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Causes, Diagnosis and Treatment of Abdominal Pain

Abdominal pain can be characterized as pain that is felt in the area anywhere between the chest and groin and it can involve any of the abdomen’s organs. Abdominal organs are contained in a bag-like membrane called peritoneum and they include stomach, pancreas, small and large intestine, appendix, liver, gallbladder, spleen, kidneys and ureters. The abdomen also contains the aorta and other blood vessels, nerves, adrenal glands and the lower end of the esophagus.

The pelvic region, including the organs such as the urinary bladder, uterus, ovaries, prostate, etc., is usually considered separately from the abdomen. Abdominal pain can also originate in another area of the body. A throat infection or a disease of an organ in the chest, such as the lungs or the heart, and nerve impingement in the back can also trigger abdominal pain.

Pain felt in the abdomen is common and may or may not signal a serious condition. The intensity of the abdominal pain is not an indicator of the seriousness of a condition. For instance, gas is a mild condition that can cause severe pain in the abdomen whereas a life-threatening condition, such as colorectal cancer, may only cause mild pain.

Potential Causes of Abdominal Pain

Both, lifestyle factors, such as overeating, hunger, eating spicy or fatty foods, and common medical conditions, like diarrhea, constipation, indigestion, vomiting, food poisoning, heartburn and food allergies, can all contribute to abdominal pain. In addition, abdominal pain is, as its name suggests, often caused by disorders in the abdominal organs, including:

  • Appendicitis (inflammation of the appendix)
  • Bowel disorders (inflammatory bowel disease or irritable bowel syndrome)
  • Cholecystitis (inflammation of the gallbladder)
  • Diverticulosis (the presence of small protruding pouches in the inner lining of the intestine) and diverticulitis (inflammation of these pouches)
  • Esophagitis (inflammation of the esophagus) or other esophageal conditions
  • Gallstones (cholelithiasis)
  • Gastritis (inflammation of the lining of the stomach)
  • Gastroenteritis also known as infectious diarrhea (inflammation of the lining of the stomach and intestines)
  • Gastroesophageal reflux disease (GERD is a condition in which food and liquid come up from the stomach into the esophagus)
  • Hepatitis (inflammation of the liver) or other liver conditions
  • Intestinal obstruction (partial or complete blockage of the bowel)
  • Kidney stones (nephrolithiasis) or bladder stones (cystolithiasis)
  • Malabsorption conditions, including lactose and gluten intolerances and metabolic disorders such as glycogen or lipid storage diseases
  • Pancreatitis (inflammation of the pancreas)
  • Peptic ulcer
  • Peritonitis (inflammation of abdominal membrane)

Other potential triggers of abdominal pain may include:

  • Abdominal migraine, also known as periodic syndrome
  • An infection elsewhere in the body such as influenza, strep throat, pneumonia, urinary tract infections and sexually transmitted diseases
  • Cancer (e.g. stomach, pancreatic, colorectal, etc.)
  • Cystic fibrosis (a genetic disorder in which abnormal production of mucus damages organs)
  • Dissecting (leaking) or ruptured abdominal aortic aneurysm
  • Drug abuse may also result in abdominal pain
  • Gastrointestinal or liver pain from HIV/AIDS
  • Gastroparesis (impaired motility of stomach muscles due to damage to the autonomic nerves, slowing digestion)
  • Hernia (protruding of an organ or tissue through an abnormal opening), including hiatal hernia and umbilical hernia
  • Heart attack
  • Parasitic infections
  • Sickle cell anemia crisis (a painful episode that occurs in patients with sickle cell anemia)
  • Somatization disorder (a mental disorder in which psychological problems cause a person to make physical complaints)
  • Straining or tearing of abdominal muscles
  • Stress or anxiety

Less common factors causing abdominal pain include:

  • Behcet’s disease (a rare inflammatory condition, which can in rare cases cause sores in the digestive tract that produce abdominal pain)
  • Colorectal polyp (an abnormal growth in the lining of the colon or rectum)
  • Diabetic ketoacidosis (an emergency condition in patients with diabetes mellitus)
  • Intussusception (a serious condition in which one part of the small intestine folds into another, mostly affecting infants)
  • Porphyria (a group of disorders in which chemical substances called porphyrins accumulate)
  • Rectal or anal fissure

There are chronic disorders, such as chronic fatigue syndrome, fibromyalgia, systemic lupus erythematosus, sarcoidosis, myositis, polymyalgia rheumatica or myofascial pain syndrome that cause pain through the body, which may also result in abdominal pain.

In women, abdominal pain may also be due to the following specific factors:

  • Ectopic pregnancy (implantation of a fertilized egg outside the uterus)
  • Endometriosis (a condition in which the tissue that makes up the lining of the uterus is found outside the uterine cavity)
  • Menstruation and premenstrual syndrome
  • Miscarriage
  • Ovarian cysts
  • Ovarian cancer or other gynecologic cancers
  • Ovulation
  • Pelvic inflammatory disease (infection of the lining of the uterus, the fallopian tubes or the ovaries)
  • Uterine fibroids (non-cancerous tumors that can form in the uterus)

In men, lower abdominal pain may also be due to prostate disorders, such as benign prostatic hyperplasia, prostatitis, prostatodynia or prostate cancer, or referred pain from the testicles.

