What Lower Abdominal Pain Could Mean

It’s a rare person who has not experienced abdominal pain from time to time. The abdomen could be described as the area between the lower ribs and the pubic bone. This part of the body contains your intestines, bladder and the female reproductive organs. In fact, women may refer to lower abdominal pain as “pelvic pain.”

Lower abdominal pain often is defined as any type of pain that occurs below the level of your belly button (navel). And there’s a laundry list of reasons you could get pain in this area. From A (appendicitis) to U (ulcers), the list of potential causes for lower abdominal pain spans nearly the entire alphabet.

Here are a few common reasons you might experience lower abdominal pain—and some additional symptoms that signal it’s time to see a doctor.

Common Causes of Lower Abdominal Pain

Interestingly, many serious abdominal disorders, such as colon cancer, do not initially cause pain. Aside from appendicitis, which typically involves sharp, localized pain in the lower-right quadrant of the abdomen, most lower abdominal complaints fall into the category of mild-to-moderate, generalized abdominal pain. The usual culprits for this type of discomfort include:

When to See a Doctor for Lower Abdominal Pain

Often, if you’re experiencing generalized abdominal pain you can take a wait-and-see approach about the situation. However, you should seek medical attention for any of these situations or symptoms:

• Abdomen is distended or very hard/rigid when you push on it
• Abdominal pain that doesn’t go away within a week
• Black and/or tarry looking stool
• Blood in your urine
• Constipation, especially with vomiting
• Diarrhea for more than 5 days
• Fever
• Inability to pass any stool at all and have not had a bowel movement for several days
• Pain that progressively gets worse instead of better over time
• Severe abdominal pain occurring in one particular spot, especially if the area also feels tender when you touch it
• Sharp pain in the groin area that occurred with a “popping” feeling on physical exertion
• Unexpected or prolonged vaginal bleeding
• You are pregnant or believe you could be pregnant

Home Treatment for Lower Abdominal Pain

If your pain feels mild or moderate and is not localized, you can try some simple home remedies to treat it:

• Stop eating solid food for a few hours. (Note: If you have diabetes, be sure to check your blood sugar levels frequently if you are not able to eat.)
• Sip clear liquids or a sports drink diluted with water.
• If the pain seems to be caused by intestinal gas, try walking around. Or take an over-the-counter anti-gas preparation.
• If you are mildly constipated, drink plenty of water and try taking a stool-softening gelcap as directed on the label until you have a bowel movement.

How to Avoid Lower Abdominal Pain

Intestinal upset is a major cause of lower abdominal pain. You can keep your bowels happy by eating a high-fiber diet and drinking plenty of water. Add leafy vegetables and fresh fruits to your meals. Exercise regularly, even if it’s only walking.

Although most cases of lower abdominal pain are mild and temporary, you should not hesitate to seek medical attention if you have a sudden onset of sharp, localized pain in your abdomen. If you need or want to see a doctor for any level of lower abdominal pain, Healthgrades can help you find one now.

Lower abdominal pain – What could be behind pain in the lower abdomen?

Most people have had abdominal pain before. It can have a variety of causes, most of which are harmless in nature and not a matter of concern. Lower abdominal pain can be caused by many different acute or chronic illnesses.

If you suffer from lower abdominal pain, we have a tip for you. Try to get it under control with your diet. We have developed a nutritional therapy program for this purpose. Click here for more information about changing your diet and get advice in a free initial consultation.

The region below the belly button is called the lower abdomen. For example, the lower abdomen can be further divided into right and left parts (quadrants).

When can lower abdominal pain be particularly dangerous?

First of all, it is important for the doctor to differentiate between threatening diseases and functional complaints.

Immediate, emergency clarification is required for the following:

• Very severe abdominal pain
• Defense tension (involuntary tensing of the abdominal wall when touched), hard stomach
• Lower abdominal pain accompanied by circulatory disorders
• Rapid pain development followed by vomiting, a heavily bloated stomach, stool and wind behavior
• Vomiting blood, tarry stools, bloody stools
• Lower abdominal pain during pregnancy
• Lower abdominal pain with urinary retention

If the following symptoms appear in connection with lower abdominal pain, this can also indicate a serious illness:

• Fever
• Jaundice
• Unwanted weight loss
• Change in stool habits
• Diarrhea lasting more than 14 days

What are functional symptoms?

Functional disorders are characterized by the fact that disrupted organ functions cannot be explained by any physical findings. Around one in four patients with such a problem presents themselves at the doctor. The disturbed organ functions present themselves to a large extent as pain disorders, whereby here again the abdominal region is very often affected.

Not all pain is the same. Whether it occurs suddenly or insidiously and whether there is a trigger or soothing factors can indicate the cause of the pain. In addition, the pain localization offers initial indications due to the location of the organs.

If you take a look at the organs directly under the abdominal wall, you only see the intestine. A distinction is made between the small and large intestines, which together are several meters long. The large intestine surrounds the long loops of the small intestine like a frame.

In the right lower abdomen is the transition between the small and large intestine. The so-called ileum of the small intestine located closer to the mouth opens into the well-known appendix of the large intestine.

Pain in the right abdomen

Appendicitis

A “classic” among the causes of pain in the lower abdomen is appendicitis. In fact, it is not the entire appendix, but only its appendage, the Vermiform appendix, that is inflamed here. A typical pain characteristic can appear with appendicitis: First the pain is perceived diffusely around the navel, later the pain migrates into the right lower abdomen and is described as a rather piercing, “light” pain. In addition, nausea and vomiting as well as wind and bowel movements and loss of appetite can occur. Subfebrile temperatures or fever are also typical. Nevertheless, appendicitis is often not easy to diagnose. Especially in children, the elderly or pregnant women, the typical symptoms may be missing or different.

Inflammatory bowel disease

Another disease that can cause right-sided pelvic pain, similar to appendicitis, is Crohn’s disease.

This is an inflammatory bowel disease of unknown origin, which usually also affects young adults and children. Inflammation can affect the entire digestive tract, but it usually affects the last part of the small intestine and the colon that immediately follows. If you want to differentiate between these two diseases, accompanying symptoms help. In over 70 percent of all patients with Crohn’s disease recurrent diarrhea is in the foreground along with pain.

If you follow the course of the large intestine, you reach the descending part of the large intestine in the left lower abdomen via two bends.

CARA CARE supports you with your digestive problems

Get the App

Pain in the lower abdomen

Diverticulosis

In the descending part, there are often protuberances of the intestinal wall, so-called diverticula. The prevalence of diverticulosis is very high in industrialized countries, occuring in 60 percent of the population over 70 years of age. However, diverticulosis is almost always symptom-free. However, around 20 percent develop an acute inflammation (Diverticulitis) if, for example, stool is stuck in the protrusions. Then the disease is also called “left-sided appendicitis”. Those affected are mostly older patients between the ages of 60 and 80. Various factors such as obesity, high meat consumption, chronic constipation and age-related weak connective tissue can lead to diverticulosis.

Colon cancer

The last section of the colon is the location of the most common type of colon cancer – the colorectal cancer. Many patients only have symptoms at an advanced stage, with little pelvic pain. Therefore colorectal cancer screening tests are recommended from the age of 50.

Inflammatory bowel disease

The rectum is also affected with ulcerative colitis. It is another inflammatory bowel disease in addition to Crohn’s disease (see above). Here, too, there is pain in the lower abdomen, but this is more on the left side. In contrast to Crohn’s disease, diarrhea with ulcerative colitis is bloody and slimy. Also typical are so-called tenesmus – cramp-like pains before or immediately after bowel movements.

Pain in the middle or entire lower abdomen

Often you cannot clearly assign the lower abdominal pain to one side. If there is more diffuse pain in the lower abdomen or the entire abdominal region, the small intestine or the entire intestine can be the cause.

Bowel obstruction and narrowing

This can be, for example, an intestinal obstruction (ileus), an intestinal narrowing (stenosis), an intestinal breakthrough (perforation) or circulatory disorders in the intestine. In these cases there is an acute, severe clinical picture with the warning symptoms mentioned at the beginning. These are absent in the case of harmless flatulence – which can also lead to severe, cramping pain.

Infections

Another acute, but less threatening and very common disease of the small intestine are gastrointestinal infections. Depending on the pathogen, in addition to acute diarrhea and vomiting, pelvic pain occurs in the case of infectious mucous membrane inflammation of the stomach and small intestine. In general, such infections are usually self-correcting within one day. With all diarrhea, the fluid and electrolyte balance must be kept in mind.

Irritable bowel syndrome

In contrast, there are chronic complaints, such as those that show up in irritable bowel syndrome. The clinical picture in irritable bowel syndrome is very diverse and can be indicated by various symptoms such as abdominal pain, diarrhea or constipation. To diagnose the syndrome, the symptoms must last longer than 3 months and other diseases that could cause the symptoms must be excluded. Irritable bowel syndrome is a functional syndrome.

Diverticulosis, chronic inflammatory bowel diseases Crohn’s disease and ulcerative colitis, colorectal cancer and food intolerance are among the most important differential diagnoses for irritable bowel complaints. Our team of therapists specializes in bowel diseases. Find out more information here.

Intolerances

With a food intolerance, the body has problems digesting certain substances. Examples include fructose, lactose or wheat. The absorption of these nutrients then leads to abdominal pain, bloating and diarrhea. Finding the cause of such non-specific abdominal discomfort is not always easy. We have therefore developed a nutritional therapy program in which you can explore your specific causes together with your personal nutritionist. Arrange a free initial consultation here and find out whether the therapy is suitable for you.

Diseases of the urinary organs

Behind the small and large intestine are the urinary organs, which include the kidney, ureter, bladder and urethra.

A common urinary tract disease in affluent societies like ours is **urinary stones. **They are not always symptomatic. When kidney stones move the ureter, there can be a strong colic-like, that is, swelling and declining pain in the lower abdomen or the groin or flank region. From a clinical point of view, this is characteristic of the motor restlessness of a colic-afflicted patient who wants to relieve their pain by constantly changing his position.

In extreme cases, a stone can make it impossible for those affected to empty the bladder. Doctors call this a **urinary retention. **Especially in acute cases, this is accompanied by severe abdominal pain. For a majority of the patients, stones are not the cause, but rather an existing chronic bladder emptying disorder, for example due to an enlarged prostate in men.

Frequent visits to the toilet are typical for cystitis**. **A dull pain can appear over the symphysis here. Inflammation of the bladder is usually easy to recognize by the burning pain when urinating and the unpleasant urge to urinate. It is much more common in women than in men.

In general, abdominal pain is often perceived as a typical female condition. It is true that there are some diseases that only occur in men or only in women, since the internal genital organs are also in the pelvis.

Pain in the lower abdomen in women

Menstrual cramps and endometriosis

Menstrual pains are not uncommon in women. Sometimes gynecological diseases such as endometriosis can also be behind cycle-dependent pelvic pain. With endometriosis, the endometrium is also outside the uterus. 2-10 percent of all women are said to be affected. These and other gynecological disorders that cause pelvic pain are usually accompanied by other symptoms such as irregular cycle and bleeding disorders.

Ectopic pregnancy

Sudden onset of abdominal pain with no bleeding at the same time can indicate rupture of the fallopian tubes during pregnancy of the abdominal cavity (ectopic pregnancy). Ectopic pregnancy refers to pregnancy outside the uterus. A pregnancy test is therefore positive.

Ovarian torsion

Another gynecological emergency is **ovarian torsion. **Here, too, right or left pelvic pain begins acute, but often after abrupt movement. With an ovarian torsion, the ovary or a large ovarian cyst rotates around its own axis and thus hinders blood flow to the ovary. With a high degree of probability, the ovarian torsion can easily be recognized by a simple sonographic examination.

Lower abdominal pain on the right or left side can also be caused by inflammation of the fallopian tube and ovary (adnexitis). It is an important differential diagnosis for suspected appendicitis in women. Adnexitis is an inflammation of the fallopian tubes, ovaries and the surrounding tissue. This usually arises via ascending infections from the vagina and uterus, e.g. after transmission of gonococci or chlamydia in sexually active women.

Tip: Abdominal pain is often caused by a bloated stomach. Unfortunately, especially women are affected by this due to hormones. Nutritional therapy can consciously reduce this flatulence. We offer nutritional therapy reimbursed by health insurers to help you reduce your abdominal pain. You can get more information about the program here (click).

Pain in the lower abdomen in men

Testicular torsion

In men, diseases of the genital organs can also cause lower abdominal pain. Sudden onset pain in the lower abdomen and testicles in children and young adolescents in particular can be signs of testicular torsion. Testicular torsion is an acute twisting of the testicles and spermatic cord and is an emergency.

Prostate and testicular inflammation

Inflammation of the prostate (prostatitis), testicular inflammation (orchitis) or epididymis (epididymitis) are less sudden, but also uncomfortable.** **At the same time, problems with urination, local signs of inflammation and general signs of infection such as fever and chills often occur.

