Colon Pain: What You Should Know

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Pain in the abdomen that is caused by a problem with the colon (large intestine) can occur for several different reasons. Colon pain could be caused by constipation, diarrhea, irritable bowel syndrome (IBS), colitis, diverticular disease, or colorectal cancer.

Because there are so many possibilities, finding the right diagnosis is important to getting the proper treatment. Seeking care from a healthcare professional will help, especially when there’s pain that doesn’t go away in a few days. If you are experiencing ongoing colon pain, contact your healthcare professional.

This article will explore reasons why you may have colon pain and the associated symptoms, when to see your healthcare professional, how they may diagnose your problem, and what treatment may be used.

Diagnosing Colon Pain - Illustration by Katie Kerpel

Verywell / Katie Kerpel

Symptoms

It may be challenging to know when pain is coming from the colon. The colon is located in the abdomen and runs up the right side, across the abdomen, and down the left side. For that reason, pain coming from the colon could cause pain in different parts of the abdomen.

The function of this part of the digestive system is to absorb water and a few nutrients from food. The muscles in the colon contract to move food along. When there is irritation, inflammation, or a blockage in the colon, you may feel pain. If there’s a lack of blood flow to part or all of the colon, you can also experience pain and other symptoms.

  • Abdominal pain (cramping, achiness, or relieved by a bowel movement)
  • Bloating (abdomen feels full and tight)
  • Constipation
  • Diarrhea

Causes

Pain that’s located in the large intestine or colon may be caused by constipation, diarrhea, IBS, colitis, diverticular disease, or colorectal cancer.

Constipation

Constipation is passing hard stools or having a bowel movement less than every three days. It is a common problem that is a condition by itself but can also be a symptom of other disorders. Constipation can cause discomfort, bloating, and abdominal pain

Some of the reasons for chronic constipation are functional constipation (constipation with no specific cause), IBS with constipation (IBS-C), or dyssynergic defecation (difficulty passing stool due to problems with the muscles and nerves of the pelvic floor).

All forms of constipation could cause pain and about 75% of people with chronic constipation report pain. However, IBS-C tends to cause pain more often than the other reasons for constipation.

Diarrhea

Diarrhea is having loose or watery stools three or more times a day. For many causes of diarrhea, abdominal pain is not usually a symptom. However, diarrhea-predominant IBS (IBS-D, Crohn's disease and ulcerative colitis) and inflammatory bowel disease (IBD) might cause diarrhea with abdominal pain. The pain might improve after having a bowel movement.

Anal Pain With Diarrhea

In some cases, diarrhea could cause pain outside of the colon but on the skin of the bottom. Wiping with toilet paper repeatedly could cause skin to become raw or broken.

Irritable Bowel Syndrome

IBS is associated with abdominal pain. The diagnosis of IBS is made using a set of criteria called the Rome Criteria. Having abdominal pain on average for at least one day a week for three months is part of the criteria, along with having other symptoms.

The abdominal pain happens around the time of a bowel movement. The pain might improve after going to the bathroom.

Colitis

Colitis is when there is inflammation in the colon. The inflammation can be caused by a number of diseases, conditions, or infections.

Some of these include Crohn’s disease and ulcerative colitis, ischemic colitis (caused by blocked blood flow to the colon), microscopic colitis, and pseudomembranous colitis (caused by an infection that may follow taking antibiotics).

Inflammation in the colon can cause abdominal pain. It could be chronic in nature if it’s caused by an IBD. Abdominal pain is common in ischemic colitis, microscopic colitis, and pseudomembranous colitis.

Diverticular Disease

Diverticular disease includes diverticulosis and diverticulitis. Diverticulosis is the presence of diverticula (outpouchings in the colon). Diverticulitis is when those pouches become infected and inflamed. 

Diverticulosis usually has no symptoms. Diverticulitis may cause achy or crampy abdominal pain.

Colorectal Cancer

One of the more serious causes of abdominal pain is colon cancer. It's important to remember, though, in most cases, pain in the colon or the abdomen won’t be due to cancer.

In colon cancer, pain is relatively common. The pain tends to be in the lower abdomen and is also sometimes accompanied by constipation.

Diagnosis

Abdominal pain is relatively common. It might not be obvious where exactly the pain is located.

There are so many reasons for pain in the abdomen or the colon, so various tests might be required. The list might be narrowed down by the presence of other symptoms, such as diarrhea, constipation, blood or mucus in the stool, or other things going on outside of the digestive system.

The first things that a healthcare professional will do include a history and a physical exam. This means answering questions about when the pain started, what it feels like, and where (such as the lower abdomen or upper abdomen).

Physical exam: The physical exam might include a look and a listen to the abdomen (with a stethoscope) and feeling it (palpating) for any masses or tender spots. There might also be a rectal exam, in which a lubricated, gloved finger is briefly inserted into the rectum to check for masses, blood, or other signs or symptoms.

Abdominal ultrasound: An ultrasound is a noninvasive test that uses sound waves to make images of the internal organs. This test doesn't use any radiation. It might be done at a doctor's office or an outpatient center.

Colonoscopy: A colonoscopy looks at the inside of the colon directly. It's used to diagnose problems in the large intestine. A colonoscope, with a light and a camera on the end, is inserted into the rectum and up into the colon. This test is usually done under sedation so the patient doesn't feel discomfort.

