Left lower abdominal pain and diarrhea—could this point to the colon specifically?

Left Lower Abdominal Pain and Diarrhea—Could This Point to the Colon Specifically?

Left lower abdominal pain and diarrhea often go hand-in-hand and can be unsettling. While many causes are benign and self-limiting, the combination of crampy pain in the left lower quadrant and loose stools can indeed point toward conditions affecting the colon. This guide walks you through the most common colon-related culprits, when to seek help, and how your doctor will evaluate these symptoms.

Why the Left Lower Abdomen?

The left lower quadrant (LLQ) houses several structures, including:

• The sigmoid colon
• Part of the descending colon
• Portions of the small intestine
• The left ureter
• In women, the left ovary and fallopian tube

Pain originating from the colon often presents as a crampy or ache-like sensation in this area. When accompanied by diarrhea, the colon’s involvement becomes more likely.

Common Colon-Related Causes

1. Irritable Bowel Syndrome (IBS)

• A functional disorder where the colon and brain interact abnormally (Chey et al., 2015).
• IBS-D (diarrhea-predominant) often features LLQ cramping relieved by bowel movements.
• No structural damage is found on tests, but symptoms can be chronic and impact quality of life.

Key features of IBS-D:

• Recurrent abdominal pain for ≥1 day/week in the last 3 months
• Pain related to stool frequency or form
• Often stresses or food triggers worsen symptoms

2. Diverticulitis

• Small pouches (diverticula) in the colon wall become inflamed or infected.
• Classic in people over 50, but can occur earlier.
• Presents with steady LLQ pain, fever, and sometimes diarrhea or constipation.

Red flags:

• High fever
• Severe pain or signs of perforation (rigid abdomen)
• Bowel obstruction symptoms

3. Infectious Colitis

• Bacterial (Campylobacter, Salmonella, Shigella, E. coli), parasitic, or Clostridioides difficile infections.
• Often sudden onset of frequent, watery or bloody diarrhea, LLQ cramps, and sometimes fever.
• Travel history, antibiotic use, or food exposures can offer clues.

Diagnosis & treatment:

• Stool cultures or toxin assays
• Hydration and, if needed, targeted antibiotics

4. Inflammatory Bowel Disease (IBD)

• Ulcerative colitis (UC) typically starts in the rectum and extends up the colon, often affecting the left side.
• Crohn’s disease can involve any part of the GI tract but may cause LLQ pain when the sigmoid or descending colon is involved.
• Symptoms: bloody diarrhea, urgency, weight loss, systemic signs.

Evaluation:

• Blood tests (inflammatory markers)
• Colonoscopy with biopsy

5. Ischemic Colitis

• Reduced blood flow to part of the colon, often in older adults or those with vascular disease.
• Sudden LLQ pain followed by bloody diarrhea.
• May require hospitalization and vascular evaluation.

Key clues:

• Cardiovascular risk factors (e.g., atherosclerosis, low blood pressure)
• Abrupt symptom onset

6. Colonic Neoplasia (Less Common)

• Colon cancer or large polyps can cause changes in bowel habits and discomfort.
• Often present in older adults, with subtle LLQ pain and intermittent diarrhea or constipation.
• Rarely the first sign, but warrants consideration if risk factors (family history, polyps) exist.

Other Possible Causes (Non-Colon)

While the colon is a frequent source, consider:

• Kidney stones (sharp pain radiating to the groin, usually no diarrhea)
• Ovarian cysts or torsion (women; may have nausea but not true diarrhea)
• Urinary tract infections (painful urination, frequent urges)
• Small intestinal infections or malabsorption

When to Seek Medical Attention

Most mild episodes of LLQ pain and diarrhea resolve in a few days. However, seek prompt care if you experience any of the following:

• Severe, unrelenting abdominal pain
• High fever (above 101°F/38.3°C)
• Bloody stools or black, tarry stools
• Signs of dehydration: dizziness, dry mouth, dark urine
• Unexplained weight loss or night sweats
• Symptoms lasting more than 48–72 hours without improvement

How Doctors Evaluate These Symptoms

1. Detailed history
   • Onset, duration, triggers, relieving factors
   • Travel, food exposures, medication use
   • Family history of GI disease
2. Physical exam
   • Abdominal tenderness, guarding, signs of peritonitis
3. Laboratory tests
   • CBC (white blood cells for infection/inflammation)
   • Inflammatory markers (CRP, ESR)
   • Stool studies (culture, ova/parasites, C. difficile toxin)
4. Imaging
   • Abdominal ultrasound or CT scan (diverticulitis, stones, ischemia)
5. Endoscopy
   • Colonoscopy or flexible sigmoidoscopy for direct view and biopsy

Treatment Overview

Treatment depends on the underlying cause:

• IBS-D:

• Diet modifications (low-FODMAP)
• Fiber adjustments
• Antispasmodics or low-dose antidepressants

• Diverticulitis:

• Antibiotics (if infection suspected)
• Liquid diet progressing to low-residue foods
• Surgery for recurrent, complicated cases

• Infectious Colitis:

• Rehydration (oral or IV fluids)
• Targeted antibiotics if bacterial

• IBD:

• Anti-inflammatories (mesalamine, steroids)
• Immune modulators (azathioprine, biologics)
• Surgery in refractory cases

• Ischemic Colitis:

• Supportive care (IV fluids, bowel rest)
• Vascular evaluation and possible intervention

Tips to Manage Mild Symptoms at Home

• Stay hydrated: sip clear fluids or electrolyte solutions.
• Eat a bland diet: bananas, rice, applesauce, toast (BRAT diet).
• Apply heat: a warm compress can ease cramping.
• Track triggers: keep a food and symptom diary.

If symptoms persist or worsen, it’s time to consult a healthcare professional.

Check Your Symptoms Online

You might consider doing a free, online symptom check for left lower abdominal pain and diarrhea. This can help you understand possible causes and guide your next steps.

Final Thoughts

While many instances of left lower abdominal pain and diarrhea are due to functional issues like IBS or mild infections, it’s important not to ignore warning signs. Conditions such as diverticulitis, IBD, or ischemic colitis require timely diagnosis and treatment to avoid complications.

Always speak to a doctor if you experience severe or persistent symptoms, any red-flag signs, or if you’re concerned about your health. Early evaluation can make a significant difference in outcomes.