Bladder infection

If you have problems urinating and have pain above the pubic bone, you should also consider that it may be a bladder infection. Because while in many cases an uncomplicated urinary tract infection can be assumed for women, a thorough investigation must be carried out for a male patient. This is because the woman’s shorter urethra anatomically favors an infection in the immediate region of the anus, but cystitis is rare in men and is therefore definitely worth clarifying.

Inguinal hernia

Due to the anatomical conditions, men are predisposed for another disease, which can occur in both sexes: inguinal hernia. Bulging in the groin area is characteristic of inguinal hernia. Under certain circumstances, however pulling groin pain (especially when moving) may be the only symptom.

Lower abdominal pain and back pain

Sometimes pain caused by abdominal organs radiates to other parts of the body. Organs that have a close relationship to the back are the kidneys **and the **pancreas in particular. But diseases of the urinary tract and genital organs can also cause back pain.

Back pain can not only be the result of an abdominal disease – the spine can also cause lower abdominal pain. Degenerative changes in the spine such as herniated discs could be the cause here.

In general, both abdominal pain and back pain are very common complaints, so that they do not necessarily have to be related even if they occur at the same time.

Sources

Herold, G. (2011). Innere Medizin 2011. Cologne: Selbstverl.

AMBOSS. (2018). AMBOSS. [online] Available at: https://www.amboss.com/ [Accessed 5 Mar. 2018].

Seiderer-Nack, J. (2012). Anamnese und körperliche Untersuchung. Berlin: Lehmanns Media.

Lower abdominal pain – What could be behind pain in the lower abdomen?

Most people have had abdominal pain before. It can have a variety of causes, most of which are harmless in nature and not a matter of concern. Lower abdominal pain can be caused by many different acute or chronic illnesses.

If you suffer from lower abdominal pain, we have a tip for you. Try to get it under control with your diet. We have developed a nutritional therapy program for this purpose. Click here for more information about changing your diet and get advice in a free initial consultation.

The region below the belly button is called the lower abdomen. For example, the lower abdomen can be further divided into right and left parts (quadrants).

When can lower abdominal pain be particularly dangerous?

First of all, it is important for the doctor to differentiate between threatening diseases and functional complaints.

Immediate, emergency clarification is required for the following:

• Very severe abdominal pain
• Defense tension (involuntary tensing of the abdominal wall when touched), hard stomach
• Lower abdominal pain accompanied by circulatory disorders
• Rapid pain development followed by vomiting, a heavily bloated stomach, stool and wind behavior
• Vomiting blood, tarry stools, bloody stools
• Lower abdominal pain during pregnancy
• Lower abdominal pain with urinary retention

If the following symptoms appear in connection with lower abdominal pain, this can also indicate a serious illness:

• Fever
• Jaundice
• Unwanted weight loss
• Change in stool habits
• Diarrhea lasting more than 14 days

What are functional symptoms?

Functional disorders are characterized by the fact that disrupted organ functions cannot be explained by any physical findings. Around one in four patients with such a problem presents themselves at the doctor. The disturbed organ functions present themselves to a large extent as pain disorders, whereby here again the abdominal region is very often affected.

Not all pain is the same. Whether it occurs suddenly or insidiously and whether there is a trigger or soothing factors can indicate the cause of the pain. In addition, the pain localization offers initial indications due to the location of the organs.

If you take a look at the organs directly under the abdominal wall, you only see the intestine. A distinction is made between the small and large intestines, which together are several meters long. The large intestine surrounds the long loops of the small intestine like a frame.

In the right lower abdomen is the transition between the small and large intestine. The so-called ileum of the small intestine located closer to the mouth opens into the well-known appendix of the large intestine.

Pain in the right abdomen

Appendicitis

A “classic” among the causes of pain in the lower abdomen is appendicitis. In fact, it is not the entire appendix, but only its appendage, the Vermiform appendix, that is inflamed here. A typical pain characteristic can appear with appendicitis: First the pain is perceived diffusely around the navel, later the pain migrates into the right lower abdomen and is described as a rather piercing, “light” pain. In addition, nausea and vomiting as well as wind and bowel movements and loss of appetite can occur. Subfebrile temperatures or fever are also typical. Nevertheless, appendicitis is often not easy to diagnose. Especially in children, the elderly or pregnant women, the typical symptoms may be missing or different.

Inflammatory bowel disease

Another disease that can cause right-sided pelvic pain, similar to appendicitis, is Crohn’s disease.

This is an inflammatory bowel disease of unknown origin, which usually also affects young adults and children. Inflammation can affect the entire digestive tract, but it usually affects the last part of the small intestine and the colon that immediately follows. If you want to differentiate between these two diseases, accompanying symptoms help. In over 70 percent of all patients with Crohn’s disease recurrent diarrhea is in the foreground along with pain.

If you follow the course of the large intestine, you reach the descending part of the large intestine in the left lower abdomen via two bends.

CARA CARE supports you with your digestive problems

Get the App

Pain in the lower abdomen

Diverticulosis

In the descending part, there are often protuberances of the intestinal wall, so-called diverticula. The prevalence of diverticulosis is very high in industrialized countries, occuring in 60 percent of the population over 70 years of age. However, diverticulosis is almost always symptom-free. However, around 20 percent develop an acute inflammation (Diverticulitis) if, for example, stool is stuck in the protrusions. Then the disease is also called “left-sided appendicitis”. Those affected are mostly older patients between the ages of 60 and 80. Various factors such as obesity, high meat consumption, chronic constipation and age-related weak connective tissue can lead to diverticulosis.

Colon cancer

The last section of the colon is the location of the most common type of colon cancer – the colorectal cancer. Many patients only have symptoms at an advanced stage, with little pelvic pain. Therefore colorectal cancer screening tests are recommended from the age of 50.

Inflammatory bowel disease

The rectum is also affected with ulcerative colitis. It is another inflammatory bowel disease in addition to Crohn’s disease (see above). Here, too, there is pain in the lower abdomen, but this is more on the left side. In contrast to Crohn’s disease, diarrhea with ulcerative colitis is bloody and slimy. Also typical are so-called tenesmus – cramp-like pains before or immediately after bowel movements.

Pain in the middle or entire lower abdomen

Often you cannot clearly assign the lower abdominal pain to one side. If there is more diffuse pain in the lower abdomen or the entire abdominal region, the small intestine or the entire intestine can be the cause.

Bowel obstruction and narrowing

This can be, for example, an intestinal obstruction (ileus), an intestinal narrowing (stenosis), an intestinal breakthrough (perforation) or circulatory disorders in the intestine. In these cases there is an acute, severe clinical picture with the warning symptoms mentioned at the beginning. These are absent in the case of harmless flatulence – which can also lead to severe, cramping pain.

Infections

Another acute, but less threatening and very common disease of the small intestine are gastrointestinal infections. Depending on the pathogen, in addition to acute diarrhea and vomiting, pelvic pain occurs in the case of infectious mucous membrane inflammation of the stomach and small intestine. In general, such infections are usually self-correcting within one day. With all diarrhea, the fluid and electrolyte balance must be kept in mind.

Irritable bowel syndrome

In contrast, there are chronic complaints, such as those that show up in irritable bowel syndrome. The clinical picture in irritable bowel syndrome is very diverse and can be indicated by various symptoms such as abdominal pain, diarrhea or constipation. To diagnose the syndrome, the symptoms must last longer than 3 months and other diseases that could cause the symptoms must be excluded. Irritable bowel syndrome is a functional syndrome.

Diverticulosis, chronic inflammatory bowel diseases Crohn’s disease and ulcerative colitis, colorectal cancer and food intolerance are among the most important differential diagnoses for irritable bowel complaints. Our team of therapists specializes in bowel diseases. Find out more information here.

Intolerances

With a food intolerance, the body has problems digesting certain substances. Examples include fructose, lactose or wheat. The absorption of these nutrients then leads to abdominal pain, bloating and diarrhea. Finding the cause of such non-specific abdominal discomfort is not always easy. We have therefore developed a nutritional therapy program in which you can explore your specific causes together with your personal nutritionist. Arrange a free initial consultation here and find out whether the therapy is suitable for you.

Diseases of the urinary organs

Behind the small and large intestine are the urinary organs, which include the kidney, ureter, bladder and urethra.

A common urinary tract disease in affluent societies like ours is **urinary stones. **They are not always symptomatic. When kidney stones move the ureter, there can be a strong colic-like, that is, swelling and declining pain in the lower abdomen or the groin or flank region. From a clinical point of view, this is characteristic of the motor restlessness of a colic-afflicted patient who wants to relieve their pain by constantly changing his position.

In extreme cases, a stone can make it impossible for those affected to empty the bladder. Doctors call this a **urinary retention. **Especially in acute cases, this is accompanied by severe abdominal pain. For a majority of the patients, stones are not the cause, but rather an existing chronic bladder emptying disorder, for example due to an enlarged prostate in men.

Frequent visits to the toilet are typical for cystitis**. **A dull pain can appear over the symphysis here. Inflammation of the bladder is usually easy to recognize by the burning pain when urinating and the unpleasant urge to urinate. It is much more common in women than in men.

In general, abdominal pain is often perceived as a typical female condition. It is true that there are some diseases that only occur in men or only in women, since the internal genital organs are also in the pelvis.

Pain in the lower abdomen in women

Menstrual cramps and endometriosis

Menstrual pains are not uncommon in women. Sometimes gynecological diseases such as endometriosis can also be behind cycle-dependent pelvic pain. With endometriosis, the endometrium is also outside the uterus. 2-10 percent of all women are said to be affected. These and other gynecological disorders that cause pelvic pain are usually accompanied by other symptoms such as irregular cycle and bleeding disorders.

Ectopic pregnancy

Sudden onset of abdominal pain with no bleeding at the same time can indicate rupture of the fallopian tubes during pregnancy of the abdominal cavity (ectopic pregnancy). Ectopic pregnancy refers to pregnancy outside the uterus. A pregnancy test is therefore positive.

Ovarian torsion

Another gynecological emergency is **ovarian torsion. **Here, too, right or left pelvic pain begins acute, but often after abrupt movement. With an ovarian torsion, the ovary or a large ovarian cyst rotates around its own axis and thus hinders blood flow to the ovary. With a high degree of probability, the ovarian torsion can easily be recognized by a simple sonographic examination.

Lower abdominal pain on the right or left side can also be caused by inflammation of the fallopian tube and ovary (adnexitis). It is an important differential diagnosis for suspected appendicitis in women. Adnexitis is an inflammation of the fallopian tubes, ovaries and the surrounding tissue. This usually arises via ascending infections from the vagina and uterus, e.g. after transmission of gonococci or chlamydia in sexually active women.

Tip: Abdominal pain is often caused by a bloated stomach. Unfortunately, especially women are affected by this due to hormones. Nutritional therapy can consciously reduce this flatulence. We offer nutritional therapy reimbursed by health insurers to help you reduce your abdominal pain. You can get more information about the program here (click).

Pain in the lower abdomen in men

Testicular torsion

In men, diseases of the genital organs can also cause lower abdominal pain. Sudden onset pain in the lower abdomen and testicles in children and young adolescents in particular can be signs of testicular torsion. Testicular torsion is an acute twisting of the testicles and spermatic cord and is an emergency.

Prostate and testicular inflammation

Inflammation of the prostate (prostatitis), testicular inflammation (orchitis) or epididymis (epididymitis) are less sudden, but also uncomfortable.** **At the same time, problems with urination, local signs of inflammation and general signs of infection such as fever and chills often occur.

Bladder infection

If you have problems urinating and have pain above the pubic bone, you should also consider that it may be a bladder infection. Because while in many cases an uncomplicated urinary tract infection can be assumed for women, a thorough investigation must be carried out for a male patient. This is because the woman’s shorter urethra anatomically favors an infection in the immediate region of the anus, but cystitis is rare in men and is therefore definitely worth clarifying.

Inguinal hernia

Due to the anatomical conditions, men are predisposed for another disease, which can occur in both sexes: inguinal hernia. Bulging in the groin area is characteristic of inguinal hernia. Under certain circumstances, however pulling groin pain (especially when moving) may be the only symptom.

Lower abdominal pain and back pain

Sometimes pain caused by abdominal organs radiates to other parts of the body. Organs that have a close relationship to the back are the kidneys **and the **pancreas in particular. But diseases of the urinary tract and genital organs can also cause back pain.

Back pain can not only be the result of an abdominal disease – the spine can also cause lower abdominal pain. Degenerative changes in the spine such as herniated discs could be the cause here.

In general, both abdominal pain and back pain are very common complaints, so that they do not necessarily have to be related even if they occur at the same time.

Sources

Herold, G. (2011). Innere Medizin 2011. Cologne: Selbstverl.

AMBOSS. (2018). AMBOSS. [online] Available at: https://www.amboss.com/ [Accessed 5 Mar. 2018].

Seiderer-Nack, J. (2012). Anamnese und körperliche Untersuchung. Berlin: Lehmanns Media.

Lower abdominal pain – What could be behind pain in the lower abdomen?

Most people have had abdominal pain before. It can have a variety of causes, most of which are harmless in nature and not a matter of concern. Lower abdominal pain can be caused by many different acute or chronic illnesses.

