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The sensation of something moving in the lower abdomen brings up many concerns. It should be investigated thoroughly with a multidisciplinary approach.

Peristalsis

Peristalsis is the regulated movement of the bowel which pushes food down its length. Complex neural networks control this movement. The part behind the food bolus contracts rhythmically while the part immediately in front of the food bolus relaxes, facilitating forward motion. All parts of the gastrointestinal tract have peristalsis.

When you swallow food, the esophagus contracts and the wave of contraction pushes food down to the stomach. The stomach empties into the small bowel periodically through the pylorus.

The small bowel has small and frequent peristaltic waves, while the large bowel has forceful periodic contractile waves. The large bowel is located mostly in the lower abdomen. The transverse colon hangs down from above, so the only the upper parts of the ascending and descending colons are in the upper abdomen. It is therefore natural to feel these powerful peristaltic waves in the lower abdomen. These peristaltic waves sometimes increase in case of bowel obstruction and hunger.

If you have symptoms like constipation, abdominal distension, nausea and vomiting, consult a gastroenterologist as soon as you can.

Bowel spasms

The bowels are a muscular organ. They have circular and longitudinal muscle layers. A spasm is an involuntary sustained contraction. Muscle irritation due to inflammation, increased extracellular calcium concentration, and continuous stimulation of the cholinergic muscarinic nerve endings of the parasympathetic system are a few known causes of bowel spasms. Inflammatory bowel disease is a prime example of bowel spasms. Anti-muscarinic drugs block continuous nerve stimulation and smooth muscle relaxants prevent calcium-induced contractions.

Subcutaneous emphysema

This is a condition where air gets trapped under the skin, and it feels like bubble wrap. On palpation, the air shifts from place to place, giving a sensation of bubbles popping. Air usually comes from the chest cavity. Local trauma, air being trapped inside necrotic tissues, and surgical interventions are a few other known causes.

Abdominal muscle spasms

Many neurological conditions and hyper-calcemia can cause involuntary muscle spasms and cramps in the anterior abdominal wall muscles. This can easily be felt like something moving around. Sometimes it can be seen as such.

Pedunculated fibroids

Pedunculated fibroids are attached to the uterus with a thin stalk of tissues. During a change of posture, the position of the fibroid inside the abdomen may also change. If the fibroid is big enough, it can certainly be felt moving. But this condition is very rare.

Formication

Formication is a tactile hallucination where one feels like there are insects crawling over the skin. This sensation can be general or limited to an area of the body. This is most commonly seen in alcohol withdrawal patient. Benzodiazepines, thiamine and intravenous fluids are the go-to treatments for alcohol withdrawal.

Delusional parasitosis

This is a form of psychosis where the patient believes that they are harboring a parasite inside their body. People suffering from this condition often seek treatment for the supposed infestation. The medical practitioner should be vigilant enough to detect the delusion and refer the patient to a psychiatrist. This can present as an isolated delusion or be a part of a psychotic syndrome.

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