Left Side Abdominal Pain: 9 Most Common Causes, Symptoms, Investigations, Treatment Options

What Can Cause Left Side Abdominal Pain?

Left Side Abdominal Pain

Left-sided abdominal pain is the pain, which occurs on the left side of an imaginary line drawn on the central point of the body, below the sternum and passing via umbilicus and ending just above the pubic region. There are many organs and structures located on the left side of the abdomen and any disease or problem with them can result in left side abdominal pain.

Structures or Organs in Left Side of Abdomen

The source of the pain on the left side of the abdomen can also be from organs and structures which are present on the left side of the abdomen.

Females have more organs in the abdomen than males, such as womb, ovaries, fallopian tubes etc. This makes them more likely to suffer from left side abdominal pain than compared to men.

Left Side Abdominal Pain

Given below are the structures and organs which are located on the left side of the abdomen and any problem with them can result in left sided abdominal pain.

Layers of the Abdominal Wall-

Skin-The Skin Covering the Left Abdomen.

Muscles-There are 3 layers of muscles covers abdominal wall. The outer layer of muscle is known as external oblique muscle, middle layer transverse muscle and internal oblique muscle.

Parietal Peritoneum- The abdominal wall from inside is coverd by a thin fibrous mucosal membrane known parietal peritoneum.

Lower Ribs and Rib Cartilages (Ribs)- Upper left abdomen is partially covered by lower rib and cartilage. The inflammation of the junction of cartilage and rib is known as Costochondritis.

Blood Vessels-

  • Arterial blood vessels- Arteries carry nutrition and oxygen to all the layers of the abdominal wall as well as peritoneum.
  • Venous blood vessels- The deoxygenated blood passes from tissue to lung through venous blood vessels.
  • Lymphatic vessels- There are smaller lymphatic vessels that collects few metabolites and waste from skin, subcutaneous tissue, muscles and peritoneal layers.
    Organs (Viscera) in the Left Side of Abdomen

Gastrointestinal System-

  • Left Side of the Liver.
  • Spleen.
  • Stomach.
  • Pancreas (body and tail end).
  • Left Side of the Large Intestine.
  • Sigmoid Colon.

Respiratory System-

  • Lower Region of the Left Lung.
  • Urinary System
  • Left Kidney (kidney stone, tumor, infection).
  • Left Adrenal Gland.
  • Left Ureter.
  • Female Genital System
  • Left Side of the Uterus.
  • Left Ovary.
  • Left Fallopian Tube.

9 Most Common Causes of Left Side Abdominal Pain

  1. Hunger Pain
  2. Constipation
  3. Trapped Wind
  4. Kidney Stone
  5. Ectopic Pregnancy
  6. Endometriosis
  7. Diverticulitis
  8. Abdominal Aortic Aneurysm
  9. Ovarian Cyst

What Can Cause Left Side Abdominal Pain?

1.Hunger Pain1

Children are more frequently affected by hunger pains that originates in stomach. Since stomach lies in left upper quadrant, pain is felt on left side.

Symptoms. Hunger pains are dull in nature and are present as a discomfort in the abdomen.

Treatment. Eating immediately usually resolves the hunger pain. If pain continues and spreads over opposite side of the abdomen then one should consult physician to rule out stomach ulcer.

2. Constipation-

Constipation is also termed as dyschezia. Patient has difficulty passing or having bowel movements resulting in abdominal pain. Patient suffering from constipation also feels pain on the left side of abdomen when defecating. Constipation is very frequently seen on individual taking recreational opioids or for pain.2

Symptoms. Painful and infrequent bowel movements. Patient may also experience some abdominal pain and swelling. Vomiting may also occur.

Investigations. Barium studies, blood tests, and colonoscopy.

Treatment. Increased fluid intake and increased fiber intake. Other options include enemas or laxatives.

3.Trapped Wind.

Symptoms. Crampy left sided abdominal pain.

