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
  • Juliajoy

    Hi there,
    On Tuesday night ( today is saturday) I started feeling pain in my stomach. I hadn’t eaten much and thought it was caused by hunger pains and would go away the next day. WEdnesday, the pain is still there… try to eat well during the day… but pain is still there kind of hidden underneath my food. THursday, I am noticing the pain is more like a direct spot in my lower abdomin, it hurts to walk, laugh, sneeze and and in some positions that i sleep in… go to bed early holding onto my stomach, hoping it will be gone the next morning. Friday… still there, so off i go to the doctor. I told him my symptoms which also included sudden loss of colour in my face, goosebumps and the hair on my arms to stand on end. My toilet activity is very minimal, no diarrhea and not many normal stools. HE gives me enemas to put up my rectum to release constipation and maybe an infection in my large intestine… they didn’t seem to work much, so today i did a salt water flush and have a lot of diarrhea, which i will hope clean out my system!!
    however i get the feeling this problem goes deeper, as the pain feels too specific, like a big ball is just stuck in my lower left side.

    I am 25, pretty fit and healthy. However in the past 2-3 week my diest changed drastically. I start work at 5:30 in the afternoon until 12:30 at night.. in this time, I do not eat anything, besides maybe a passing few pieces of bread. So i have gotten used to one big meal a day for lunch , besides a small breakfast… so i know my stomach is not used to this. but the sudden pain, just seems a little too big of a reaction.

    any help????

  • Jan Modric

    Juliajoy,

    if your symptoms appeared after you started to eat less, I recommend you to start eating as you did before. Paleness and goose bumps may be from dehydration or simply feeling cold due to less eating. When you don’t eat, constipation and bloating that follow may cause quite painful cramps anywhere in the abdomen.

  • Anton

    Hello,l am suffering with lower left abdominal pain now for approx.4 months and prier on and off for approx.4 years.lately l ‘ve had blood work done a few different times only to show there isn’t a problem with kidneys ect.l do not generaly have constipation,l do drink a fair amount of water,l am active,and this pain has caused me and my docter concern,l am 58 yrs old.l have had both hernia and a ruptured alcer,could one of these old problems be creating a new one?

  • Jan Modric

    Anton,

    was the hernia in the groin, and ulcer in the stomach? It is important to say where excatly is the pain (in inches from the navel), what triggers it, how long it lasts when it starts, is it affected by moving, tender to touch…

  • Anton

    Hi,thanks for returning a reply,yes the hernia was the grion and the ulcer was of the stomach.the pain is at the back side,left side approx l think were the kidney might be.it hurts after l fall asleep,which it wakes me up,it is hurtfull when l get out of bed , then it disappears.if l move around on my left side then it persists,however ,when l turn over to my right side,and go back to sleep ,l am ok untill l am on my left side again.any suggestions are gratefully appreciated as this is driving me bonkers.thanks again for for patience and time and concern.
    hopefully yours

  • Anton

    the pain is while l lay on the bed it seems sensative to the touch only in bed but not after l stand up or when l am on my right side,thanks again

  • Jan Modric

    Anton,

    kidney pain would be more likely felt on the back, toward the left side, just below the rib cage. If the pain is in the front, and the spot is tender to touch it is more likley a gas built in the transverse colon. This is sometimes caused by certain food intolerances, and a low-FODMAP diet could help in few days.

  • Zilpah 5

    Hi Jan, I wonder if you have any suggestions. I am a 54 year old female with a rather stressful and demanding job. For the last 15 months I have suffered on and off (mainly on) from lower/mid left abdominal pain. The pain occurs predominantly after a bowel movement, sometimes immediately and sometimes after an hour or two. Sometimes it lasts for a few hours and sometimes all day and can be quite severe. It rarely bothers me at night. The type of pain and location within the lower left quadrant also varies (sometimes like a stitch and sometimes an ache). I am prone to constipation and take 4 teaspoons of benefiber a day. Bowel movements can be difficult, I tend to get an urge which dissipates before I get to the toilet.
    I also suffer from GERD and take one Pariet tablet a day. I had a colonoscopy and endoscopy a year ago, which showed a hiatus hernia and mild diverticulosis respectively. I had a fecal occult test which was clear. However a fructose breath test showed moderate fructose intolerence (52 something?). I have been on a low FODMAP diet for about 3 months. At first it seemed to work but now the symptoms are back for no apparant reason.

