Abdominal Pain

Overview

All of us will experience abdominal pain of greater or lesser severity at some time or other. In most instances these pains are mild, transient and not important.

Causes

Causes include the stomach or intestines being distended with acid, food or air or going into spasm. These conditions are functional disorders as there is no visible disease causing the pain, and they are compatible with good health.

Other and fortunately less common causes of abdominal pain are potentially more serious. Ulcers of the stomach or duodenum (also known as peptic ulcers disease) sometimes lead to life threatening bleeding or perforation. Gallstones may give rise to infection and obstruction of bile flow. A liver enlarged due to cancer can cause abdominal pain.

Other conditions which can give rise to abdominal pain include infections, inflammation or growths in the oesophagus, pancreas, kidneys, small and large intestines, the uterus and ovaries. Such conditions due to visible disease of various organs are said to be structural disorders.

One subgroup of structural disorders is known as the acute abdomen. These include conditions like acute appendicitis or perforated ulcer for which urgent surgery may be required. It is important for patients and doctors alike to differentiate between the functional causes of pain, which are fully compatible with good general health, and the structural causes, which usually require medical treatment. In particular, patients with acute abdomens must be identified as immediate hospital admission is required.

Symptoms

Characteristics of Pain from Various Causes

Functional Disorders
Upper abdominal discomfort after meals, often associated with a sensation of fullness, belching, nausea, early satiety or inability to finish a meal are typical features of functional disease, also known as non-ulcer dyspepsia.

Irritable bowel syndrome (see related articles on this website) is due to spasm of the intestine and gives rise to upper or lower generalised abdominal pain. There is usually associated constipation and/or diarrhoea, and defecation may relieve the pain. Pain severity vary from mild to excruciating. Patients often report that pain exacerbations are precipitated by stressful life situation.

Structural disorders
Peptic ulcer disease (see related articles on this website) usually gives rise to upper abdominal pains worse on hunger, relieved by food and sometimes waking the patient up at night. Stomach cancer can give rise to similar pains but usually of shorter duration and associated with loss of appetite and weight. Gallbladder stones (see related articles on this website) give rise to very severe upper abdominal pain lasting up to several hours, sometimes going to the back or right shoulder. There may also be darkening of the skin and eyes (jaundice) or of the urine.Renal colic is due to a stone passing down from the kidneys. It results in excruciating pain lasting up to hours, usually in one loin but often going into the lower abdomen and groin on the same side. The urine may turn dark due to the presence of blood.

A gynecological problem is suspected in a female with lower abdominal pain if there is associated abnormality of the periods or if the pain tends to occur at a particular phase of the menstrual cycle.

The acute abdomen
The pain of acute appendicitis is often generalised initially but becomes concentrated in the right lower abdomen. This pain is constant and becomes increasingly severe. It may get worse on touching the abdomen, on movement or even on breathing or coughing. There may be vomiting and fever. The pain from perforated ulcer is similar in character but occurs in the upper abdomen.

In intestinal obstruction, there is generalised abdominal pain which comes in waves (colic). The abdomen becomes distended and vomiting occurs. Stools and flatus are not passed.

Treatment Options

Mild abdominal discomfort can be ignored or treated by a hot drink or simple antacid preparations available over the counter. Structural diseases should be suspected if the pains are persistent or severe. They are also more likely in persons over the age of forty, if the symptoms are of recent onset, when the pain goes to the back or wakes the person up at night. Other 'alarm' symptoms include vomiting, loss of appetite and weight, the passage of blood and yellowing of the eyes and skin. In such cases the doctor should be consulted so that appropriate tests can be carried out to diagnose or exclude structural causes of abdominal pain. Urgent medical attention should be sought when the pain is excruciating or unremitting, when there is persistent vomiting and/or high fever. These features may be due to an acute abdomen and prompt admission to hospital is then advisable.