Pain in the lower belly is common, and often it’s something minor like constipation, gas, or menstrual cramps. But sometimes, it can signal a more serious problem that needs medical attention. The lower abdomen includes your intestines, bladder, reproductive organs, and parts of the urinary system. Doctors figure out the cause by looking at where the pain is, how it started, and associated symptoms. Below are some causes that can require medical care.
What Could Be Causing It?
Digestive causes
- Appendicitis – generally on the right side, often with nausea and vomiting
- Diverticulitis – when small pouches in the colon wall become swollen or infected; often on the left side, and involves steady pain that builds over days
- Colitis – inflammation of the colon, which can be caused by infections, inflammatory bowel disease (like Crohn’s or ulcerative colitis), or other problems such as poor blood flow to the colon (ischemic colitis), or side effects from certain medicines. Colitis often leads to diarrhea, cramping, and sometimes fever or blood in the stool
Urinary causes
- Bladder infection – burning when you pee, frequent urges, pressure in the lower belly
- Kidney stones – severe, sometimes wave-like pain in the side or lower abdomen
- Kidney infection – fever, chills, back pain, urinary symptoms
- Urinary retention – fullness and pain in lower abdomen with difficulty urinating
Reproductive causes
- In women:
- Ovarian torsion or cysts (sudden sharp pain on one side)
- Fibroids (cause pressure pain if they grow large)
- Ectopic pregnancy (needs immediate care)
- In men:
- Testicular torsion (starts as lower belly pain that shifts to the groin, often with nausea)
- Epididymitis or orchitis, infection/inflammation of the tubes and tissues around the testicle (pain usually starts in the lower belly and moves down into the groin/scrotum).
- Prostatitis, infection/inflammation of the prostate gland (can cause aching pain in the lower belly, pelvis, or lower back, along with urinary symptoms like burning or urgency)
Red Flags: When to Get Care Right Away
Get urgent care if you have:
- Severe pain that is worsening quickly
- Fever and chills
- Dizziness or feeling faint
- Difficulty urinating
- Pain with vomiting
- Lower belly pain with positive pregnancy test
- A tender belly that hurts with small movements
How Doctors Figure Out What’s Going On
Most people will start with blood tests to check for infection and inflammation, a urine test, and a pregnancy test for anyone who could be pregnant.
Ultrasound is often the first imaging test, especially in younger people or pregnancy.
A CT scan is usually recommended if you:
- Are 65 or older
- Have a weakened immune system
- Had an ultrasound that didn’t explain the pain
- Have concerning lab results or severe symptoms
If you are pregnant and the ultrasound doesn’t give answers, an MRI may be used for further evaluation without radiation.
What If My Pain Isn’t Severe?
If your pain is mild and you don’t have any red flags, your doctor may recommend watching it for a short time to see if it improves. But if symptoms worsen, or you feel unwell, don’t wait—get checked right away.
Questions You May Want to Discuss With Your Doctor
- Even if my lab tests are normal, should I also get an ultrasound to make sure we are not missing anything?
- If my ultrasound is normal but the pain continues, should I get additional imaging?
- Given my positive pregnancy test result, should I get an ultrasound to rule out an ectopic pregnancy?
- Given my weakened immune system, would I benefit from a CT scan to make sure we are not missing anything?
- Since I’m over 65, would a CT scan be recommended to help rule out serious causes?
- What warning signs mean I need to go to the emergency room immediately?