Most people experience abdominal discomfort or pain at some point in their lives. Abdominal pain (sometimes called stomachache or bellyache) is usually felt in the part of the trunk below the ribs, above the pelvis and the groin. It can range in intensity from a mild ache to severe, disabling pain.
Pain in the abdomen is the single most important symptom of an acute abdominal pathologic process. It is the symptom that brings the patient to his physician and the symptom that deserves the utmost care in evaluation. It has been said that a skilled clinician can identify the source of abdominal pain from the history alone 80 to 90% of the time. To achieve that goal requires a thorough understanding of the pathogenesis of the many abdominal diseases that produce pain, and the pathways over which it is transmitted.
While abdominal pain isn’t normal, it isn’t necessarily serious, and it often resolves itself.
Pain in the stomach is a normal occurrence, an uncomfortable experience that almost everyone goes through from time-to-time. But for some people this pain can become so disruptive, due to its frequency and/or severity, that it can seriously lower their quality of life. For those unfortunate enough to go through this, finding out the cause and receiving treatment for their pain is a necessity.
Abdominal pain is a very common medical condition that can either be acute or chronic in nature. Basically it refers to pain that is felt within the abdomen which is the region of the body bounded by the ribs superiorly and the pelvis below. The image to the right displays a lady holding her lower abdomen in an attempt to relieve her pain.
Abdominal pain may be a feature of numerous medical and surgical conditions and arise from organs within or adjacent to the abdominal cavity. In most cases it will be caused by something benign (not serious) but it important that it gets evaluated by a doctor to exclude sinister conditions that require urgent medical attention. Doctors diagnose the cause based on the features of the pain (location, duration, and other symptoms), physical examination and a number of diagnostic tests.
Identifying the cause is particularly challenging as signs and symptoms may be non-specific, investigations are not always abnormal, different causes can mimic each other, and characteristics of the pain may change over time.
What Is Abdominal Pain?
Abdominal pain in simple terms refers to pain that is felt in the abdomen (the anatomical region bounded by the ribs superiorly and the pelvis inferiorly). Abdominal pain is a challenging complaint for physicians as there are numerous possible causes some of which are benign and some that are potentially serious and possibly life-threatening. Unfortunately it can be difficult distinguishing between the two as they can present similarly.
Furthermore, abdominal pain may arise from various anatomical structures including tissues comprising the abdominal wall (such as the muscles and skin) or from the actual abdominal organs themselves (stomach, small intestine, colon, liver, gallbladder, kidneys, aorta and pancreas) making diagnosis more difficult. [Please refer to anatomy and physiology of the gastrointestinal system for more information on these organs].
Occasionally pain may be felt in the abdomen even though it originates from nearby organs outside the abdominal cavity such as the lungs in pneumonia, heart during a heart attack or pelvic structures such as the uterus and ovaries. Likewise pain originating from abdominal organs may be referred to the skin or back depending on the nerve supply of the organs.
The type of abdominal pain varies greatly depending on the underlying cause. The abdominal organs are fitted with various pain receptors that detect abnormal mechanical and chemical stimuli. These send signals to the brain which leads to the sensation of pain. The mechanisms to produce abdominal pain include:
- Inflammation: This leads to the production of special chemicals that activate the pain receptors;
- Ischaemia (lack of blood supply);
- Stretching of muscles and the capsules (coverings) of organs;
- Nerve stimulation: Sometimes tumours can invade nerves and cause pain signals.
You may hear doctors use the term ‘acute abdomen.’ This refers to a condition where patients are really unwell with signs and symptoms (almost always including pain) that suggest an abdominal cause. These patients required urgent hospital admission and often may need surgery.
Type and Location of the Abdominal Pain
The type and location of pain may help the doctor find the cause. The intensity and duration of pain must also be considered when making a diagnosis. A few general characteristics of abdominal pain are:
What the pain feels like: Abdominal pain can be sharp, dull, stabbing, cramp-like, knifelike, twisting, or piercing. Many other types of pain are also possible.
How long the pain lasts: Abdominal pain can be brief, lasting for a few minutes, or it may persist for several hours and longer. Sometimes the abdominal pain comes on strongly for a while and then lessons in intensity for a while. Is the pain continuous or does it come and go?
Events that trigger pain: The pain may be worsened or relieved by certain events, such as worse after meals, better with a bowel movement, better after vomiting, or worse when lying down. Do certain foods trigger the pain?
Location of the pain – The location often will help your doctor diagnose the cause of the pain.
