Why is it pulling down? Nagging pain in the lower abdomen

Nagging pain in the lower abdomen is a common symptom that worries many people, both men and women. And if such a symptom is constantly present to you, and you cannot explain the nature of its origin, then it is better to visit a doctor to determine the causes of the pain. Since self-medication can dull the pain, but also hide the disease, which will continue to develop on the sly.

What kind of pain is called nagging?

The pain can be localized in the lower abdomen, above the pubis, lower right side or left. The nagging pain is usually aching, lasts at least half an hour, moderately strong, but not sharp or cramping. It brings significant discomfort to the person; if you take a comfortable position, the pain may ease, but there will still be a pulling sensation. This pain usually lasts for some time, then subsides and returns again.

Tugging sensations often bother women more than men. This is due to the fact that in addition to the general causes of nagging pain, women experience these sensations for a number of physiological reasons related to gynecology.

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Causes

The reasons why the lower abdomen hurts in men can be:

Aching unpleasant pain in women in the lower abdomen can be due to the following reasons.

Physiological state

With increased pressure on the bladder, a pregnant woman experiences frequent urination. The enlarged uterus puts pressure on the intestines and therefore pain may occur in the right side, or the left side may be affected, depending on which has more pressure.

Previously, the abdominal muscles felt freer, but now, due to the woman’s “interesting position,” they feel constant tension. Sometimes the cause of nagging pain can be constipation, because the fetus interferes with the active movement of feces, compressing the intestinal walls.

Pathological conditions

For women, judging by the points mentioned, there may be much more reasons for concern. But their abdominal pain can also be caused by a physiological condition, while in men it is always a sign of pathology. So a man, feeling a nagging pain in the lower abdomen, should immediately consult a doctor to determine the cause of this phenomenon.

A woman may initially wonder if this symptom is normal, and if so, then there is no reason to visit a doctor. But if none of the woman’s physiological conditions are noted, or other symptoms are added to the abdominal pain (bloody vaginal discharge, severe weakness, headaches, nausea), then it is better to consult a doctor about this.

Women should know that during menopause, pain in the lower abdomen can appear only in the first and third periods, and a pulling sensation in the second period is a reason to consult a doctor.

Diagnostics

To find out why there is nagging pain in the lower abdomen you need to:

If you do go to the doctor, then be prepared to undergo an examination; for women this is a mandatory gynecological examination; men can be examined by a proctologist or urologist, if necessary.

You will definitely need to take the following tests and examinations:

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A gynecologist, proctologist, urologist, traumatologist, surgeon, and rheumatologist can examine the patient. The choice of specialist will depend on what disease is suspected.

Treatment

If you have established the physiological nature of abdominal pain, then here you can take an antispasmodic or painkiller, try to rest or sleep. The nagging feeling in this case goes away after a few hours and becomes less noticeable with each passing moment. But if you don’t know what it is, then it’s better not to self-medicate, so as not to stop the symptoms of an incipient disease, but to identify it in the early stages.

In this case, the doctor will conduct a diagnosis and prescribe treatment depending on the established diagnosis. It may be appropriate to use antiseptics for inflammation, antibiotics for bacterial infections, radiation and chemotherapy for malignant neoplasms, surgery for a hernia, or any other therapy selected individually.

Therefore, if you notice nagging pain in your lower abdomen, try to see a doctor as soon as possible, especially if they bother you for a long time, are chronic, or occur simultaneously with other symptoms. A good doctor will choose treatment for your disease, not the symptom, and this is much more effective than spending your whole life on painkillers without treating the cause. Having been treated in this way once, you will be able to forget about abdominal pain, if not forever, then certainly for a long time.

There can be many reasons for this phenomenon. This may include inflammatory diseases, hypothermia, weakened immune function and physiological processes.

The first reason for a tummy tug is the onset of menstruation. Many girls endure the unpleasant painful syndrome. It usually lasts one to two days. This symptom is of a shingles nature. In this case, an additional symptom may be headache.

There is a solution to the problem - taking an analgesic, analgesic or antispasmodic.

But why does the lower abdomen feel tight during menstruation? The main reason for this phenomenon is considered to be the rhythmic contraction of muscle structures in the uterine cavity. They try to push out the unfertilized egg and the extra layer of endometrium.

