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Abdominal pain

Definition

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

Alternative Names

Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps

Considerations

There are many organs in the abdomen. Pain in the abdomen can originate from any one of them, including:

• Organs related to digestion -- the end of the esophagus, the stomach, the small and large intestines, the liver, the gallbladder, and the pancreas.
• The aorta -- a large blood vessel that runs straight down the inside of the abdomen
• The appendix -- an organ in the lower right abdomen that no longer serves much function
• The kidneys -- two bean shaped organs that lie deep within the abdominal cavity
• The spleen -- an organ involved in blood maintenance and infection control

However, the pain may start from somewhere else -- like your chest or pelvic area. You may also have a generalized infection, such as the flu or strep throat, that affects many parts of your body.

The intensity of the pain does not always reflect the seriousness of the condition causing the pain. Severe abdominal pain can be from mild conditions, such as gas or the cramping of viral gastroenteritis. On the other hand, relatively mild pain or no pain may be present with life-threatening conditions, such as cancer of the colon or early appendicitis.

Causes

Many different conditions can cause abdominal pain. The key is to know when you must seek medical care right away. In many cases you can simply wait, use home care remedies, and call your doctor at a later time only if the symptoms persist.

Possible causes include:

• Appendicitis (inflammation of the appendix)
• Bowel obstruction
• Cholecystitis (inflammation of the gallbladder) with or without gallstones
• Chronic constipation
• Dissecting abdominal aortic aneurysm
• Diverticular disease, including diverticulitis
• Easly-stage shingles (a viral infection where pain begins before the appearance of a rash)
• Excessive gas
• Food allergy
• Food poisoning (salmonella, shigella)
• Gastroesophageal reflux
• Heartburn or indigestion
• Hernia
• Infectious mononucleosis
• Inflammatory bowel disease (Crohn's disease or ulcerative colitis)
• Intussusception -- while uncommon, this is a serious possible cause of pain in an infant who may be bringing the knees to the chest and crying
• Irritable bowel syndrome
• Kidney stones
• Lactose intolerance
• Pancreatitis (inflammation of the pancreas)
• Parasitic infections (Giardia)
• Sickle cell crisis
• Spinal fracture
• Ulcers
• Urinary tract infections
• Viral gastroenteritis (stomach flu)

When an inflamed organ (such as the appendix) in the abdomen ruptures or leaks fluid, you not only have excruciating pain, your abdomen will be very stiff and you likely will have a fever. This occurs as peritonitis (inflammation and infection of the lining of the abdominal cavity) develops and spreads from the site of the rupture. This is a medical emergency.

In infants, prolonged unexplained crying (often called "colic") may be caused by abdominal pain that may end with the passage of gas or stool. Colic is often worse in the evening. Cuddling and rocking the child may bring some relief.

Abdominal pain that occurs during menstruation may be from menstrual cramps or it may indicate a problem in a reproductive organ. This includes conditions such as endometriosis (when tissue from the uterus is displaced to somewhere else like the pelvic wall or ovaries), uterine fibroids (thick bands of muscular and fibrous tissue in the uterus), ovarian cysts, ovarian cancer (rare), or pelvic inflammatory disease (PID) -- infection of the reproductive organs, usually from a sexually transmitted disease.

Abdominal pain may actually be caused by an organ in the chest, like the lungs (for example, pneumonia) or the heart (like a heart attack). Or, it may stem from a muscle strain in the abdominal muscles.

Cancers of the colon and other gastrointestinal areas are serious but uncommon causes of abdominal pain.

Other more unusual causes of abdominal pain include a type of emotional upset called somatization disorder, reflected as physical discomfort (including recurrent abdominal pain). Strep throat in children can cause abdominal pain.

Home Care

For mild pains:

• Sip water or other clear fluids.
• Avoid solid food for the first few hours. If you have been vomiting, wait 6 hours. Then eat small amounts of mild foods such as rice, applesauce or crackers.
• If the pain is high up in your abdomen and occurs after meals, antacids may provide some relief, especially if you feel heartburn or indigestion. Avoid citrus, high-fat foods, fried or greasy foods, tomato products, caffeine, alcohol, and carbonated beverages. You may also try H2 blockers (Tagamet, Pepcid, or Zantac) available over the counter. If any of these medicines worsen your pain, CALL your doctor right away.
• AVOID aspirin, ibuprofen or other anti-inflammatory medications, and narcotic pain medications unless your health care provider prescribes them. If you know that your pain is not related to your liver, you can try acetaminophen (Tylenol).

