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Abdominal Pain: Symptoms & Signs, Diagnosis, Treatment & Relief

What’s Causing Your Abdominal Pain and How to Treat It

Abdominal Pain Symptoms, Signs, Diagnosis, Treatment Relief

Abdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly.

Abdominal pain is pain that occurs between the chest and pelvic regions. Abdominal pain can be crampy, achy, dull, intermittent or sharp. It’s also called a stomachache.

You know that awful feeling: you’re nauseous; your stomach feels like it’s tied in a knot, and you don’t even want to move. What does your pain mean? Well, let’s talk today about abdominal pain. So, what causes abdominal pain? Almost everyone has pain in their belly at one time or another. Most of the time, a serious medical problem is not the cause, and how bad your pain is doesn’t always reflect the seriousness of the problem causing your pain.

Pain in the belly (abdomen) can come from conditions affecting a variety of organs. The abdomen is an anatomical area that is bounded by the lower margin of the ribs above, the pelvic bone (pubic ramus) below, and the flanks on each side. Although abdominal pain can arise from the tissues of the abdominal wall that surround the abdominal cavity (for example, skin and abdominal wall muscles), the term abdominal pain generally is used to describe pain originating from organs within the abdominal cavity (for example, beneath the skin and muscles).

These organs include the stomach, small intestine, colon, liver, gallbladder, and pancreas. Occasionally, pain may be felt in the abdomen even though it is arising from organs that are close to but not within the abdominal cavity, for example, the lower lungs, the kidneys, and the uterus or ovaries. This latter type of pain is called “referred” pain because the pain, though originating outside the abdomen, is being referred to (felt) in the abdominal area.

You may feel very bad pain if you are having gas or stomach cramps due to viral gastroenteritis, better known as a stomach virus. And some life-threatening conditions, such as colon cancer or a very early case of appendicitis, may cause only mild pain, or no pain at all. The important thing to know about abdominal pain is when you need immediate medical care.

Less serious causes of abdominal pain include constipation, irritable bowel syndrome, food allergies, lactose intolerance, food poisoning, and a stomach virus. Other, more serious, causes include appendicitis, an abdominal aortic aneurysm, a bowel blockage, cancer, and gastroesophageal reflux.

Sometimes, you may have abdominal pain from a problem that isn’t in your belly, like a heart attack, menstrual cramps, or pneumonia. So, what do you do about abdominal pain? Well, if you have mild abdominal pain, here are some helpful tips; Try sipping water or other clear fluids. Avoid solid food for the first few hours. If you’ve been vomiting, wait 6 hours and then eat small amounts of mild foods like rice, applesauce, or crackers. If your pain is high in your abdomen and occurs after meals, antacids may help, especially if you are feeling heartburn or indigestion.

You should seek medical attention if you have abdominal pain and are being treated for cancer, you can’t pass any stool, you’re vomiting blood, or you have chest, neck, or shoulder pain.

Call your doctor if you have abdominal pain that lasts 1 week or longer, if your pain doesn’t improve in 24 to 48 hours, if bloating lasts more than 2 days, or if you have diarrhea for more than 5 days.

What Is Abdominal Pain?

Abdominal pain is any pain or discomfort that occurs between the lower chest and the groin. Commonly referred to as the “belly,” the abdomen contains the stomach, intestines (small and large bowel), appendix, liver, gallbladder, pancreas, esophagus, and numerous blood vessels. Abdominal pain may be generalized—occurring throughout most of the abdomen—or it may be felt in a small area of the belly.

Abdominal pain is a symptom of a wide variety of mild to serious diseases, disorders and conditions. Abdominal pain can occur from indigestion, stress, infection, gallstones, inflammation, intestinal obstruction, peptic ulcer, cancer, and as a side effect of medication.

Depending on the cause, abdominal pain can last briefly, such as indigestion from eating rich food. Abdominal pain may last for a longer period of time, such as chronic pancreatitis, stomach cancer, or gastroesophageal reflux disease (GERD). Long-term abdominal pain may be continuous or occur sporadically.

People may describe abdominal pain as mild to severe, acute, ongoing, stabbing or cramp-like. While most people will experience abdomen pain in their lifetime, it is rarely caused by a serious medical problem.

However, chronic pain in your belly or abdominal pain with vomiting blood, bloody stools, dizziness, abdominal distention, fainting, shortness of breath, or yellowing of the skin (jaundice) can be a sign of a serious, potentially life-threatening condition and should be immediately evaluated in an emergency setting. If your abdominal pain is persistent or causes you concern, contact a medical professional.