This factor is physiological and is considered normal. If the pain is unbearable and lasts more than two days, then you should visit a doctor.

Factors that cause nagging abdominal pain

There are other factors that lead to an unpleasant feeling. Most of them are pathological in nature, but occur in most women.

Ovulation

When the lower abdomen is tight, the reasons may be hidden in ovulatory syndrome. Most often, discomfort appears in the groin area. Doctors say that this is physiology, and it consists in the maturation of the egg inside the follicle. In the middle of the menstrual cycle, it breaks and the female cell comes out.

Against this background, there is a little blood, an increase in temperature and a nagging pain in the lower abdomen in women.

Premenstrual syndrome

Another common cause of unpleasant abdominal pain is premenstrual syndrome. Doctors explain that this is an individual feature of the female body.

If the released egg has not undergone fertilization, then it, together with the inner lining of the uterus, comes out in the form of red discharge. This phenomenon is always accompanied by a strong spasm, which is a bit like labor pains.

Often, premenstrual syndrome is accompanied not only by aching, but also by headaches, insomnia or, conversely, drowsiness and irritability.

Symptoms can be eliminated with medication and proper rest. You can take tea drinks based on licorice, oregano, sage and lemon balm. Their effect is aimed at normalizing sex hormones.

Much more so with inflammation of the appendix. This concept is usually understood as a small process that extends from the cecum. If you abuse junk food or alcohol, it can become inflamed.

Treatment of the disease is carried out only by surgery. The patient may complain of severe sharp pain inside the abdomen. Usually it occurs on the right side, and then gradually moves to the navel.

Additional symptoms may include fever, nausea, repeated vomiting, diarrhea, dizziness, and loss of consciousness.

Inflammatory process in the appendages

Inflammation in the fallopian tubes and testicles may be accompanied by a periodic, nagging painful sensation. In this case, there is a rise in temperature, frequent and painful urination. The cause is often hypothermia.

Treatment consists of taking antibacterial and anti-inflammatory drugs, antispasmodics and douching with herbal infusions. Self-medication is not applicable in this case. In the future, you need to strengthen your immune system, keep your legs and lower back warm.

Ovarian apoplexy

This concept is commonly understood as hemorrhage. It occurs as a result of the rupture of a mature follicle with an egg after prolonged and hard sex, as well as heavy physical exertion.

Then the woman’s lower abdomen hurts and pulls. The symptoms are similar to an ectopic pregnancy, but there is no delay in menstruation. The whole process begins with a sharp painful feeling in. Then it starts to go into the rectum. The patient complains of nausea, dizziness, and weakness.

The pathology is treated only with surgical intervention.

Discomfort after sex

If there is a pulling in the lower abdomen after sexual intercourse, then the cause is a pathology in the pelvic organs. In such a situation, only a gynecologist can help. When pain constantly torments after each act, then you should not hesitate to visit a doctor and receive treatment. This can lead to serious complications.

Most often, pain in the lower abdomen occurs in women due to inflammation of the ovaries. The cyst is a benign formation and can go away on its own.

Venereal diseases or thrush can lead to pain. To ensure the correct assessment of the condition, it is necessary to undergo ultrasound diagnostics and be tested for hidden infections.

Nagging abdominal pain as a symptom of pregnancy

Why does a woman's stomach ache? Much less often, patients notice that the lower abdomen may periodically hurt during pregnancy. Often this sign is correlated with a signal for the appearance of menstruation.

To make sure of this, the girl needs to take a pregnancy test at home. If everything is confirmed, then consult a doctor. Stretching your stomach during pregnancy can occur even before the delay, one or two days. This indicates the attachment of the fertilized egg and changes in hormonal levels.

Additional symptoms may include drowsiness, increased fatigue, breast tenderness, and changes in taste preferences. It is much more dangerous when nagging pain is accompanied by bleeding or the appearance of spotting brown discharge. Such a process may signal placental abruption, incipient miscarriage, hematoma, or fetal death.

Nagging pain in later stages of pregnancy

Often during the pregnancy stage, expectant mothers complain of nagging pain in the abdominal area. At later stages, this symptom often signals the development of serious problems.

