Ask the Nurse

Abdominal pain has a very wide differential diagnosis. When we localize it to the left side, we think of the organs located in that area. However, from skin down to the abdominal cavity, any number of things can be affected. Also, pain may be multifactorial, which increases the complexity. Below are general highlights on left-sided abdominal pain. You should seek the care of your doctor for further evaluation.

• Diverticular disease occurs when there are small pockets of the colon which can be asymptomatic or it can result in cramping, bloating or abnormal bowel movements. When these pockets become inflamed or infected, it is called diverticulitis and classically presents in the left lower abdomen.
• Kidney stones or ureterolithiasis can often manifest as left-sided or right-sided abdominal pain. A stone which originated in the kidney travels through the tubes leading to the bladder called the ureters. When these stones are too large, they cause pain as they move through the tubes. Kidney stones typically present as back pain that can wrap around the groin causing severe pain which often leaves patients feeling restless.
• Pelvic pain. Women with left sided abdominal pain have special considerations because there are unique organs which can be the underlying cause. Often this is labeled as pelvic pain which can originate from the muscles, bowel, bladder, ovaries or uterus.
• Irritable bowel syndrome and bladder infections. Common causes of bowel and bladder pain would be irritable bowel syndrome and bladder infections. Irritiable bowel syndrome is a diagnosis of exclusion, meaning that a patient must be evaluated for other causes before making this diagnosis. Patients with IBS typically present with cramping abdominal pain, improved by defecation, and associated with either diarrhea or constipation or both. It can be further classified as diarrhea predominant IBS or constipation predominant IBS. In fact, constipation or diarrhea itself can present as abdominal pain so it is important to maintain regular bowel movements by incorporating adequate fiber into your diet.
• Urinary tract infections. The female anatomy lends itself to frequent urinary tract infections. The tube from the bladder to the outside of the body, called the urethra, is very short compared to a male. Bacteria only have to travel a short distance to cause infection of the bladder. Urinary tract infections are characterized by lower abdominal pain, burning with urination, frequency of urination, and sometimes blood in the urine. Sometimes the bladder infection can rise into the kidneys, which causes back pain in addition to the above symptoms. A fever often accompanies this kidney infection called pyelonephritis.
• Pelvic inflammatory disease is an infection of the female reproductive tract. Organisms that cause sexually transmitted infections such as chlamydia or gonorrhea can cause disease limited to the bottom portion of the uterus, called the cervix. If untreated, the infection can rise into the uterus and attack the fallopian tubes and ovaries. When this occurs, patients present with sided abdominal pain, fevers and chills, vaginal discharge and pain with intercourse. It is important to seek care immediately because untreated pelvic inflammatory disease may lead to infertility.
• Uterine fibroids. If the left-sided abdominal pain is characterized with heavy periods, then there are other considerations. The most common tumor in women are uterine fibroids, which are benign masses within the uterus. If these grow to be large or twist on themselves, it can lead to pain. On exam, a clinician may be able to feel a larger uterus which would prompt further evaluation.
• Endometriosis. If the pain occurs at the time of a period and is associated with painful intercourse, difficulty conceiving, and irregular cycles, then it may be caused by endometriosis. Endometriosis is the condition in which the lining of the uterus, called the endometrium, becomes lodged in other areas of the body such as the bowel or ovaries.
• Ovarian mass. As part of the reproductive process, the ovaries produce follicles which eventually rupture and release an egg for fertilization. Sometimes, the follicle fails to rupture and develops into a cyst. If this cyst grows and then ruptures, it can result in abdominal pain. In fact, any ovarian mass can cause pain and the differential diagnosis is wide including blood filled cysts, an ectopic pregnancy, and various tumors. Of note, there is no screen for ovarian cancer so women should pay attention to their body. Pain after eating, early satiety, constipation, bloating, and loss of appetite can be warning signs of ovarian cancer.

Please keep in mind that this is a brief overview of left-sided abdominal pain and that you should seek care with your provider to better understand the cause of your pain.

All My Best,
Speaking of Women's Health Nurse

August 14, 2014 at 2:20pm