If you suffer from lower abdominal pain, we have a tip for you. Try to get it under control with your diet. We have developed a nutritional therapy program for this purpose. Click here for more information about changing your diet and get advice in a free initial consultation.

The region below the belly button is called the lower abdomen. For example, the lower abdomen can be further divided into right and left parts (quadrants).

When can lower abdominal pain be particularly dangerous?

First of all, it is important for the doctor to differentiate between threatening diseases and functional complaints.

Immediate, emergency clarification is required for the following:

• Very severe abdominal pain
• Defense tension (involuntary tensing of the abdominal wall when touched), hard stomach
• Lower abdominal pain accompanied by circulatory disorders
• Rapid pain development followed by vomiting, a heavily bloated stomach, stool and wind behavior
• Vomiting blood, tarry stools, bloody stools
• Lower abdominal pain during pregnancy
• Lower abdominal pain with urinary retention

If the following symptoms appear in connection with lower abdominal pain, this can also indicate a serious illness:

• Fever
• Jaundice
• Unwanted weight loss
• Change in stool habits
• Diarrhea lasting more than 14 days

What are functional symptoms?

Functional disorders are characterized by the fact that disrupted organ functions cannot be explained by any physical findings. Around one in four patients with such a problem presents themselves at the doctor. The disturbed organ functions present themselves to a large extent as pain disorders, whereby here again the abdominal region is very often affected.

Not all pain is the same. Whether it occurs suddenly or insidiously and whether there is a trigger or soothing factors can indicate the cause of the pain. In addition, the pain localization offers initial indications due to the location of the organs.

If you take a look at the organs directly under the abdominal wall, you only see the intestine. A distinction is made between the small and large intestines, which together are several meters long. The large intestine surrounds the long loops of the small intestine like a frame.

In the right lower abdomen is the transition between the small and large intestine. The so-called ileum of the small intestine located closer to the mouth opens into the well-known appendix of the large intestine.

Pain in the right abdomen

Appendicitis

A “classic” among the causes of pain in the lower abdomen is appendicitis. In fact, it is not the entire appendix, but only its appendage, the Vermiform appendix, that is inflamed here. A typical pain characteristic can appear with appendicitis: First the pain is perceived diffusely around the navel, later the pain migrates into the right lower abdomen and is described as a rather piercing, “light” pain. In addition, nausea and vomiting as well as wind and bowel movements and loss of appetite can occur. Subfebrile temperatures or fever are also typical. Nevertheless, appendicitis is often not easy to diagnose. Especially in children, the elderly or pregnant women, the typical symptoms may be missing or different.

Inflammatory bowel disease

Another disease that can cause right-sided pelvic pain, similar to appendicitis, is Crohn’s disease.

This is an inflammatory bowel disease of unknown origin, which usually also affects young adults and children. Inflammation can affect the entire digestive tract, but it usually affects the last part of the small intestine and the colon that immediately follows. If you want to differentiate between these two diseases, accompanying symptoms help. In over 70 percent of all patients with Crohn’s disease recurrent diarrhea is in the foreground along with pain.

If you follow the course of the large intestine, you reach the descending part of the large intestine in the left lower abdomen via two bends.

CARA CARE supports you with your digestive problems

Get the App

Pain in the lower abdomen

Diverticulosis

In the descending part, there are often protuberances of the intestinal wall, so-called diverticula. The prevalence of diverticulosis is very high in industrialized countries, occuring in 60 percent of the population over 70 years of age. However, diverticulosis is almost always symptom-free. However, around 20 percent develop an acute inflammation (Diverticulitis) if, for example, stool is stuck in the protrusions. Then the disease is also called “left-sided appendicitis”. Those affected are mostly older patients between the ages of 60 and 80. Various factors such as obesity, high meat consumption, chronic constipation and age-related weak connective tissue can lead to diverticulosis.

Colon cancer

The last section of the colon is the location of the most common type of colon cancer – the colorectal cancer. Many patients only have symptoms at an advanced stage, with little pelvic pain. Therefore colorectal cancer screening tests are recommended from the age of 50.

Inflammatory bowel disease

The rectum is also affected with ulcerative colitis. It is another inflammatory bowel disease in addition to Crohn’s disease (see above). Here, too, there is pain in the lower abdomen, but this is more on the left side. In contrast to Crohn’s disease, diarrhea with ulcerative colitis is bloody and slimy. Also typical are so-called tenesmus – cramp-like pains before or immediately after bowel movements.

Pain in the middle or entire lower abdomen

Often you cannot clearly assign the lower abdominal pain to one side. If there is more diffuse pain in the lower abdomen or the entire abdominal region, the small intestine or the entire intestine can be the cause.

Bowel obstruction and narrowing

This can be, for example, an intestinal obstruction (ileus), an intestinal narrowing (stenosis), an intestinal breakthrough (perforation) or circulatory disorders in the intestine. In these cases there is an acute, severe clinical picture with the warning symptoms mentioned at the beginning. These are absent in the case of harmless flatulence – which can also lead to severe, cramping pain.

Infections

Another acute, but less threatening and very common disease of the small intestine are gastrointestinal infections. Depending on the pathogen, in addition to acute diarrhea and vomiting, pelvic pain occurs in the case of infectious mucous membrane inflammation of the stomach and small intestine. In general, such infections are usually self-correcting within one day. With all diarrhea, the fluid and electrolyte balance must be kept in mind.

Irritable bowel syndrome

In contrast, there are chronic complaints, such as those that show up in irritable bowel syndrome. The clinical picture in irritable bowel syndrome is very diverse and can be indicated by various symptoms such as abdominal pain, diarrhea or constipation. To diagnose the syndrome, the symptoms must last longer than 3 months and other diseases that could cause the symptoms must be excluded. Irritable bowel syndrome is a functional syndrome.

Diverticulosis, chronic inflammatory bowel diseases Crohn’s disease and ulcerative colitis, colorectal cancer and food intolerance are among the most important differential diagnoses for irritable bowel complaints. Our team of therapists specializes in bowel diseases. Find out more information here.

Intolerances

With a food intolerance, the body has problems digesting certain substances. Examples include fructose, lactose or wheat. The absorption of these nutrients then leads to abdominal pain, bloating and diarrhea. Finding the cause of such non-specific abdominal discomfort is not always easy. We have therefore developed a nutritional therapy program in which you can explore your specific causes together with your personal nutritionist. Arrange a free initial consultation here and find out whether the therapy is suitable for you.

Diseases of the urinary organs

Behind the small and large intestine are the urinary organs, which include the kidney, ureter, bladder and urethra.

A common urinary tract disease in affluent societies like ours is **urinary stones. **They are not always symptomatic. When kidney stones move the ureter, there can be a strong colic-like, that is, swelling and declining pain in the lower abdomen or the groin or flank region. From a clinical point of view, this is characteristic of the motor restlessness of a colic-afflicted patient who wants to relieve their pain by constantly changing his position.

In extreme cases, a stone can make it impossible for those affected to empty the bladder. Doctors call this a **urinary retention. **Especially in acute cases, this is accompanied by severe abdominal pain. For a majority of the patients, stones are not the cause, but rather an existing chronic bladder emptying disorder, for example due to an enlarged prostate in men.

Frequent visits to the toilet are typical for cystitis**. **A dull pain can appear over the symphysis here. Inflammation of the bladder is usually easy to recognize by the burning pain when urinating and the unpleasant urge to urinate. It is much more common in women than in men.

In general, abdominal pain is often perceived as a typical female condition. It is true that there are some diseases that only occur in men or only in women, since the internal genital organs are also in the pelvis.

Pain in the lower abdomen in women

Menstrual cramps and endometriosis

Menstrual pains are not uncommon in women. Sometimes gynecological diseases such as endometriosis can also be behind cycle-dependent pelvic pain. With endometriosis, the endometrium is also outside the uterus. 2-10 percent of all women are said to be affected. These and other gynecological disorders that cause pelvic pain are usually accompanied by other symptoms such as irregular cycle and bleeding disorders.

Ectopic pregnancy

Sudden onset of abdominal pain with no bleeding at the same time can indicate rupture of the fallopian tubes during pregnancy of the abdominal cavity (ectopic pregnancy). Ectopic pregnancy refers to pregnancy outside the uterus. A pregnancy test is therefore positive.

Ovarian torsion

Another gynecological emergency is **ovarian torsion. **Here, too, right or left pelvic pain begins acute, but often after abrupt movement. With an ovarian torsion, the ovary or a large ovarian cyst rotates around its own axis and thus hinders blood flow to the ovary. With a high degree of probability, the ovarian torsion can easily be recognized by a simple sonographic examination.

Lower abdominal pain on the right or left side can also be caused by inflammation of the fallopian tube and ovary (adnexitis). It is an important differential diagnosis for suspected appendicitis in women. Adnexitis is an inflammation of the fallopian tubes, ovaries and the surrounding tissue. This usually arises via ascending infections from the vagina and uterus, e.g. after transmission of gonococci or chlamydia in sexually active women.

Tip: Abdominal pain is often caused by a bloated stomach. Unfortunately, especially women are affected by this due to hormones. Nutritional therapy can consciously reduce this flatulence. We offer nutritional therapy reimbursed by health insurers to help you reduce your abdominal pain. You can get more information about the program here (click).

Pain in the lower abdomen in men

Testicular torsion

In men, diseases of the genital organs can also cause lower abdominal pain. Sudden onset pain in the lower abdomen and testicles in children and young adolescents in particular can be signs of testicular torsion. Testicular torsion is an acute twisting of the testicles and spermatic cord and is an emergency.

Prostate and testicular inflammation

Inflammation of the prostate (prostatitis), testicular inflammation (orchitis) or epididymis (epididymitis) are less sudden, but also uncomfortable.** **At the same time, problems with urination, local signs of inflammation and general signs of infection such as fever and chills often occur.

Bladder infection

If you have problems urinating and have pain above the pubic bone, you should also consider that it may be a bladder infection. Because while in many cases an uncomplicated urinary tract infection can be assumed for women, a thorough investigation must be carried out for a male patient. This is because the woman’s shorter urethra anatomically favors an infection in the immediate region of the anus, but cystitis is rare in men and is therefore definitely worth clarifying.

Inguinal hernia

Due to the anatomical conditions, men are predisposed for another disease, which can occur in both sexes: inguinal hernia. Bulging in the groin area is characteristic of inguinal hernia. Under certain circumstances, however pulling groin pain (especially when moving) may be the only symptom.

Lower abdominal pain and back pain

Sometimes pain caused by abdominal organs radiates to other parts of the body. Organs that have a close relationship to the back are the kidneys **and the **pancreas in particular. But diseases of the urinary tract and genital organs can also cause back pain.

Back pain can not only be the result of an abdominal disease – the spine can also cause lower abdominal pain. Degenerative changes in the spine such as herniated discs could be the cause here.

In general, both abdominal pain and back pain are very common complaints, so that they do not necessarily have to be related even if they occur at the same time.

Sources

Herold, G. (2011). Innere Medizin 2011. Cologne: Selbstverl.

AMBOSS. (2018). AMBOSS. [online] Available at: https://www.amboss.com/ [Accessed 5 Mar. 2018].

Seiderer-Nack, J. (2012). Anamnese und körperliche Untersuchung. Berlin: Lehmanns Media.

An Overview of Gynecologic Abdominal Pain

Abdominal pain refers to pain or discomfort felt in the abdomen, the anatomical area below the lower margin of the diaphragm and above the pelvic bone. While pain can arise from the tissues of the abdominal wall, the term abdominal pain generally defines discomfort that comes from organs adjacent to the abdominal cavity. The pain is caused by distention of an organ, inflammation, or by loss of blood supply to the organ. Organs of the abdomen include small intestines, stomach, liver, colon, spleen, pancreas, and gallbladder.

The lowermost portion of the abdomen is the pelvis, which contains the rectum, urinary bladder, ovaries, and fallopian tubes. In most cases, it can be difficult to know if abdominal pain is coming from the pelvis or the lower abdomen. Sometimes the pain may be experienced in the belly even if it’s originating from organs surrounding the abdominal cavity, such as the lower lungs, uterus, ovaries, and the kidneys. It’s also possible for the discomfort to arise from organs within the belly but be felt outside of it. For instance, pain caused by pancreatic inflammation can be felt in the back. Such pain is defined as “referred” since it doesn’t arise from the location that it is felt.

The cause of abdominal pain is diagnosed by its characteristics, physical examination, and testing. In some cases, surgery may be required for diagnosis. The medical diagnosis can sometimes be challenging since the characteristics may be atypical, diseases responsible for pain may mimic each other, and the characteristics of the discomfort may change over time. Treatment is based on the patient’s history of diseases or health conditions, causing pain.

Types of Abdominal Pain

Abdominal pain can be cramp-like, localized, or colicky.

• Cramp-like pain. This type of abdominal pain may be associated with constipation, diarrhea, flatulence, or bloating. In women, however, the pain can be linked to miscarriage, menstruation, or complications in the female reproductive organs. This pain often comes and goes and may subside on its own.
• Localized pain. This type of abdominal pain is limited to one section of the abdomen and often caused by problems in a particular organ.
• Colicky Pain. This pain is a sign of more severe conditions like kidney stones or gallstones. This pain may feel like a severe muscle spasm and tends to happen suddenly.

