Severe Lower Abdominal Pain: Causes and When to Seek Medical Help

Lower abdominal pain, cold sweats, and weakness?

Hello, doctor.
Last night, I was suddenly awakened by severe pain in my lower abdomen (the area near the uterus was the most painful, but upon closer examination, it seems like there was also some pain in my stomach, just not as intense as the lower abdomen).
I initially thought I might need to use the restroom due to diarrhea, but after sitting on the toilet, the pain in my lower abdomen became so intense that I started to feel a bit dizzy (similar to the onset of fainting).
I didn't pass anything.
After returning to my room, I knelt by the bed (unable to straighten up due to the pain; curling up felt more comfortable), and I started to sweat, feeling slightly nauseous.
I forced myself to take a spoonful of Tai-Tian gastric powder, and after a while (maybe half an hour to an hour), the pain suddenly subsided.

Doctor, what could this possibly indicate? If I need to seek medical attention, which department would you recommend? (My medical history includes polycystic ovary syndrome, and I had an ultrasound in mid-September where the doctor said my uterus was clear with no other issues.
As of the evening of October 25, I have been taking progesterone for six days, and my period should arrive in 4-7 days.
I also regularly take metformin, two pills a day.) (Additionally, for dinner, I had black vinegar, and after the meal, I drank a glass of watermelon milk.
In the middle of the night, I burped and felt a bubbly sensation, so I'm unsure if the vinegar or the juice caused the issue.)

Miss Lin, 20~29 year old female. Ask Date: 2022/10/26

Dr. Chen Shidian reply Gastroenterology and Hepatology

For acute pain, visit the emergency department or the obstetrics and gynecology outpatient clinic, and if necessary, the gastroenterology outpatient clinic.

Reply Date: 2022/10/26

More Info

Severe lower abdominal pain can be alarming, especially when accompanied by symptoms such as dizziness, sweating, and nausea. Based on your description, there are several potential causes for your pain, and it is essential to consider both gastrointestinal and gynecological issues, particularly given your medical history of polycystic ovary syndrome (PCOS).

Possible Causes of Severe Lower Abdominal Pain
1. Gastrointestinal Issues:
- Gastritis or Gastroenteritis: Inflammation of the stomach lining can cause severe pain, especially after eating certain foods. The fact that you experienced discomfort after consuming vinegar and watermelon milk could suggest a gastrointestinal reaction.

- Irritable Bowel Syndrome (IBS): This condition can lead to episodes of abdominal pain, bloating, and changes in bowel habits. Stress and certain foods can trigger symptoms.

- Appendicitis: Although your pain is more localized to the lower abdomen, appendicitis typically presents with pain that starts around the navel and then moves to the lower right abdomen. It is accompanied by fever and possibly vomiting.

- Diverticulitis: Inflammation or infection of small pouches that can form in the walls of the colon may cause severe pain, especially in the lower left abdomen.

2. Gynecological Issues:
- Ovarian Cysts: Given your history of PCOS, it is possible that an ovarian cyst could have ruptured, leading to acute pain. This can also cause nausea and dizziness.

- Ectopic Pregnancy: Although less likely if you are not pregnant, it is a serious condition where a fertilized egg implants outside the uterus, often causing severe pain and requiring immediate medical attention.

- Pelvic Inflammatory Disease (PID): An infection of the reproductive organs can cause severe abdominal pain and is often accompanied by fever and unusual discharge.

3. Other Considerations:
- Urinary Tract Infection (UTI): Sometimes, UTIs can present with abdominal pain, especially if the infection has spread to the kidneys.

- Kidney Stones: These can cause severe pain that radiates from the back to the abdomen and may be accompanied by nausea.

When to Seek Medical Help
You should seek medical attention if:
- The pain is severe and persistent.

- You experience additional symptoms such as fever, vomiting, or changes in bowel habits.

- You feel faint or dizzy, as this could indicate a more serious condition.

- There is any unusual vaginal bleeding or discharge.

Recommended Medical Specialties
Given your symptoms and medical history, it would be appropriate to consult with:
- Gynecologist: To rule out any gynecological issues, especially considering your history of PCOS and the nature of your pain.

- Gastroenterologist: If gastrointestinal issues are suspected, especially if your symptoms persist or worsen.

Conclusion
In summary, your severe lower abdominal pain could stem from a variety of causes, including gastrointestinal and gynecological issues. It is crucial to monitor your symptoms closely and seek medical attention if they persist or worsen. A thorough evaluation by a healthcare professional, including a physical examination and possibly imaging studies, will help determine the underlying cause and guide appropriate treatment.

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