Lower abdominal pain in men can stem from dozens of different conditions, ranging from a pulled muscle to a surgical emergency. The most common acute causes tend to be digestive in origin, with appendicitis dominating on the right side and diverticulitis on the left, but several male-specific conditions, including testicular torsion, epididymitis, and prostate-related disorders, can produce pain that localizes to the lower abdomen rather than the groin or genitals. That mismatch between where the problem is and where the pain shows up is actually one of the trickiest parts of getting the right diagnosis.
Right Side Versus Left Side
The side of the pain often gives the first diagnostic clue. Right lower quadrant pain in an otherwise healthy man triggers concern for appendicitis, the single most common reason for emergency abdominal surgery. A typical case involves pain that starts vaguely around the navel, then migrates to the right lower abdomen over several hours, accompanied by nausea and a low-grade fever. But appendicitis does not always follow the textbook script. Chronic appendicitis, a less familiar variant, can cause recurring right-sided pain over weeks or months without the classic fever or tenderness, sometimes showing up on a CT scan only as a thickened appendix with an appendicolith (a small calcified deposit).1PubMed. Chronic appendicitis “syndrome” manifested by an appendicolith and thickened appendix presenting as chronic right lower abdominal pain in adults
On the left side, the leading cause of acute pain in adults is diverticulitis, an infection or inflammation of small pouches that form in the wall of the colon.2PubMed. ACR Appropriateness Criteria Left Lower Quadrant Pain-Suspected Diverticulitis The pain tends to be steady rather than crampy, often worsens over a day or two, and may come with fever and a change in bowel habits. Diverticulitis is far more common after middle age, though it does show up in younger men occasionally.
Inflammation of the terminal ileum, the last segment of the small intestine where it meets the colon, is another source of right lower quadrant pain. When this inflammation is acute and self-limited, bacterial infections are a frequent cause, but chronic or recurring ileitis is strongly associated with Crohn’s disease.3PubMed Central. Ileitis: when it is not Crohn’s disease The distinction matters because Crohn’s requires long-term management, while an infectious episode usually resolves on its own.
Testicular Torsion and Why Doctors Should Check Below the Belt
One of the most commonly missed causes of lower abdominal pain in young men is testicular torsion, a condition where the spermatic cord twists and cuts off blood supply to the testicle. You might assume the pain would be felt in the scrotum, and it usually is, but a meaningful fraction of cases present as abdominal pain instead. In one study of 76 torsion cases, about 12% came to the emergency room complaining primarily of lower abdominal pain rather than scrotal pain, and the pain was on the same side as the affected testicle.4PubMed Central. Clinical evaluation of testicular torsion presenting with acute abdominal pain in young males Seven of those nine patients were initially misdiagnosed as having a routine abdominal problem because nobody examined the genitals.
That is a dangerous miss. Testicular torsion is a true emergency: the testicle can be saved if surgery happens within about six hours, but the odds drop steeply after that. The takeaway from the research is that a genital exam should be part of the workup whenever a young male presents with unexplained lower abdominal pain.5PubMed. Management and outcomes of pediatric patients with testicular torsion initially presenting as acute abdominal pain If you are a man or the parent of a teenage boy and the emergency department skips this step, it is worth requesting it.
Epididymitis and Other Reproductive Infections
Epididymitis, an inflammation of the coiled tube at the back of the testicle, is one of the most frequent causes of scrotal pain in adult men. It typically develops over a few days, causing progressive swelling and tenderness on one side. In younger men, sexually transmitted infections like chlamydia and gonorrhea are the usual culprits; in older men, urinary tract bacteria are more often to blame. Without adequate treatment, the infection can spread to the testicle itself within days.6European Urology Supplements. Acute and Chronic Epididymitis Pain from epididymitis can radiate into the lower abdomen, which sometimes leads to confusion with appendicitis or a kidney stone.
Less well known is seminal vesiculitis, an infection of the seminal vesicles that sit just behind the bladder. Symptoms can include pelvic pain, blood in the semen, and irritative urinary symptoms.7PubMed Central. Detecting diseases of neglected seminal vesicles using imaging modalities: A review of current literature Because the seminal vesicles are deep in the pelvis and not easily examined, this condition is frequently overlooked. In rare cases it can cause enough swelling to obstruct a ureter.8PubMed Central. Seminal Vesiculitis: A Rare Cause of Unilateral Ureteric Obstruction
Hernias and Sports Hernias
An inguinal hernia, where tissue pushes through a weak spot in the lower abdominal wall into the groin, is far more common in men than in women. It is not always the painless bulge people picture. A study comparing hernia patients with matched controls found that groin pain, genital pain, and even urinary symptoms and increased bowel activity were all significantly more common in people with inguinal hernias.9PubMed. Do we really know the symptoms of inguinal hernia? The pain is typically worse with coughing, straining, or standing for long periods. A hernia that suddenly becomes very painful and cannot be pushed back in may be incarcerated or strangulated, which requires urgent surgery.
