Heaviness in Lower Abdomen in Non-pregnant Females: 8 causes (Dr. Farahat).

Common causes of lower abdominal heaviness in females include:

• Menstrual cramps.
• Premenstrual syndrome
• Ovulation pain.
• Pelvic congestion syndrome.
• Ovarian cysts or tumors.
• Uterine fibroids.
• Gut-related conditions such as IBS and food intolerance.
• Urinary bladder inflammation (cystitis) or tumors.
• Lower abdominal muscle strain.
• And others. 

1. Menstruation & premenstrual syndrome.

91% of menstruating females experience some heaviness or pain in the lower abdomen (reference).

Most of the 91% experience heaviness rather than pain. The heaviness is not necessarily during menstruation.

Frank menstrual pain affects less than 30% of females (reference).

You may experience lower abdominal heaviness a day or two before your period. 

Features suggesting you have menstruation-related lower abdominal heaviness or discomfort:

• Onset: with your period. Sometimes, it starts a couple of days before menstruation.
• Duration: The Heaviness fades gradually after 24-72 hours after the onset of your menses.
• How it feels: Constant tightness or heaviness in the lowermost part of your abdomen.
• Associated symptoms: Menstruation, nausea, diarrhea, headache, fatigue, a general sense of malaise. 
• Who are at higher risk? Younger females. The condition gradually decreases with age.

How to deal (treatment):

• Heat application in the lower abdomen (reference).
• Massaging (you can use essential oils during the massage).
• Natural antispasmodic drinks such as chamomile tea, fennel seeds, ginger, and cinnamon.
• Avoid alcoholo, caffeine, carbonated beverages, fatty foods.
• OTC medication can help in severe cases such as ibuprofen and naproxen.
• Mild aerobic exercises.

What is premenstrual syndrome (PMS)?

It is a group of physical and mental symptoms affecting some females before the onset of their period.

PMS can lead to the recurrent sense of heaviness in the lower abdomen days before the menstruation.

Symptoms of PMS:

• Abdominal heaviness, tightness, or pain.
• Bloating.
• Sore breasts before the menses.
• Food cravings (especially for sweets).
• Changes in your bowel habits (constipation or diarrhea).
• Headaches.
• Changes in your mood (irritability, sadness, or emotional disturbances).
• Anxiety and/or depression.
• Fatigue.

Learn More.

2. Ovulation.

Ovulation can lead to lower abdominal heaviness or pain in up to 40% of females during reproductive age (reference).

The cause is still unclear. This type of pain usually starts to affect you a few years after the onset of menses (less common in the teenage).

Features suggesting you have ovulation-related heaviness:

• Timing: often, in the mid-cycle (the middle two weeks between two menses).
• It occurs periodically every month. Sometimes, it occurs between the two menses. However, some females don’t experience it every month.
• Site: lower abdominal, on one side (slightly more frequent on the right).
• Duration: the heaviness or pain usually is a short-living. Often, it lasts for 3-12hours, but it may last longer.
• Severity: varies from mild lower abdominal heaviness to severe pain.
• The severe form of right ovulation pain can present similarly to appendicitis.
• Sometimes, it is associated with mild lower backache (reference). 
• Interestingly, this type of pain frequently improves or disappears when women take oral contraceptive pills (reference).

Home remedies are also helpful with ovulation-related lower abdominal heaviness. OTC anoanorectalgesics as Tylenol, Advil, Aleve may help. 

When it turns into frank pain rather than heaviness, your doctor may prescribe oral contraceptive pills (OCPs).

Learn more about Ovulation pain (Mittelschmerz).

3. Pelvic congestion syndrome.

Congestion is the build-up of blood inside your blood vessels. When it affects your pelvic vessels it causes pelvic congestion syndrome (reference).

The exact cause of pelvic congestion syndrome is unclear. But risk factors have been identified:

• Previous pregnancy.
• Giving birth to more than one child.
• Hormonal disturbances (estrogen makes veins wider).
• Being a female in the child-bearing period (less common at menopause).
• History of the same condition in a family member.

Features suggesting you have pelvic congestion syndrome:

• Lower abdominal tightness or heaviness. 
• The heaviness or discomfort increased with prolonged standing, walking, or after having sex. 
• It becomes worse during or just before menses.
• Sometimes, you may experience urine urgency.

