Left lower quadrant pain

Where is my left lower quadrant?

The left lower quadrant (LLQ) is a section of your tummy (abdomen). Look down at your tummy (abdomen) and mentally divide the area from the bottom of your ribs down to your pubic hair into four quarters. The quarter on your left side below your belly button (umbilicus) is your LLQ.

Abdominopelvic Quadrants

By Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.

What is in my left lower quadrant?

Abdominal Quadrant Regions

OpenStax, CC BY 3.0, via Wikimedia Commons

• Small bowel (ileum).

• Parts of the large bowel (colon) - transverse colon, descending colon and sigmoid colon.

• Rectum.

• Left ureter (at the back of the other organs).

• Left ovary and Fallopian tube (women only).

And don't forget the skin and nerves of that area.

Common causes of left lower quadrant pain

The list of causes of left lower quadrant (LLQ) pain is almost endless but the following are some of the more common possibilities. They are not in order of how common they are.

Constipation

• If your guts are full of poo (faeces) this can cause discomfort anywhere in your tummy (abdomen).

• You will normally be aware that you are not opening your bowels as often as usual.

• Your poo will be hard and pellet-like.

See the separate leaflet called Constipation for more information.

Gastroenteritis and food poisoning

• Causes diarrhoea.

• May also make you feel sick (nausea) or be sick (vomit).

• Pain may be anywhere in the tummy (abdomen).

• Pain may ease for a while each time some diarrhoea is passed.

See the separate leaflets called Gastroenteritis and Food Poisoning for more information.

Irritable bowel syndrome (IBS)

• This is very common.

• It tends to cause crampy tummy (abdominal) pains.

• It often causes bloating.

• It comes and goes and may be associated with diarrhoea and/or constipation.

• It is a diagnosis of exclusion made when there are typical symptoms with no other causes found - your doctor will probably do some blood tests, but these are to look for other causes, rather than to specifically diagnose IBS.

See the separate leaflet called Irritable Bowel Syndrome (IBS) for more information.

Diverticulitis

• This is an inflammation of a pouch or pouches which people who have diverticular disease have in their guts.

• Diverticulitis in the last part of the large gut (sigmoid colon) is the most common cause of LLQ pain in adults.

• Diverticulitis in other parts of the colon can also cause pain in the LLQ.

• It usually comes with a temperature (fever) and a change in bowel habit (opening your bowels more or less often than usual for you).

See the separate leaflet called Diverticula (including Diverticulosis, Diverticular Disease and Diverticulitis) for more information.

Colon cancer and rectal cancer

• Colon cancer and rectal cancer (sometimes called colorectal cancer) are two of the most common cancers in the UK.

• Although colon cancer can affect any part of the large bowel (colon), it commonly affects the last part (descending colon and sigmoid colon) which is on the left-hand side. Rectal cancer affects the very last part of the large bowel (rectum) just before it ends at the anus.

• There is usually a change in how often you need to open your bowels and you may notice that you have lost weight, without trying.

• You may get a feeling of not fully emptying your bottom (rectum) after opening your bowels.

See the separate leaflet called Colon, Rectal and Bowel Cancer (Colorectal Cancer) for more information.

Trapped inguinal or femoral hernia

• A left inguinal or femoral hernia occurs when a piece of bowel or other tissue from inside the tummy pushes through a weakness in the muscles of the tummy (abdominal) wall near the left groin.

• It can happen on either side.

• If whatever has pushed through gets stuck and can't slide back inside the tummy, it is trapped (incarcerated).

• If it happens on the left-hand side, there will be a tender swelling in the left groin.

• It causes pain in the groin and in the tummy, usually on the side of the hernia but it may cause pain over the whole tummy.

• It is common to be sick (vomit).

See the separate leaflet called Hernia for more information.

Can kidney infections cause left lower quadrant pain?

Kidney infection

• A kidney infection can cause pain anywhere along your urinary tract. So this could be anywhere from the loin in your back, round the side and down to the LLQ. However, it would be unusual to have pain in the LLQ only, it would usually be associated with pain in the left loin/left upper quadrant as well.

• You may notice that it hurts when you pass urine and that you need to pass urine more often.

• You may have a temperature (fever), or feel shivery.

See the separate leaflet called Kidney Infection (Pyelonephritis) for more information.

Left lower quadrant pain causes in women

Mittelschmerz

• Pain at the time that you release an egg (ovulation), which is usually about halfway between two periods.

• Can be very severe and stop you short but usually eases over several minutes.

• Will only be felt on one side but can be left or right - could be on a different side the next month when your other ovary produces an egg.

Pelvic inflammatory disease

• Pain is usually on both sides but may just be in the LLQ.

• Pain is worse during sex.