The most common reasons include:

training contractions. This process is a kind of preparatory exercises that the body itself produces before the onset of childbirth. They usually occur two to three weeks before the birth process;
hypertonicity of the uterine cavity. This phenomenon is understood as premature uterine contraction, which is caused by overexcitation of the muscle walls. This condition is considered dangerous;
placental abruption. This condition is very dangerous not only for the expectant mother, but also for the fetus itself. To prevent placental abruption, you must maintain strict bed rest and avoid heavy lifting.

The problem may also be hidden in a sore stomach. This occurs due to compression of the organ by the uterine cavity. The patient may complain of heartburn, nausea and vomiting.

Whatever the cause of the discomfort, you need to seek help from a specialist. Only he can prescribe adequate treatment.

Pain in the lower abdomen occurs periodically in all women, and the reasons for this can be very different. They depend on the position of the woman (pregnant or not), and on the presence of chronic and acute diseases of the reproductive system, and even on the day of the menstrual cycle. Let's take a quick look at the possible reasons.

1. If you are in the middle or end of your menstrual cycle and have pain in the lower abdomen, then in the first case it could be ovulation (of course, we are talking about women of reproductive age), and in the second case it could be PMS. Many women begin to experience pain in the uterine area 1-3 days before menstruation and in its first 2-3 days.

2. It may well be that nagging pain in the lower abdomen is caused by inflammation of the pelvic organs:

endometritis (inflammation of the mucous membrane of the uterus, usually occurs as a result of the introduction of an infectious pathogen during abortion or diagnostic curettage), metroedermitis (inflammation of the mucous and muscular membranes of the uterus) and parametritis (an advanced process when tissues located near the uterus are also affected);
salpingoophoritis (inflammation of the fallopian tubes and ovaries as a result of a bacterial infection) and a complication - pelvioperitonitis (in this case, not only pain in the lower abdomen occurs in women, but also many other symptoms appear, the clinical picture is very similar to peritonitis).

3. If pain occurs when urinating and it becomes more frequent, the lower back begins to ache, then the reason is most likely in pathology of the urinary tract. First of all, you need to visit a urologist and take a urine test, which will make everything clear. It is possible that you will need to do an ultrasound of the kidneys. Cystitis and pyelonephritis are quite common infectious diseases in women. Cystitis can be triggered by hypothermia, sexual intercourse, and often occurs during or immediately after menstruation. Treatment is usually with antibiotics as the infection is bacterial.

4. Tumors of the uterus, namely fibroids. They are also characterized by intermenstrual bleeding.

5. Endometriosis is a disease in which endometrial cells of the uterus appear and begin to grow outside the uterus, in any organs. Another common pathology is adenomyosis, a special case of endometriosis.

6. Surgical pathologies. For example, appendicitis. Usually its first symptom is aching pain in the right side of the abdomen.

6. Nagging pain in the lower abdomen in the early stages of pregnancy, not accompanied by bleeding, is a fairly common occurrence and usually does not lead to any consequences. These unpleasant sensations are caused by changes in hormonal levels, and a little later - by the rapid growth of the uterus.

7. If there is not only pain in the lower abdomen during pregnancy, but also spotting, this is most likely an incipient miscarriage, and in the second and third trimesters - placental abruption - a dangerous condition for a woman, when she can lose a lot of blood, and the fetus can die. If these are the first weeks of pregnancy, and an ultrasound has not yet been done, and the growth of hCG is too slow, an ectopic pregnancy can be suspected.

Poor diagnostic criterion. However, there are several common conditions that cause abdominal pain in men and women.

Why does the lower abdomen pull in women?

Nagging pain in the lower abdomen in women can be associated with menstruation, pregnancy or gynecological diseases.

1. Pulling in the lower abdomen during pregnancy

In pregnant women, the lower abdomen can feel tight both in the early and late stages. In the first weeks after conception, the stomach may hurt due to the increase in the size of the uterus: its muscles stretch as the fetus grows, so the woman feels discomfort and pain. Usually, either women who have become pregnant for the first time or mothers whose interval between pregnancies exceeds 7 years turn to obstetricians-gynecologists with complaints of nagging pain.

If the lower abdomen does not last long, the pain is mild, and no other pathological symptoms are observed, there is, as a rule, nothing to worry about. But when the pain is accompanied by bloody, dizziness, high fever, chills, weakness and nausea, you should immediately consult a doctor: there is a risk of ectopic pregnancy, miscarriage and premature birth.