Treatment. Drugs like buscopan or mebeverine are helpful in treating trapped wind causing left side abdominal pain. Antibiotics are given if diarrhea accompanies the pain, as this indicates infection.

4.Kidney Stones3.

Kidney Stone is also known as renal calculus, it causes severe abdominal pain, which resembles the pain from biliary colic.

Symptoms. Severe, abrupt pain in the left loin which radiates to the kidney and ureter. Most common cause of such pain is kidney or ureter stone. Pain is crampy in nature. Nausea and vomiting may occur.

Treatment. Treatment for kidney stone causing left side abdominal pain depends on the size of kidney stone. If it is small, then it usually passes out and no additional treatment is needed. If the stone is large in size (< 7 mm), then surgery is done such as extracorporeal shock wave lithotripsy, ureteroscopy and percutaneous nephrolithotomy.

5.Ectopic Pregnancy.

When a fertilized egg gets implanted outside the uterus, it results in an ectopic pregnancy.

Symptoms. Pain which is dull in nature initially, then progresses to spasmodic pain. It occurs on one side of the abdomen, either left or right side of the abdomen where the pregnancy has occurred. There is abnormal bleeding such as brown spotting preceding the pain. In case of rupture of the fallopian tube, patient may have nausea, vomiting, dizziness, acute abdominal pain, rectal pressure, heavy bleeding and shock.

Investigations. An ultrasound and hormonal level confirms an ectopic pregnancy.5

Treatment. Drugs such as methotrexate/misoprostol are given; however, surgery is required in most cases to treat ectopic pregnancy causing left side abdominal pain.

6.Endometriosis.

The normal uterine tissue, i.e. endometrium, growing outside the uterus is termed as endometriosis. Left side abdominal pain caused due to endometriosis is a common among many people.

Symptoms. Pelvic pain which can be crampy in nature with menstrual period, heavy bleeding. Pain also occurs with intercourse and bowel movements. Patient also may have infertility.

Investigations. Pelvic exam, ultrasound and laparoscopy.

Treatment for Left Side Abdominal Pain Caused Due to Endometriosis. Pain medications, hormonal therapy and surgery. Abdominal wall endometriosis is treated with endoscopy surgery.6

7.Diverticulitis

Inflammation of one or more diverticulum is termed as diverticulitis.

Symptoms. Sudden, acute left sided abdominal pain, fever, nausea, vomiting, constipation, diarrhea, rectal bleeding, and bloating. Diverticuli when inflamed is known as diverticulitis. The inflamed diverticuli when rupture forms a fistula and fistula results in peritoneal or abdominal abscess that causes severe pain.7

Investigations. Physical exam, CT scan, X-rays.

Treatment for Left Side Abdominal Pain. Rest, light liquid diet, antibiotics. Surgery is done for recurrent diverticulitis, abscess, fistula and perforation.

8.Abdominal Aortic Aneurysm (AAA).

Enlarged or dilated area in the lower region of the aorta is termed as abdominal aortic aneurysm and can cause severe pain on the left side of abdomen.

Symptoms. Constant pain in the abdomen, throbbing is felt near the umbilicus, pain in the back.

Investigations. Abdominal ultrasound, computerized tomography (CT) scan8and MRI.

Treatment. Surgery is required for large aneurysms.

9.Ovarian Cyst.

Fluid filled pockets or sacs present on the surface or inside the ovary are termed as ovarian cysts which can cause left side abdominal pain.

  • Symptoms. Irregular periods, pain in the pelvis, heaviness felt in the abdomen, pain during intercourse and bowel movements, nausea, vomiting.
  • Investigations. Pelvic ultrasound, laparoscopy, CA 125 blood test and pregnancy test.
  • Treatment for Left Side Abdominal Pain Caused Due to Ovarian Cyst. OCPs are given. Surgery is done if the cyst is large.
  • Other Causes of Left Side Abdominal Pain.