• There is abnormal bleeding, so bleeding not just at period time but in between periods and often after sex.

• There is usually a vaginal discharge, which may be smelly.

See the separate leaflet called Pelvic Inflammatory Disease for more information.

Twisted ovary

• Twisted ovary (ovarian torsion) usually only occurs if a fluid-filled sac (cyst) has developed on the left ovary.

• Pain can be constant or intermittent.

See the separate leaflet called Ovarian Cyst for more information.

Endometriosis

• Sometimes endometriosis can cause constant lower tummy pain, although usually it is worse just before, during and for a short while after a period.

• Pain is usually across the lower part of the tummy but it can be just on the left side.

See the separate leaflet on Endometriosis for more information.

Ectopic pregnancy

• Pain may develop sharply, or may slowly get worse over several days. It can become severe.

• Vaginal bleeding often occurs but not always. It is often different to the bleeding of a period. For example, the bleeding may be heavier or lighter than a normal period. The blood may look darker. However, you may think the bleeding is a late period.

• Other symptoms may occur such as diarrhoea, feeling faint, or pain on passing poo (faeces).

• Shoulder-tip pain may develop. This is due to some blood leaking into the abdomen and irritating the muscle used to breathe (the diaphragm).

• You may feel dizzy or faint.

• If you have taken emergency contraception (the 'morning after pill') and your next period is late, light, or unusual in any way then the emergency contraception may have failed and you might be pregnant. If this is accompanied by LLQ pain, seek help urgently in case it is an ectopic pregnancy.

See the separate leaflet called Ectopic Pregnancy.

There is also a separate leaflet called Left Lower Quadrant Pain in Pregnancy.

Left lower quadrant pain causes in men

Any pain coming from the left side of the scrotum can cause pain in the LLQ but usually the pain in the scrotum will be worse.

Torsion of the testicle

• Torsion of the testicle (testis) causes severe pain in the scrotum and severe lower quadrant pain.

• It most commonly affects teenage boys but young adult men can be affected.

• It is unusual over the age of 25 years but can affect any man at any age.

• The testicle is very tender.

• You should seek urgent medical advice.

See the separate leaflet called Torsion of the Testis for more information.

Epididymo-orchitis

• Epididymo-orchitis is an inflammation of the testicle and/or the tubes surrounding it (epididymis).

• It is caused by an infection.

• The affected side of the scrotum swells and goes very red and tender.

• There may also be pain on passing urine, or discharge from the penis.

See the separate leaflet called Epididymo-orchitis for more information.

Other possible causes of left lower quadrant pain

Inflammatory bowel disease

Crohn's disease and ulcerative colitis are forms of inflammatory bowel disease (IBD). IBD is not to be confused with irritable bowel syndrome (IBS) which is very different. These conditions cause the lining of the gut to become inflamed. Diarrhoea (sometimes with blood mixed in) is usually the main symptom.

• Crohn's disease:

  • Any part of the gut can be affected and the pain depends on which part is affected.

See the separate leaflet called Crohn's Disease for more information.

• Ulcerative colitis:

  • Diarrhoea is often mixed with mucus or pus.

  • Blood mixed with the diarrhoea is common.

  • The tummy pain is typically crampy.

  • A feeling of wanting to go to the toilet but with nothing to pass (tenesmus) is also common.

See the separate leaflet called Ulcerative Colitis for more information.

Sigmoid volvulus

• Sigmoid volvulus happens when the very last part of the large bowel, the sigmoid, twists on itself causing a blockage.

• This causes colicky pain and a very bloated tummy (abdomen).

• The people it affects are usually elderly and have often had long-term problems with constipation.

• It is dangerous and requires emergency surgery.

Kidney stones

• Kidney stones are hard stones that can form in the kidney, in the tube (the ureter) draining urine from the kidney, or in the bladder.

• A stone that passes into the tube (the ureter) draining urine from your left kidney may cause pain that starts in your left loin and spreads (radiates) to your groin and left LLQ, or into your testicle (testis) if you are a man.

• You may notice blood in your urine.

See the separate leaflet called Kidney Stones for more information.

Shingles

• In some cases you may have pain from shingles before a blistery rash appears.

• Pain tends to be sharp or burning sensation.

• You may not feel quite yourself.

• The tummy is a common place for shingles rash.

See the separate leaflet called Shingles (Herpes Zoster) for more information.

Abdominal aortic aneurysm

• An abdominal aortic aneurysm is a swelling of the largest blood vessel in the body (the aorta) inside the abdomen.

• It doesn't usually cause any symptoms but can occasionally cause pain before it bursts. The pain is usually felt in your back or the side of your tummy (abdomen) but it can occasionally be felt in the left lower (or in the right) quadrant.

See the separate leaflet called Abdominal Aortic Aneurysm for more information.