Solutions:

If the pain is not severe, take a no-shpa tablet, lie down, place a pillow under your feet and try to relax.
If the nagging pain recurs and radiates to the right or left side, your doctor may recommend an ultrasound and examination for genitourinary infections.
If pain in the lower abdomen is accompanied by nausea and vomiting, it may be a symptom of acute appendicitis. In this case, pregnant women are advised to undergo an operation that is completely safe for the child.
If your lower abdomen is tight due to digestive disorders, ask your gynecologist to choose a special diet for you.
If discomfort in the lower abdomen is felt at 18-24 weeks of pregnancy, this may indicate sprains and spasms of the round ligament. Lie on your side that doesn't hurt for a while, and the discomfort will go away.

2. Pulling in the lower abdomen during menstruation

The most common cause of nagging (aching) pain in the lower abdomen in the absence of pregnancy is the approaching menstruation. As a rule, girls easily recognize PMS symptoms, but many mistakenly believe that they are the norm.

Indeed, slight discomfort in the lower abdomen is quite acceptable, because under the influence of hubbub the muscles of the uterus contract. But severe spasms radiating to the rectum, appendage area or bladder may indicate dysmenorrhea - a pathological condition often caused by hormonal imbalances, endometriosis, adhesions in the pelvic organs and other diseases.

Solutions:

Make an appointment with a gynecologist: if you treat dysmenorrhea at random, you may miss a hidden disease.
To treat painful sensations during PMS, the doctor may prescribe: hormonal therapy reduces the frequency of uterine contractions, and the nagging pain goes away.
Stop smoking. Harmful substances contained in tobacco smoke affect the synthesis of certain hormones, increasing PMS symptoms.

3. Pulls in the lower abdomen in the middle of the menstrual cycle

If your lower abdomen feels tight in the middle of your menstrual cycle, the cause may be. Mild discomfort for 1-2 days indicates that the maturing follicle is stretching the walls of the ovary. When a follicle bursts, the fluid flowing from it irritates the uterus, causing it to begin to contract, causing nagging pain in the lower abdomen.

Solutions:

Usually, mild nagging pain during ovulation does not last more than 2 days and does not require specific treatment. To reduce discomfort, a woman can take a no-shla tablet.
If your stomach hurts after ovulation, consult your gynecologist. A pulling sensation and spasms may indicate inflammation of the ovaries and other gynecological diseases.

4. Pulling in the lower abdomen after intercourse

The most harmless cause of nagging pain in the lower abdomen is intense sex, when a man’s penis reaches the cervix. In this case, the best solution is to experiment with positions, use more lubricant, or ask your partner to be careful.

This symptom is also characteristic of infectious and inflammatory diseases: chlamydia, gonorrhea, adhesions in the pelvis, endometriosis, etc. Such pathologies are often accompanied by liquid discharge with an unpleasant odor, urination problems, and other alarming signs.

Solution:

To clarify the causes and solutions, consult a gynecologist. You should not endure discomfort: you risk developing hidden sexually transmitted infections or other dangerous pathologies.

Why does the lower abdomen pull in men?

A pulling feeling in the lower abdomen may indicate diseases of the male reproductive system. The most common cause is sexually transmitted infections and prostatitis.

Pulling in the lower abdomen during sexually transmitted infections and prostatitis

In men with chronic prostatitis, the lower abdomen often feels tight - this is one of the common symptoms that should be the reason for an immediate visit to a urologist. Pain from inflammation of the prostate gland can radiate to the perineum, genitals and rectum. It is accompanied by various urination disorders: polyuria, a feeling of a full bladder. Pay attention to body temperature: during exacerbations of chronic prostatitis, it often rises.

Solution:

Men are recommended to get tested for STIs and have an ultrasound of the pelvic organs. The doctor will also conduct a rectal examination of the prostate: this is necessary to clarify the diagnosis and obtain a sample of prostate secretion, which will be used for bacteriological examination.
To treat prostatitis, a man may be prescribed antibiotics, antiandrogens, thermal procedures, anti-inflammatory drugs and microenemas.

Pain in the lower abdomen in women can have many different causes, related both to female physiology and anatomical structure, and caused by diseases, dysfunctions and pathologies independent of the patient’s gender.