Diseases of Layers of the Abdominal Wall-

Skin Disease- Skin infection and injury on left side of abdomen causes mild to severe left side abdominal pain. Following skin diseases causes left side abdominal pain-

  • Boil,
  • Cellulitis and
  • Blunt or penetrating injuries

Muscles Diseases-Muscle diseases and injuries on left side of abdomen causes muscle spasm and abdominal pain. Following diseases and injuries can cause abdominal pain on left side.

  • Muscle spasm
  • Pulled abdominal muscles
  • Myofibrosis
  • Fibromyalgia
  • Parietal Peritoneum-
  • Peritonitis
  • Lower ribs and rib cartilages(Ribs)-
  • Costochondritis.
  • Fracture of cartilage or rib
  • Organs (Viscera)

Gastrointestinal system-

  • Hepatitis- liver infection
  • Liver abscess.
  • Spleen rupture.
  • Stomach ulcer or cancer
  • Gastritis
  • Pancreas (body and tail end)- Pancreatitis or .pancreatic cancer

Large Intestine- Chron’s disease, ulcerative colitis

  • Intestinal ostruction
  • Respiratory System-
  • Lower left lone pneumonia
  • Left side pleuritis
  • Urinary System
  • Left Kidney stone,
  • Kidney tumor, i
  • Kidney infection (pyelonephritis).
  • Left Adrenal Gland inflammation
  • Left Ureter stone
  • Left ureter infection
  • Female Genital System
  • Left Side fibroid of Uterus.
  • Left side cancer of uterus
  • Left Ovary.

Left Fallopian Tube.

Mittelschmerz- Mid-cycle ovulation pain

As you can see, there are various causes for left side abdominal pain. Treatment depends on what is causing the pain on the left side of abdomen. If you have severe, persistent pain in the abdomen, then you should visit the ER immediately, as ignoring it could prove to be life threatening.

References

  1.  Visceral Pain. Grundy L1,2Erickson A1,2Brierley SM1,2., Annu Rev Physiol. 2019 Feb 10;81:261-284.
  2.  Efficacy of Treatments for Opioid-Induced Constipation: Systematic Review and Meta-analysis.Nee J, Zakari M, Sugarman MA, Whelan J, Hirsch W, Sultan S, Ballou S, Iturrino J, Lembo A., Clin Gastroenterol Hepatol. 2018 Oct;16(10):1569-1584.e2. 
  3.  Bloating and Abdominal Distension: Old Misconceptions and Current Knowledge. Malagelada JR1Accarino A1Azpiroz F1., Am J Gastroenterol. 2017 Aug;112(8):1221-1231. 
  4. Nephrolithiasis. Favus M22.,  Feingold KR1Anawalt B2Boyce A3Chrousos G4Dungan K5Grossman A6Hershman JM7Kaltsas G8Koch C9Kopp P10Korbonits M11McLachlan R12Morley JE13New M14Perreault L15Purnell J16Rebar R17Singer F18Trence DL19Vinik A20Wilson DP21, editors. 
  5. Diagnosing ectopic pregnancy in the emergency setting. Lee R1Dupuis C1Chen B1Smith A1Kim YH1., Ultrasonography. 2018 Jan;37(1):78-87. 
  6. Comparison of ultrasound-guided high-intensity focused ultrasound ablation and surgery for abdominal wall endometriosis. Zhao L1Deng Y1Wei Q2Chen J2,3Zhao C1., Int J Hyperthermia. 2018;35(1):528-533.   
  7. Small bowel diverticulum complicated by enterocutaneous fistula and abdominal wall abscess – Case report. Almalki MA1Yaseen WY2Baatiyyah M2., Int J Surg Case Rep. 2019 Mar 5;57:39-41.   
  8. Abdominal Aortic Emergencies. Lech C1Swaminathan A2., Emerg Med Clin North Am. 2017 Nov;35(4):847-867. 

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