Differential Diagnosis for Radicular Pain to Lower Abdomen or Suprapubic Area

Single Most Likely Diagnosis

• Lumbosacral Radiculopathy: This condition, often due to a herniated disc or spinal stenosis, can cause pain radiating from the lower back down to the suprapubic area or lower abdomen, following the distribution of the affected nerve root, typically L4-S1.

Other Likely Diagnoses

• Urinary Tract Infections (UTIs): Infections of the bladder (cystitis) or kidneys (pyelonephritis) can cause pain in the suprapubic area or lower abdomen, often accompanied by other symptoms like dysuria, frequency, or flank pain.
• Inguinal Hernia: Especially if the hernia is large or incarcerated, it can cause pain in the lower abdomen that may radiate to the suprapubic area.
• Ovarian Cysts or Torsion: In women, ovarian cysts or torsion can cause severe, acute pain in the lower abdomen that may be referred to the suprapubic area.
• Prostatitis: In men, inflammation of the prostate gland can cause pain in the suprapubic area, perineum, or lower back.

Do Not Miss Diagnoses

• Appendicitis: Although the pain typically starts near the navel and then moves to the lower right abdomen, in some cases, especially if the appendix is retrocecal, the pain can be more diffuse or located in the suprapubic area.
• Ectopic Pregnancy: A pregnancy that develops outside the uterus can cause severe, acute pain in the lower abdomen, which may be referred to the suprapubic area, and is a medical emergency.
• Ruptured Aortic Aneurysm: A life-threatening condition where the aorta ruptures, causing severe abdominal or back pain that can radiate to various areas, including the suprapubic region.
• Kidney Stones: While the pain from kidney stones (nephrolithiasis) typically starts in the flank and radiates to the groin, in some cases, it can be felt in the lower abdomen or suprapubic area.

Rare Diagnoses

• Spinal Tumors: Tumors in the spine, whether benign or malignant, can cause radiculopathy leading to pain in the distribution of the affected nerve root, potentially including the suprapubic area or lower abdomen.
• Cauda Equina Syndrome: A condition where the nerves in the spinal canal are compressed, leading to pain, numbness, and potentially severe neurological deficits in the lower limbs and pelvic area.
• Neurogenic Causes: Such as diabetic neuropathy or other forms of peripheral neuropathy that can cause pain in unusual distributions, including the suprapubic area or lower abdomen.