Pain in the Left Iliac Trench: Causes, Triggering Diseases and Treatment

It is a discomfort in the left hip.

This information shows the various causes of pain in the left iliac fossa and how common are these diseases or conditions in the general population.

The iliac fossa

The iliac fossa is a concave, large, smooth surface on the inner surface of the ilium (part of the 3 fused bones that make up the hip bone). The pit is bounded above by the iliac crest, and below by the arcuate line; in front and behind, by the anterior and posterior edges of the ilium.

The fossa gives origin to the Iliacus muscle and is perforated in its internal part by a nutrient channel; below this, there is a smooth and rounded edge, the arched line, which extends from the anterior, inferior and medial.

The causes of pain in the left iliac fossa include:

Diverticulitis

Diverticulitis is the inflammation or infection of small pouches called diverticula that develop along the walls of the intestines.

The formation of the bags themselves is a relatively benign condition known as diverticulosis. The most serious disease, diverticulitis, can involve anything from a small abscess in one or more of the pouches to a massive infection or perforation of the bowel.

The bags can develop in any part of the digestive tract, but more often they form at the end of the two sigmoid and descending points located on the left side of the abdomen.

They also occur frequently in the first section of the small intestine, although they rarely cause problems.

Constipation

Constipation refers to infrequent or difficult-to-pass stools. The stool is often hard and dry. Other symptoms may include abdominal pain, swelling and a feeling that one has not completely passed the bowel movement.

Complications of constipation may include hemorrhoids, anal fissure, or fecal impaction. The normal frequency of bowel movements in adults is between three per day and three per week. Babies often have three to four stools per day, while young children usually have two to three per day.

Constipation has many causes. Common causes include slow movement of stool within the colon, irritable bowel syndrome, and pelvic floor disorders.

Associated underlying diseases include hypothyroidism, diabetes, Parkinson’s disease, celiac disease, non-celiac gluten sensitivity, colon cancer, diverticulitis, and inflammatory bowel disease.

Medications associated with constipation include opioids, certain antacids, calcium channel blockers, and anticholinergics. Of those who take opioids, about 90% develop constipation.

Constipation is more concerning when there is weight loss or anemia, there is blood in the stool, there is a history of inflammatory bowel disease or colon cancer in a person’s family, or it is new in someone who is older.

The treatment of constipation depends on the underlying cause and the duration that has been present. Measures that can help include drinking enough fluids, eating more fiber, and exercising.

If this is not effective, laxatives of the mass-forming agent, the osmotic agent, the stool softener or the type of lubricant can be recommended. Stimulant laxatives are usually reserved for when other types are not effective. Other treatments may include biofeedback or, in exceptional cases, surgery.

Irritable bowel syndrome

Irritable bowel syndrome (IBS) is a group of symptoms, including abdominal pain and changes in the pattern of bowel movements without evidence of underlying damage.

These symptoms occur for a long time, often years. It has been classified into four main types according to whether diarrhea is common, constipation is common, both are common or neither occurs very frequently:

  • Irritable bowel syndrome with diarrhea.
  • Irritable bowel syndrome with constipation.
  • Irritable bowel syndrome with alternating constipation and diarrhea.
  • Irritable bowel syndrome without subtype / not specified (respectively).

Irritable bowel syndrome adversely affects quality of life and can lead to the loss of school or work. Disorders such as anxiety, major depression and chronic fatigue syndrome are common among people with irritable bowel syndrome.

The causes of irritable bowel syndrome are unclear. Theories include combinations of bowel-brain axis problems, bowel motility disorders, pain sensitivity, infections that include bacterial overgrowth in the small intestine, neurotransmitters, genetic factors, and food sensitivity.

The onset can be triggered by an intestinal infection or a stressful life event. Irritable bowel syndrome is a functional gastrointestinal disorder. The diagnosis is based on signs and symptoms in the absence of disturbing characteristics.

Disturbing features include the onset to more than 50 years of age, weight loss, blood in the stool or family history of inflammatory bowel disease.

Other conditions that may occur in a similar manner include celiac disease, microscopic colitis, inflammatory bowel disease, bile acid malabsorption, and colon cancer.

There is no cure for irritable bowel syndrome. The treatment is carried out to improve the symptoms. This may include changes in diet, medications, probiotics and counseling.

Dietary measures include increasing the intake of soluble fiber, a gluten-free diet or a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP).

The medication loperamide can be used to help with diarrhea, while laxatives can be used to help with constipation. Antidepressants can improve symptoms and pain in general. Patient education and a good doctor-patient relationship are an important part of care.

It is believed that around 10 to 15% of people in the developed world are affected by irritable bowel syndrome. It is more common in South America and less common in Southeast Asia.

It is twice as common in women as in men and typically occurs before age 45. The condition seems to become less common with age. Irritable bowel syndrome does not affect life expectancy or cause other serious diseases.