Most often, pain in the lower abdomen occurs due to dysfunction of the gastrointestinal tract, urinary system, reproductive organs, but it can also occur due to a violation of the innervation of the nerves due to infringement in the lumbar spinal column, a systemic disease (for example,), overstrain of the peritoneal muscles, increased gas formation or sensitivity during ovulation and during the menstrual period. How to determine the cause of pain in the lower abdomen?

Pain in the lower abdomen: organic causes

Pain in the lower peritoneal region, with a clear and vague localization (right, left, lower part, covering the entire lower abdomen) can occur as a result of organic causes and physiological processes in women. Pain syndrome can also accompany physiological processes, for example, pain when the intestines are distended by gases formed during the digestion process, or pain when the muscular-ligamentous apparatus adapts to the growing volume of the uterus during the period of bearing a child.
Pain in the lower abdomen due to organic disorders is caused by various diseases and can occur in the following cases:

for diseases of the reproductive system (endometritis, endometriosis, ovarian apoplexy and cystic formations in this organ, andexitis, uterine fibroids, etc.);
for diseases and pathologies of the urinary system, digestive tract, acute surgical pathologies (appendicitis, cholecystitis, pyelonephritis, inflammation of the bladder, intestinal infections, etc.);
the presence of a foreign body in the uterine cavity (intrauterine device, especially if the rules of use, timing of replacement are not followed, the device grows into the endometrium);
pathologies of the gestation period: ectopic pregnancy, developing miscarriage, the process of premature placental abruption, the consequences of medical abortions and other surgical interventions.

Painful sensations are determined by the nature of the disease or pathology and can be characterized as sharp, pulling, cramping, aching, spreading, stabbing, sharp, dull, etc.

Pain in the lower abdomen as a symptom of appendicitis

Inflammation of the appendix or, contrary to popular belief, can be accompanied not only by pain in the iliac region on the right. The classic picture of appendicitis starts with pain in the epigastric region, most often shifting to the right, but pain can spread to other parts of the abdominal cavity and radiate to the lower back. The severity and type of sensations can change from sharp, cutting pain to dull and aching, depending on the severity of the inflammatory process. Appendicitis is also accompanied by an increase in body temperature and symptoms of general malaise (nausea, vomiting, chills).

Pain due to intestinal infections

With the development of an intestinal infection, pain begins with a dull, non-localized pain, covering most of the peritoneum, further concentrating in the lower abdomen with a return to the lumbar region.

Pain due to urinary tract infections

Most often, with cystitis and pyelonephritis, the lower abdomen hurts in women; male patients with urinary tract diseases note different symptoms due to the different anatomical structure of the body.
Pain in infectious diseases of this type is accompanied by a frequent urge to urinate, and there may be bloody inclusions in the urine. With pyelonephritis, there is also pain in the lumbar region, often – body hyperthermia, signs of general intoxication (decreased appetite, nausea, headaches, etc.).

Endometriosis

The proliferation of endometrial cells, characteristic of the uterine cavity, in the intrauterine space and beyond, is most often expressed by nagging pain that increases during the premenstrual and menstrual periods. Pain sensations vary depending on the stage of the disease and localization: the lower abdomen hurts in the middle region when the endometrium grows in the uterine cavity; with the retrocervical form of endometriosis and tissue growth in the appendages, it can hurt below the abdomen, in the groin or pubic region.

Pain as a symptom of ovarian apoplexy

Ovarian apoplexy develops due to the rupture of a mature follicle during the ovulatory period. The condition is accompanied by damage to the ovarian vessels and hemorrhage into the peritoneal cavity. Provoking factors include intense physical activity, sexual intercourse, etc.
Sharp pain on the right or left (depending on the location of the damaged ovary) in a woman during the period of ovulation, accompanied by a drop in blood pressure, fainting, and pale skin, is a reason to urgently call a specialist. Ovarian apoplexy is a life-threatening condition that requires emergency surgical intervention.

Pain due to uterine fibroids

Uterine fibroids are accompanied by pain in the lower abdomen when a formation of significant size is formed, exerting pressure on the surrounding tissues and neighboring organs (aching, pulling pain), as well as when the formation is removed: a rejected myomatous node is accompanied by cramping pain and bleeding from the vagina. Treatment is exclusively surgical.

