovarian syndrome
• Ruptured ovarian cyst
• Twisted ovarian cyst
• Ovarian cancer
• Irritable bowel disease
• Coeliac disease
• Crohns disease
• Ulcerative colitis
• Trapped wind
• Kidney stone
• Adhesion abdominal pain
• Chronic Pelvic pain syndrome
• Pelvic congestion syndrome
• perimenstrual tension
• Sexual abuse
• Emotional worries

To fully understand what could be causing lower abdominal pain in a woman, we shall take each of the regions of the lower abdomen in a woman and describe the organs and structures that are there. We will then briefly discuss a number of disease conditions that would cause female abdominal pain.

Organs in the Right Lower Abdomen of a Woman

If a woman is having pain in the right lower abdomen, what are the organs that could be in trouble? For uniformity, the right lower abdomen is defined here as the part of the abdomen below the level of the umbilicus, to the right of a straight imaginary line drawn from the level of the nipple to the waist line in front.

Organs found here include the:

• Right Ovaries

• Right Fallopian Tube

• Right Round Ligament

• Part of the Uterus may encroach here too

These organs are off course in association with the other organs normally found in the right lower abdomen like the appendix, part of the large intestines or bowel (called the ascending colon), lower pole of the right kidney, the right ureter, and possible part of the bladder if it is filled up or large enough.

Organs in the Central Lower Abdomen of a Woman

The part of the abdomen directly below the belly button is here described as the central lower abdomen.Organs that could be found here in the female include:

• Uterus

• Bladder

• Central ends of the two fallopian tubes

• Cervix

• Upper part of the vagina

• Ends of the round ligaments

• Part of the usually mobile gut could also come to lie here.

Organs in the Left Lower Abdomen of a Woman

These are essentially the same as on the right. There is however, no appendix here.

The last part of the large intestine and rectum lies here. This makes conditions like constipation and diverticulitis more likely to cause female abdominal pain on the left, just as in men, in association with all the other conditions on the right except of course appendicitis.

Because these unique female reproductive structures are located in the lower abdomen also called the pelvis, female abdominal pain or lower abdominal pain in women is also called pelvic pain or female pelvic pain.

Specific Causes of Female Abdominal Pain

A brief discussion of common conditions that causes female abdominal pain to help in spot identification is presented.

Menstrual Pain or Period Pain?

Except for those having their period for the first time, female abdominal pain due to menstruation would be relatively easy to identify. This is a central lower abdominal pain occurring a few days before the commencement of menstruation or ones period. It usually resolves a day or two after the menses begin to flow.

Use of pain killers like panadol or paracetamol or stronger non- steroidal anti-inflammatory medication like ibuprofen helps in overcoming menstrual pain.

This needs to be taken a day or two before the expected onset of your period and a couple of days into the period. For very troublesome period pain not responding to simple pain killers, use of oral contraceptive pills is an option you could discuss with your family doctor.

Read more on menstrual pain here

Is It a Mid Cycle Pain?

have you notice that this pain may come on suddenly, sometimes in the lower right abdomen, and then left, lasts for a few minutes, hours or not more than three days and goes away, till another time? It could be a mid-cycle pain, otherwise called Mittleschmerz that is causing a female abdominal pain in you or your daughter.

This is a nagging pain felt by quite a few women at the middle of their menstrual cycle. This pain could re-occur after every 2 -3 months.

Pain killers or oral contraceptive pills would do, as in menstrual pain.

Please read more on this topic here

Could It Be Pelvic Inflammatory Disease (PID)?

Any abnormal vaginal discharge?

Do you experience a deep pain during sexual intercourse?

Any bleeding in between your menstrual period?

You may or may not also have fever. There could also be a concomitant upper right abdominal pain with the above symptoms.

If these are present, then it could be a pelvic inflammatory disease or PID that is causing a typical female abdominal pain in you.

Commonly referred to as PID, pelvic inflammatory disease refers to infection of the womb and fallopian tubes, usually due to spreading sexually transmitted disease (gonorrhea and chlamydia being the most common cause in people with multiple sexual partners), from the vagina and cervix.

This is a very common cause of lower abdominal pain in a woman, especially those who are sexually active. The pain is often felt bellow the belly button and usually on both sides of the lower abdomen. It may be moderate to severe pain with or without fever. There may also be foul smelling vaginal discharge and abdominal pain during sex.