What Causes Abdominal Pain?

Abdominal pain has many potential causes. The most common causes — such as gas pains, indigestion or a pulled muscle — usually aren’t serious. Other conditions may require more-urgent medical attention.

While the location and pattern of abdominal pain can provide important clues, its time course is particularly useful when determining its cause.

Acute abdominal pain develops, and often resolves, over a few hours to a few days. Chronic abdominal pain may be intermittent, or episodic, meaning it may come and go. This type of pain may be present for weeks to months, or even years. Some conditions cause progressive pain, which steadily gets worse over time.

Acute

The various conditions that cause acute abdominal pain are usually accompanied by other symptoms and develop over hours to days. Causes can range from minor conditions that resolve without any treatment to serious medical emergencies, including:

  • Abdominal aortic aneurysm
  • Appendicitis
  • Cholangitis (bile duct inflammation)
  • Cholecystitis
  • Cystitis (bladder inflammation)
  • Diabetic ketoacidosis
  • Diverticulitis
  • Duodenitis (inflammation in the first part of the small intestine)
  • Ectopic pregnancy (in which the fertilized egg implants and grows outside of the uterus, such as in a fallopian tube)
  • Fecal impaction (hardened stool that can’t be eliminated)
  • Heart attack
  • Injury
  • Intestinal obstruction
  • Intussusception (in children)
  • Kidney infection (pyelonephritis)
  • Kidney stones
  • Liver abscess (pus-filled pocket in the liver)
  • Mesenteric ischemia (decreased blood flow to the intestines)
  • Mesenteric lymphadenitis (swollen lymph nodes in the folds of membrane that hold the abdominal organs in place)
  • Mesenteric thrombosis (blood clot in a vein carrying blood away from your intestines)
  • Pancreatitis (pancreas inflammation)
  • Pericarditis (inflammation of the tissue around the heart)
  • Peritonitis (infection of the abdominal lining)
  • Pleurisy (inflammation of the membrane surrounding the lungs)
  • Pneumonia
  • Pulmonary infarction (loss of blood flow to the lungs)
  • Ruptured spleen
  • Salpingitis (inflammation of the fallopian tubes)
  • Sclerosing mesenteritis
  • Shingles
  • Spleen infection
  • Splenic abscess (pus-filled pocket in the spleen)
  • Torn colon
  • Urinary tract infection (UTI)
  • Viral gastroenteritis (stomach flu) (stomach flu)

Chronic (intermittent, or episodic)

The specific cause of chronic abdominal pain is often difficult to determine. Symptoms may range from mild to severe, coming and going but not necessarily worsening over time. Conditions that may cause chronic abdominal pain include:

  • Angina (reduced blood flow to the heart)
  • Celiac disease
  • Endometriosis
  • Gallstones
  • Gastritis (inflammation of the stomach lining)
  • Gastroesophageal reflux disease (GERD)
  • Hiatal hernia
  • Inguinal hernia
  • Irritable bowel syndrome
  • Mittelschmerz (ovulation pain)
  • Functional dyspepsia
  • Ovarian cysts
  • Pelvic inflammatory disease (PID)
  • Peptic ulcer
  • Sickle cell anemia
  • Strained or pulled abdominal muscle
  • Ulcerative colitis

Progressive

Abdominal pain that steadily worsens over time, often accompanied by the development of other symptoms, is usually serious. Causes of progressive abdominal pain include:

  • Cancer
  • Crohn’s disease (a type of inflammatory bowel disease)
  • Enlarged spleen (splenomegaly)
  • Gallbladder cancer
  • Hepatitis
  • Kidney cancer
  • Lead poisoning
  • Liver cancer
  • Non-Hodgkin’s lymphoma
  • Pancreatic cancer
  • Stomach cancer
  • Tubo-ovarian abscess (pus-filled pocket involving a fallopian tube and an ovary)
  • Uremia (buildup of waste products in your blood)

Symptoms of Abdominal Pain

You may think of the abdomen as the stomach and the rest of the digestive system—liver, gallbladder, pancreas, intestines—but there are many other organs, including the appendix, bladder, kidneys, numerous blood vessels, and parts of the reproductive system. So abdominal pain may accompany many other types of symptoms, depending on the underlying cause and the organ(s) involved

The type of pain can vary greatly. When abdominal pain occurs, it can:

  • be sharp, dull, stabbing, cramp-like, twisting or fit many other descriptions
  • be brief, come and go in waves, or it can be constant
  • make you throw up (vomit)
  • make you want to stay still or make you so restless that you pace around trying to find ‘just the right position’
  • vary from a minor problem to one needing urgent surgery.