  • Jan Modric

    Zilpah 5,

    I can’t give you an exact answer, but pain in the lower left/middle abd. after a bowel movement might originate from the colon (more likely rectum). You have confirmed diverticles, so these could worsen in one year…A rectoscopy or sigmoidoscopy, or X-ray with barium enema would all reveal diverticles. Thrombosed hemorrhoids would be also possible. Ulcers caused by ulcerative colitis, Crohn’s disease or colorectal cancer would possibly cause blood in the stool, and this can easily occur within a year (from your last fecal occult test). Bowel urges also speak for a process within a rectum. So, I recommend you to visit a gastroenterologist.

    You can check these articles about low-fructose diet, and low-FODMAP diet.

  • Zilpah 5

    Sorry, I probably didnt make myself clear. There is no evidence of any blood in my stool and the clear stool test test was about 6 months ago. The problem is the daytime pain, which while not constant is very bothersome.

  • Jan Modric

    Zilpah 5,

    you were clear, but probably I wasn’t. I wanted to say, if there was no blood in the stool at your last test, it can be now, even if none can be seen with a naked eye. Blood could come from an ulcer in the rectum. But some other causes, like thrombosed hemorrhoids would not necessary cause any bleeding. In summary, pain after a bowel movement and urgency, to me, speaks for some organic disorder in the rectum. In food intolerances and IBS it’s usually just the opposite – symptoms resolve after a bowel movement.

  • Zilpah 5

    Thanks, I’ll check it out. By the way I went to the phyio today for a shoulder problem and mentioned the abdominal stitch like pain near my waist. He applied some pressure with his hand and the pain disappeared. He has also given me some suggestions to reduce the straining for bowel movements.

  • Jan Modric

    Zilpah 5,

    pain, disappearing after applying some pressure may disappear due to redistribution or release of gas in the colon/rectum. I still can’t reliably exclude some organic disorder, like thrombosed internal hemorrhoids, since it might be possible that gas built could aggravete pain from hemorrhoids. An experienced gastroenterologist could answer this. Straining at stool could maybe stretch some diverticles to the point they would be painful for some time after bm.

    Here are some foods that may relieve constipation mentioned.

  • src30945

    I have been having perdiodic episodes of shard LLQ abdominal pains on & off for about a year. It is not constant, it comes in waves, quite sharp. The area is not tender or painful to palpate.Everything esle is normal (stools, urine, etc) I am 49, great health, fitness enthusiast. The only thing out of the ordinary is that I take lots of vitamins. Multi, C, B complex,D, Quercetin, Alpha Lipoic acid, elderberry, resveratrol,Creatine capsules. I am beginning to get the feeling that the vitamins are causing this. A couple of times i stopped the vitamins for a few days and didnt get these episodes. These episodes are now occurring for several days at a time, every other week or so. Could the vitamins really be causing this? Or is this something more serious. Its becomming very nagging. It has even woken me up from sleep a few times recently.

  • Jan Modric

    src30945,

    in case your vitamins and other supplements were not prescribed by a doctor, and you are otherwise healthy, I don’t see the reason why to take them. Vitamins are usually taken where some vitamin deficiency is confirmed by blood tests. Supplements contain sweeteners, like fructose or sorbitol and other substances that may irritate your bowel.