- Upper left abdominal pain: Enlarged spleen
- Upper right abdominal pain: Gallbladder disease, hepatitis
- Lower left abdominal pain: Diverticulitis, ovarian cysts, ovarian torsion
- Lower right abdominal pain: Appendicitis, right ovary problems
- Upper abdominal pain: Stomach ulcers, gastritis, pancreatitis
- Lower abdominal pain: Urinary tract infections, gynecologic problems like uterine fibroids and cancer
Signs and Symptoms of Abdominal Pain
Abdominal pain may take several different forms. In addition to how severe it is, abdominal pain can be described in the following ways:
Generalized Pain This refers to pain felt in more than half of your abdominal area, and is typical of stomach viruses, indigestion, or gas as the cause of your pain.
Localized Pain This refers to pain felt in just one area of your abdomen, and is typical of a problem with an organ like your stomach, appendix, or gallbladder as the cause of your pain.
Cramping This type of pain come and goes, or changes in its severity or perceived position in your abdomen. Cramping is rarely serious and is typical of gas, passing a stool, or menstruation as the cause of your pain.
Colicky Pain Like cramping, this type of pain comes and goes, but tends to be severe and to start and end suddenly. It’s typical of kidney stones or gallstones as the cause of your pain, according to Mount Sinai.
It’s important to call your doctor if your abdominal pain is so severe that you can’t move without feeling more pain, or sit still in a comfortable position.
Seek immediate medical attention if your abdominal pain is accompanied by any of the following symptoms:
- Bloody stool
- Nausea and vomiting that doesn’t resolve
- Weight loss
- Yellowish skin
- Abdomen very tender to touch
- Swollen abdomen
What Are The Common Causes Of Abdominal Pain?
Patients often have difficulty describing abdominal pain. Sometimes described as lower abdominal pain, upper abdominal pain, upper stomach pain, stomach pain, etc. It can present as any form of discomfort between the chest and the pelvis. It can seem vague and hard to define.
- Stomach or Abdominal pain can be caused due to several less serious issues:
- Indigestion (dyspepsia)
- A potential stomach virus- could be a stomach flu or other virus
- Food poisoning- (foodborne illness) due to toxins in food from bacteria, viruses, and parasites. Includes nausea, vomiting, and abdominal cramps.
- food allergies such as lactose intolerance or gluten intolerance- common allergies include nuts, milk, fish, eggs, and shellfish.
- Irritable bowel syndrome– pain commonly presents in the lower abdomen but can be anywhere in the abdomen. Pain may worsen soon after eating.
Other potentially more serious conditions include:
- Appendicitis- Inflammation of the appendix. Could feel like a dull pain in the abdomen that moves to the lower right abdomen and grows sharper.
- Decreased blood supply to the intestines- (intestinal ischemia) due to a blocked blood vessel. Could affect intestinal function.
- Kidney stones- (nephrolithiasis) Symptoms manifest as severe pain in the back and side from the lower abdomen to groin.
- Pancreatitis– Inflammation of the pancreas. Pain is felt from the upper abdomen, radiating to the back.
- Bowel blockage or obstruction- Prevention of digested material from passing through the bowel.
- Cancer of the stomach- symptoms could include pain and unusual “fullness” in the upper abdomen.
- Colon Cancer– symptoms could include severe and long-lasting abdominal pain, and/or change in bowel habits.
- Cholecystitis- Inflammation of the gallbladder that presents as severe pain in the upper right or center of the abdomen.
- GERD– (Gastroesophageal Reflux Disease) occurs when stomach acid flows back into the esophagus. Symptoms include frequent heartburn.
- Crohn’s Disease– an inflammatory disease of the intestines that results in abdominal pain and frequent diarrhea.
- Ulcerative Colitis– inflammatory bowel disease that can result in abdominal and rectal cramping and pain.
- Ulcers– sores in the lining of the stomach that can result in abdominal pain.
- Diverticulitis– infection/inflammation of the colon. Can result in bowel obstruction and abdominal swelling.
What Is the Cause of Lower Abdominal Pain?
Some of the most common causes of lower abdominal pain include:
- Diverticulitis– the inflammation or infection of the walls of the intestines.
- Gas- feels like a pressure in your abdomen and includes burping and flatulence.
- Lactose Intolerance– the inability to fully digest lactose found in dairy.
- Celiac Disease– (Celiac sprue) Triggered response of the body to gluten- found in wheat, barley, and rye.
- IBD– (Crohn’s Disease or Ulcerative Colitis) term describing any chronic inflammation of the digestive tract.