Ovarian cyst: pain when torsion of the leg

An ovarian cyst is a formation consisting of a body and a “leg” containing blood vessels. With physical effort, a fall, sudden movements of the body, or gymnastic exercises, the leg of the cystic formation is prone to twisting due to a shift in the position of the body of the cyst. With partial torsion, the outflow of venous blood from the body of the cyst is disrupted, which is accompanied by nagging, aching pain from the affected ovary.
Complete torsion of the leg stops the flow of arterial blood, causing tissue necrosis. This process is accompanied by a clinical picture of an “acute abdomen”: severe, cramping pain in the lower abdomen on the right or left, hyperthermia, signs of poisoning of the body. Urgent surgical intervention is required.

Inflammation of the appendages, uterine cavity

Andexitis, salpingoophoritis, endometritis, inflammation of the uterus and its appendages of various etiologies, depending on the form of the disease, can be accompanied by both aching, nagging pain in the lower abdomen and groin area, and severe painful sensations that increase with palpation of the inflamed organ.

Pain during ectopic pregnancy

Implantation of the egg after fertilization outside the uterine cavity (most often in one of the fallopian tubes, less often inside the ovary, in the peritoneum) is accompanied by a pulling, aching pain in the lower abdomen, radiating to the lumbar region.

As the embryo grows, increased pressure on the surrounding tissues begins; in tubal pregnancy without surgical intervention, this is accompanied by rupture of the fallopian tube, sharp, severe pain, and internal hemorrhage. Treatment is emergency, surgical.

Why does the lower abdomen hurt in women during pregnancy?

The first trimester of gestation is often accompanied by pain in the lower abdomen. Pain below the abdomen, in the groin area in the first months can occur with a threatening miscarriage, ectopic pregnancy, accompanying pregnancy and diseases aggravated by it.

However, most often such nagging, aching pain is called “uterine tone” and means the physiological process of adaptation of muscle tissue and ligamentous apparatus to changes in the reproductive organ. In the absence of additional symptoms, such pain does not require therapy or anesthesia. In some cases, antispasmodic drugs (Papaverine, No-Shpa) may be prescribed.

Pain below the abdomen in the second and third trimester can also be due to an increasing load on the ligamentous apparatus, accompanied by softening of the ligament tissue, lack of calcium, and pressure on the cervix. Normally, physiological pain does not require treatment and goes away with relaxation, changing body position, and moderate physical activity.
A sharp, severe pain localized in the lower abdomen with a low location of the placenta may be a sign of its premature detachment and require urgent medical intervention. Cramping pain and periodic tension of the uterus can be both a sign of the onset of Braxton-Hicks “training contractions,” a physiologically normal phenomenon, and a symptom of a threatened miscarriage. If any new pain occurs, consult a specialist.

Algomenorrhea

This diagnosis is most common at the age of puberty and the formation of the organs of the reproductive system. Algomenorrhea is accompanied by pain before menstruation. Requires differentiation from premenstrual syndrome, endometritis, endometriosis, congestion associated with uterine bending, intrauterine inflammatory diseases, etc.

Why does the lower abdomen hurt in the middle of the menstrual cycle?

Pain during the ovulation period occurs in approximately 10% of women of reproductive age. They are most often characterized as stabbing, localized on the side of one of the ovaries (lower right or left), or pulling, accompanied by a sensation of a “tight lump” in the lower abdomen.

As a rule, such sensations last no more than 24-48 hours, ending with the release of the egg from the ovary. If you pay attention to the vaginal discharge, then on this day it will be more mucous, thick, “vitreous”, and minor bloody inclusions are possible.

Such pain, not accompanied by additional symptoms, does not require treatment. A one-time dose of antispasmodics or painkillers is possible as prescribed by a doctor.

Pain after intercourse

Most often, pain at the end of sexual intercourse, which is not accompanied by orgasmic contractions, is associated with swelling of the tissues, a rush of blood to the organs during the process of arousal. There may also be pain associated with tissue trauma during excessively intense sexual intercourse, and pain as a symptom of diseases of the pelvic organs: adhesions, endometriosis, endometritis or andexitis in chronic form, cervicitis, tumor neoplasms of the genital organs.

Pain is most often a sign of disorders, dysfunctions, and painful processes in organs and tissues. The physiological causes of pain in the female reproductive system are limited by the menstrual cycle, ovulation, gestation period and are usually manifested by nagging, aching pain, limited in time and occurring on certain days and periods.

All other manifestations should be a reason for examination by a specialist and a course of treatment.