  • natetzhba

    hi i am a 25yr old male about a year ago i started getting a dull pain in my lower left back usually only felt it on my drive home from work when sitting in the car. i didnt think much of it cause at the time i had an infected tooth so i thought maybe the infection was causing some pain in my kidney, so i took the meds for my tooth infection, and the pain seemed to disapate, got my tooth fixed and about a month later started feelin the lower left back pain again usually when sitting mainly in the car, than as time went on started getting the pain more and worse i was feeling it more even when standing it would radiate across my lower back also into my left leg, my growing area,im alsways tired and i was getting like a crampy feeling in my stomach cramping pain would radiate all over and for about a week i was urinating alot i would get up in the middle of the night 3-4 times to go, well the constant urinating went away but i was still having the pains. so i went to the hospital and they took a urin sample, said it was fine, than said it was just muscles, so they gave me flexeril, i never took the flexeril thinking if its just muscles pain than ill deal with it, but than shortly after that i felt constipated so i started drinking crannberry juice and took a laxative, than i had loose stool for a while than started having 3-4 small bowel movements a day soft with mucas, so i went to the family doctor he took a urin sample and an x-ray and said it was just muscle problems and probaly a little dehidrated, told me if i was to get any better i would have to take the flexeril and possibly therapy, so i started taking the flexeril it helped some i was still feeling some back pain on the left lower back side across my lower back and on my right lower back side and and usually have a bowell movement three times a day regular size bowel movements are usually softer with mucas always brown color and the last month or so iv been burping alot sometimes makes me feel better when burping. than i started peeing alot again for about a week usually always clear no blood not cloudy than about bedtime wed night i got a really bad pain worst pain iv had in my back in my left side back kidney area and my right side back kidney area so i had a bowel movement took a cyclobenzaprine for flexeril, got in a comfortable position where the pain wasnt as bad than went to sleep the next day i woke up i had diareah and very nausas i went to work and by 5pm i was feelin alot better diahreah pretty much went away, but iv been havin alot of nauseah since along with burping and my back pain, so i went to the hopsital sat (3days later) they did a urin test said it was fine and to see my family doctor so now its back the family doc, back pain is worse when sitting sometimes i dont even notices it till im sitting other days it hurts all day but its getting worse, always burping specially after eating the last 4 days iv felt nauseah and i have at least 3 bowell movments a day, do you think this is all related i cant seem to get a doctor to help me. im always worry about this very scared, please help thanks nathan

  • Jan Modric

    nathan,

    excessive burping and diarrhea arise from the gastrointestinal tract. Intestinal parasites, fructose malabsorption, small intestinal bacterial overgrowth (SIBO) are some possible causes. A gastroenterologist can tell which tests to run (stool test for parasites, breath test for fructose malabsorption or SIBO, etc). Frequent urination, but normal urine, can arise from gas in the rectum pressing upon the bladder.

    Pain radiating toward the inner (?) side of the upper leg and groin could arise from the urinary tract…but burping and diarrhea is from the bowel.

  • sameasmoe

    Hello,
    I am writing this to find some help with my problems. Here it goes i am a 28 yr old female 185 5’5 i know i need to lose weight but thats another thing. I have been having frequent loose stools, 5 to 8 x a day sometimes hard not always though. Occasional blood in stool and when i wipe( bright red) . Always bloated and just had a colonoscopy( came back fine) and 4 days after that was in ER for severe stomach pain ( always have pain in LLQ )and vomiting.. Had to have an operation on colon had a henia. They put a 15cm mesh inside. Also i have been on a lactose free diet now for month’s ( still having bathroom trouble. Doctors are giving me no answers … Can anyone help?

  • Jan Modric

    sameasmoe,

    red blood in the stool may arise from a disorder in the colon (including hemorrhoids), and if this is excluded by a colonoscopy, a disorder in the small intestine (celiac disease, Crohn’s disease limited to the small intestine), or by intestinal parasites, for example. Small intestine can be investigated by a capsule endoscopy.

    Lactose intolerance can be accompanied by fructose malabsorption – in this case a low-fructose diet would likely help in few days.

  • sameasmoe

    Thanks Jan,
    I will mention this to my doctor. I will be relieved when i know what exactly is happening with my health. Thankyou for your help.

  • mike

    hello
    i am 22 year old male active, i was sick about 2 and half weeks ago with fever sore throat, i took my mothers old antibiotics from 2007 only 3 days then went to the docs and got amox for 7 days and finished it on the 5 day of amox i felt better fever gone throat clearing up but started felling a nagging pain in the lower left side near lower rib cage kinda towards my lower back left side i read online my sypmtoms, thought it was mono so got tested …came back negative (but i read mono doesn’t show for the first week of symptoms) so i went back to the doctors few days later its been almost a week since the naggin still naggin and im always tired. My urine seems normal i drink alot of water so its clear, i had diarrea but went away when i got off the amox now just light brown/green/yellow stool normal looking just wondering what it could be the pains not extreme but really annoying and dont know what it could be from Mono? Antibotics? or something else

  • Jan Modric

    mike,

    sore throat, fever, and tiredness occur in flu, including swine flu. In infectious mononucleosis, sore throat, enlarged or painful lymph nodes in the neck, armpits and groin, tiredness and rash are common; symptoms may lat for a month or more. High fever, enlarged red tonsils (?), and enlarged lymph nodes in the neck or back of the head (but not armpits and groin) appear in bacterial (streptococcal) infection of the tonsils.

