Where Women Have No Doctor - A Health Guide for Women (Hesperian Foundation, 1997, 600 p.) Chapter 21: Pain in the Lower Abdomen (introduction...) Sudden, Severe Pain in the Abdomen Kinds of Pain in the Lower Abdomen (introduction...) During monthly bleeding After childbirth, abortion or miscarriage With fever With diarrhea During pregnancy With urination With discharge or light bleeding from the vagina During sex When moving, walking or lifting In the middle of the monthly cycle Within 3 weeks of getting an IUD Without other signs Questions about Pain in the Abdomen

Where Women Have No Doctor - A Health Guide for Women (Hesperian Foundation, 1997, 600 p.)

Chapter 21: Pain in the Lower Abdomen

How to use this chapter:

1. For sudden, severe pain in the belly or abdomen, see Sudden, Severe Pain in the Abdomen and follow that advice.

2. Look up the different kinds of pain on Kinds of Pain in the Lower Abdomen. Most of these problems are described in other parts of the book.

3. If you are still unsure of the cause of the pain, look at the questions on Questions About Pain in the Abdomen.

4. For information on how to examine a woman with pain in the abdomen, see How to Examine the Abdomen.

The reproductive organs are in a woman’s lower abdomen, along with other internal organs.

Most women have pain in the lower belly or abdomen at some time in their lives. Often women are taught that this pain is normal for them, and that they should endure such pain in silence. Some people think that a woman’s pain is not serious until she cannot stand, walk or talk. But when a woman waits that long to seek care for pain, the result could be serious infection, infertility, loss of a pregnancy, and even death.

¨ Pain should not be a normal part of a woman’s life - it is a sign that something is wrong. Seek care before you are so ill that you cannot stand, walk, or talk.

This chapter describes different kinds of pain in the lower abdomen (below the navel), and what might be causing the pain. Some pain in the lower abdomen spreads above the navel and could have other causes. Some problems of the lower abdomen will also cause pain in the low back. If the pain seems different from what is described in this chapter, see a health worker trained to give an abdominal exam.

Sudden, Severe Pain in the Abdomen

Some lower abdominal pain is an emergency. If you have any of the following danger signs, go to the nearest hospital. A trained health worker will need to do an examination of your abdomen, a pelvic exam, and perhaps special tests. For information about how to do an abdominal exam and a pelvic exam, see How to Examine the Abdomen.

Danger signs: · sudden, severe pain in the abdomen · high fever · nausea and vomiting · swollen abdomen, which is hard like a piece of wood · silent abdomen (no noises) Figure

Kinds of Pain in the Lower Abdomen

Pain in the lower abdomen can have many causes. It can be difficult to find the cause because so many organs in the abdomen are close together.

During monthly bleeding

Pain in the lower abdomen can have many causes. It can be difficult to find the cause because so many organs in the abdomen are close together

Kind of pain	May be caused by	What to do
Severe, unusual pain during monthly bleeding or after a monthly bleeding was missed	pregnancy in the tube	URGENT! Go to a hospital right away.
Ongoing pain during monthly bleeding	fibroids	See ‘pain with monthly bleeding’, and ‘problems of the womb’ Use a mild pain medicine.
Cramps during monthly bleeding	normal squeezing of the womb. Some kinds of intra-uterine devices (IUDs) may make the pain worse.	See ‘pain with monthly bleeding’
If the monthly bleeding is late	miscarriage	If pain becomes severe, go to a hospital.

After childbirth, abortion or miscarriage

Kind of pain	May be caused by	What to do
Pain after childbirth, miscarriage, or abortion	infection from pieces of afterbirth (placenta) left in the womb, or germs that got into the womb during the birth or abortion	See ‘womb infection’, and ‘infection after abortion’.

With fever

Kind of pain	May be caused by	What to do
Severe pain with fever (infection)
with or after having an STD or pelvic infection on	another pelvic infection, or a pocket of pus in the abdomen (pelvic abcess)	URGENT! Go to a hospital right away.
one side of the abdomen, with fever, nausea, vomiting, and no appetite	appendicitis or other intestinal infection	URGENT! Go to a hospital right away.
	kidney infection	See ‘bladder and kidney infections’

With diarrhea

Kind of pain	May be caused by	What to do
Pain with diarrhea	intestinal infection from bacteria or parasites	See ‘diarrhea’.

