Lower abdominal pain in males most commonly comes from the intestines, since the small and large bowel take up most of the space in the lower abdomen. Everyday causes like gas, constipation, and indigestion account for many cases. But several conditions specific to male anatomy, including hernias, prostate problems, and testicular issues, can also produce pain in this area. Where exactly the pain sits, how it started, and what other symptoms come with it all help narrow down the cause.
Digestive Causes: The Most Common Culprits
Because your intestines, colon, and appendix all live in the lower abdomen, gut-related problems are the most frequent source of pain here. Constipation and trapped gas can cause surprisingly sharp, crampy discomfort that shifts around. Diarrhea from a stomach bug or food intolerance often brings lower abdominal cramping along with it. These causes tend to come and go, change with meals or bowel movements, and resolve within hours to a couple of days.
More serious digestive conditions also show up as lower abdominal pain. Appendicitis typically starts as a vague ache near the belly button, then migrates to the right lower side over several hours, becoming sharper and more constant. Diverticulitis, where small pouches in the colon wall become inflamed, tends to cause pain on the left lower side instead. Both usually come with fever, nausea, or changes in bowel habits, and both need prompt medical attention. Inflammatory bowel diseases like Crohn’s disease and ulcerative colitis cause recurring pain, often alongside bloody stool, weight loss, and fatigue.
Inguinal Hernias
About 25% of men will develop an inguinal hernia at some point in their lives, compared to just 2% of women. This happens when tissue, usually part of the intestine, pushes through a weak spot in the lower abdominal wall near the groin. The hallmark sign is a visible or palpable bulge on one side of the pubic bone that becomes more obvious when you stand up, cough, or strain. Along with the bulge, you may notice a burning or aching sensation at the site, and pressure or discomfort in the groin when bending, lifting, or coughing.
In men, large hernias can extend down into the scrotum, causing pain and swelling there too. Most inguinal hernias are manageable and not immediately dangerous, but they don’t heal on their own. If a hernia becomes “incarcerated,” meaning the tissue gets trapped and can’t be pushed back in, or “strangulated,” meaning its blood supply gets cut off, it becomes a surgical emergency. Warning signs of strangulation include sudden worsening pain, nausea and vomiting, fever, and a bulge that turns red or purple.
Kidney Stones
Kidney stones produce some of the most intense pain people experience, and the location of that pain depends on where the stone is. The classic pattern is a sudden onset of severe pain starting in the flank (your side, just below the ribs) that radiates downward and forward. As a stone moves through the ureter toward the bladder, it gets lodged at narrow points along the way, and the pain shifts with it.
For men specifically, stones stuck in the lower portion of the ureter cause pain that radiates into the groin or testicle on the same side. This can feel like lower abdominal pain even though the stone itself is in the urinary tract. The pain typically comes in waves (often called renal colic), is hard to find a comfortable position during, and may come with blood in the urine, nausea, or an urgent need to urinate.
Prostatitis and Chronic Pelvic Pain
The prostate gland sits just below the bladder, and when it becomes inflamed, it can cause pain across the lower abdomen, groin, lower back, and the area between the scrotum and rectum (the perineum). Prostatitis also commonly produces urinary symptoms: needing to urinate frequently (especially at night), urgency, and difficulty starting or maintaining a urine stream.
Acute bacterial prostatitis comes on suddenly with fever, chills, and significant pain. It’s treated with antibiotics and typically resolves. Chronic pelvic pain syndrome is more puzzling. It causes the same pattern of pelvic pain and urinary symptoms that come and go over weeks or months, but no infection is found. This is actually the more common form, and it can be frustrating to manage because there’s no single clear cause. Treatment often involves a combination of approaches, and symptoms can wax and wane over time.
Testicular Torsion
Testicular torsion is a true emergency that can masquerade as abdominal pain. It happens when a testicle rotates on the cord that supplies its blood flow, cutting off circulation. The primary symptom is sudden, severe scrotal pain, but abdominal pain, nausea, and vomiting are common accompanying symptoms. In younger boys, it often wakes them from sleep in the middle of the night or early morning.
Other signs include swelling of the scrotum, a testicle sitting higher than normal or at an odd angle, frequent urination, and fever. The key feature is how quickly it comes on: the pain is sudden and severe, not gradual. A testicle deprived of blood flow can be permanently damaged within hours, so this requires immediate emergency care. Any sudden onset of scrotal pain combined with lower abdominal pain in a male, particularly in adolescents and young men, should be treated as torsion until proven otherwise.
Sports Hernias and Muscle Injuries
Not all lower abdominal pain comes from an organ. A sports hernia (also called athletic pubalgia) is a tear in the muscles or tendons of the lower abdomen or groin that causes chronic pain in the area. Despite the name, there’s no actual hernia bulge. The pain typically builds during physical activity, may ease with rest, and returns when you resume sports or exercise. Nerve irritation from the injury can make the area especially sensitive.
Sports hernias are notoriously difficult to diagnose because so many other conditions cause groin pain, including hip arthritis, pelvic fractures, and referred pain from the leg or back. The groin is a crossroads for nerves extending to many parts of the body, so pain originating elsewhere can show up here. Muscle strains of the abdominal wall or hip flexors can also mimic deeper internal pain, particularly after heavy lifting, awkward movements, or intense exercise. If lower abdominal pain consistently ties to physical activity and goes away with rest, a musculoskeletal cause is worth investigating.
What the Location Tells You
The side of your lower abdomen where pain concentrates offers useful clues. Right-sided pain raises concern for appendicitis, especially if it started centrally and migrated, or for a right-sided kidney stone or hernia. Left-sided pain is more suggestive of diverticulitis, a left-sided hernia, or constipation (the last portion of the colon sits on the left). Pain that’s central or hard to pinpoint is more typical of bladder issues, prostatitis, or intestinal problems affecting the small bowel.
Pain that radiates to the testicle has a narrower list of possibilities: kidney stones, inguinal hernias, and testicular torsion are the main considerations. Pain that worsens with urination or comes alongside urinary changes points toward the prostate or urinary tract. Pain tied to eating or bowel movements stays firmly in digestive territory.
How Doctors Figure Out the Cause
When lower abdominal pain needs imaging, the approach depends on your age and body type. For patients under 30 with a lower body weight, ultrasound is a reasonable first step since it avoids radiation exposure. For most other adults, a CT scan with contrast is the preferred first-line imaging test because it provides the most detailed and reliable view of the abdomen and pelvis. A CT can identify appendicitis, diverticulitis, kidney stones, hernias, and many other causes in a single study.
Before imaging, your doctor will likely press on different areas of the abdomen, ask about urinary and bowel symptoms, and may examine the groin and testicles. Blood work and a urine sample help screen for infection, inflammation, and blood in the urine. For suspected prostate issues, a digital rectal exam and urine testing are standard. Many cases of lower abdominal pain, particularly those caused by gas, mild constipation, or a stomach bug, resolve on their own and never need imaging at all.
Signs That Need Urgent Attention
Certain combinations of symptoms with lower abdominal pain warrant a trip to the emergency room rather than waiting for a scheduled appointment:
- Sudden, severe pain that escalates rapidly, particularly with nausea and vomiting
- Fever above 101°F (38.3°C) combined with worsening abdominal pain
- Inability to pass gas or have a bowel movement, which may signal a bowel obstruction
- Scrotal pain or swelling that came on suddenly
- Blood in your urine or stool
- A hernia bulge that can’t be pushed back in, especially if it changes color or becomes increasingly painful
Pain that has been building gradually over days, keeps getting worse rather than better, or is severe enough to wake you from sleep also warrants prompt evaluation rather than a wait-and-see approach.