    Pain in the lower left rib cage could arise from the spleen or gas built in the colon. Green/yellow stools may be simply due to quick travel of the stool through the gut, or antibiotics, cant say. If you had no rash or enlarged lymph nodes, and if ssymptoms persist, I recommend you to ask a doctor about which investigations would be reasonable (swine flu, ultrasound of the spleen…).

  • rbg

    Hi,

    I am a 30year old male and have been suffering from constant upper left abdominal pain since the last 1 year. The CT scan with contrast and colonoscopy all came out negative and the doctor told me that all reports were perfectly fine there were no issues reported. Infact i am suffering from this pain a lot and not knowing on how to proceed. When i press in the area it is very painful.

    Please advise.

  • Jan Modric

    rbg,

    is the pain there just all the time, I mean is the affected site tender at any given time? Is the pain aggravated by meals or relieved after bowel movements? Does the pain changes with the body movements or deep breathing? Any change in bowel movements, or excessive gas? What is your diet in general?

  • rbg

    Hi,

    I have discomfort all time. Anytime when i press under the left abdomen there is pain or tenderness. It increases a lot before bowel moment after which i have discomfort.

    Please advise

  • rbg

    Hi,

    Forgot to mention, i was having a lot of gas and hence was asked to use aciphex. The gas has reduced to some extend but not the pain & discomfort.

    When i lie down on my back and press the abdomen below the left ribcage i can feel it like i am wounded.

  • Jan Modric

    rbg,

    according to your symptoms, one possible cause of your pain is gas built in the part of the colon that runs below the left rib cage. If you are otherwise healthy and have no diet restrictions, you can try the following:
    - a low-fructose diet for 2-4 days. If it helps, it’s likely you have fructose malabsorption. If no relief, you can try…
    - a lactose-free diet for 2-4 days. If it helps, it’s likely you have a lactose intolerance.
    You can also try a low-FODMAP diet, which is a combination of above two.
    - a gluten-free diet for at least a week. If it helps, it’s likely you have a celiac disease.

    If nothing of above helps, you can ask a gastroenterologist for a stool test for parasites or other investigations which would reveal the cause of excessive gas.

  • rbg

    Hi,

    I have mild pain and discomfort all times and this increases before passing the stools.

    When i lie down on my back and press the tender area under the left rib its intense pain as if i am wounded.

    I was passing gas which is under control by using Aciphex. But these symptoms would never come down.

    Please help me

  • DNaz

    Hi,

    I have had upper middle to left side bloating & pain for over a year. I had an endoscopy and was diagnosed with gastritous due to H.Pylori and was treated with meds. The first treatment failed and had to be re-treated. I was retested via Endoscopy and was told all results came back negative. I still feel the same though. I have been on Nexium for over a year through this process. I was told after the 3rd endoscopy I still have slight gastritous and should stay on the meds. I was told to try a new med (Dexilant) which i have been on for about 4 weeks. I still feel the same. About 9 months ago I noticed a lower left crampy type of pain which has gotten more noticeable thru the more recent months. I told my doctor and he gave me another med to try (dicyclomine)for what the doctor said was spasmatic colon. I had a colonoscopy a year ago, and had a copy of non cancerous small polups removed and diagnosed with diverticulosis and was told to add fiber to my diet. I have also had 2 pelvic ct scans and 1 ultrasound with all negative results. Whew – that is about everything I can remember. Any help would be appreciated. – Thanks

  • Jan Modric

    DNaz,

    do you burp excessively or have a heartburn?

  • DNaz

    No heartburn, I do burp a little.

  • Jan Modric

    DNaz,

    - a low-FODMAP diet for few days could help in irritable bowel syndrome
    - a low-fat diet for few days could help, if there is a problem with a bile flow (biliary reflux)

  • DNaz

    Hi Jan,

    The lower left pain comes and goes.
    The upper Bloating/Pain seems to build as the day goes on. In the morning I feel pretty good but it seems to come on as the day goes by. I have a followup appt. with my gastro doc this Wednesday to discuss this more. Is there anything I should ask him to help diagnose the problem? Not sure what other tests he can suggest?