During pregnancy

Kind of pain	May be caused by	What to do
Severe pain in the first 3 months of pregnancy, often with bleeding that comes and goes	pregnancy in the tube	URGENT! Go to a hospital right away.
Severe pain in the last 3 months of pregnancy, with or without bleeding	placenta has pulled away from the wall of the womb	URGENT! Go to a hospital right away.
Mild, occasional pain during pregnancy	probably normal	No treatment needed.

With urination

Kind of pain	May be caused by		What to do
Pain with frequent urination	bladder or kidney infection	Figure	See ‘bladder and kidney infections’,
Pain with blood in the urine	kidney stone		See ‘kidney or bladder stones’.

With discharge or light bleeding from the vagina

Kind of pain	May be caused by	What to do
Pain with discharge or light bleeding from the vagina, sometimes with fever	Figure pelvic infection which may be caused by a sexually transmitted disease (STD), or by infection after miscarriage, abortion, or childbirth	See ‘pelvic inflammatory disease’, ‘womb infection’, and ‘infection after abortion’.

During sex

Kind of pain	May be caused by	What to do
Pain during sex	pelvic inflammatory disease (PID), or scars from an old pelvic infection	See ‘PID’.
	a growth on ovary (ovarian cyst)	See ‘problems of the ovaries’.
	fibroids	See ‘problems of the womb’.
	unwanted sex	See ‘if sex is painful’.

When moving, walking or lifting

Kind of pain	May be caused by	What to do
Pain when moving, walking, or lifting	old pelvic infection, or any of the reasons listed above	Use mild pain medicine if needed.

In the middle of the monthly cycle

Kind of pain	May be caused by	What to do
Pain that lasts only a few hours in the middle of your monthly cycle	the lining of the abdomen gets irritated when the ovary releases an egg (ovulation) because there is blood a small amount of blood	Use mild pain medicine if needed. See the chapter on “Understanding Our Bodies.”

Within 3 weeks of getting an IUD

Kind of pain	May be caused by	What to do
Pain within 3 weeks of getting an intra-uterine device (IUD)	infection with an IUD is most common soon after the IUD is put in	See a health worker right away.

Without other signs

Kind of pain	May be caused by	What to do
Pain without other signs	pelvic infections, which can cause constant or on-and-off pain in the abdomen or lower back that lasts for months or years	See a health worker trained to do a pelvic exam.
	intestinal infection from bacteria or parasites	See a health worker or Where There Is No Doctor.
	tumor or growth on the womb or ovary	See a health worker trained to do a pelvic exam.

Questions about Pain in the Abdomen

If your pain does not fit one of the kinds described on the previous pages, these questions may help to learn more about it.

What is the pain like? Is it sharp and severe - or dull, achy, and not so bad? Does it come and go, or is it constant?

· Terrible pain that comes and goes could be from a kidney stone. Severe grabbing, clenching, or cramping pain could be from an intestinal problem.

· Sharp, severe pain, especially just in one place, could be appendicitis or a pregnancy outside the womb in the tube.

How long has the pain lasted?

· Sudden, severe pain that does not get better is probably serious. It could be from a pregnancy in the tube, appendicitis or other gut problems, something wrong with the ovary, or pelvic inflammatory disease (PID).

· Pain that lasts for many days or weeks, especially if it is not severe, may be caused by scars from an old infection, indigestion, or nerves. It may be possible to treat this at home.

Does the pain affect your hunger?

· If you have pain in the abdomen and you DO NOT want to eat anything, you may have a serious infection in your intestines, or appendicitis.

· If you have pain and you DO feel like eating, you probably do not have one of these problems.

For more information on pain in the lower abdomen, see Where There Is No Doctor or another general medical book.

A woman who walks with pain today could die from it tomorrow. Get help early if you are not sure.