- Indigestion- pain from indigestion in the lower abdomen is rare and due to the buildup of acid following eating.
- IBS- (Irritable Bowel Syndrome) common disorder of the large intestine.
- Constipation– inability and/or difficulty to pass stool.
- Hernia- when another body part or organ pushes into the abdominal wall.
- Bowel Obstruction- Prevention of digested material from passing through the bowel.
- Appendicitis- Inflammation of the appendix. Could feel like a dull pain in the abdomen that moves to the lower right abdomen and grows sharper.
- Flu- (stomach flu) infection of the intestines. Could be characterized by cramping, nausea, and fever.
Examination and Diagnosis
Examination, level of emergency and urgency of diagnosis and management depends on the cause of the pain. All patients with abdominal pain do not require diagnostic tests. Sometimes, clinical evaluation alone is sufficient for diagnosis and management.
Some of the major factors that are assessed by emergency physicians include:
- Degree of pain – severity is best evaluated with a familiar 1-10 scale.
- Changes in vital signs like heart rate, blood pressure, respiratory rate. If the vitals are abnormal with heart rate over 100 beats per minute, blood pressure less than 100 (systolic), respiratory rate over 20 per minute etc. a deeper cause should be suspected.
- History of any disease like diabetes, alcoholism, or injury that may provide clues for diagnosis.
- Location of the pain – there are six anatomic locations. These include – right hypochondriac region, epigastrium, left hypochondriac region, right lumbar, left lumbar, umbilical, right iliac, left iliac and hypogastric region.
- Nature of onset of the pain. Pain may originate abruptly or may begin slowly over time.
- Nature of pain.
- Radiation of the pain or if the pain moves to the back or to the groin.
- Any presence of aggravating and reliving factors. For example, some pains may be relieved after eating and some after sitting or lying in a particular position.
- Presence of other symptoms such as vomiting, diarrhea, dizziness, pain on urination etc.
Treatment and Medication Options for Abdominal Pain
The treatment for abdominal pain depends on its cause. Depending on the cause of your pain, the best course of treatment may involve self-care measures, over-the-counter or prescription medications, or procedures including drug injections or surgery, according to the Cleveland Clinic.
Mild abdominal pain due to digestive upset may respond to short-term self-care measures such as the following:
- Avoiding solid foods for a few hours
- Sipping water or clear fluids
- Resting until you feel better
- Avoiding dairy products, citrus fruits, fatty foods, tomato products, caffeine, alcohol, and carbonated beverages
- Sticking to mild foods, like crackers, rice, bananas, or applesauce
Don’t take aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs) for abdominal pain, since these medications can irritate your stomach and actually increase your pain, notes Kaiser Permanente.
It’s generally not advised to take any medications for abdominal pain without first talking to your healthcare provider, since some common drugs for pain can irritate your digestive tract and make your pain worse.
If you have an underlying health condition that requires medical treatment, your doctor may prescribe medications such as the following:
- Drugs to treat gastroesophageal reflux disease (GERD)
- Antibiotics to treat infection
- Drugs to reduce inflammation
- Targeted treatments for inflammatory bowel disease (IBD)
Procedures and Surgery
In rare cases, office procedures or surgery may be needed to effectively treat your abdominal pain. These procedures may include the following:
- Injection of a numbing agent
- Corticosteroid injections
- Hernia repair surgery
Alternative and Complementary Therapies
In addition to self-care measures, certain alternative therapies may help you reduce or cope with abdominal pain. According to MedlinePlus, these measures include:
- Relaxation training
Prevention of Abdominal Pain
In many cases, abdominal pain can be prevented by adopting lifestyle and dietary choices that address the cause of your pain. Constipation, digestive upset, and even abdominal injury can often be prevented.
The following steps may help you prevent abdominal pain:
Drink plenty of water. Staying hydrated can help you avoid constipation.
Develop regular bowel habits. Many people can train themselves to have regular bowel movements to help avoid constipation.
Follow a balanced, fiber-filled diet. Eating a variety of fruits, vegetables, and fiber-rich foods, like whole grains, can help support healthy digestion and reduce constipation.
Eat regularly and slowly. Eating moderately-sized meals, instead of waiting until you’re very hungry and stuffing yourself, can help avoid pain from overeating or eating on an empty stomach.
Exercise regularly. Getting enough physical activity can help prevent constipation and strengthen your abdominal muscles, which may help prevent straining.
Wear a seatbelt properly. Abdominal injury from car accidents can often be prevented by wearing a seatbelt as it’s designed to be worn, notes Kaiser Permanente.