What could be causing intermittent pain in the lower left abdomen that lasts 2-8 minutes and then resolves?

Intermittent Left Lower Quadrant Pain: Differential Diagnosis and Management

Your brief episodes of left lower quadrant pain lasting 2-8 minutes that spontaneously resolve are most consistent with either intermittent colonic spasm (as seen in irritable bowel syndrome) or early/mild diverticular disease, but you need clinical evaluation to distinguish between benign functional disorders and potentially serious structural pathology.

Most Likely Diagnoses Based on Your Symptom Pattern

Irritable Bowel Syndrome (IBS)

• IBS classically presents with colicky abdominal pain that is intermittent and crampy in nature, most commonly occurring on the left side 1
• The pain in IBS is typically related to bowel movements or dietary triggers and may be accompanied by bloating, though bloating can vary throughout the day 1, 2
• Pain episodes lasting minutes and resolving spontaneously fit the pattern of colonic spasm, which is a hallmark of IBS 3
• IBS pain is often triggered by eating and may be associated with altered bowel habits (diarrhea, constipation, or alternating patterns) 1

Early or Intermittent Diverticular Disease

• Diverticulitis is the most common cause of left lower quadrant pain in adults, though it typically presents with more persistent pain 4, 5
• Brief episodes of pain could represent intermittent diverticular inflammation or spasm that resolves before progressing to full diverticulitis 6
• Diverticular disease can cause intermittent symptoms between acute episodes 4

Red Flags Requiring Immediate Emergency Evaluation

You must seek emergency care immediately if you develop any of the following 7:

• Fever (temperature >38°C/100.4°F)
• Inability to pass gas or stool
• Severe abdominal tenderness with guarding or rebound tenderness
• Vomiting, especially if persistent
• Bloody stools or rectal bleeding
• Signs of shock (rapid heartbeat, lightheadedness, confusion)
• Pain that becomes constant and progressively worsens over hours to days

Recommended Diagnostic Approach

Initial Clinical Assessment

• Clinical diagnosis alone is unreliable for left lower quadrant pain, with misdiagnosis rates between 34-68% 7
• You should undergo evaluation including assessment for fever, leukocytosis, and inflammatory markers (CRP), though the classic triad of left lower quadrant pain, fever, and leukocytosis is present in only 25% of diverticulitis cases 7

Imaging Strategy

• CT abdomen and pelvis with IV contrast is the preferred imaging modality if your symptoms persist, worsen, or are accompanied by any red flag features, with 98% diagnostic accuracy 7
• The American College of Radiology rates CT with IV contrast as 8/9 (usually appropriate) for evaluating left lower quadrant pain 4, 7
• However, imaging may not be necessary if you have mild, intermittent symptoms without fever or signs of peritonitis, and conservative outpatient management is appropriate in this scenario 7

When to Obtain Imaging

You should proceed to CT imaging if 7:

• Fever develops
• Pain becomes severe or progressively worsening
• You cannot tolerate oral intake
• Signs of peritonitis develop (severe tenderness, guarding)
• Symptoms persist beyond 2-3 days despite conservative management

Conservative Management for Mild Intermittent Pain

If No Red Flags Are Present

• Conservative outpatient management without antibiotics is appropriate for mild, intermittent left lower quadrant pain in the absence of fever or peritonitis 7
• Monitor for development of red flag symptoms that would require immediate evaluation 7
• Consider dietary modifications if symptoms are related to eating 1

Additional Testing to Consider

• Coeliac screening test should be undertaken to rule out celiac disease 1
• Inflammatory markers (CRP or ESR) can help distinguish inflammatory conditions from functional disorders 1
• Fecal calprotectin is a marker for gastrointestinal inflammation; a negative test almost certainly rules out inflammatory bowel disease, especially with normal CRP 1

Important Caveats and Pitfalls

Don't Assume It's Benign Without Evaluation

• Functional bowel disorders become the most likely diagnosis only after structural pathology has been excluded by appropriate testing 6
• Weight loss, anemia, or change in bowel habits warrant colonoscopy despite the intermittent nature of your pain 6
• New or persistent symptoms require re-evaluation even if initial workup was negative 6

Special Considerations

• If you are a premenopausal woman, gynecologic causes should be considered, and pelvic/transvaginal ultrasound may be indicated if there's concern for ovarian or fallopian tube pathology 4, 7
• Cyclical pain in women suggests gynecologic etiology requiring pelvic ultrasound 6

Follow-Up Strategy

• If symptoms persist or recur frequently despite conservative management, gastroenterology referral is appropriate for further evaluation and management of potential functional bowel disorder 6
• Repeat imaging is generally not indicated unless new symptoms develop or significant time has passed 6