Diagnosis of pelvic inflammatory disease is made by your doctor taking a thorough sexual history, examining you and then request for blood test, vaginal swabs to take to the laboratory, and use of ultrasound scans too.

Treatment is achieve using the right antibiotics like doxycycline and flagyl taken together at a dose of 100mg three times a day of doxycycline, and flagyl 400mg three times a day for 14 to 28 days depending on the severity of infection.

Some also give a shot of Ceftriaxone injection daily for 1 - 5days or the tablet if the injection is not available, again depending on severity of infection.

Please ensure you contact your doctor if you suspect you may be suffering with PID. They need to test you to identify the specific bacteria responsible, and then choose a matching antibiotics that would help clear the bugs.

It is also important to treat one's partner, to prevent re-infection.

Read more about PID here

How Do I know If It Is Ectopic Pregnancy?

This is another common cause of lower abdominal pain in young women of child bearing age. Ectopic pregnancy causes female abdominal pain on the right or left side of the lower abdomen. The pain is usually severe. This may be followed by vaginal bleeding.

Diagnosis of ectopic pregnancy is made from the history given by the patient to the doctor, the findings on examination, blood and urine test to confirm pregnancy and an urgent ultrasound scan of the abdomen where possible.

Treatment of a ruptured ectopic pregnancy is by emergency operation.

There are medications that can be given to dissolve a non-bleeding ectopic pregnancy. Discuss with your doctor.

Please read more about ectopic pregnancy by following this link .

Endometriosis?

Endometriosis is a condition where cells that line the uterus are found in other parts of the abdomen or body where they are not suppose to be.

These abnormally situated uterine cells behave life normal uterus, producing menses at the end of each month. This could cause blood to accumulate at that site. Excess blood accumulating in a confined space would lead to pressure and pain. The blood could form clots and adhesions, binding other structures like the intestines together too, causing obstruction.

The symptoms of endometriosis may be just lower abdominal or female abdominal pain during sex. Other signs may include abdominal pain and increase in weight during the menstrual period.

I am Pregnant. How Do I know If It Is a Miscarriage?

Female abdominal pain associated with miscarriage is often distinct. The woman would be pregnant. There is usually signs of vaginal bleed or spotting before the unset of pain. The pain may be in the central lower abdomen it comes and go in cycles of few seconds to minutes like cramp.

If this is occurring within the first 10 weeks of pregnancy, it is strongly advised that you go to see your doctor immediately. There is always a need to differentiate a miscarriage, from an ectopic pregnancy, which could be life threatening.

What If It Is Due To Fibroid?

Fibroids are an abnormal lumpy growth of muscles of the uterus, causing a hard stone like mass in the wall or inside of the womb. They are also called womb stone.

The pain from fibroid is usually in the central lower abdomen. The pain could be moderate to severe. It is cramping, and may last all day. It is often worse during the menstrual period, though could occur at any time.

Women with fibroid would also have heavy period bleed associated with the lower abdominal pain. They may notice their abdomen looking bigger than expected, and may even be able to feel a lump mass in the lower abdomen. They may become perpetually anaemic from the continuous blood loss.

They are also more prone to developing recurrent urinary tract infections (UTI). Fibroid commonly leads to infertility, if the womb stone blocks off both fallopian tubes or even occupy the space in the uterus where babies are suppose to stay, causing repeated miscarriages.

An ultrasound of the abdomen requested by the G.P or family doctor is the surest way of diagnosing fibroid.

Treatment depends on the number and size of the fibroid, and if it is in a woman who still wants a child or not.

A recent advance in treatment of fibroid includes blocking off the blood supply of part of the uterus where the fibroids are leading to their shrinkage in what is called uterine embolectomy.

Microwave ablation of the surface of the uterus is done for persistent bleeders.

Myomectomy is an operation to directly remove the fibroid from the uterus, but is a very bloody operation. It is safe and worth the risk in good hands and where the woman still desires to have children. The problem with myomectomy is that the fibroid may re-occur again.

Removal of the whole womb in what is called hysterectomy is the definitive treatment for fibroid, especially where the woman has completed her family. It is less risk operation compared to myomectomy, and offers cure. See your doctor if you have any suspicion of fibroids as a cause of female abdominal pain in you.