The first description of the condition was in 1820, while the current term ” irritable bowel syndrome ” came into use in 1944.

Pelvic inflammatory disease

Pelvic inflammatory disease or pelvic inflammatory disorder (IPT) is an infection of the upper part of the female reproductive system, namely the uterus, the fallopian tubes and the ovaries, and inside the pelvis. Often there may be no symptoms.

Signs and symptoms, when present, may include lower abdominal pain, vaginal discharge, fever, burning during urination, pain with sex, or irregular menstruation. Untreated pelvic inflammatory disorder can result in long-term complications including infertility, ectopic pregnancy, chronic pelvic pain and cancer.

The disease is caused by bacteria that spread from the vagina and cervix. Neisseria gonorrhoeae or Chlamydia trachomatis infections are present in 75 to 90 percent of cases.

Often multiple different bacteria are involved. Without treatment, approximately 10 percent of those who have a chlamydial infection and 40 percent of those who have a gonorrhea infection will develop a pelvic inflammatory disorder.

The risk factors are similar to those of sexually transmitted infections in general and include a high number of sexual partners and drug use. Vaginal douching can also increase the risk.

The diagnosis is usually based on the signs and symptoms that occur. It is recommended to consider the disease in all women of childbearing age who have low abdominal pain.

The definitive diagnosis of pelvic inflammatory disorder is made by finding pus that affects the fallopian tubes during surgery. Ultrasound may also be useful in the diagnosis.

Efforts to prevent the disease include not having sex or having few sexual partners and using condoms. The detection of women at risk for chlamydial infection followed by treatment decreases the risk of pelvic inflammatory disease.

In those with mild or moderate symptoms, a single injection of the antibiotic ceftriaxone is recommended along with two weeks of doxycycline and possibly metronidazole orally.

For those who do not improve after three days or who have a serious illness, intravenous antibiotics should be used.

It is estimated that it affects approximately 1.5 percent of young women annually. In the United States, the pelvic inflammatory disorder is estimated to affect around one million people per year.

A type of intrauterine device (IUD) known as the Dalkon shield caused an increase in rates of pelvic inflammatory disorder in the 1970s. Current intrauterine devices are not associated with this problem after the first month.

Carcinoma rectal

Colorectal cancer (CRC), also known as colon and colon cancer, is the development of cancer in the colon or rectum (parts of the large intestine). A cancer is the abnormal growth of cells that have the ability to invade or spread to other parts of the body.

The signs and symptoms may include blood in the stool, a change in bowel movements, weight loss and feeling tired all the time.

Most colorectal cancers are due to old age and lifestyle factors with only a small number of cases due to underlying genetic disorders. Some risk factors include diet, obesity, smoking and lack of physical activity.

Dietary factors that increase risk include red and processed meat, as well as alcohol. Another risk factor is inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis .

Some of the hereditary genetic disorders that can cause colorectal cancer include familial adenomatous polyposis and hereditary nonpolyposis colon cancer; however, they represent less than 5% of cases.

It usually begins as a benign tumor, often in the form of a polyp, which eventually becomes cancerous.

Bowel cancer can be diagnosed by getting a sample of the colon during a sigmoidoscopy or colonoscopy . This is followed by medical images to determine if the disease has spread.

Screening is effective in preventing and decreasing deaths from colorectal cancer. Detection, by one of several methods, is recommended from 50 to 75 years. During colonoscopy, small polyps can be removed if they are found.

If a large polyp or tumor is found, a biopsy may be done to check if it is cancerous. Aspirin and other nonsteroidal anti-inflammatory drugs decrease the risk.

However, its general use is not recommended for this purpose, due to side effects.

The treatments used for colorectal cancer may include some combination of surgery, radiotherapy, chemotherapy and targeted therapy.

Cancers that are confined within the wall of the colon may be curable by surgery, while cancer that is widely disseminated is generally not curable, and treatment is aimed at improving quality of life and symptoms.

The five-year survival rate in the United States is around 65%. The individual chance of survival depends on how advanced the cancer is, whether the entire cancer can be removed with surgery or not, and the general health of the person.

Worldwide, colorectal cancer is the third most common type of cancer, accounting for approximately 10% of all cases. In 2012, there were 1.4 million new cases and 694,000 deaths from the disease.

It is more common in developed countries, where more than 65% of cases are found. It is less common in women than in men.

Ulcerative colitis

Ulcerative colitis (UC) is a long-term condition that causes inflammation and ulcers in the colon and rectum. The main symptom of active disease is abdominal pain and diarrhea mixed with blood. There may also be weight loss, fever and anemia.

Often, the symptoms appear slowly and can vary from mild to severe. Symptoms usually occur intermittently with periods without symptoms between eruptions. Complications can include megacolon, inflammation of the eye, joints or liver and colon cancer.

