Lower Abdominal Pain/Suprapubic Pain

Abstract

The term “lower abdomen” refers to the portion of abdomen below the umbilicus in which three topographic regions can be identified: the hypogastrium in the middle and the left and right iliac fossa, both located lateral to the hypogastrium, in the left and right inferior part of the surface of the human abdomen, respectively. The majority of men and women will complain, at least once in their life, of a pain localized in the lower abdomen. For this reason, the number of GP’s referrals because of a lower abdominal pain is expected to be high. A number of different diseases can cause a pain, of variable mode of presentation, intensity, and duration, in the left iliac fossa, the right iliac fossa, and the hypogastrium (this latter also termed suprapubic pain), respectively. These may arise from different organs (bowel, lower urinary tract, and female reproductive system) and thus potentially involve different specialists (general surgeon, urologist, and gynecologist). Importantly, the physician needs to suspect those few cases that need an urgent referral, i.e., extrauterine pregnancy in fertile females and cecal or sigmoid perforation, more common in elderly patients. The aim of this chapter is to provide general criteria (essentially based on patient’s history and examination) that may lead a GP to suspect a urological origin of lower abdominal pain (and the need for a urological referral). The main features for the differential diagnosis with diseases belonging to other apparatus will also be provided in order to identify the most appropriate specialist referral.