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:

• LLQ pain and tenderness
• Blood and mucus in the stool
• Vomiting bile
• Constipation

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.