An Overview of Gynecologic Abdominal Pain

As a woman, you will experience some discomfort or pain in your abdomen from time to time. It could be because of poor sleeping habits or something you ate that is distressing your stomach. However, issues arising from the digestive tract are not always the root cause of abdominal pain. For women, gynecological problems may manifest as abdominal pain arising from the pelvic area and at times, the back.

The symptoms of abdominal pain may vary from one woman to another. Some women feel a mild irritation, while others experience severe pain that makes it difficult to manage everyday responsibilities. In essence, abdominal pain may be:

• A dull ache
• Intense or constant
• A sharp, cramping sensation
• Intermittent (on-and-off)

The discomfort may also feel like pressure, fullness, or heaviness in the lower abdomen. Symptoms of abdominal pain may worsen during urination or bowel movements, intercourse, or long periods of standing or sitting.

Certainly, you should consider seeking medical attention if the pain persists. However, most women choose to persevere, hoping the pain will go away. Persistent abdominal pain should never be overlooked because it can be a sign of a serious underlying gynecological problem. For this reason, it’s recommended that you visit a gynecologist to have it checked. It can be difficult to tell whether the discomfort is being caused by something simple or more serious. The first fear for every woman experiencing abdominal pain is cancer. While there are chances that it is caused by cancer, it could be as a result of something different.

Discussed below are conditions that could cause abdominal pain in women.

OVULATION

If you have not gone through menopause and your ovaries are still intact, you may get cramps about 10-14 days before your period. This occurs when an egg is released to prepare your body for a possible pregnancy. Physicians depict painful ovulation as “mittelschmerz,” which means middle pain.

During ovulation, the ovaries release an egg together with other fluid. The egg then moves through the fallopian tube into the uterus. The fluid discharged can spread within the pelvic area and can cause irritating and pain in the pelvis. The distress may last for a few minutes or hours and may switch sides, depending on which ovary the egg is released from. The pain can be sharp and impulsive, or you just may have a dull cramp. This pain is temporary and does not require any specific treatment.

MENSTRUATION

Pelvic pain can also occur during and is typically described as cramps in the lower abdomen or the pelvis. The intensity of pain can vary from month to month. Pain experienced before menstruation is referred to as premenstrual syndrome (PMS). When the pain is so severe that it prevents you from going about your daily activities, it’s called premenstrual dysphoric disorder (PMDD).  PMDD and PMS are often accompanied by other symptoms such as irritability, bloating, anxiety, insomnia, tender breasts, joint pain, headache, and mood swings. Though not always, these symptoms dispel as soon as menstruation begins.

Pain experienced during menstruation is known as dysmenorrhea. This pain may feel like a badgering pain in the thighs and lower back, or like cramps in the abdomen. The pain might be accompanied by headache, nausea, vomiting, and lightheadedness. If you experience severe menstruation pain, consider visiting a gynecologist to discuss pain management. OTC medications may help.

OVARIAN CYST

A cyst is a sac of fluid that forms on your ovaries. Ovarian cysts are common, especially with women in the childbearing age as well as expectant mothers. They are usually harmless, painless, and disappear on their own without requiring medical attention. You could even have one every month without even noticing it. One type of cyst referred to as follicular cyst breaks open to release an egg and later on dissolves. An ovarian cyst becomes a problem when it grows bigger and does not disappear. Also, there is a likelihood of it becoming cancerous, though uncommon. The risk increases with age.

If a cyst is large, you may feel a dull or sharp pain in your abdomen or pelvis. You may also experience bloating or heaviness in the lower part of your abdomen, lower back, or thighs. An enlarged cyst could burst, causing sudden, sharp pain in the area below the belly button. The pain can be felt on either side of your lower stomach, depending on which ovary had the cyst. You may experience spotting as well.

Since most ovarian cysts disappear on their own, treatment is not always required. However, it may be important to see a gynecologist if the cyst is too large or causing problems. Your doctor could recommend medication to make the cysts disappear or prescribe birth control pills to stop new ones from developing. Since ovarian cysts in women near menopause can be cancerous, surgery may be necessary to remove the cysts or ovaries, depending on how severe the condition is. Common types of procedures used include laparoscopy or laparotomy.

UTERINE FIBROIDS (Uterine myomas)

Fibroids are benign tumors that develop in the uterus. These non-cancerous growths occur in more than 70% of women in their reproductive years. Symptoms of uterine fibroids are varied and depend on their size and location of growth. Many women may not exhibit any symptoms at all. Large fibroids may cause dull aching pain or a feeling of pressure in the lower abdomen or the pelvis. They may also cause heavy periods, bleeding during sexual intercourse, leg pain, back pain, constipation, or trouble with urination. Fibroids can cause infertility.

When fibroids outgrow their blood supply and begin to die, they can cause a very sharp, severe abdominal pain. You should seek immediate medical attention if you experience the following:

• Sharp pelvic pain
• Chronic pelvic pain
• Trouble voiding your bladder
• Heavy vaginal bleeding in between periods

PELVIC INFLAMMATORY DISEASE (PID)

PID is an infection or inflammation of the female reproductive organs. It can affect the ovaries, fallopian tubes, uterus, or a combination. The pelvic inflammatory disease usually occurs when sexually transmitted bacteria from the vagina or cervix spread to other reproductive organs. PID often causes no symptoms but might be detected later if you develop chronic pelvic pain or have trouble with conception.

PID is usually a complication of an STI like chlamydia or gonorrhea. If you have this disease, you may feel pain in your lower abdomen, pelvis, and lower back. Other symptoms include heavy vaginal discharge with a foul odor, abnormal uterine bleeding, pain or bleeding during intercourse, nausea, vomiting, fever, or painful or difficult urination. Seek urgent medical care if you experience these symptoms. PID escalates a woman’s risk of infertility. According to the CDC, 1 in 8 women who have had PID have trouble becoming pregnant. Treatment for PID usually involves taking antibiotics to treat bacterial infection.

Scarring cannot be treated, which makes early treatment all the more important. Immediate medical attention also helps prevent PID complications, such as:

• Ectopic pregnancy
• Infertility
• Scaring on the reproductive organs
• collections of infected fluid in your fallopian tubes (abscesses)

ENDOMETRIOSIS

Endometriosis occurs when the tissue that lines the inside of the uterus (endometrium) attaches to other organs and begins to grow. This condition may be a source of chronic, long-term abdominal pain in some women. When an individual’s periods start, the tissue outside of the uterus acts the way it would if it were within the uterus, including responding to hormonal changes, thickening, and shedding. This may cause inflammation and bleeding in the pelvis. The discomfort may feel like regular period cramps but can occur at any time of the month. You may feel pain and cramps in your stomach below your belly button and your lower back.

Abdominal pain caused by endometriosis can be mild, severe, or debilitating.  Often, this pain is most definite during the menstruation period. It can as well occur during intercourse and with bladder or bowel movements. Pain is mainly centered within the pelvic area but can extend into the abdomen. Other symptoms include nausea, heavy periods, and bloating.

Although rare, endometriosis can affect the lungs and diaphragm. Endometriosis can also cause infertility by:

• causing inflammation that disturbs the function of the uterus, ovary, fallopian tube, and the egg
• distorting the fallopian tubes making it difficult for them to pick an egg

Treatments may include OTC pain medications or surgical procedures like laparoscopy. Early diagnosis of endometriosis can help reduce chronic symptoms.

PREGNANCY PAIN

In many cases, abdominal or pelvic pain during pregnancy is not a cause for concern. Your bones and ligaments tend to stretch as the body adjusts and grows. That can cause pain and discomfort.  You may also be experiencing “implantation pain,” which happens when the baby inside of you is attaching to the lining for your uterus. This type of pain is a sign of pregnancy progress. About four weeks into your pregnancy, you might have a few instances of cramps and discomfort. It’s a good idea to take a test if you aren’t sure whether you’re pregnant.

Nevertheless, any type of pain that makes you nervous should be discussed with your own doctor. This is highly recommended, particularly if it’s accompanied by other symptoms such as vaginal bleeding, or if it lasts for a protracted period of time.

ECTOPIC PREGNANCY

An ectopic pregnancy occurs when a fertilized egg implants itself in a fallopian tube or somewhere other than the womb. In most cases, an ectopic pregnancy occurs in one fallopian tube. This type of pregnancy is not viable and is life-threatening to the mother because it may result in the rupture of the fallopian tube as well as internal bleeding.

Ectopic pregnancy is characterized by mild cramps followed by impulsive, sharp stabbing pains on one part of the abdomen or the pelvis. This pain can be so intense that it radiates up toward the shoulder, lower back or neck if there’s internal bleeding and the blood has pooled under the diaphragm. Before the abdominal pain, you may have had other typical pregnancy signs, such as sore breasts and nausea.

Ectopic pregnancies can be dissolved with medication, but some may require a surgical procedure.

PELVIC-FLOOR MUSCLE DYSFUNCTION

Pelvic-floor dysfunction is a group of disorders that affect a person’s ability to have a bowel movement. It involves severe spasms in the muscles that support your vagina, womb, and rectum, and bladder. It can occur after an injury or after you’ve had trauma with vaginal childbirth. You may experience sudden, severe leg cramps in your lower belly. You may as well have ongoing pain in your back and groin.

Others symptoms of pelvic-floor muscle dysfunction include:

• Pain during sex or periods
• Problems pushing out stools
• A burning feeling in the vagina when you pee
• A very strong urge to urinate all the time

If you have the aforementioned signs, it’s important to see a gynecologist for a urine test to rule out a bladder infection. Your doctor may as well perform a physical evaluation to check for muscle spasms, knots, or muscle weakness. Treatment includes medication, surgery, kegel exercises, and other self-care techniques.

OVARIAN CANCER

Ovarian cancer is a type of cancer that starts inside, near, or on the outer layer of the ovaries, the organs that make your eggs. In many cases, this type of cancer is not detected until when it spreads to the pelvis and abdomen. As such, you may not experience any symptoms of ovarian cancer in its early stages. Symptoms of advanced-stage cancer are non-specific and can be confused for common benign diseases.

Abdominal pain or discomfort caused by ovarian cancer tends to be vague, and you may pass it off as something like gas or constipation. However, the pain and pressure in your lower abdomen won’t go away. Also, your belly may bloat or swell so much to the extent that you may not be able to button your pants. You might notice a strong, frequent urge to pass urine and might get full quickly when you eat. Other symptoms include constipation and weight loss.

If you have these symptoms for more than two weeks, make sure that you see a doctor. It’s had to treat advanced-stage ovarian cancer effectively, so early diagnosis is crucial. Ovarian cancer is generally treated using surgery and chemotherapy.

How Does Your Gynecologist Diagnose the Cause of Abdominal Pain

Since there are many possible causes of abdominal pain, your gynecologist will do a thorough physical exam and a series of tests. The physical examination may include pressing down on different parts of the abdomen to check for swelling and tenderness. Your gynecologist will also take an oral history to understand better the type of pain you have, other symptoms, and general health history. Typical questions you may be asked regarding the pain include:

• When and where does the pain occur?
• How suddenly did the pain begin?
• How long does the pain last?
• What does the pain feel like (is it dull or sharp)?
• Is the pain related to urination, sexual activity, or your menstrual cycle?
• Under what conditions did the abdominal pain begin?

Your doctor will use this information and the severity of the pain and its exact location within the abdomen to determine which tests to order. Imaging tests, such as X-rays, ultrasounds, and MRI scans, are used to provide a detailed view of tissues, organs, and other structures in the abdomen. These tests can help diagnose inflammation, ruptures, tumors, and fractures. Depending on the exact symptoms and duration of abdominal pain, other tests may include:

• Vaginal swabs or cervical smears. Your doctor may perform specialized CA-15, blood tests for ovarian cancer. More invasive tests may be done depending on your doctor’s suspicion of the cause of pain.
• An ultrasound may be performed from inside the vagina to allow your doctor to view your uterus, ovaries, vagina, fallopian tubes, and other organs within your reproductive system. The tests involve the use of a wand inserted into the vagina, which then transmits sound waves to a computer screen.
• Urinary causes can be evaluated by ultrasound, urinary culture, or CT scan.
• Blood and urine tests may be performed to check for signs of infection.

If the main cause of the pain is not identified from the aforementioned tests, additional tests may be required. This may include:

• Cystoscopy
• Pelvic laparoscopy
• Pelvic MRI
• Colonoscopy

How a Gynecologist Can Help You Deal with Abdominal Pain

Mild abdominal pain may go away on its own without treatment. In some cases, however, abdominal pain may require a visit to the doctor. If you experience any of the following symptoms, make sure you schedule an appointment with your doctor:

• Abdominal pain that lasts for longer than 24 hours
• Vomiting
• Unexplained weight loss
• Prolonged constipation
• Fever
• A burning sensation when urinating
• Loss of appetite

Women above 21 years of age should visit an OBGYN at least once every year for checkups and screening. Early diagnosis is crucial in the treatment or management of a health problem. If you’re having abdominal pain, your OBGYN should be in a position to assess the problem and offer treatment options. Treatment will basically depend on your medical history and overall health, the cause of your condition, the extent of your condition, expectations for the course of the condition, and your tolerance for certain therapies, procedures, and medication.