    Thanks

  • Jan Modric

    DNaz,

    for me, the first question is, does the bloating arises from the stomach or colon? Stomach is located below the spot where the ribs meet (pictures) and slightly to the left, but not far toward the left side. With bloated stomach you would likely burp excessively during and shortly after the meals. H.pylori infection is a common cause of a bloated stomach. It is a breath test that can reveal if you have an active H. pylori infection again. The other common cause of stomach bloating is gastroparesis (slow stomach emptying). Diagnosis is made by a stomach emptying test (you eat a specific meal, and a scan is made to show how far the food has traveled in a certain time).

    A lower left abdominal pain may be caused by gas built in the descendant colon (the diverticles, even if not inflamed, can contribute to pain, and if pain comes and goes, diverticles are not likely inflamed). So, if this lower pain was caused by gas, you would likely have excessive gas, and some bloating there. Gas could be due to fructose malabsorption or some other food intolerance like celiac disease or lactose intolerance. It could help a lot, if you can identify any group of foods (wheat products or fruits or milk products) that aggravate your symptoms.

    This personal medical history questionnaire may help you to recall more symptoms or circumstances.

    In “spasmatic colon” which is also called irritable bowel syndrome, you would very likely have some constipation or diarrhea or both, aggravated by meals and relieved by bowel movements.

  • DNaz

    Jan,

    The most recent Lower Left Pain has been in the morning upon wakeup (not today though, no pain today). The upper Bloating/Pain first thought to be the H. Pylori still appears as the day goes on. I was recently tested via endoscopy and biopsy samples (all negative). The pain is not severe, just more annoying & mentally stressing. I was wondering if this is more stress related or something the tests do not show.

  • Jan Modric

    DNaz,

    if I got you right, your last endoscopy/biopsy revealed no H. pylori, but there was some gastritis detected. In this case, gastritis is probably due to excessive gastric acid secretion, and this could be caused by stress, irritant foods or medications or biliary reflux (the bile flowing up from the duodenum)…You could additionally have a gastroparesis – a slow stomach emptying, which would explain upper middle bloating. Diagnosis is made by a ‘stomach emptying test’. In both gastritis and gastroparesis, symptoms would lessen at night and worsen during the day, especially after the meals. The lower left pain, coming and going, is probably caused by gas built in the last part of the colon. In this case, pain would be likely relieved by a bowel movement.

  • DNaz

    Jan,

    Thanks for all your input, I’ll let you know what they say.

    Dave

  • Ana

    Hi,
    I am a 29 year old female, weigh 120 pounds and have been suffering from occasional stomach pain, bloating and constipation all my life. The pain is sometimes strong but more often uncomfortable, accompanied by bloating and made worse by intake of more food or liquid. The silly thing is it stops hurting AS SOON AS I lie down although the bloating and an uncomfortable feeling are still there. The only remedy is BM that usually happens after 2-5 days. I would say I have a pretty good diet, eat home cooked meals every day, love eating fruit and veg. I have noticed sometimes it is provoked by stress or excitement (it happens a lot when I’m travelling and having irregulars/different meals than usually). Sometimes it may occur twice a week, sometimes once a month. I have tried introducing more fibre into my diet, avoiding gluten thinking it might be a gluten intolerance… It is possible my father and a cousin are suffering from the same condition because they seem to have similar symptoms.
    I hope you can help me because I am out of ideas. Any information would be greatly appreciated. Thanks.

  • DNaz

    Jan,

    My currect doctor has me getting a Gastric Emptying Study next week. But does not have anything else to check. He said all the previous tests have been done. We decided to discontinue the nexium to see if it make a difference in my symptoms. If this comes up normal, where do I go from here? Should I try a new doctor or specialist?

  • Jan Modric

    Ana,

    a combination of your symptoms sounds like what is known as irritable bowel syndrome (IBS). It was found out in last years that people diagnosed with IBS often have some underlying problem, like some sort of a food intolerance, though.

    With a low-FODMAP diet, nutrients that often irritate the bowel and cause constipation, diarrhea, bloating and gas, are removed. These nutrients include fructose (in fruits), lactose (in milk), sorbitol and certain types of fiber known as fructooligosacchardides (FOS), fructans and galactans (in legumes, wheat, onions and certain other vegetables). I recommend you to read the article about the low-FODMAP diet and maybe have a low-FODMAP diet trial for few days. One part of this diet is a low-fructose diet, which usually helps in fructose malabsorption. It’s quite possible a combination of stress and certain foods trigger symptoms in your case.