The cause of ulcerative colitis is unknown. The theories involve dysfunction of the immune system, genetics, changes in normal intestinal bacteria and environmental factors.

Rates tend to be higher in the developed world, and some propose that this is the result of less exposure to intestinal infections, or a western diet and lifestyle.

Removing the appendix at an early age can be protective. The diagnosis is usually by colonoscopy with tissue biopsies. It is a type of inflammatory bowel disease (IBD) along with Crohn’s disease and microscopic colitis.

Changes in diet can improve symptoms, such as maintaining a high-calorie diet or a lactose-free diet.

Several medications are used to treat symptoms and cause and maintain remission, including aminosalicylates such as sulfasalazine, steroids, immunosuppressants such as azathioprine, and biologic therapy.

Removal of the colon by surgery may be necessary if the disease is severe, does not respond to treatment, or if complications such as colon cancer develop. The removal of the colon and rectum can cure the disease.

Along with Crohn’s disease, around 112 million people were affected as of 2015. Each year it occurs again from 1 to 20 per 100,000 people, and from 5 to 500 per 100,000 people are affected.

The disease is more common in North America and Europe than in other regions. It often begins in people between 15 and 30 years old, or among people older than 60 years. Men and women seem to be affected in equal proportions. It has also become more common since the 1950s.

Collectively, ulcerative colitis and Crohn’s disease affect approximately one million people in the United States. With adequate treatment, the risk of death seems to be the same as that of the general population. The first description of ulcerative colitis occurred around the 1850s.

Ectopic pregnancy

Ectopic pregnancy, also known as tubal pregnancy, is a complication of pregnancy in which the embryo sticks outside the uterus. The signs and symptoms classically include abdominal pain and vaginal bleeding.

Less than 50 percent of affected women have both symptoms. The pain can be described as acute, dull or cramping. The pain can also spread to the shoulder if there has been a hemorrhage in the abdomen.

Severe bleeding can cause a rapid heart rate, fainting or shock. With very rare exceptions, the fetus can not survive.

Risk factors for ectopic pregnancy include: pelvic inflammatory disease, often due to chlamydia infection, smoking, previous tubal surgery, history of infertility, and use of assisted reproductive technology.

Those who have had an ectopic pregnancy previously are at a much greater risk of having another. Most ectopic pregnancies (90%) occur in the fallopian tube, which are known as tubal pregnancies.

Implantation can also occur in the cervix, ovaries or inside the abdomen. The detection of ectopic pregnancy is typically done by blood tests for human chorionic gonadotropin (hCG) and ultrasound. This may require tests on more than one occasion.

Ultrasound works best when it is done from inside the vagina. Other causes of similar symptoms include: spontaneous abortion, ovarian torsion and acute appendicitis.

Prevention is to reduce risk factors, such as chlamydia infections, through screening and treatment. Although some ectopic pregnancies will be resolved without treatment, this approach has not been well studied since 2014.

The use of the drug methotrexate works as well as surgery in some cases. Specifically, it works well when beta-HCG (pregnancy hormone) is low and the size of the ectopic is small.

Surgery is still generally recommended if the tube is broken, there is a fetal heartbeat or the person’s vital signs are unstable. The surgery can be laparoscopic or through a larger incision, known as a laparotomy . The results are generally good with treatment.

The rate of ectopic pregnancy is around 1 and 2% of that of live births in developed countries, although it can be as high as 4% among those who use assisted reproductive technology.

It is the most common cause of death among women during the first trimester, approximately 10% of the total. In the developed world, the results have improved, while in the developing world they often remain poor.

The risk of death among people in the developed world is between 0.1 and 0.3 percent, while in the developing world it is between one and three percent.

The first known description of an ectopic pregnancy is by Al-Zahrawi in the eleventh century. The word “ectopic” means “out of place.”

Treatment

This depends on the diagnosis and is the underlying disorder.

An acute abdomen and / or a hemodynamically unstable patient will require immediate referral to the hospital for further evaluation. If an ectopic pregnancy is suspected, refer to emergency care immediately.

The respiratory tract, breathing and circulation should be evaluated and managed appropriately. The traditional teaching was that analgesia should not be given to patients with an acute abdomen before seeing a surgeon, since it can suppress physical signs.

This has been subject to much debate and the modern opinion is that it is not necessary to withhold pain relief. The doctor who receives the analgesia should be informed.

A Cochrane systematic review published in 2007 provided some evidence to support the notion that the use of opioid analgesics in patients with abdominal pain is useful in terms of comfort for the patient and does not delay treatment decisions.

Non-steroidal anti-inflammatory drugs are good analgesics. A GP should have a high index of suspicion, especially in girls and adolescent women due to the possible effect on fertility if an operation is delayed.

Very often, a general practitioner will refer a patient to the hospital, the patient will be admitted and observed, and discharged without surgery. You should not feel that this was an inappropriate admission.