When to Contact a Medical Professional

Seek immediate medical help or call your local emergency number (such as 911) if you:

• Are unable to pass stool, especially if you are also vomiting
• Are vomiting blood or have blood in your stool (especially if maroon or dark, tarry black)
• Have chest, neck, or shoulder pain
• Have sudden, sharp abdominal pain
• Have pain in your shoulder blades with nausea
• Your belly is rigid, hard, and tender to touch

Call your doctor if you have:

• Abdominal discomfort that lasts 1 week or longer
• Bloating that persists for more than 2 days
• Burning sensation when you urinate or frequent urination
• Diarrhea for more than 5 days, or if your infant or child has diarrhea for more than 2 days or vomiting for more than 12 hours -- call right away if a baby younger than 3 months has diarrhea or vomiting
• Fever (over 100°F for adults or 100.4°F for children) with your pain
• Pain that develops during pregnancy (or possible pregnancy)
• Prolonged poor appetite
• Unexplained weight loss

What to Expect at Your Office Visit

From your medical history and physical examination, your doctor will try to determine the cause of your abdominal pain. Knowing the location of pain and its time patten will help, as will the presence of other symptoms like fever, fatigue, general ill feeling, nausea, vomiting, or changes in stool.

During the physical examination, the doctor will test to see if the pain is localized to a single area (point tenderness) or whether it is diffuse. He or she will be checking to see if the pain is related to inflammation of the peritoneum (called peritonitis). If the health care provider finds evidence of peritonitis, the abdominal pain may be classified as an "acute abdomen", which may require surgery right away.

Your doctor may ask the following questions about your abdominal pain:

• Is the pain all over (diffuse or generalized) or in a specific location?
• What part of the abdomen is affected? Lower or upper? Right, left or middle? Around the navel?
• Is the pain severe, sharp or cramping, persistent or constant, periodic and changing intensity over minutes?
• Does the pain awaken you at night?
• Have you had similar pain in past? How long has each episode lasted?
• How often do you have the pain?
• Does it occur within minutes following meals? Within 2 to 3 hours after meals?
• Is it getting increasingly more severe?
• Does it occur during menstruation (dysmenorrhea)?
• Does the pain go into your back, middle of the back, below the right shoulder blade, or your groin, buttocks, or legs?
• Does the pain get worse after lying on the back?
• Does the pain get worse after eating or drinking? After greasy foods, milk products, or alcohol?
• Does the pain get worse after stress? After straining efforts?
• Does the pain get better after eating or a bowel movement?
• Does the pain get better after milk or antacids?
• What medications are you taking?
• Have you had a recent injury?
• Are you pregnant?
• What other symptoms are occurring at the same time?

Diagnostic tests that may be performed include:

• Barium enema
• Upper GI and small bowel series
• Blood, urine, and stool tests
• Endoscopy of upper GI (gastrointestinal) tract (EGD)
• Ultrasound of the abdomen
• X-rays of the abdomen

Prevention

For prevention of many types of abdominal pain:

• Eat small meals more frequently.
• Make sure that your meals are well-balanced and high in fiber. Eat plenty of fruits and vegetables.
• Limit foods that produce gas.
• Drink plenty of water each day.
• Exercise regularly.

For prevention of symptoms from heartburn or gastroesophageal reflux disease:

• Quit smoking.
• Lose weight if you need to.
• Finish eating at least 2 hours before you go to bed.
• After eating, stay upright for at least 30 minutes.
• Elevate the head of your bed.

References

American Academy of Pediatrics Subcommittee on Chronic Abdominal Pain. Chronic Abdominal Pain in Children. Pediatrics. 2005; 115(3): 812-815.

Ohge H. Levitt MD. Intestinal Gas. In: Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa: WB Saunders; 2006: Chap. 10.

Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery, 17th ed. St. Louis, Mo: WB Saunders; 2004.

Abdominal Pain. In: Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 6th ed. St. Louis, Mo: Mosby; 2006: Chap. 22.

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