Athletic pubalgia, commonly called a sports hernia, is a different animal. Despite the name, there is no actual hernia. Instead, the condition involves weakening or tearing of the muscles and tendons where the lower abdominal wall attaches to the pubic bone. It shows up most often in athletes who do a lot of twisting and cutting movements. The pain typically centers in the groin and lower abdomen and can radiate toward the inner thigh and perineum.10PubMed. Athletic Pubalgia (Sports Hernia): Presentation and Treatment Unlike a standard hernia, there is no visible bulge on exam, and imaging findings can be subtle, which is why diagnosis is often delayed. Conservative treatment with physical therapy focused on core stabilization is the first line of approach.11PubMed Central. Athletic pubalgia and associated rehabilitation
Chronic Pelvic Pain Syndrome
Among the most frustrating conditions for both patients and doctors is chronic pelvic pain syndrome, sometimes still referred to as chronic prostatitis. This diagnosis is given when a man has persistent pelvic or perineal pain for three months or longer and no identifiable infection or structural cause can be found. The pain often sits in the lower abdomen, the area between the scrotum and anus, or at the tip of the penis, and it can come with urinary urgency, difficulty starting urination, or sexual dysfunction.12PubMed Central. Chronic Primary Pelvic Pain Syndrome in Men The cause appears to be multifactorial, involving some combination of nerve sensitization, pelvic floor muscle dysfunction, and psychological stress.13PubMed Central. Clinical Evaluation of a Pollen-Extract-Based Phytotherapy Compared to Conventional Therapies in Chronic Prostatitis and Chronic Pelvic Pain Syndrome
Treatment tends to be multimodal. Pelvic floor physical therapy, stress management, and anti-inflammatory medications are commonly tried. Some emerging research has looked at laser-based approaches; a small study of 51 men with an average age of 37 found that a non-ablative laser treatment reduced prostate swelling and improved symptoms for at least a year with no adverse effects, though the evidence is still preliminary.14The Journal of Sexual Medicine. NON-ABLATIVE ERBIUM YAG LASER TREATMENT FOR CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME For many men, the condition waxes and wanes over years, and finding the right combination of therapies requires patience.
Bladder and Prostate Problems
As men get older, the prostate gland gradually enlarges, a condition called benign prostatic hyperplasia, or BPH. While BPH is best known for causing a weak urinary stream and nighttime trips to the bathroom, it can also produce a dull, pressure-like discomfort in the lower abdomen, especially when the bladder is not emptying properly. Urinary retention, the inability to fully empty the bladder, is the most common single cause of which is BPH-related obstruction.15Emergency Medicine Clinics of North America. Urinary Retention Chronic retention can lead to a cascade of complications including bladder stones, recurrent urinary infections, and even kidney damage.16PubMed Central. Management of the complications of BPH/BOO
A full bladder that cannot drain is also surprisingly painful in its acute form. Acute urinary retention is a medical emergency: the lower abdomen becomes distended and extremely tender, and the condition requires catheter drainage. Any man who suddenly cannot urinate and feels increasing suprapubic pressure should seek immediate care.
Nerve Entrapment and Abdominal Wall Pain
Not all lower abdominal pain comes from the organs inside the abdomen. The ilioinguinal nerve runs through the muscles of the lower abdominal wall and can become trapped or irritated, producing a burning or shooting pain in the lower abdomen and upper inner thigh.17PubMed. Ilioinguinal Neuropathy This sometimes happens after inguinal hernia repair or other lower abdominal surgery, but it can also occur without a clear trigger.
One simple bedside test, Carnett’s test, helps distinguish abdominal wall pain from pain coming from the organs. The examiner presses on the tender spot while the patient tenses the abdominal muscles by lifting the head or legs. If the pain gets worse with tensing, the source is likely in the abdominal wall itself rather than inside the abdomen.18PubMed. The Diagnostic Value of Carnett’s Test with Chronic Abdominal Pain: A Narrative Review This distinction is useful because abdominal wall pain is often treated very differently, sometimes with a simple nerve block, while visceral causes may require imaging and further workup.