Computed tomography (CT) scan: A CT scan is a type of X-ray that produces a series of images of the organs in the abdomen. A radiologist can then look at the images to see if there are any problems with the structures in the abdomen.

Lab tests: A complete blood count (CBC) might be done to see the levels of red and white blood cells, hemoglobin (the pigment in red cells that carries oxygen), and platelets (blood cells that aid in clotting). Other blood tests, such as those to test liver enzymes, might also be ordered by a healthcare provider.

Magnetic resonance imaging (MRI): This test uses magnets to create images of the organs inside the body. There's no radiation used in this test, and it provides a better look at the body's soft tissues than other types of tests.

Sigmoidoscopy: This test is similar to a colonoscopy, but the difference is that only the last part of the colon that joins the rectum (the sigmoid colon) can be seen, and it is usually done without sedation. It can also be done in a doctor's office (such as by a gastroenterologist or a colorectal surgeon).

Stool tests: A stool test might be ordered because some causes of pain in the colon are associated with changes in the feces. Some of the things that might be tested for include infections, fecal calprotectin (a protein that may be seen in IBD), and blood.

Upper endoscopy: In an upper endoscopy, a special tube with a camera and a light on the end (an endoscope), is inserted into the mouth and down into the esophagus, stomach, and upper small intestine. This test doesn't include the colon, but it might help rule out the pain coming from a problem in the upper digestive tract.

Treatment

The treatment for abdominal pain from the colon will be based on the cause. Having a diagnosis will be helpful in getting the right treatment.

Constipation: The treatments for constipation that causes abdominal pain will range from home self-care, including drinking water, exercising, and eating enough fiber, to dealing with any underlying causes. In some cases, laxatives might be used to treat constipation.

Severe or chronic constipation might also be treated with prescription medication. For constipation that’s due to an underlying condition, treatment for that disease or condition will also be needed.

Diarrhea: Acute diarrhea that causes pain might be treated with home remedies like the BRAT diet (bananas, rice, applesauce, and toast), drinking more water, and avoiding fatty or gassy foods. Over-the-counter (OTC) drugs that slow down diarrhea might also be used, but only after talking to a doctor.

For chronic diarrhea with pain that’s caused by IBS or IBD, prescription medications and lifestyle changes might also be used to treat the condition.

IBS: IBS causes abdominal pain and might be treated with OTC or prescription medication, dietary changes, and psychotherapy (talk therapy). Dietary changes might include adding more fiber or following a special eating plan, such as the low-FODMAP (fermentable oligo-, di- and monosaccharides, and polyols) diet, which is designed to reduce the level of liquids and gases in your intestines, thereby lowering your risk of abdominal symptoms.

Medications might include antibiotics, antidepressants, laxatives, or medications developed to treat pain and other IBS symptoms.

Colitis: Treating the underlying inflammation will be important to preventing abdominal pain from colitis caused by IBD. IBD is treated with dietary modifications, medications, and lifestyle changes.

Ischemic colitis might be treated in the hospital with antibiotics, intravenous (IV) fluids, and pain management. Clostridium difficile (C.diff) infections (which cause pseudomembranous colitis) might be treated with antibiotics.

Diverticulitis: Pain that’s caused by diverticulitis may improve after treatment with antibiotics and a liquid diet at home. If the condition is more severe or is causing a lot of pain, it might need to be treated in the hospital with IV fluids and fasting.

Colorectal cancer: Pain from colorectal cancer might be treated with pain medications, but the underlying condition will also need to be treated. This might be done with radiation therapy, chemotherapy, or surgery. The treatment will depend on the stage of the cancer and how extensive it is.

When to See a Healthcare Provider

Abdominal pain that’s in the colon may be caused by a variety of reasons. It may take time to find the cause if it’s a chronic condition rather than one that will go away on its own (such as a virus).

When pain continues for a few days, is sudden and sharp, or is accompanied by vomiting, blood in the stool, black or tarry stool, or constipation or diarrhea, see a healthcare professional. If it feels like the pain or other symptoms are an emergency, seek care right away.

Summary

Pain in the colon can be caused by a variety of conditions, which could be either acute (short term or sudden onset) or chronic (ongoing). For pain that goes on for more than a few days or is accompanied by other symptoms like constipation or diarrhea, seeing a healthcare professional for treatment is important.

The treatment used will depend on the reason for the abdominal pain. In some cases, pain management might be part of the treatment.

A Word From Verywell

Abdominal pain that’s lower down can be difficult to cope with and can impact your quality of life. Getting a diagnosis and the right treatment are important. This is especially true when the reason for the pain is chronic or needs treatment.

It can sometimes take time to find the right diagnosis. In some cases, getting a referral to a digestive specialist (a gastroenterologist) might be an option. Being really clear and honest when describing symptoms can also help.

Frequently Asked Questions

  • Can you have colon pain in your back?

    Pain that’s caused by a problem with the colon could feel like pain in the sides or back. This could be because of inflammation in the parts of the colon that are closer to the back.

    Pain in the back can also be caused by a problem with other abdominal organs, so it’s important to discuss this pain with a healthcare professional.

  • Can your colon cause left side pain?

    Pain that’s coming from the colon can cause pain on the left side of the abdomen. People with ulcerative colitis, for instance, report left-sided pain. However, there are many other reasons for this type of pain, so it should be discussed with a healthcare professional.

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