  • Jan Modric

    DNaz,

    you can check this personal medical history questionnaire:
    http://www.healthhype.com/patients-personal-and-family-medical-history-questionnaire-form.html

    and write down all your current symptoms, and then past symptoms, tests results, medications..and anything other, like the form says. From a combination of all details a doctor may imagine more clearly what could be the cause. If the emptying test will be negative, you may want to have some diet trials, like a low-FODMAP diet trial (link in one of my above comments) before jumping on the next investigation.

  • bj

    I am 59 yr old male.
    I have chronic on and off, consistent LLQ ab pain since 2006 spring.
    Since then, I had MRI yearly, CT yearly and blood, urine tests, which are all unremarkable or unrelated to the LLQ ab pain.
    Doctors had sent me to hernia surgeon (because the area of burning and pressure and dull pain has been about 1″ about midpoint of inguinal canal), osteopath surgeon (to clarify femoral head necrosis concerns). I also had colonoscopy yearly, that the doc said I do not have diverticuli or other colon lining findings. I also had seen urologist and although have some BPH (and frequent urinations with residual drippings) but they said the sensation should not be at LLQ ab area. One GI doc said I may have IBS or Crohn diseases, but I do not have constipation or diarrhea or BM abnormalities. The symptoms (currently I am feeling it now), is not exertion related (went to Gym, ok) not bowel movement related, no bloating. Usually can I feel it when waking up lying on bed (but the dull pain does not severe to hamper sleep), but can persist the day. It feels like a pencil sticking taut in my LLQ ab that produces dull, some burning sense pain.
    Docs mostly are fed up with my complaints (because I understand their points that I can carry out daily functions without wt loss, or clear and relevant clinical testing results supporting my claims). They usually prescribed anti-anxiety drugs or NSAID to discharge me (helps slightly but not consistently, did not take anti-anxiety drugs).
    I did some diary and have upload some excel spreadsheet data of mine that I ask if you can please download and take a look. As soon as you respond me, I will delete that from my hotmail skydrive.
    *****

  • Jan Modric

    bj,

    I can’t open the file; it says it was probably deleted; but I have few questions:
    - Is the pain always on the same spot?
    - Is the area tender to touch, can you feel any bulge?
    - Is the pain obviously affected by body position, like sitting, walking, and if yes, how quickly after body position the pain appears?
    - Any pain in the back, buttocks, legs?
    - Is pain aggravated by meals or relieved by bowel movements?
    - Have you ever had any abdominal injury or surgery?

  • Justin Graham

    I am a 26 year old male, 5’6″, 175 lbs. A little over a week ago I began having pain in my abdomen on the lower left side. I thought it may be kidney stones. The pain increased, but as it did it moved around my side and has now been in the front of my abdomen for a few days. Now it is just in the front, no pain on the side or in the back, only to the left of my belly button. I also have an uncomfortable throbbing and tingling feeling inside, along with heat. The only way I can describe it is that it feels like someone took one of those heat packs and dropped it inside of my stomach. I went to the hospital, they ran urine and blood work, and said they looked fine and sent me home. I’m still not feeling well. Do you think I should be more concerned, or will it go away since those tests “looked fine”.

  • Jan Modric

    Justin Graham,

    to diagnose urinary stones, specific urinary tests and some imaging investigation, like ultrasound, would be needed. Another set of causes could arise from the bowel – constipation, diverticles, partial bowel obstruction, hernia…In shingles (a virus reactivation in one or more spinal nerves) rash would appear in a band-like pattern (from back to front) in few weeks. If you think, it could be constipation, try to solve that with appropriate diet with more fibers, exercise, drinking enough fluid..If this does not help, or if pain becomes worse, visit a doctor.

  • termsak

    Hi, first of all let me tell you what a fantastic job you are doing.

    I am an Asian 35 year old male. Height 1.83m. Weight 74kg.