This may include:

• Pain medication
• Antibiotics
• Trigger point injection
• Anti-inflammatory medications
• Antidepressants
• Physical therapy
• Hormonal medications or birth control pills
• Transcutaneous electrical nerve stimulation (TENS)
• Relaxation exercises
• Laparoscopy surgery

Your gynecologist could recommend counseling to help manage depression, stress, as well as the anxiety of living with chronic abdominal pain. 

Persistent abdominal pain is one thing that you never ignore. It could be a sign of something minor or something serious, but it’s better to be safe than sorry. It’s highly important that you visit a gynecologist for evaluation. At All Women’s Care, we believe that early intervention is crucial for almost all underlying health conditions causing abdominal pain. It helps us make the right diagnosis and come up with an effective treatment plan.

Call us at 213-250-9461 or visit our offices for an appointment.

Pain Around Belly Button | 10 Belly Button Pain Causes & More

What causes stomach pain around the belly button?

Pain around the belly button is often due to an issue in the lower abdomen. The organs in this area include:

• Cecum: This is a small sac at the end of the large intestine that absorbs fluids and salts that remain after digestion is completed.
• Appendix: This is a hollow tube attached to the cecum that serves an important role in fetuses and young adults.
• Ascending colon: This part of the large intestine.
• Right ovary and fallopian tube: These are reproductive organs in women.
• Right ureter: This is a long, thin tube that transports urine from the kidney to the bladder.

See this image here for a visual representation.

Inflammatory causes

Inflammatory causes of pain around the belly button may be related to the following.

• Infectious: Infection or inflammation of the organs in the lower abdomen can cause pain. The appendix is a very common cause, as it begins in the belly button and travels into the lower right abdomen. Symptoms can also occur when the urinary tract becomes infected.
• Autoimmune: Conditions that primarily affect the gastrointestinal tract (inflammatory bowel diseases) can result in pain and other symptoms.

Obstructive causes

Obstructive causes of pain around the belly button may be related to the following.

• Large intestine: The colon (also known as the large intestine) is an extremely long organ that folds upon itself. As a result, any particularly weak parts of the colon can be exposed to extreme pressure. Other parts of the colon can break through these weak spots and push through the muscle and surrounding tissue. This condition is called a hernia. Hernias can occur in any part of the abdomen but the pain is most often felt in the lower abdomen around the navel.
• Small intestine: A blockage in the small intestine can be caused by scar tissue, cancer, or hernias. Blockages prevent material from moving forward. This causes the bowel behind the blockage to become large, dilated, and filled with fluid. This can result in symptoms such as cramping and constipation in addition to pain around the belly button.

Digestive causes

The acid that the stomach makes to digest food can irritate the components of the digestive tract, including the area around the belly button. Gas found throughout the digestive tract can also cause transient pain and discomfort.

Indigestion (dyspepsia)

Indigestion, also called upset stomach, dyspepsia, or functional dyspepsia, is not a disease but a collection of very common symptoms. Note: Heartburn is a separate condition.

Common causes are eating too much or too rapidly; greasy or spicy foods; overdoing caffeine, alcohol, or carbonated beverages; smoking; and anxiety. Some antibiotics, pain relievers, and vitamin/mineral supplements can cause indigestion.

The most common symptoms are pain, discomfort, and bloating in the upper abdomen soon after eating.

Indigestion that lasts longer than two weeks, and does not respond to simple treatment, may indicate a more serious condition. Upper abdominal pain that radiates to the jaw, neck, or arm is a medical emergency.

Diagnosis is made through patient history and physical examination. If the symptoms began suddenly, laboratory tests on blood, breath, and stool may be ordered. Upper endoscopy or abdominal x-ray may be done.

For functional dyspepsia – “ordinary” indigestion – treatment and prevention are the same. Eating five or six smaller meals per day with lighter, simpler food; managing stress; and finding alternatives for some medications will provide relief.

Rarity: Common

Top Symptoms: nausea, stomach bloating, dyspeptic symptoms, bloating after meals, vomiting

Symptoms that always occur with indigestion (dyspepsia): dyspeptic symptoms

Symptoms that never occur with indigestion (dyspepsia): vomiting (old) blood or passing tarry stools, rectal bleeding, bloody diarrhea, fever

Urgency: Self-treatment

Appendicitis

Appendicitis refers to inflammation of the appendix, a small finger-like structure in the lower right corner of the belly. Appendicitis is extremely common, occurring in about five to 10 percent of people at some point in their lifetime. While it can occur at any age, the most commonly affected group…

Acute gastritis

When something interferes with the protective mechanisms of the stomach, a range of problems can occur from mild indigestion to deadly bleeding ulcers. Gastritis is an umbrella term for one of the most common problems, inflammation of the stomach lining.

Symptoms include nausea or vomiting…

Viral (norovirus) infection

If you ever heard of an entire cruise ship of people coming down with the same “stomach bug,” chances are that was norovirus. Fortunately, norovirus usually goes away on its own after a few days, but is pretty unpleasant and can spread extremely easily. The …

Viral (rotavirus) infection

Rotavirus infection is a contagious gastrointestinal virus that most often affects babies, toddlers, and young children. It causes severe watery diarrhea, sometimes with vomiting and fever.

Adults may also be infected, though usually with milder symptoms.

Rotavirus spreads very quickly when any trace of stool from an infected child contaminates food or drink, or gets onto any surface. If another child consumes the food or drink, or touches the surface and then their mouth, the child will become infected.

Rotavirus in adults does not usually need a trip to the ER unless the degree of dehydration is severe but dehydration can set in quickly in children and is a medical emergency. A child can die if not treated immediately. Take the child to an emergency room or call 9-1-1.

Treatment consists of drinking fluids or IV fluids in severe cases and supportive care, usually in a hospital. Antibiotics will not help rotavirus because they only work against bacteria.

The best way prevention is frequent and thorough handwashing, as well as washing toys and surfaces when possible. There is now a vaccine that will either prevent rotavirus infection or greatly lessen the symptoms if the child still gets the virus.

Rarity: Ultra rare

Top Symptoms: diarrhea, vomiting or nausea, nausea, fatigue, abdominal pain (stomach ache), headache

Symptoms that always occur with viral (rotavirus) infection: diarrhea, vomiting or nausea

Symptoms that never occur with viral (rotavirus) infection: constipation, tarry stool

Urgency: Self-treatment

Stomach ulcer

A peptic ulcer is a sore in the lining of the stomach or the first part of your small intestine (the duodenum), which causes pain following meals or on an empty stomach.

Rarity: Uncommon

Top Symptoms: fatigue, nausea, loss of appetite, moderate abdominal pain, abdominal cramps (stomach cramps)

Symptoms that never occur with stomach ulcer: pain in the lower left abdomen

Urgency: Primary care doctor

Gall bladder infection (cholecystitis)

Gallbladder infection, also called cholecystitis, means there is a bacterial infection of the gallbladder either with or without gallstones.

The gallbladder is a small organ that stores bile, which helps to digest fats. If something blocks the flow of bile out of the gallbladder – gallstones, damage to the bile ducts, or tumors in the gallbladder – the bile stagnates and bacteria multiplies in it, producing an infected gallbladder.

Risk factors include obesity, a high-fat diet, and a family history of gallstones.

Symptoms include fever; chills; right upper quadrant abdominal pain radiating to the right shoulder; and sometimes nausea and vomiting. A gallbladder infection is an acute (sudden) illness, while the symptoms of gallstones come on gradually.

Untreated cholecystitis can lead to rupture of the gallbladder, which can be life-threatening.

Diagnosis is made through physical examination, ultrasound or other imaging, and blood tests.

Treatment involves hospitalizing the patient for fasting with IV fluids, to rest the gallbladder; antibiotics; and pain medication. Surgery to remove the gallbladder is often done so that the condition cannot recur.

Rarity: Uncommon

Top Symptoms: abdominal pain (stomach ache), nausea, loss of appetite, diarrhea, constipation

Symptoms that always occur with gall bladder infection (cholecystitis): abdominal pain (stomach ache)

Symptoms that never occur with gall bladder infection (cholecystitis): pain in the upper left abdomen, pain in the lower left abdomen

Urgency: Hospital emergency room

Intestinal inflammation (diverticulitis)

Diverticula are small pouches that bulge outward through the colon, or large intestine. Diverticulitis is a condition where the pouches become inflamed or infected, a process which can cause fever, nausea, vomiting, chills, cramping, and constipation.

Rarity: Uncommon

Top Symptoms: abdominal pain (stomach ache), nausea, loss of appetite, diarrhea, constipation

Symptoms that never occur with intestinal inflammation (diverticulitis): pain below the ribs, pain in the upper right abdomen

Urgency: Hospital emergency room

Acute pancreatitis

Acute pancreatitis is the inflammation of the pancreas, which creates and releases insulin and glucagon to keep the sugar levels in your blood stable. It also creates the enzymes that digest your food in the small intestine. When these enzymes accidentally get activated in the pancreas, they digest the pancreas itself, causing pain and inflammation.

Rarity: Rare

Top Symptoms: constant abdominal pain, nausea or vomiting, being severely ill, severe abdominal pain, fever

Symptoms that always occur with acute pancreatitis: constant abdominal pain

Urgency: Hospital emergency room

Normal abdominal pain

The complaint of nonspecific abdominal pain and discomfort, with no apparent cause, is one of the most common in medicine. It is a primary reason for patients to visit a medical provider or the emergency room.

The cause of abdominal pain can be difficult to find, because it can come from many different sources: the digestive tract, the urinary tract, the pancreas, the gall bladder, or the gynecologic organs.

The pain may simply be caused by overly sensitive nerves in the gut. This hypersensitivity can occur after repeated abdominal injury and/or it may have an emotional cause due to fear of the pain itself.

Diagnosis is made through physical examination, patient history, and simply ruling out any other condition. CT scan is often requested, but can rarely find a specific cause. The benefits must be weighed against the risks of radiation.

Treatment first involves making any needed lifestyle improvements regarding diet, exercise, work, and sleep, in order to reduce stress. In some cases, counseling, hypnosis, mild pain relievers, and antidepressants are helpful.

Rarity: Common

Top Symptoms: abdominal pain (stomach ache), vaginal discharge, fever, nausea

Symptoms that always occur with normal abdominal pain: abdominal pain (stomach ache)

Symptoms that never occur with normal abdominal pain: fever, vomiting, diarrhea, nausea, severe abdominal pain, unintentional weight loss, vaginal discharge, rectal bleeding

Urgency: Self-treatment

4 Common Causes of Abdominal Pain on the Left Side of Your Body

Abdominal pains can appear at any time. While it may just be a cramp, the pain may also be a sign of a more serious illness. If the abdominal pain is on the left side of your body or your left lower quadrant, it may be a number of diseases or conditions.

4 Common Causes of Abdominal Pain on the Left Side of Your Body

If the abdominal pain on the left continues, look for symptoms of the following conditions:

1. Appendicitis

Do you feel pain about 2 inches left of your belly button? While appendicitis is usually associated with the right side of your body, the initial pain often starts near the belly button and can be misinterpreted as coming from the left. An appendicitis infection can cause serious problems if left untreated. Be on the lookout for pain moving to the right side of the abdomen, fever, nausea, and vomiting, and seek medical treatment immediately.

2. Diverticulitis

Diverticulitis is the inflammation of diverticula pouches in the large intestine. While diverticulitis is not always a serious condition, in some patients with severe infections surgery is required.

If you, or a loved one over 40, are experiencing abdominal pains, fevers, and nausea, it may be diverticulitis.

3. Constipation

Another cause of abdominal pain on the left side of the body is constipation. Constipation is usually caused by dehydration or a diet that is low in fiber. Not all constipation requires a trip to the emergency room, but in some cases, the sharp pain may warrant a visit. If the pain does not improve after using over-the-counter products, seek medical attention.

4. Kidney Stones

Kidney stones, or nephrolithiasis, are small deposits of calcium or uric acid that build up in the kidneys. They are incredibly painful when passing through the urinary tract. Common symptoms of kidney stones include abdominal pain, painful urination, fever, nausea, and vomiting.

Contact Complete Care

If you, or a loved one, are experiencing abdominal pain on the left side of the body, seek medical treatment at your nearest Complete Care emergency room. With multiple locations across Texas, there is one near you.

Why the left side hurts and what to do about it

Let’s say right away: pain in the left side is a common and most often safe thing. However, you should not leave it unattended. Sometimes even minor discomfort on the left side can signal serious illness.