Vascular Causes That Are Easy to Miss
Abdominal aortic aneurysm, a dangerous ballooning of the body’s largest artery, is a cause of lower abdominal or back pain that can be overlooked because it often mimics musculoskeletal complaints. When symptomatic, an AAA usually presents with abdominal pain, flank pain, or signs of reduced blood flow to the legs.19PubMed Central. Abdominal Aortic Aneurysm: An Overlooked Etiology of Low Back Pain In one reported case, a patient came in for what he thought was low back pain: nothing made it better or worse, there was no injury to point to, and the pain was constant, including at night. A pulsating mass was found on abdominal exam, and imaging confirmed a 5.5-centimeter aneurysm.20PubMed. Abdominal aortic aneurysm in a patient with low back pain AAAs are far more common in men over 60 who smoke or have high blood pressure. Patients with the inflammatory variant tend to be younger and are more often symptomatic.21JAMA. Inflammatory Abdominal Aortic Aneurysm
Ischemic colitis, where part of the colon loses blood flow, is another vascular cause of lower abdominal pain. It is most associated with elderly patients who have cardiovascular disease, with one imaging study reporting a mean patient age of 72.22PubMed. Ischemic colitis: CT evaluation of 54 cases The pain typically comes on suddenly and is followed by bloody diarrhea. It is worth knowing about because younger men who take certain medications (particularly vasoconstrictors and some stimulant drugs) can develop it too.23PubMed Central. Ischemic colitis
How Age Shifts the Odds
A large emergency department study of over 5,300 patients with acute abdominal pain found that the likely cause varies substantially by age. In patients under 65, kidney stones (renal colic) were the single most common reason men came to the emergency room with abdominal pain, while nonspecific abdominal pain (meaning no clear diagnosis after initial testing) was the leading category in women. After age 65, gallbladder disease and diverticulitis both became significantly more common, while appendicitis and kidney stones grew less frequent.24PubMed Central. Epidemiology and outcomes of acute abdominal pain in a large urban Emergency Department: retrospective analysis of 5,340 cases This does not mean a 70-year-old cannot get appendicitis or a 25-year-old cannot develop diverticulitis, but the base rates shift enough that age should inform which conditions you and your doctor think about first.
How Doctors Figure Out What Is Going On
Ultrasound is recommended by European guidelines as the first-line imaging test for suspected appendicitis and suspected diverticulitis, with CT reserved for cases where ultrasound is inconclusive.25Ultrasonography. Non-traumatic lower abdominal pain: ultrasonographic and clinical differential diagnosis CT has a clear accuracy advantage: one head-to-head comparison found CT detected appendicitis with 94% sensitivity versus 76% for ultrasound, and diverticulitis with 81% sensitivity versus 61%.26PubMed Central. A comparison of the Accuracy of Ultrasound and Computed Tomography in common diagnoses causing acute abdominal pain The trade-off is radiation exposure, cost, and the time required, which is why many emergency departments use ultrasound as a screening step and escalate to CT when needed.
For left-sided pain specifically, a study comparing different diagnostic approaches against CT as the reference standard found that physical examination alone had the highest sensitivity for catching urgent conditions (about 75%), while ultrasound had the best overall accuracy at roughly 51%.27PubMed Central. Diagnostic Value of Physical Examination, Ultrasound, and Radiography Compared to Computed Tomography in the Evaluation of Nontraumatic Left Lower Quadrant Acute Abdominal Pain Plain X-rays performed poorly across the board, so if your doctor orders a CT after an inconclusive exam and ultrasound, that is a reasonable escalation rather than overkill.
Post-Vasectomy Pain
Roughly half a million vasectomies are performed each year in the United States, and about one to two percent of those men develop chronic testicular pain lasting more than three months afterward.28PubMed Central. Post-vasectomy pain syndrome: diagnosis, management and treatment options Post-vasectomy pain syndrome can manifest as a dull ache in the scrotum, groin, or lower abdomen that worsens with ejaculation or physical activity. The suspected mechanisms include nerve damage during surgery, inflammation compressing nerves in the spermatic cord, and back-pressure from congestion in the epididymis. The diagnosis is one of exclusion, meaning other causes of scrotal and pelvic pain need to be ruled out first. Treatment ranges from anti-inflammatory medications and spermatic cord blocks to, in refractory cases, vasectomy reversal or denervation of the spermatic cord. If you had a vasectomy months or years ago and are experiencing new lower abdominal or groin pain, it is worth mentioning the surgical history to your doctor even if it feels unrelated.
Irritable Bowel Syndrome in Men
IBS is often thought of as a condition affecting women, and it is diagnosed more frequently in women, but men get it too and tend to experience it differently. Research comparing men and women with IBS found that men had fewer contacts with the healthcare system, fewer co-occurring psychiatric conditions, fewer sleeping problems, and less chronic pain in other parts of the body. Men with IBS also reported less urgency to defecate and less nausea but had higher stool frequency.29Neurogastroenterology & Motility. Symptoms and health experience in irritable bowel syndrome with focus on men Those differences may partly explain why men are underdiagnosed: they have fewer of the classic symptoms that trigger an IBS workup, and they are less likely to seek medical attention for ongoing gut complaints. Lower abdominal cramping that comes and goes, fluctuates with stress, and is associated with changes in stool pattern is the hallmark presentation, regardless of sex.