    For the past 3 days I have had extreme pain on my left lower abdomen. Nothing particular triggered it. Made me have night sweats but no fever. Took some Tylenol and it helped for a while. Food appetite was reduced the following day. Didn’t feel like I was hungry until 5pm. After meal, the pain would come back and last for hours. I am quite tolerant to pain, but this was really annoying so I decided to go to hospital. Did an ultrasound and blood test. All came out normal. Doctor just prescribe me colofac. It didn’t help and the pain got even worse last night. It used to be all over my abdomen and back, but last night it was exactly at left side slightly at the back. It hurt especially when I lift my left leg sitting or if I had to pull a sock up. It also hurt there when I took a deep breath. This morning it seems fine just bruised a bit. I have not eaten today (only water) so it might tell you something.

    I have a slight constipation problem (been only once to bathroom the past 3 days and only a small solid sample came out last night) and I am kinda bloated (for the past year). I took some Dulcolax last night 4 hours before bed time, but so far no luck.

    I have had occasional irritation in my bowel for the past year, but nothing particular painful as this. Did stool test back then and nothing abnormal.

    I drink a lot and smoke. I don’t drink milk and don’t eat seafood. Most of my diet is beef and pork. Spicy food as well. I am not allergic to any food. Have often non smelly gas. Normally I would go 1-2 times a day to toilet (one in the right after digesting first food) and maybe one later.

    I was also diagnosed with mild SLE (if there is such thing) 15 years ago. The SLE has never affected my internal organs such as kidney and liver.

    I am planning to admit myself to hospital today. I do not trust the doctors here in Thailand. Would appreciate your recommendation on what it could be and what they should look for/what kind of tests should be done.

  • termsak

    Additional info: I take 1 tablet daily of Cellcept and one of Azithoprine for the SLE. This been taken for 3 years now. I stopped taking Prednisone 2 years ago.

  • Jan Modric

    termsak,

    pain in the lower left abdomen aggravated by meals strongly speaks for a bowel involvement, probably large bowel, but I cannot exclude small bowel involvement. Constipation, intestinal hernia, diverticulosis or polyps are examples of possible causes of a bowel obstruction. Colorectal cancer is extremely rare in your age. Eating green leafy vegetables, whole-grain bread, brown rice, fruit/vegetable juices and avoiding alcohol, meat, chips, French fries and other heavy sugary/fatty foods may help to prevent constipation. Doctors may suggest you having a stool test for parasites, or (when a disorder within the bowel is suspected) X-ray with barium enema or colonoscopy, or (when a disorder outside the bowel is suspected) an ultrasound or CT or MRI of the abdomen. They might offer you a laxative to clear the bowels. They might run blood tests to evaluate if the SLE (systemic lupus erythematosus) has worsened. They might order a urine test to exclude kidney disorders. They may ask you several details about pain triggers and other circumstances, so you can use this questionnaire to prepare for the visit.

  • CJ

    I have had a nagging, low-intensity LLQ abdominal pain for ~4 weeks. It is very slightly tender when pressed. Over the same period, my bowel movements have fluctuated between regular and diarrhea (sometimes somewhat urgent). I go 2-4 times per day, often just after eating. The pain is usually present, but occassionally abates (seemingly at random).

    This is the second time I have experienced a similar pain, though the first time (~6 months ago) it was accompanied by intense constipation and was ultimately relieved after ~1 week by going on first a high-fiber and then a 2-day liquid-only diet. I have not yet tried the same thing due to difference in symptoms.

    I’m male, 30 years old, 5’11″, ~160 lbs. I take no medications. I quit smoking ~1.5 years ago, and was two-pack-per-week smoker for ~8 years prior. I have 1-3 drinks with dinner usually 3 out of 5 week days, sometimes a few more on weekends. I eat a varied diet, usually relatively healthy, but have indulged somewhat over the holidays despite the pain. I walk to and from work, and run occassionally, but have not exercised regularly since summer.

    My bowel movements have been somewhat irregular over the last few years (without pain), but generally seemed to improve with my diet and flare up only with fatty foods.

    How urgent is it that I see a doctor? Should I try dietary modifications again first? Any help or advice would be much appreciated.

  • OTD

    60-year-old female, obese, pain in LLQ (2-3 years), now radiating somewhat down the outside of my left leg, but not reaching the knee. I’m quite fearful, my father had colon cancer. Also extreme itching in my vulvar region (unhelped by Vagisil), 2-3 small nodules felt in the labia.