Acute & Chronic Left Lower (LLQ) Abdominal Pain – Diagnosis

ACUTE Left Lower (LLQ) Abdominal Pain

Causes of acute (sudden, newly appearing) lower left quadrant (LLQ) abdominal pain lasting from few seconds to several weeks include:

1. Constipation

Constipation may appear as constant or cramping pain, often in LLQ. Dry food (cookies) or low-fiber food (meat, cakes etc.), skipped meal, not drinking enough, pain anywhere in the body or lying in bed (like in hospital) for some days are main causes of constipation in a person with the otherwise healthy gut.

2. Diverticulitis

Diverticulitis is inflammation of pouches that bulge out (usually) from the end part of the colon, mostly in old constipated persons, but may also affect young people (rarely children though). Main symptoms:

  • Sudden or sometimes gradually developing LLQ pain
  • Bloating in lower or left part of abdomen
  • Fever
  • Diarrhea with occasional bright red blood

Diagnosis is often possible from symptoms alone. The presence of diverticles can be confirmed by ultrasound or CT. X-ray with barium enema and colonoscopy (to evaluate an extent of diverticulosis)  may be done only after inflammation has healed (to avoid perforation of the colon).

3. Pseudomembranous Colitis After Antibiotic Treatment

Antibiotics may destroy normal intestinal bacteria and enable overgrowth of bacterium Clostridium difficile(normally present in small amount) in the colon resulting in the following symptoms appearing from 5 days to several weeks after starting antibiotic therapy:

  • LLQ pain
  • Diarrhea
  • High fever
  • Barnyard smell of the stool and gas

Diagnosis is made by finding a Clostridium difficile toxin in the stool and NOT by regular stool culture test.

4. Volvulus

Volvulus, twisting of the end part of the colon (sigma) around its axis, is rare and occurs mostly in small children. Main symptoms:

Diagnosis is made by an X-ray with barium enema.

5. Appendicitis

Rarely, appendicitis may cause LLQ pain, even if the appendix is on the (normal) right side but especially in a rare “situs versus” with left sided appendix and liver (and right sided heart and spleen). For other symptoms and diagnosis check right lower abdominal pain.

6. Pain from Male and Female Reproductive Organs

Disorders of testes, spermatic cord and testicular veins in menand ovulation, rotated ovary, ruptured ovarian cyst and ectopic pregnancy in women trigger about the same symptoms in the left and right lower abdomen.

7. Abdominal Muscles and Skin Disorders

Psoas abscess, inguinal hernia and Herpes zoster can cause the same symptoms as on the right side.

CHRONIC Left Lower Abdominal Pain

Causes of chronic (several weeks to years or recurrent) lower left quadrant (LLQ) abdominal pain:

1. Constipation

Non-intestinal causes of chronic constipation include lack of exercise, low-fiber food, low fluid intake, depression, stress and certain medications. Constant or cramping pain on the left side or/and in other parts of abdomen is often associated with bloating.

2. Diverticulosis

Diverticles in the lower left colon can cause chronic LLQ pain even if the are not inflamed. Diagnosis is with an X-ray with barium enema and colonoscopy.

3. Chronic Colitis

Crohn’s disease and ulcerative colitis may cause:

  • LLQ pain
  • Urgency to have bowel movement
  • Diarrhea
  • Blood in the stool
  • Skin rash, mouth ulcers, low-grade fever, nausea, general malaise

Diagnosis is often possible only after several tests: specific antibodies in the blood and stool, an X-ray with barium enema and investigation of a sample of colonic mucosa (obtained during colonoscopy) under the microscope.

Chronic ischemic colitis usually affects old people (after 60) with diabetes. Microscopic (lymphocytic or collagenous) colitis affects old people from unknown reason. Symptoms include:

  • LLQ or LUQ pain
  • Diarrhea
  • Blood in the stool
  • Nausea

Diagnosis is often possible from symptoms; in doubtful cases colonoscopy and histological examination of colonic mucosa can be done.

4. Colorectal Cancer

Colorectal cancer is rare before 50 years of age. Symptoms include:

  • Blood in the stool
  • Urgency to have a bowel movement
  • LLQ pain, nausea, poor appetite, weight loss (late symptoms)
  • Constipation or diarrhea (rarely)

Diagnosis is by colonoscopy and histological examination of the tumor.

5. Polycystic Ovarian Syndrome – PCOS

PCOS may cause LLQ or RLQ pain.

About Jan Modric (249 Articles)
Health writer
  • Dr. Chris

    Hi OTD

    The priority here is to exclude any gynecological and urinary tract conditions. I would advise that you first start with your gynecologist. The lack of symptoms (gastrointestinal and urinary) means that this is not a priority right now but should be followed through after gynecological examination. There is no reason to suspect colon cancer just yet but regular examinations (colonoscopy) would be advisable.

  • Dr. Chris

    Hi CJ

    You should see a doctor about this and have it investigated further. Cannot comment on the urgency but bowel disruptions should not be taken lightly given the prevalence of inflammatory bowel disease (IBD) and colon cancer these days. This is not to say that you have colon cancer. A more likely cause would be IBS (irritable bowel syndrome) but this should only be diagnosed once other conditions like IBD have been excluded. The fluctuation between constipation and diarhhea, improvement with dietary change and possibly quitting smoking may all be indicative of IBS. Other digestive disorders that may be affecting digestion of fats and so on would also be responsible but this will be confirmed with a stool test. It is advisable to see your doctor as self-medicating could exacerbate the condition and cloud the clinical presentation thereby making it more difficult for your doctor to reach a diagnosis.

  • Chris

    Hi, I have had lower left pain for a while, but mine comes on with eating rich tea biscuits or especially choc or plain digestives, could this be a wheat intollerance or something like ibs, I did a home celiac tsst 2 years ago and that was negative, I am on omeprazole 15 mg, for acid reflux and the doc reckons I have a hiatus hernia, but I have never had an endoscopy, also my liver enzymes were slightly up and gilberts syndrome was a maybe, but not really sure about those two because the liver test is bound to go up and down anyway and gilberts is benign