When to call an ambulance

Call an ambulance immediately if ^:

• Acute or dull pain on the left side of the chest radiates to the left arm ^{, shoulder, jaw.}
• Perceptible pain is accompanied by an increase in temperature to 38.8 ° C and above.
• Sudden sharp pain is concentrated in one point and does not stop for several minutes or longer.
• The stomach hurts badly (both on the left and at any other point), and relief comes only when you lie still on your back.
• The pain does not subside over time, but even seems to intensify.
• It is accompanied by vomiting. The situation is especially threatening if there is blood in the contents of the stomach.
• The pain is sharp, it is impossible to urinate.
• Black or blood-streaked stools.
• The abdomen is tense, even the slightest touch is painful.
• In the lower abdomen – severe pulling or stitching pain, and at the same time you are pregnant or do not exclude it.
• Shortly before the onset of severe pain, there was a blow to the stomach or ribs.

When you need to go to the doctor as soon as possible

Schedule a visit to the doctor in the near future if ^:

• Pain in the left side is mild, but worries regularly, making itself felt for a week or longer.
• Perceptible pain appears and disappears, and this condition lasts longer than 1–2 days, or is accompanied by nausea and vomiting, or becomes more and more painful.
• Tightening sensations in the left abdomen are accompanied by poor appetite, diarrhea that lasts longer than a couple of days, or (option for women) bloody vaginal discharge.
• In addition to the discomfort in your left side, you notice that you are losing weight for no apparent reason.

Why does the left side hurt?

There are dozens of answers.The stomach, spleen, pancreas, large and small intestines, as well as the left lung and kidney, bladder, uterus and ovaries in women can hurt.

A separate song is the heart, which is displaced to the left: failures in its work often make themselves felt by reflected pains in the left side of the body.

However, unpleasant sensations do not always indicate illness. These are the most common causes of pain in the left side – both the abdomen ^{and the hypochondrium.}

1.Increased gas production

When food that we have eaten and digested in the stomach enters the small intestine, bacteria are taken to break it down. During operation, they emit carbon dioxide and other gases. If there is too much gas in the intestines, the pressure rises. The sections of the intestine expand, press on the nerve endings located around it. This causes bloating and pain.

What to do about it

First, find out the cause of flatulence. Most often, it is simple: you overeat, lean on fatty foods, or, for example, eat too fast, swallowing air.Try to reconsider your diet and eating habits:

• eat more slowly;
• Chew food thoroughly;
• Avoid foods that increase gas production – convenience foods, fast food, cabbage, carrots, etc.

If bloating is bothering you on a regular basis, consult a gastroenterologist. Perhaps the problem is in the intestinal microflora: you have bacteria that release gas too actively. In this case, the doctor will prescribe prebiotics that will help normalize the microflora.

2. Constipation

Lack of stool can cause discomfort and sometimes pain in the intestines. ^{is usually caused by a lack of fiber or fluid.}

What to do about it

Drink plenty of water and eat foods that contain fiber, such as leafy vegetables, whole grain breads, bran, legumes, hard fruits. You can take a laxative by consulting a physician.

If constipation becomes regular, talk about it with your doctor – the same therapist, gastroenterologist or nutritionist.Most likely, you will be asked to reconsider your diet.

3. Strong physical activity

You ran fast or jumped too vigorously, swam and so on. Exercise increases blood flow. If it is excessive, the blood overflows the spleen. The organ increases in size and begins to press on its own shell-capsule, which contains nerve endings. This is how the famous “pricks in the left side” appears.

By the way, the no less famous “pricks in the right side” has similar reasons, only the liver overflows with blood.

What to do about it

To get rid of the pain in the side caused by physical activity, simply slow down and wait until breathing becomes even.

For the future: do not start an active workout without a warm-up. Try to keep a comfortable pace and do not demand extra efforts from the body.

4. Muscle pain

Maybe you did active crunches in training and overdid it. Maybe we sat in a draft. Or maybe you have poor posture, stress, or an autoimmune disease.Myalgia ^{, that is, muscle pain, has dozens of causes.}

What to do about it

If pain in the side appeared after exercise or, for example, after you sweated and sat under the air conditioner, you can simply endure it. To relieve the condition, take an over-the-counter pain reliever such as ibuprofen.

But if unpleasant sensations do not go away for 3-4 days, intensify, or if you have no idea about their causes, be sure to visit a therapist.The doctor will clarify the diagnosis and prescribe treatment.

5. Injury

For example, you slipped and fell on your left side. Or you were hit in the stomach or in the ribs.

What to do with it

Perhaps you got off with only a slight bruise. Although such injuries cause discomfort, they heal quite quickly on their own.

But if after a blow you feel severe sharp pain, weakness, tinnitus, or suspect that a rib may be broken, call an ambulance immediately.Or contact the emergency room if it is nearby.

6. Monthly

During or before menses, the lower abdomen may hurt. Including in the left part of it, sometimes giving it to the back.

What to do about it

Menstrual pain, although unpleasant, is not dangerous. You can just endure it. Or take an over-the-counter pain reliever – based on the same ibuprofen.

Doesn’t help? Yes, unfortunately, this also happens. See your gynecologist: the doctor will choose stronger pain relievers or prescribe hormonal oral contraceptives that reduce discomfort.

7. Endometriosis or ovarian cyst

These diseases can be recognized by pulling pains in the pelvic region – both left and right. The sensations are similar to menstrual cramps, but can appear at any time. With such violations, menstruation lengthens and becomes more painful.

What to do with it

If there is even the slightest suspicion of a disease of the reproductive system, undergo an examination by a gynecologist.

It is important to make the correct diagnosis on time, sometimes life depends on it.For example, rupture of a large ovarian cyst can cause uterine bleeding and death from blood loss. Don’t risk it.

8. Ectopic pregnancy

An ectopic pregnancy is said to be when a fertilized egg is attached ^{not to the uterus, but to the fallopian tube, cervix, ovary or other place in the abdominal cavity. Sooner or later, the growing embryo tears apart the organ to which it has attached. This can lead to severe and fatal bleeding and peritonitis.}

What to do with it

If you are pregnant or suspect it, then any acute pain in the lower abdomen, especially if it is accompanied by dizziness, nausea, bloody discharge and does not go away within a few minutes, is a definite reason to call an ambulance.

9. Inflammation of the intestinal mucosa

There are many possible causes of inflammation. The most common ones are:

• Viral or bacterial infections. They can be obtained by eating something expired or by taking a sip of dirty water, for example.
• Food and alcohol poisoning.
• Taking antibiotics, especially if you bought them without consulting your doctor. As a reminder, don’t do this!
• Parasites. The same worms, helminths.
• Various diseases of the gastrointestinal tract – gastritis, pancreatitis, cholecystitis, ulcerative colitis, Crohn’s disease, hepatitis.

Inflammatory bowel lesions, in addition to pain, are accompanied by nausea, prolonged diarrhea or constipation, bloating, fever.

What to do about it

See a gastroenterologist. Treatment depends on the diagnosis, which can only be made by a qualified doctor. In some cases – for example, with rotavirus (aka intestinal flu) – it is enough to lie down and follow the drinking regimen. Other situations will require taking antibiotics or other medications.

10. You have stones or other kidney disease

Urolithiasis, pyelonephritis, and other kidney problems manifest themselves as sudden excruciating pain in the lower abdomen.Such pain clearly radiates to the lower back and then intensifies, then weakens.

What to do about it

If you suspect a kidney problem, do not hesitate to visit your nephrologist. The doctor will make an accurate diagnosis and prescribe the necessary medications. In some cases, surgery will be required, and it is in your best interest to have it done as quickly as possible.

11. Pneumonia or pleurisy

Pneumonia is inflammation of the lungs, and pleurisy is inflammation of the membrane that surrounds the lungs.Most often, these ^{diseases are caused by bacteria or viruses.}

Recognizing lung lesions is easy: acute chest pain occurs with deep breathing or coughing. Additional symptoms: fever, weakness, chills, difficulty breathing.

What to do with it

If the temperature has risen above 38 ° C, it is difficult and painful for you to breathe, you are constantly coughing – you need to urgently call a doctor at home. In other cases, you can get to the therapist yourself.

12. Appendicitis

In most cases, inflammation of the appendix makes itself felt with pain in the right side. However, sometimes pain occurs in the upper left ^{part of the abdomen.}

What to do about it

If the causes of dull pain on the left are unknown to you, but at the same time you notice bloating, loss of appetite, fever – be sure to consult a physician as soon as possible.

Call an ambulance immediately if other symptoms are added:

• increasing pain;
• vomiting;
• severe weakness, cold clammy sweat;
• heart palpitations.

They may indicate that the appendicitis has turned into an acute form, that is, the appendix has ruptured. This condition requires immediate surgical intervention.

13. Abdominal aortic aneurysm

The aorta is the main blood vessel in the abdominal cavity that runs downward from the heart. When it enlarges and swells, it is called a ^{aneurysm. This happens mainly in older people, especially in smokers.}

Vera Serezhina

As a rule, an aneurysm does not have any obvious symptoms.But sometimes pain is felt when the dilated vessel compresses the internal organs. If an aneurysm ruptures, the person may die from internal bleeding.

What to do about it

It is almost impossible to determine an aortic aneurysm at home, the diagnosis is made only with the help of computed tomography. Therefore, if you regularly feel a dull pain in the abdomen (it does not really matter, on the left or on the right), and especially if it is accompanied by pulsation, go to the therapist. The doctor will refer you to the necessary tests.

When the aorta ruptures, the person feels sudden severe pain in the abdomen or back. Immediately thereafter, collapse occurs – a life-threatening condition in which the pressure drops and the blood supply to the organs deteriorates. In this case, you need to call an ambulance without wasting a second.

14. Diverticulitis

Diverticula ^{are small sacs-like protrusions in the lower part of the colon. They occur in many people over the age of 40 and most often do not bother.}

But sometimes diverticula become inflamed – this process is called diverticulitis. And in some cases, they can break, which entails serious complications: perforation of the intestinal walls, abscess, peritonitis, intestinal obstruction …

What to do about it

If you experience unexplained pain in the left lower abdomen and especially if they are accompanied by an increase temperature, nausea, constipation or diarrhea, be sure to visit a gastroenterologist. If diverticulitis is confirmed, you will be prescribed antibiotics and pain relievers.In some cases, surgery may be required.

15. Heart problems

Pain – sharp or dull – in the left side can also cause various heart disorders, from angina pectoris to heart attack.

What to do about it

If you are regularly worried about pain in the left hypochondrium, radiating to the shoulder or arm, in no case do not leave them unattended. Be sure to consult at least a therapist or immediately contact a cardiologist.

Sharp pain in the left hypochondrium, accompanied by weakness, breathing problems, abdominal pain, arrhythmia – a clear indication for an immediate ambulance call.We can talk about a heart attack, and here every second counts.

16. One of the types of cancer

Unfortunately, cancer of the intestine, stomach, pancreas in the early stages almost do not make themselves felt. They can be noticed except for some discomfort in the abdomen, mild symptoms of indigestion, unexplained weight loss.

What to do about it

Be attentive to any incomprehensible sensations in the left side (however, not only in the left). If they become regular, be sure to consult with a therapist or gastroenterologist and go through all the examinations prescribed by them.

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Lower abdominal pain

Vostretsova Yulia Vladimirovna, anesthesiologist-resuscitator:

This pain is often called “pelvic” – patients complain of pain in the lower abdomen below the navel, and often in the lower back and sacrum, in the perineum, in the area of ​​the external genitalia, rectum.

The temporal characteristic of pain is important – acute (strong, lasting up to several hours or days) or chronic (lasting more than 6 months).

In case of acute pain, you should immediately seek medical help, since many conditions accompanied by acute pain in the lower abdomen can be life-threatening.

But with chronic pain, a patient can coexist for a long time if the patient himself or the attending physician in time does not pay attention to the initially rare, but over time, more and more persistent signals of the body about trouble.

In such cases, treatment should be started with the advice of specialized specialists: gynecologist, urologist, gastroenterologist, surgeon, coloproctologist. Specialists conduct an examination, prescribe the necessary examinations, for example, ultrasound, CT or MRI, etc. Most often, the cause is established, appropriate treatment is prescribed, the problem goes away.

Unfortunately, there are times when it is not possible to identify the cause: examination, laboratory and instrumental studies do not reveal obvious deviations from the norm.But pain is still there, it reduces the patient’s quality of life, disrupts his daily activity. It also happens that the cause of the pain syndrome is known, but the treatment does not bring relief, the pain persists, despite all the efforts of specialists, it becomes chronic. This pain can be of both visceral or somatic and neuropathic nature.

A doctor-algologist, a specialist in pain treatment, will help to cope with such pain.
Consultation with an algologist at City Clinical Hospital No. 52 can be obtained at:

• According to the compulsory medical insurance policy – in the consultative and diagnostic department of the City Clinical Hospital No. 52 if there is a referral for consultation.
• At the request of the patient – in the department of paid medical services.
• Sign up for a consultation 8 (925) 612-24-90 daily from 9:00 to 16:00.

How to self-administer a hypodermic injection using a pre-filled syringe

This information will help you learn how to self-administer a subcutaneous injection (shot) using a pre-filled syringe. A subcutaneous injection is an injection that is given under the skin. A pre-filled syringe is a syringe that comes with the medicine inside.

A healthcare professional will show you how to inject yourself. You can use the information in this resource as a reminder when you inject at home.