Consult your doctor if you suspect pelvic congestion syndrome. Your doctor may request pelvic imaging to diagnose the condition.

The treatment of pelvic congestion syndrome may range from simple medication to surgical intervention. Learn more.

4. Ovarian cysts or tumors.

Ovarian cysts are common. They occur naturally and go away within a few months in most cases (reference).

About 8-18% of females in the childbearing period have ovarian cysts (reference).

Symptoms:

• The ovarian cysts cause pain that is similar to ovulation heaviness or pain.
• The heaviness is usually at the lower abdomen, at one side (right or left according to the cyst site).
• Pain during sex.
• The pain is more continuous and prolonged than ovulation pain (it can affect you at any time irrespective of your ovulation and menses).
• A frequent need to urinate.
• Bloating, tummy swelling.
• The heaviness can become more severe up to sharp pain with vomiting. 

Learn More at Mayoclinic.org.

5. Uterine fibroid.

Uterine fibroids are common benign growths in the wall of your uterus. Fibroids are very common. In This  study, the prevalence of fibroid was:

• 40% of caucasian women have fibroids by the age of 35.
• Up to 70% of Caucasian women have fibroids by the age of 50.
• 40% of African American women have fibroids by the age of 35.
• Over 80% of African American females have fibroids by the age of 50.

Symptoms suggestive of uterine fibroids:

• Continous lower abdominal heaviness or tightness in the middle. 
• The tightness turns into pain during menses or when the fibroids get bigger.
• Painful intercourse.
• Increased menstrual bleeding. 
• Lower back pain.
• Urine urgency, frequent urination.

Who are at higher risk of getting uterine fibroids? (reference)

• The risk increases as you grow older.
• Black race (2-3 fold increase in the risk of fibroids).
• Getting older without having a baby or previous pregnancies.
• Early-onset menses (before the age of ten).
• Being obese.
• Eating a diet high in red meat, dairy, low in vitamin D.’
• Alcoholo.
• Having Hypertension. 

6. Gut-related diseases and conditions.

Many gut-related diseases and conditions lead to lower abdominal heaviness or pain. 

Common conditions include:

• Irritable bowel syndrome (IBS): a common functional bowel disease characterized by abdominal pain and changes in bowel habits. Being a female, you have 2.5X fold of getting IBS more than males. Learn more about IBS here.
• Chronic constipation.
• Inflammatory bowel disease.
• Bowel tumors (benign or malignant).
• Food intolerance (as lactose intolerance).
• Diverticular disease.

The pain or heaviness from the colon is more generalized. It usually affects a wider area of your abdomen rather than your lower abdomen. IBS is confined to the lower abdomen in only 13% of patients (Learn More). 

7. urinary bladder heaviness.

Diseases affecting the urinary bladder may lead to lower abdominal heaviness or pain.

Common causes include:

• Cystitis: infection or inflammation of the urinary bladder.
• Urinary bladder stones.
• Urinary bladder gravels.
• Painful bladder syndrome (interstitial cystitis).
• Urinary bladder tumors.

Symptoms suggesting urinary bladder disease:

• Urinary urgency (persistent urge to pee).
• Sense of incomplete evacuation of your bladder after urination.
• ‘Frequent peeing of small amounts.
• Turbid or bloody urine. 
• loin pain.
• with urinary tract infections, you may experience fever, muscle aches, and headaches. 

8. Abdominal wall muscles.

Any tear, stretch, or damage to the muscles of your lower abdomen can cause heaviness, discomfort, or pain. Lower abdominal Heaviness arising from muscles usually occurs due to:

• Intensive workouts (especially abs workouts).
• Lifting heavy objects.
• Sudden twisting or any wrong movements that stretch or tear your abdominal muscles.
• Vigorous coughing or sneezing.

During the moment of strain, you might have felt pain. But later, you may continue to feel lower abdominal pain or discomfort. It can last anywhere from several hours to several weeks.

9. Others (less common)

• Pelvic adhesions (previous abdominal operations).
• Intraabdominal tumors (arising from the colon, bladder, uterus, ovary, and others).
• Hernia (inguinal hernia).
• Chronic Pelvic inflammatory disease.
• Endometriosis.
• Fecal impaction. 
• Inflammation of the peritoneum (peritonitis).

MORE:

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