Diagnosing Abdominal Pain

In order to determine the cause of abdominal pain the doctor will first need to obtain the patient’s medical history and perform a thorough physical examination. Patients will be asked to describe their pain symptoms. Determining the location of the pain can greatly help shorten the list of possible triggers. Pain in different regions of the abdomen can suggest a number of causes, such as:

  • Belly button area: appendicitis, abdominal migraine, gastroenteritis, obstructed bowel, ruptured aortic aneurysm, small intestine disorder
  • Lower left abdomen: Crohn’s disease, diverticulitis, ectopic pregnancy, hernia, inflamed fallopian tube, irritable bowel, kidney stones, ovulation
  • Lower middle abdomen: colon disorder, pelvic inflammatory disease, urinary tract infection
  • Lower right abdomen: appendicitis, ectopic pregnancy, hernia, inflammation of the colon, kidney stones, ovulation
  • Upper left abdomen: disorders of the colon, pancreas, stomach or spleen
  • Upper middle abdomen: disorders of the gallbladder, heart, pancreas, stomach, upper small intestine or ruptured aortic aneurysm
  • Upper right abdomen: inflammation of the liver, pancreas, gallbladder or duodenum; pleurisy, pneumonia

Once the location of the pain has been determined, the doctor may ask the patient a number of other specific questions about their pain symptoms. Women, for example, may be also asked about their menstrual history and use of contraception and a pregnancy test may be ordered. Both, women and men may need to answer questions about their sexual history. This should help the doctor to rule out certain conditions, such as pelvic inflammatory disease, ectopic pregnancy or sexually transmitted diseases.

During the physical examination, the doctor will measure the patient’s blood pressure, heart rate and temperature and may examine the skin and eyes for signs of jaundice, the lungs for signs of consolidation and the heart for rubs and murmurs. The abdomen will be first examined visually and for bowel sounds. The doctor may then touch the abdomen to search for masses and localized tenderness. Rectal and pelvic exams may also be performed on certain patients. In addition, some patients may also be examined for signs of nerve and muscle wall injury or hernia.

Medical tests used to detect and rule out conditions that may be causing abdominal pain include:

  • Blood tests (blood count CBC, liver tests e.g. bilirubin, liver enzyme tests and tests of pancreatic enzymes e.g. lipase and amylase)
  • Capsule endoscopy
  • Colonoscopy (it is an endoscopy of the lower gastrointestinal tract)
  • Computed axial tomography (CAT) scan
  • Endoscopy of the upper gastrointestinal tract (upper endoscopy also known as an esophagogastroduodenoscopy EGD)
  • Stool tests (blood, infection or worm infestation)
  • Ultrasound of the abdomen
  • Upper gastrointestinal and small bowel series (a barium-containing liquid is swallowed to improve the images of the esophagus, stomach, and small intestine made by an x-ray)
  • Urine tests (blood or infection)
  • X-rays of the abdomen (a barium-containing liquid can be introduced into the rectum and colon to improve the images made by an x-ray what is known as barium enema)

Laparoscopy may sometimes be required to closely examine the abdominal cavity and pinpoint the cause of abdominal pain. During this surgical procedure, a small incision is made near the navel through which a thin lighted tube with camera, called laparoscope, is inserted into the abdomen. The doctor may then view and examine abdominal organs on a monitor.

Relieving Abdominal Pain

Abdominal pain often does not require an immediate visit to the doctor. Instead, several home remedies and over-the-counter medications can be used efficiently to relieve abdominal discomfort. Some of the common home remedies offering relief for mild abdominal pain include sipping water or sucking on ice chips, avoiding solid food for the first few hours after the occurrence of the abdominal pain and thermotherapy using hot water bottles. In addition, certain forms of chronic abdominal problems can be sometimes eased with alternative pain management methods such as acupuncture, acupressure, cognitive behavioral therapy, biofeedback, stress management or hypnosis.

There is a number of over-the-counter and prescription medications available to treat the various sources of abdominal pain, including:

  • Acetaminophen is a common painkiller. It should not be used if the abdominal pain is due to a liver condition.
  • Antacids help ease heartburn by neutralizing excess stomach acid.
  • Antidiarrheals are used to treat persistent diarrhea.
  • Antiemetics are used to relieve symptoms of and prevent nausea and vomiting.
  • Anti-inflammatories like corticosteroids or aminosalicylates are used to ease conditions such as inflammatory bowel disease.
  • Antimicrobials are a group of drugs that includes antibiotics used to fight bacterial infections, antivirvals to fight viral infections and antiparasitics to fight parasitic infections.
  • Antispasmodics are used to ease gastrointestinal cramps or spasms.
  • H2 blockers or proton pump inhibitors reduce the production of stomach acid and thus relieve symptoms of conditions such as heartburn or gastroesophageal reflux disease.
  • Laxatives are used to relieve constipation.
  • Prokinetics stimulate contractions of stomach muscles and are used to ease conditions such as gastroesophageal reflux disease and gastroparesis.

Although these medications are helpful for some types of abdominal pain, such as those caused by stomach acid, relief is dependent on the cause of the pain. If abdominal pain persists or worsens, patients should contact their doctor as some causes require treatment with more specific prescription medications and/or surgery (see also “Which Painkillers Are Safe for Your Child?“).

Preventing Abdominal Pain

Abdominal pain can be often prevented by:

  • Avoiding high-fat foods, fried foods, citrus fruits and juices, caffeine, alcohol, carbonated beverages and tomato products
  • Avoiding meals shortly before bedtime
  • Avoiding unnecessary use of aspirin, ibuprofen and some other medications that may irritate the digestive tract, unless prescribed by a doctor
  • Drinking enough liquids
  • Eating a balanced diet high in fiber, including plenty of fruits and vegetables
  • Eating smaller meals more frequently to prevent overloading the stomach
  • Exercising regularly
  • Keeping a food diary to identify problematic foods and excluding such foods
  • Limiting foods that cause gas