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Medicine information

• Name of the medicine: ______________________________

• Time of drug administration: ____________________________

• Dose: ____________

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How to store pre-filled syringes

The storage method for pre-filled syringes depends on the type of medication in them.Most medicines are kept at room temperature, but some should be refrigerated. Your healthcare professional will tell you how to store your syringes. Do not store pre-filled syringes in the freezer or leave them in the sun.

Check one of the boxes below to remember how to store your syringes.

• Store pre-filled syringes at room temperature.
• Store pre-filled syringes in refrigerator.

If you have any questions about storing or transporting pre-filled syringes while traveling, please contact your healthcare provider.

What to do if the medicine is frozen

If the medicine inside the syringe is frozen, put it near the front of the refrigerator or on the shelf in the refrigerator door to thaw it. Do not use the medicine if it has frozen more than once. Call your healthcare provider for further instructions.

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How to self-administer a subcutaneous injection

Prepare everything you need

Place accessories on a clean, level surface (such as dining table or kitchen countertop). You will need:

• 1 alcohol pad
• 1 small gauze or cotton swab, unless you inject yourself with enoxaparin (Lovenox ^® ) or heparin
• 1 dressing (e.g. Band-Aid ^® )
• Sturdy container for disposal of syringe and needle (for example, a plastic bottle with a lid for a liquid detergent)
• 1 pre-filled syringe with needle cap
  • If you store pre-filled syringes in the refrigerator, remove one syringe 30 minutes before injection.The medicine should be at room temperature when you give the injection.
  • Do not shake the syringe. Shaking may spoil the medicine.

Check the pre-filled syringe

Check the following drug information:

• Name. Make sure it matches your assigned healthcare provider.
• Dose. Make sure it matches your assigned healthcare provider.
• Expiry date. Verify that the expiration date has not passed.
• Color Make sure the medicine in the syringe is clear and colorless. Do not use if it is foamed, discolored, cloudy, or crystallized.

If the name of the medicine or its dose does not match what your healthcare provider ordered, the medicine has expired, or the medicine has foamed, discolored, cloudy, or has crystals in it, do not use a syringe.If you have another syringe, use it. Then contact your healthcare professional or pharmacist and inform about it. You may be able to bring a full syringe to the pharmacy to have it replaced.

Prepare the injection site

Select an injection site on your body where the skin can be pulled back 1–2 inches (2.5–5 cm). It is best to choose one of the following areas (see figure 1):

• Abdomen (belly), excluding 2 inches (5 centimeters) around the navel;
• mid-front or mid-outer thigh;
• upper part of the buttocks;
• the back of your shoulder if another person gives you an injection.

If your healthcare provider asks you to inject at a specific site, follow these guidelines. Some medicines work better when they are injected at specific sites. Do not inject into painful, reddened, bruised, hard areas or areas with scars or stretch marks.

Figure 1. Injection sites

Give each subsequent injection at a different site.It is convenient to use a notebook or calendar to keep track of places. The injection of the drug in the same place leads to the formation of scar tissue. This may cause the medicine to stop working as it should. This will also make it difficult to insert the needle into the skin.

Once you have selected your injection site, follow the instructions below.

1. Wash hands thoroughly with soap and water or an alcohol-based hand rub.
   • If you wash your hands with soap and water, wet them, lather, rub together thoroughly for 20 seconds, then rinse.Dry your hands with a disposable towel and turn off the tap with the same towel.
   • When using an alcohol-based antiseptic, be sure to apply it to your hands and rub your hands together until it dries completely.
2. Tuck up the clothing covering the injection site.
3. Open the alcohol pad. Wipe the skin at the injection site with a tissue, pressing it firmly against the skin. Start at the center of your selection and work your way to the outer edges in a circular motion.
4. Let the skin dry. Do not fan or blow on the area.

Inject yourself

1. Remove the syringe from the packaging.
   • If you are injecting Lovenox, make sure there is an air bubble in the syringe. If there is no bubble, put this syringe aside and use another. After you have given yourself an injection, contact your healthcare professional or pharmacist to let you know. You may be able to bring a full syringe to the pharmacy to have it replaced.
2. With your dominant hand (the hand you write with), grasp the middle of the syringe like a pen or dartboard.
3. Carefully remove the needle cap (see Figure 2). After removing the cap from the needle, do not put the syringe down. Try to keep nothing, not even your fingers, touching the needle. If anything touches the needle, place the syringe in a sharps container. Start over with a new syringe. After you have given yourself an injection, contact your healthcare provider and let them know.

   Figure 2. Remove the cap from the needle

4. If you are injecting yourself with a medicine other than Lovenox, check the syringe for air bubbles. If there is a vial in the syringe, hold the syringe with the needle pointing up. Tap the syringe gently with your fingers so that air bubbles rise to the top of the syringe, closer to the needle. Slowly push the plunger down to release air bubbles from the syringe. Do not do this with Lovenox.
5. Make sure you continue to hold the middle of the syringe as you hold a dart pen or dart. With your free hand, pull back the skin at the injection site.
6. In one steady and rapid motion, insert the needle completely at right angles into the skin (see Figure 3). Don’t put your thumb on the plunger yet.

   Figure 3. Figure 3. Insert the needle into the skin

7. Stop pulling on the skin. Use your thumb to slowly push the plunger and lower it all the way until you have injected all of the medication (see picture).Figure 4). You can use the thumb of either hand for your convenience.

   Figure 4. Lower the piston until it stops

8. When the syringe is empty, pull the needle straight up out of the skin.
   • Do not apply pressure to the injection site if you have injected yourself with Lovenox or heparin. Cover the injection site if necessary.
   • If you have given yourself an injection of any medicine other than Lovenox and heparin, place a cotton ball or gauze pad over the injection site and press it down for a few seconds.Cover the injection site if necessary.

   Do not put a cap on the needle. Be careful not to inject yourself with the needle.

9. Place the needle guard on the needle.
   • If you have injected yourself with Lovenox, press down firmly on the plunger and lower it all the way. The protective cap should sit in the right place by itself.
   • If you have injected yourself with any medication other than Lovenox, grip the clear plastic finger rests on the sides of the syringe with one hand.Grasp the guard with your other hand (see figure 5). Slide the needle guard over the needle until the needle is completely covered (see Figure 6). You will hear a click when the guard snaps into place.

     Figure 5. Take the guard

     Figure 6. Slide in the guard

10. Dispose of the syringe in a sharps container.Do not reuse a pre-filled syringe.

For information on how to select a sharps container and how to dispose of used syringes and other household medical needles, see our resource Storage and Disposal of Household Medical Needles.

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When should you contact your healthcare provider?

Call your healthcare provider if:

• Blood does not stop flowing from the injection site.
• You have very severe pain.
• You injected medication in the wrong place.
• You have a fever of 100.4 ° F (38 ° C) or higher.
• You have signs of an allergic reaction, such as swelling, redness, itching, or rash.
• You cannot use the syringe because the medicine has expired, the medicine has foamed, discolored, cloudy, or crystals have appeared in it.
• You cannot use the syringe because you touched something with the needle before injecting.
• You cannot use a pre-filled syringe with Lovenox because there is no air bubble in it.
• You are having difficulty getting the injection.

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90,000 Comparison of laparoscopic and open surgery for suspected appendicitis

Review question

We reviewed the evidence for the effects of open surgery and minimally invasive surgery in people with suspected appendicitis.

Relevance

In the lower right abdomen, there is a small, blind-ended portion of the intestinal tube called the appendix. Inflammation of the appendix is ​​called appendicitis and is most common in children and young adults. In most cases, emergency surgery is needed to prevent the appendix from tearing into the abdomen. In an operation called an appendectomy, the inflamed appendix is ​​surgically removed.With a traditional surgical approach, a small incision (about 5 cm or 2 inches) is made in the lower right abdominal wall. Alternatively, the inflamed appendix can be removed with another surgical technique, laparoscopic appendectomy. This operation requires three very small incisions (each about 1 cm or 1/2 inch). The surgeon then inserts the camera and instruments into the abdomen and removes the appendix.

Research characteristics

We included 85 studies with 9,765 participants.75 trials compared laparoscopic and open appendectomy in adults. The remaining 10 studies included only children. The evidence is current to February 2018.

Main Findings

The main advantages of laparoscopic appendectomy over open appendectomy were reduced postoperative pain, reduced risk of wound infection, shorter hospital stay, and faster return to normal activities in adults. At the same time, laparoscopic appendectomy was superior to open appendectomy in terms of wound infections and shorter hospitalization times in children.Two studies reported that adults who underwent laparoscopic appendectomy had better quality of life when assessed at 2 weeks, 6 weeks, and 6 months after surgery. Data for children was not available. As for the disadvantages of laparoscopic appendectomy – in adults, but not in children, intra-abdominal abscesses were more often detected. With the exception of the trend towards a decrease in the incidence of intra-abdominal abscesses after PA, the results in children were similar to those in adults.

Quality of evidence

The quality of the evidence ranged from moderate to low due to poorly conducted studies.

Thank you for making this fabulous life giver …

Problem
: # 1: 1999 – Tendonitis, cervicobrachial syndrome, severe pain in the forearms and hands, inability to use the hands. # 2: October 2000 – Injury to the soft tissues of the inner side of the thigh, overstretching when stumbling down stairs. # 3: December 03 hand injury, turning the fingers back when falling on the sidewalk with a brick in the compensator – partial incision of the middle finger tendon, misdiagnosis of the middle and ring fingers – both were broken (learned 2 months after the injury, 1st 5 weeks, of which the left arm was immobilized and the tendon healed).Scar tissue formed on all four fingers, the hand was purple, severely swollen, excruciating pain, and the range of motion of the fingers and wrists was severely impaired.

Solution : # 1: Infratonic was lying next to the forearm (10 minutes low), chiropractic adjustments (in Arizona) 5 days a week for one month (about 6 months before onset), Cellebrex was discarded (which did not worked after the previous 6 weeks), adding natural anti-inflammatories, laser acupuncture.I bought my Infratronic 8 when I returned to the Chicago area and started seeing a Chicago chiropractor 3 times a week, using the Infratronic for 20 minutes inside each forearm for 20 minutes 3 times a day, sleeping with it on my stomach two inches below my navel. After four months of treatment, the tendonitis disappeared, the pain in my forearm subsided, and I returned to work at the computer.

# 2: Chiropractic massage and correction, trauma, natural anti-inflammatories, Infratronic all night for soft tissue injuries.Frozen during the day 10 minutes per hour. And all this for many months. I burned out the transponder, but it was repaired and returned to me after a few days (thanks!). # 3: After 5 weeks, I left the hand surgeon who advised me not to use ice or heat, but Tylenol when I was in pain. He and the emergency room doctors did not notice the broken fingers. My arm was immobilized in a cast that I was told to keep dry for 5 weeks. I told the doctor when I first saw him that I was using my Infratronic (almost constantly at a low level, next to my hand – all day and all night).By the way, he gave me a rough look. When I started visiting a chiropractor from Arizona again, I was instructed to do adjustments 5 times a week (for the first two weeks), laser acupuncture, take natural supplements, use traumel, ice for 12 minutes 3 times a day, use Infratronic for 20 minutes every 5 times a day. At night, I sleep on my back with my left arm bent and my wrist resting on a pillow next to my face – the Infratronic was next to me all night, guiding it to my arm, which was still very painful.

In February, after my injury failed due to another manual surgeon (who discovered two tears) prescribed OT (which I once did, making my arm purple and swollen again), I stopped OT and continued chiropractic more month (until I got a job that required a lot of finger movement – I quit the next day). It was a very bad setback. The chiropractor directed, in addition to his office treatments, which I ice for 5 minutes, put the Infratronic under my palm next to me while I sat for 10 minutes, put the Infratronic under the pads of each foot for 10 minutes each, 10 minutes between breasts ( to reduce anxiety) and repeat until I go to bed.I have always slept with the Infratronic all night, but until recently I often woke up to rearrange it due to the sensitivity of my hand. I did this for 5 days (the timeout was only for going to the doctor and back). Over the past month, the pain has subsided so much that I can sleep on my back and put my hand on the Infratronic all night.

Improving the quality of life : # 1: My hands were not working, I had no strength, I could not open doors, turn doorknobs, cut vegetables, a vegetable garden, make or fold laundry, hang clothes.I stopped working (I was a computer artist) and had to do a men’s haircut because I couldn’t style my hair, and before I was a fashionable woman, now I wore pants and slip-ons. I could hardly take care of myself. I had just moved into a new home when it started and couldn’t unpack the boxes for months. Without Infratronic, I would not have gotten my life back. I have visited 5 Western doctors, none of whom gave me a good explanation, and one of them treated me with Cellebrex, which some chiropractors believe interferes with my recovery.The Infratronic gave me complete peace of mind in my forearms after several months of therapy. After that, every time I had a problem, I knew that in 20 minutes this terrible deep pain in each hand would stop.