Many times the location of the pain in your stomach can determine the potential cause: (Check the Diagram below for more information)

  • Upper right: Gallstones, cholecystitis, stomach ulcer, duodenal ulcer, hepatitis
  • Upper center: Heartburn/indigestion, hiatal hernia, epigastric hernia, stomach ulcer, duodenal ulcer, hepatitis
  • Upper left: Functional dyspepsia, stomach ulcer, gastritis, pancreatitis
  • Middle right: Kidney stones, kidney infection, inflammatory bowel disease, constipation
  • Middle center: Umbilical hernia, appendicitis, stomach ulcer, inflammatory bowel disease, pancreatitis
  • Middle left: Kidney stones, kidney infection, inflammatory bowel disease, constipation
  • Lower right: Appendicitis, inflammatory bowel disease, constipation, pelvic pain
  • Lower center: Bladder infection, prostatitis, inflammatory bowel disease, inguinal hernia, pelvic pain
  • Lower left: Constipation, diverticulitis, irritable bowel syndrome, inflammatory bowel disease, pelvic pain, inguinal hernia

How Is the Cause of Abdominal Pain Diagnosed?

Diagnosis – Physical Examination

Examining the patient will provide the doctor with additional clues to the cause of abdominal pain. The doctor will determine:

  • The presence of sounds coming from the intestines that occur when there is obstruction of the intestines
  • The presence of signs of inflammation (by special maneuvers during the examination)
  • The location of any tenderness
  • The presence of a mass within the abdomen that suggests a tumor, enlarged organ, or abscess (a collection of infected pus)
  • The presence of blood in the stool may signify an intestinal problem such as an ulcer, colon cancer, colitis, or ischemia.

Diagnosis – Exams and Tests

While the history and physical examination are vitally important in determining the cause of abdominal pain, testing often is necessary to determine the cause. These include laboratory tests, X-rays of the abdomen, radiographic studies, endoscopic procedures, and surgery.

Exams and Tests – Laboratory Tests

Laboratory tests such as the complete blood count (CBC), liver enzymes, pancreatic enzymes (amylase and lipase), and urinalysis are frequently performed in the evaluation of abdominal pain.

Exams and Tests – Plain X-rays of the Abdomen

Plain X-rays of the abdomen also are referred to as a KUB (because they include the kidney, ureter, and bladder). The KUB may show enlarged loops of intestines filled with copious amounts of fluid and air when there is intestinal obstruction. Patients with a perforated ulcer may have air escape from the stomach into the abdominal cavity. The escaped air often can be seen on a KUB on the underside of the diaphragm. Sometimes a KUB may reveal a calcified kidney stone that has passed into the ureter and resulted in referred abdominal pain or calcifications in the pancreas that suggests chronic pancreatitis.

Exams and Tests – Radiographic Studies

Radiology studies of the patient’s abdomen can be useful. Your physician may perform one or any of the associated tests listed.

Exams and Tests – Endoscopic Procedures

Endoscopy is the examination of the inside of the body (commonly the esophagus, stomach, and portions of the intestine) by using a lighted, flexible instrument called an endoscope. Examples of abdominal tests are listed on this slide.

Diagnosis – Surgery

Sometimes, diagnosis requires examination of the abdominal cavity either by laparoscopy or surgery. Laparoscopy is a type of surgery in which small incisions are made in the abdominal wall through which a laparoscope and other instruments can be placed to permit structures within the abdomen and pelvis to be seen. In this way, a number of surgical procedures can be performed without the need for a large surgical incision.

Why Can Diagnosis of the Cause of Abdominal Pain Be Difficult?

Modern advances in technology have greatly improved the accuracy, speed, and ease of establishing the cause of abdominal pain, but significant challenges remain. There are many reasons why diagnosing the cause of abdominal pain can be difficult. These are discussed on the following slides.

Diagnosis Difficulties – Symptoms May Be Atypical

For example, the pain of appendicitis sometimes is located in the right upper abdomen, and the pain of diverticulitis is on the right side. Elderly patients and patients taking corticosteroids may have little or no pain and tenderness when there is inflammation, for example, with cholecystitis or diverticulitis. This occurs because the elderly show fewer symptoms and signs of inflammation and corticosteroids reduce the inflammation.

