Abdominal pain is one of the most common complaints that takes patients to hospitals or emergency rooms. Sometimes the pain occurs only in certain circumstances, such as lower and left abdominal pain that occurs when coughing or sneezing that can be extremely annoying and make you worry. To figure out the cause of abdominal pain, sometimes your doctor needs to perform some examinations using imaging techniques such as CT scans or abdominal sonography. In the following article, we will discuss in detail the main causes of abdominal pain with the main focus being on hernia, which is the most common cause of “Pain in lower left abdomen when coughing or sneezing.

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Causes of lower and left abdominal pain

1- Hernia

If you experience lower back and left abdominal pain following sneezing or coughing, or while laughing or lifting a heavy object, you may be suffering from hernia. the lower abdomen is a very common site for hernias. One way of knowing if you have hernia or not is that hernias usually cause pain in the lower left abdomen when coughing or sneezing.

What is a hernia?

When some part of the tissue exits or protrudes through its normal position, it is called a hernia. As the definition shows, hernia can happen in various organs and locations within our body.

The abdomen wall is the most common site for the bowel or intestine hernias, meaning that, it is very common for these organs to pass the weak muscle wall of the abdomen and move out of their original position. The other common site for a hernia to happen is through the weakness of the lower abdominal muscles during which organs may enter the groin.

Abdominal hernia divides into different types. Among them, the inguinal hernia is the most common type of a hernia which can cause lower abdominal pain when sneezing, coughing, lifting heavy objects, or even straining during defecation. In this hernia, part of the right or left intestine comes out of the muscles of the lower abdominal wall and enters the scrotum or labia in male or female patients, respectively.

If any of these hernias occur on the left side of your abdomen, whether it is abdominal, inguinal, or femoral hernia, you will have lower and left abdominal pain when sneezing and coughing.

Cause of hernia (inguinal and femoral):

Generally, the weakness of the abdominal wall muscles is the main cause of these hernias. This weakness may be present at birth or occur later with aging. The later can happened for multiple reasons such as:

• Improper physical activities
• Pregnancy
• Obesity
• Constipation
• Lifting heavy objects
• Chronic coughing
• History of abdominal surgery

General symptoms of hernias:

a) Mass or bulging
One of the common symptoms of a hernia could be the emergence of constant or transient mass around the place hernia is happening.
In the early stage of this complication, a hernia can occasionally exit through abdominal wall and creates mass specially when the pressure inside the abdomen rises with some daily activities.
As the pressure decreases, the involved organ like intestine goes back and the mass disappears. Thus, in the early phase, a hernia causes transient mass. Later as the problem progresses, the bulging and mass become more permanent.

b) Pain
If you have a hernia, you will typically feel no pain. In some cases, mild pain or a slight pressure at the site of a hernia may happen.
This pain and pressure may intensify during certain activities. The pain usually increases with the intensity of the physical activity. These activities include:
•    Lifting a heavy object
•    Sneezing
•    Coughing
•    Running
•    Straining when defecating
•    Laughing or crying hard
Besides all these activities, sneezing and coughing can also cause lower and left abdominal pain in some abdominal and groin hernias like inguinal and femoral hernias, especially when they occur on the left side of the body.

Incisional hernia:
If you have had a history of surgical incisions in the left and lower abdomen, parts of the intestines may be able to overcome the weakness created at the incision site and protrude under the skin, especially if you are not careful when sneezing, coughing, lifting heavy objects, etc. This protrusion can cause pain in the lower and left abdomen.
These hernias that form at the site of the previous incision are called incisional hernias and can be another cause of pain in this area.

2- Sciatica or Discopathy
Like abdominal hernia, lumbar disk herniation that puts pressure on sciatic nerve can also cause pain in the lower abdomen and groin area.
This pain at the groin and lower abdomen usually gets worse as the pressure on herniated disk rises like when you cough or sneeze. The pain may even extend into the leg or foot and has some burning characteristics.

3- Pelvic inflammation disease or PID
The pelvic inflammation disease or PID is one of the most common causes for lower abdomen pain in females.
Any infectious or noninfectious inflammation in the reproductive system may cause pain in the lower abdomen. This pain also gets worse with coughing or sneezing.

4- Pelvic joint inflammation or sacroiliitis
These are some kinds of inflammatory disease that involve pelvic joints and cause pain and stiffness. They are further classified as “seropositive” or “seronegative” sacroiliitis based on whether some inflammation is present or absent in the blood stream, respectively.
The main characteristic of these types of diseases is the presence of morning stiffness in joints. The pain will spread into the left lower abdomen and gets worse by coughing or sneezing.