What else could it be?

These lists of possible causes for LLQ are by no means exhaustive and there are many other conditions that can cause pain in the LLQ. Problems in your spine or back could be 'referred'. Referred pain in this situation means that it is coming from your back but you are feeling it around the front.

Muscular pulls and sprains can also affect you in the tummy area. If this is the case, moving the particular muscle would make the pain worse, whereas if you were to lie completely still, it wouldn't hurt.

When to see a doctor

Yes, if you have a pain which doesn't settle, you will probably need to consult a health professional to help you figure out the cause. Consult a doctor urgently if you:

• Have very severe pain.

• Have persistent sickness (vomiting).

• Have recently lost weight without trying to do so.

• Have persistent diarrhoea.

• Feel giddy, light-headed, faint or breathless.

• Are bringing up blood or have blood in your poo (faeces).

• Have a change from your usual bowel habit. This means you may open your bowels more or less often than usual, causing bouts of diarrhoea or constipation.

• Could be pregnant (you should do a pregnancy test from a pharmacy first).

What are the usual tests for left lower quadrant pain?

Your doctor will narrow the (enormous) field of possible LLQ pain diagnoses or treatments by talking to you and examining you. They may be able to find the cause simply by doing so. For example, if they find the typical rash of shingles, you will need no further tests to find the cause.

The doctor will certainly need to feel your tummy (abdomen) in the area you have the pain, but may also need to examine other parts too, such as the rest of your tummy. Your doctor may also need to examine your bottom (rectal examination). Women may need an internal examination to rule out or diagnose problems such as pelvic inflammatory disease. You should always be offered a chaperone for an intimate examination.

You may be asked to provide a sample of urine, to look for infection. Swabs might be taken from women to look for infections such as chlamydia - in men, these are usually tested for by a urine sample.

You may have to go for blood tests. These might include tests to:

• Check the function of your liver and kidneys.

• Rule out any inflammation or infection in your body.

• Look for anaemia.

• Check your blood sugar level.

What other tests might be needed for left lower quadrant pain?

Next it will depend on what the examination and the tests above have suggested. In some cases no further tests will be needed - if, for example, your doctor is confident you have constipation or shingles.

If a problem with your large bowel is suspected, you may need an examination with a tube with a camera put into your large bowel (a colonoscopy). A computerised tomography (CT) scan or an ultrasound scan may be helpful to look for diverticula and to look at your kidneys.

These tests are also used in women to look at the ovary and tubes. In some cases an X-ray of the tummy may be useful. Further tests include other 'scopes' (such as a sigmoidoscopy), a barium enema and other scans (such as a magnetic resonance imaging (MRI) scan).

If it is thought you might have an ectopic pregnancy - women - or a torsion of your testicle (testis) - men, you may only have one or two of these tests before having emergency surgery to treat your problem.

Nobody will need all these tests, and some people may not need any.

Left lower quadrant pain treatment

There is no single answer to this until you know what the cause of your pain is. See the relevant leaflet for the condition with which you have been diagnosed. Treatments for a few of the causes of LLQ pain are briefly discussed below.

• Constipation can be treated with medicines, but often changes to your diet are needed to prevent it happening again. It is important to drink plenty of fluids.

• Gastroenteritis usually doesn't need any treatment, other than drinking plenty of fluid to compensate for all that is being lost. Occasionally when germs (bacteria) which can be treated with antibiotics are causing the infection, an antibiotic may help. If the symptoms persist, or if you have travelled anywhere exotic recently, a stool sample may be sent.

• Shingles. The pain and rash settle on their own in time, but an antiviral tablet is often given to reduce the risk of post-shingles nerve pain.

• Kidney infections are treated with antibiotics. Mild infections can be treated with antibiotics at home. If you are very unwell you may need admission to hospital for antibiotics and fluids through a drip (intravenously).

• Kidney stones. Small kidney stones pass on their own eventually, in which case you will need to drink plenty of fluids and take strong painkillers. Larger kidney stones may need one of a number of procedures done to break them up or remove them altogether.

• Torsion of the testicle (testis) is cured with an operation (ideally this should be performed within 6-8 hours of the pain starting).

• Ectopic pregnancy is usually treated by an operation but medical treatment is now more common. This avoids the need for surgery and means the tube is less likely to be permanently damaged.

What is the outlook?

Again this depends entirely on the cause of the pain. Some conditions settle very quickly on their own (for example, gastroenteritis), or with the help of antibiotics (for example, a kidney infection). Others can be cured with surgery, such as torsion of the testis.

Some are long-term conditions, for which there is no cure, although there are treatments, such as those used for people who have Crohn's disease. Your doctor should be able to give you an idea of the outlook (prognosis) once a diagnosis has become clear.