Diagnosis Difficulties – Tests Are Not Always Abnormal

  • Ultrasound examinations can miss gallstones, particularly small ones.
  • CT scans may fail to show pancreatic cancer, particularly small ones.
  • The KUB can miss the signs of intestinal obstruction or stomach perforation.
  • Ultrasounds and CT scans may fail to demonstrate appendicitis or even abscesses, particularly if the abscesses are small.
  • The CBC and other blood tests may be normal despite severe infection or inflammation, particularly in patients receiving corticosteroids.

Diagnosis Difficulties – Diseases Can Mimic One Another

  • IBS symptoms can mimic bowel obstruction, cancer, ulcer, gallbladder attacks, or even appendicitis.
  • Crohn’s disease can mimic appendicitis.
  • Infection of the right kidney can mimic acute cholecystitis.
  • A ruptured right ovarian cyst can mimic appendicitis; while a ruptured left ovarian cyst can mimic diverticulitis.
  • Kidney stones can mimic appendicitis or diverticulitis.

Diagnosis Difficulties – The Characteristics of the Pain May Change

Examples discussed previously include the extension of the inflammation of pancreatitis to involve the entire abdomen and the progression of biliary colic to cholecystitis.

How Is Abdominal Pain Treated?

Common causes of gastrointestinal abdominal pain, such as gas, indigestion (dyspepsia), constipation, and upset stomach, will likely resolve within a few hours up to day, even without treatment. You can try over-the-counter (OTC) drugs for faster relief. Your doctor or pharmacist can help you select the right medicine. OTC options include:

  • Antacids and acid reducers
  • Antigas products like Maalox
  • Anti-nausea medicine
  • Stool softeners for constipation

Other gastrointestinal causes of abdominal pain, such as food poisoning, gastritis or peptic ulcer, may also resolve after the stomach or intestinal lining has a chance to heal. Medical treatments may include:

  • Antibiotics for bacterial causes
  • Acid reducers and acid blockers
  • Pepto-Bismol
  • Electrolyte replacement fluids in case of vomiting or diarrhea, to prevent dehydration

Treatment options for other causes of abdominal pain depend on the cause. Treatment of chronic conditions, such as inflammatory bowel syndrome, will most likely involve a combination of medications, lifestyle changes, and perhaps surgery at some point. Acute conditions, such as bowel obstruction, appendicitis, or gallstones, may involve hospital care and possibly surgery to repair or remove the diseased tissue.

Home remedies for abdominal pain
Getting an accurate medical diagnosis is the first and safest step to relieve abdominal pain, because a doctor or other healthcare provider can perform an exam and order tests to rule out serious causes. However, if you have generalized abdominal pain and suspect it is due to minor gastrointestinal issues, consider these home remedies:

  • Baking soda for heartburn (1 teaspoon in 8 ounces of water)
  • Ginger to aid digestion and reduce nausea (ginger root is best; try steeping some in hot water or tea)
  • Heated (not hot) compress on your belly for cramp-like pain
  • Liquid diet of broth and watered-down, non-caffeinated sports drinks
  • Lying reclined on your left side, which can help you pass gas
  • Modifying your diet to exclude problem foods, such as dairy products, beans, broccoli, and potential allergens
  • Blackstrap molasses for constipation (1 tablespoon a day)
  • Tylenol for pain or fever

When to see a doctor

Most cases of abdominal pain are not serious, and symptoms resolve with basic home care, such as rest and hydration, within hours to days.

Many medications available over-the-counter or online, such as antacids and gas medications, also help reduce and manage symptoms.

Acute (sudden and severe) or chronic (long-lasting) abdominal pain, however, are often signs of conditions that do require medical attention and treatment.

Symptoms that require medical attention include:

  • unexplained weight loss
  • unexplained exhaustion
  • changes or disturbances in bowel movements, such as chronic constipation or diarrhea, that do not resolve within a few hours or days
  • minor rectal (anal) bleeding or blood in stool
  • unusual vaginal discharge
  • chronic pain that continues after taking over-the-counter medications or returns after stopping prescribed medication
  • signs of urinary tract infection

Symptoms that require emergency care include:

  • sudden, severe pain, especially if accompanied by a fever over 102°F
  • severe pain that is very concentrated
  • bloody or black stool that may be sticky
  • uncontrollable vomiting, especially if vomit includes blood
  • the abdomen is extremely painful and sensitive to the touch
  • being unable to urinate
  • fainting or becoming unconscious
  • pain that gets dramatically worse quickly
  • pain in the chest, especially around the ribs, extending into the abdomen
  • severe abdominal pain that improves with lying very still
  • Though rare, it is important for people experiencing these symptoms to seek emergency medical attention.

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