5- Irritable bowel syndrome or IBS
Although diarrhea is the most common symptom in patients with IBS, but various other problems can accompany irritable bowel syndrome like pain in the lower abdomen.
The exact cause of IBS is unknown, but stress and psychological factors may play a role.
If your left lower abdomen pain gets worse by coughing or sneezing and you have diarrhea and stressful life, then IBS may be the reason.

6- Inflammatory bowel disease; Crohn’s or Ulcerative colitis
Inflammatory bowel disease or IBDs refers to two major diseases, Crohn’s and Ulcerative colitis.
Detailed explanation of these two diseases is beyond this topic. But to explain them briefly, they are inflammatory diseases that involve multiple sites in our body, especially the bowel, and cause ulcer and pain in the abdomen.

7- Bladder problems
Bladder and kidney stones or infections can also cause pain in the lower abdomen which may get worse by any pressure placed on the abdominal area like by coughing and sneezing.
Benign prostate hyperplasia (BPH), and testicle problems may also case abdominal pain.

8- Anal fissure
Anal fissure or ulcer near anal sphincter may cause serious pain while laughing of coughing. The pain is worst during defecation, but it can happen in other circumstances like lifting heavy materials or sneezing as well.

9- Chronic coughs
The recurrent chronic coughs as seen in asthma, can strain and weaken the abdominal muscles and cause the pain in lower abdominal.
This pain can be provoked either directly for example by the pressure placed on abdominal muscle or indirectly like by the creation of a hernia.

10- Pelvic and hip problems
the pain you feel in the lower left or right abdomen may sometimes be due to the malfunctioning of the pelvic biomechanics.
Our pelvic structure consists of specific muscles that strengthen the pelvic and cover it from below.
In general, if these muscles’ scaffold become weak for any reason, including repeated deliveries, surgeries, aging, chronic constipation, or obesity, it may disturb the biomechanics of pelvic girdle and cause various problems such as pain in the lower left abdomen.
In addition to the fact that you may experience urinary and anal incontinence, you may feel pain in the right or left side of the lower abdomen with each cough or sneeze.

11- Causes in pregnant women
In pregnant women, the cause of lower and left abdominal pain can be stretching of the ligaments that hold the uterus. As the uterus gets larger during pregnancy, the ligaments that are attached to the uterus get stretched. In this case, the pregnant woman may experience lower back and left abdominal pain or lower and right abdominal pain when sneezing and coughing, lifting objects, crying and laughing hard, and straining due to constipation.

12- Diverticulitis
Inflammation of the intestinal diverticula is called diverticulitis. These diverticula often develop in the left side of the large intestine named “colon” in the elderly patients and are usually asymptomatic until they become inflamed.

13- Causes related to the digestive system
This includes any movement and function disorder of the large intestine in the lower and left abdomen, chronic constipation, bloating, and intestinal obstruction.

14- Shingles

• Painful and itchy rashes sensitive to touch and burning feeling
• Inflammation of the skin in the lower and left abdomen

15- Less common but serious causes

• Ovarian cysts, ovarian torsion and PID in women
• Orchiditis or inflammation of the testicles and torsion of the testicles in men
• Appendicitis (in rare cases)

The reasons mentioned above are not necessarily associated with lower abdominal pain when coughing or sneezing, but can be exacerbated when sneezing and coughing.
You should remember that lower and left abdominal pain can be a sign of critical and high-risk conditions such as intestinal torsion, intestinal perforation, insufficient blood flow to the intestines (ischemia), and rupture of the abdominal aortic aneurysm, which can be very fatal.
 

As you should have seen by now, there are lots of different causes for this symptom and of course each one would have its own treatment.
For example, the pain caused by a hernia may disappear simply by putting a warm towel on the affected area or you can use anti fissure cream and warm bath to lessen the pain and discomfort caused by ulcers near anal sphincter.

 When to see a doctor when feeling the lower left abdomen pain?

As a simple rule, every acute and sever pain should be examined by the physician if it doesn’t resolve spontaneously in a few days or if it gets worse. After diagnosing the cause of the pain, the pain and discomfort can be reduced significantly by following your doctor’s advices.
Be sure to see your doctor if you experience any of the followings:
•    If you experience recurrence of pain specially when the intervals between pain attacks are reducing
•    If the pain intensity is increasing and progressing
•    If there is fever and lethargy
•    If the pain has become unbearable
•    If you have blood in your stool
•    If you do not have bowel movements or gas
•    If you have high blood pressure
•    If you have a bulge in your groin or abdomen