As I got better and better, my attitude changed, I became less depressed and felt that I would take my life back. I was able to find another job, keep a leash for my new dog, and do most of the things I have done before.I was so grateful that I told everyone about it (and still is). # 2: During my hip recovery, I was lucky to receive the Infratronic 8. It soothed, relieved pain and helped me heal. The recovery was long, but sleeping with the Infratronic is very reassuring. During my recovery, my right leg was doing most of the work, and it was great that I didn’t have to hold back again while moving my left leg. I could run with my dog ​​in the yard – in the snow and not worry that I would not have enough strength not to get hurt again.What a blessing!

# 3: This is great! Quality of life: Wow! My chiropractor and I think my arm has improved at least 80% since he took over my therapy. He said, and I quote, “Your hand would be a frozen fist if you didn’t have this Infratronic.” The resulting scar tissue (due to poor therapy recommended by both hand surgeons) is reconstructed. I can close and open my hand 2/3 of the way. My hand is no longer purple and rarely turns blue.The swelling was reduced by 80%. The pain is treatable. My chiropractor says he expects a 100% recovery. To be honest, I was shocked by this injury and very upset that I could only use one hand for so long. I think that worrying about my hand never getting back to normal made it difficult for me to be confident in my recovery. Infratronic is amazing when you put it on your chest. If you are worried, it will calm you down. Both of my chiropractors think that no one uses Infratronic as often as I do.They may be right. Thank you for making this fabulous life-giving creature. God bless you all. ”

Cheryl McCorkle, Scottsdale, AZ

90,000 Abdominal pain is one of the most common complaints of patients.

How to get to the medical center

1st Nagatinsky proezd, 14.

from metro Nagatinskaya:

Exit # 4 from the metro station, bus stop “Metro Nagatinskaya”. Bus 142 to the stop 1-y Nagatinsky proezd.Cross the road, walk along the Post Office and Western Union along the Projected Passage. Exit to 1st Nagatinskiy proezd. On the left there will be a large red building with a balcony, go up to the balcony, there will be a sign “ElKlinik”.

from metro Prazhskaya:

From the Prazhskaya metro station, go to the Nagatinskaya metro station.

Exit # 5 from the metro station. Trams: 3, 16 to the stop 1st Nagatinsky proezd.

From the metro exit No. 4, bus stop “Metro Nagatinskaya”, bus t8 to the stop 1-y Nagatinskiy proezd.

from metro Anino:

Exit 4 from the metro station. Walk to the Metro Anino bus stop, take bus t40 to the stop 1-y Nagatinskiy proezd.

Yuzhnaya metro station:

From the Yuzhnaya metro station, get to the Nagatinskaya metro station.

From the metro exit No. 4, to the bus t8, or exit No. 5 to trams 3, 16. To the stop 1-y Nagatinskiy proezd.

from Varshavskaya metro station:

From the metro go to the bus stop and buses t40, 142, t8 to the stop “1st Nagatinskiy proezd”.

from Nagornaya metro station:

From the Nagornaya metro station, get to the Nagatinskaya metro station. Exit 4 to buses t8, 142, n8 (night), t40, or exit 5 to trams 3, 16 to the stop “1st Nagatinskiy proezd”.

from Tulskaya metro station:

Exit 2 from the metro, cross Bolshoi Starodanilovskiy lane, on the left there will be a Rigla pharmacy and a chain of stores. Go through the park to the Danilovskaya chapel, turn right and get off at the Serpukhovskaya Zastava tram stop.Take the 3rd tram, get to the stop “1st Nagatinskiy proezd”.

from Tsaritsyno metro station:

From Tsaritsyno, get to the Kashirskaya metro station, walk to the bus stop. Take bus t71, get to the stop “1st Nagatinskiy proezd”.

from Orekhovo metro station:

From the Orekhovo metro station, get to the Kashirskaya metro station, exit No. 4, turn right, go through the monument to G.K. Zhukov, walk to the bus stop. Take bus t71, get to the stop “1st Nagatinskiy proezd”.

from metro Domodedovskaya:

Exit 12 from the metro, there will be a bus stop on the left. Take bus t71. Get to the stop “1st Nagatinskiy proezd”.

from the railway station Chertanovo:

From the station, cross the road, walk along the Projected passage to Dorozhnaya Street, turn left, walk to the bus stop “Center for Martial Arts”. Buses: 683, 225, 241. Get to the stop “Metro Varshavskaya”. Cross the road, go to the bus stop and buses t40, 142.Get to the stop 1-y Nagatinsky proezd.

from Kolomenskaya metro station:

From the metro, cross the road and walk Beeline and Unistream to the Kolomenskaya metro stop. Take tram 47, 49, get to the Yuvelirny Zavod stop. Turn left towards Projected Passage, walk along the Medical Center and Investigation Department, and pass Dixie. Go around the residential building and walk along the Projected passage until the traffic light. Cross the road to the large red building (house 14) with a balcony.Climb to the balcony, there will be a sign “ElKlinik”.

Exit 7 from the metro station, to the bus stop “Metro Kolomenskaya”. Buses: 751, 351. Get to the stop “Nagatinskaya embankment, 10”. Walk along the embankment to the Tatneft gas station and the barrier. Walk to the residential building and turn left. Get off at 1st Nagatinsky passage. Go through the Glafira coffee shop to the traffic light. Cross the road. Walk forward and exit to a large red building (house 14) with a balcony. Climb to the balcony, there will be a sign “ElKlinik”.

Exit 5 from the metro, there will be a bus stop on the right. Buses: 901, 299, 608, t71. Get to the stop “1st Nagatinskiy proezd”. Pass Pyaterochka (will be on the left), turn left towards the Post Office and Western Union, go straight along the Projected passage. Exit to 1st Nagatinskiy proezd. On the left there will be a large red building with a balcony, go up to the balcony, there will be a sign “ElKlinik”.

from the Technopark metro station:

From the Technopark, get to the Kolomenskaya metro station, exit No. 1, go through “French pastry”, get off at the tram stop.Take tram 47, 49, get to the Yuvelirny Zavod stop. Turn left towards Projected Passage, walk along the Medical Center and Investigation Department, and pass Dixie. Go around the residential building and walk along the Projected passage until the traffic light. Cross the road to the large red building (house 14) with a balcony. Climb to the balcony, there will be a sign “ElKlinik”.

from Avtozavodskaya metro station:

From the Avtozavodskaya metro station, get to the Kolomenskaya metro station, exit No. 1, go through the French pastry, get off to the tram stop.Take tram 47, 49, get to the Yuvelirny Zavod stop. Turn left towards Projected Passage, walk along the Medical Center and Investigation Department, and pass Dixie. Go around the residential building and walk along the Projected passage until the traffic light. Cross the road to the large red building (house 14) with a balcony. Climb to the balcony, there will be a sign “ElKlinik”.

Performing and Processing FNA of Anterior Fat Pad for Amyloid

Introduction

Systemic amyloidosis is a highly variable disease that refers to the extracellular deposition of various proteins, collectively referred to as amyloid.The deposition of these amyloid fibrils with a beta pleated configuration results in different clinical manifestations depending on the organs involved. The most clinically significant manifestations of systemic amyloidosis are observed when there is involvement of critical organs such as the heart, liver, and / or kidney. Historically, these involved organs would have been biopsied to demonstrate the presence of amyloid. These are moderately invasive procedures performed including a significant risk of bleeding. The fat aspiration pad has since been shown to provide a reliable and non-invasive method for detecting amyloid in systemic amyloidosis ^1. This procedure is substantially similar to liposuction of subcutaneous fat in the anterior abdominal wall under local anesthesia to obtain fibrous fat tissue to assess the scarce deposits of amyloid in small blood vessel walls ^2.

The most commonly used methods of identifying amyloid in tissue remain characteristic The apple green birefringence pattern is visible when Congo red stained sections are visualized under a microscope with polarized light ^3. When a fat aspiration pad is exercised, Congo red spots can be made either by directly smeared slides or cellular preparations to block atmospheric adipose tissue. However, patients in the early stages of amyloidosis have scant deposits of amyloid, which significantly reduces the sensitivity of Congo red stained cell block sections ^4.5. Ultrastructural evaluation of the fat aspirate pad using electron microscopy has better reproducibility and improved sensitivity ^4. Therefore, it is recommended to present all fat aspirates with a pad for cell block preparation and for performing electron microscopy ^2.

Fat aspiration pad is a relatively low cost and non-invasive method for obtaining tissue for the diagnosis of systemic amyloidosis. This article describes the fat pad aspiration procedure along with details of sample handling to submit a sample for Congo red staining and ultrastructural evaluation by electron microscopy.In this video, we demonstrate this reproducible and simple procedure for obtaining optimal diagnostic material.

1. Performing FNA Anterior adipose tissue

A. Local anesthesia (Fig. 1 and 2)

1. Taking alcohol swabs or skin cleansing agent preferred by the particular institution, clear skin on the lower quadrant of the abdominal region lateral to the midline and below the navel (Fig. 1).
2. A diamond shaped mark approximately 2 “x 2” as shown in Figure 1 with a marker.
3. Aspirate approximately 10 ml of 1% lidocaine with an 18G needle. Attach a 25G 1 ½ inch syringe needle. Remove air bubbles by vertically pressing the syringe while pressing down on the plunger until liquid is dispensed with and no air bubbles are present.
4. Anesthetize along the borders of the diamond-shaped area already marked as shown in Figure 2. Begin by inserting the 25G needle under the skin at point and gently pushing the needle subcutaneously at point X. Step back onto the syringe plunger to make sure you are not in the vessel.Then slowly push the plunger to penetrate up to 2.5 ml of lidocaine (about ¼ of lidocaine in a 10 ml syringe) while withdrawing the needle to point, preventing the needle from coming out of the skin at point A (Fig. 2a3). With the needle still under the skin change direction towards the Y point (Figure 2A4) and press the needle subcutaneously at the Y point (Figure 2b1). As before, make sure that the needle is not in the vessel and dispense with about 2.5 ml of lidocaine, slowly withdraw the needle through the point (Fig. 2B3 through 2B4). Repeat similar steps starting at point B and dispensing lidocaine subcutaneously from point B to X and B to Y (Fig.2c1 through 2d4). Prevent bleeding from pricks and B firm the application of a sterile rut piece.
5. It is now possible to verify that the area is anesthetized by lightly touching the skin during anesthesia with a diamond-shaped tip / corner of a piece of cotton gauze, versus adjacent unanesthetized skin.

B. Fat aspiration pad performance (Figure 3)

(Application of local anesthesia prior to fat pad aspiration performance can be circumvented, depending on regional and individual preference.Correctly performed FNAB procedures for the front fat aspiration pad can be completed in a single shot. However, depending on the pain threshold of the individual patient, maneuver the 18G needle back and forth so that the subcutaneous tissue is relatively distressed. The analgesic method described here achieves the effect of only two pricks with a 25G needle and prevents pain with improved tolerance to the procedure.)

1. Assemble an 18G 1 ½ inch needle onto a 10 ml syringe. Mount the syringe with the needle assembly into a syringe grip (“FNAB grip / gun”) for proper application and release of vacuum.
2. Insert the tip of the needle into the subcutaneous fat in the cleaned and anesthetized diamond-shaped area (Fig. 3a).
3. Completely discard the plunger of the syringe with the needle into the subcutaneous tissue to create a vacuum (Fig. 3b).
4. Maintain a vacuum and maneuver the needles back and forth in different directions in the subcutaneous fat (Fig. 3c through 3i). Each stroke should be kept as long as possible with the length of the needle selected without letting the needle come out of the skin. The maximum sampling rate is achieved by changing direction with each beat (Fig.3i). It is important to keep the direction of the needle tangent to the serous and parallel to the skin surface to avoid punctures in the abdominal cavity.
5. Fibrous adipose tissue accumulates in the syringe. After sufficient fibro-adipose tissue fragments (up to 1 ml fragments of a rich blood, mixed sample) are extracted, release the vacuum completely and remove the needle (Fig. 3 kb).
6. At Patient or Assistant Apply pressure to the procedure area with gauze pad to prevent bleeding.

2. Sample processing

1. Place at least 5-6 fibrous adipose tissue fragments in the glutaraldehyde solution for electron microscopy (Figure 4B).
2. Depending on the institutional protocol, multiple smears of fibrous adipose tissue fragments can be obtained by spreading them between two glass slides (Figure 4A).
3. Remaining material is allowed to clot into the syringe (this may take 5-7 minutes, depending on clotting time) (Fig.4C).
4. Aspirate 10% formalin into the syringe so that the clots of fibrous fat tissue material are displaced from the syringe wall and float freely (Fig. 4C2). Remove the plunger from the syringe (Fig. 4C3) and transfer the tissue clots into a fibrous fat 10% formalin container with the open end of the syringe to the opposite end of the nozzle (Fig. 4C4).
5. Label containers appropriately and submit glutaraldehyde for electron microscopy and formalin for H&E section and Congo red spot for evaluation under a polarizing microscope.If swabs are ready, they can be processed according to the individual laboratory protocol.

Figure 1. Anesthetic area for anterior adipose tissue FNAB.

Figure 2. Pain relief in the region.

Figure 3. Performing FNAB of anterior adipose tissue.

Figure 4. Processing of the anterior adipose tissue of the aspirate, which will be presented to the laboratory for the detection of amyloid deposits.