What should I do if I experience lower back pain and abdominal pain on day 5 after a medical abortion?

Lower back pain and abdominal pain on day 5 after a surgical or medication-induced abortion are relatively common but warrant careful evaluation. Mild cramping and low-back discomfort can result from uterine contractions as the uterus returns to its pre-pregnancy size and expels residual tissue or clots. However, persistent, severe, or worsening pain—especially when accompanied by fever (>38°C), heavy vaginal bleeding (soaking more than one pad per hour), foul-smelling discharge, chills, or dizziness—may indicate complications such as incomplete abortion, endometritis, pelvic inflammatory disease, or retained products of conception.

It is essential to seek prompt medical assessment if symptoms are concerning. A healthcare provider will typically perform a pelvic examination, review vital signs, and may order transvaginal ultrasound to assess for retained tissue or uterine abnormalities. Blood tests—including complete blood count (CBC) and C-reactive protein (CRP)—can help detect infection or anemia. In cases of confirmed infection, empiric antibiotic therapy (e.g., doxycycline plus metronidazole or clindamycin plus gentamicin) is indicated. For retained tissue with ongoing bleeding or pain, uterine aspiration (vacuum curettage) may be necessary.

In the absence of red-flag symptoms, supportive care includes rest, adequate hydration, and over-the-counter analgesics such as ibuprofen (400–600 mg every 6–8 hours as needed) to reduce both pain and uterine prostaglandin-mediated contractions. Avoid aspirin or NSAIDs if there is significant bleeding, and refrain from sexual intercourse, tampon use, and douching for at least two weeks—or until cleared by a clinician—to minimize infection risk. Follow-up within 1–2 weeks post-procedure is standard to confirm clinical resolution and assess for return of menses.