Abdominal Pain

Abdominal pain has many causes, from those that pass quickly to very serious, even life-threatening. Common causes, such as gases and indigestion, menstrual cramps and even food poisoning and flu can be recognized immediately.

However, sometimes abdominal pain is a sign of a serious condition. Discomfort that arises may not always be related to the stomach and could be a sign of a disorder in another organ within or outside the digestive system. Since many health conditions can cause abdominal pain, the diagnosis includes a physical examination, detailed medical history, blood, urine, stool, and enzyme tests. Imaging tests (X-rays, MRI, and CT scans) can also help doctors diagnose conditions in the stomach.

You should always seek medical help if the abdominal pain is unexplained, persistent, or intense.

What is abdominal pain?

Abdominal pain refers to discomfort in the area between the chest and the pelvis. It is accompanied by symptoms such as gas, cramps, bloating, belching, ulcers, and urinary infections.

Unlike mild cramps, severe abdominal pain is a greater cause for concern and a reason to visit a doctor, especially if they intensify or recur.

Sudden abdominal pain – The causes of sudden abdominal pain can be:

Overeating – If you eat too much, it can lead to stomach bloating and discomfort.
Stomach flu – Symptoms of stomach flu (also known as viral gastroenteritis) occurs suddenly. It can cause stomach pain, nausea, vomiting or diarrhea.
Ulcer perforation – A sore on the gastric mucosa (ulcer) can worsen and cause gastric acid leakage which is very painful and sometimes life-threatening.

Common misconceptions about abdominal pain

Every time an organ in the abdomen is affected by inflammation, it manifests as abdominal pain. However, this doesn’t necessarily mean that the digestive tract is involved. For example, inflammation of the pancreas and appendicitis can both cause abdominal pain. Another organ that can lead to abdominal pain is the gallbladder. Unpleasant symptoms of chronic pain occur when gallstones block the drainage of the gallbladder, leading to an infection.

Abdominal pain can also be caused by kidney stones, heart attack or heart conditions such as angina pectoris or congestive heart failure, organ cancer, hiatal hernia, cysts.

Common locations of abdominal pain

Upper – Pain in the upper part of the stomach is above the navel.
Lower – Pain in the lower part of the stomach is below the navel.
Left – Pain that occurs to the left of the navel.
Right – Pain that occurs to the right of the navel.

Symptoms and causes associated with different locations of pain

Describing the pattern and location of symptoms to a doctor can help identify the cause of abdominal pain.

Peptic ulcer — The pain is often felt in the upper part of the abdomen, it is like stabbing a knife-like sensation that passes to the back.
Gastroesophageal reflux disease (GERD) – The pain usually occurs in the middle of the abdomen and is accompanied by heartburn, which develops just below the sternum. Belching is also common.
Appendicitis – The pain typically starts near the belly button before moving down to the lower right abdomen. It then becomes more constant.
Gallstones or gallbladder irritation – Pain occurs in the upper right part of the abdomen, back, or right shoulder.
Pain in the lower abdomen — comes from the intestines.
Menstrual pain – This is usually a dull, cramp-like pain felt in the lower abdomen and may radiate to the back. The cause of the pain will determine how long the symptoms last.
Gastroenteritis – A viral or bacterial infection of the intestines typically lasts for several days and is accompanied by severe symptoms such as nausea, vomiting, and diarrhea.
Food poisoning can take several hours or days to develop and can then last for several days. It is characterized by symptoms like nausea, vomiting, diarrhea, and a fever.

What the location of pain can tell us

The location is an important indicator in discovering the cause of abdominal pain.

Right Upper Quadrant – Organs located in this quadrant include the liver, gallbladder, duodenum, upper part of the pancreas, and the hepatic flexure of the colon. Pain in the right upper quadrant may indicate hepatitis, cholecystitis, or the formation of a peptic ulcer (ulcer).

Right Lower Quadrant – Organs in the right lower quadrant include the appendix, upper part of the colon, and the right ovary and fallopian tube in women. Pain in the right lower quadrant may occur with appendicitis or ovarian issues in women.

Left Upper Quadrant – Organs in the left upper quadrant include the stomach, spleen, left part of the liver, main part of the pancreas, left kidney, adrenal glands, splenic flexure of the colon (the bend where the transverse and descending colon meet in the upper left quadrant and is also the highest point the colon reaches in the body), and the lower part of the colon. This quadrant can be sensitive in cases of appendicitis and abnormalities in the position and function of the intestines, such as malrotation (lack of rotation or incomplete rotation).

Left Lower Quadrant – Organs in this quadrant include the sigmoid colon, left ovary, and fallopian tube in women. Pain in this quadrant may be a symptom of colitis, diverticulitis, or a kidney stone. Ovarian cysts (in women) or pelvic inflammatory disease can also be the cause of pain in this quadrant.

Type of abdominal pain based on the location of pain

The location of pain may indicate which organs are affected by the disease and what kind of symptoms are manifested. For example, pain in the upper right quadrant may indicate a problem with the liver or gallbladder.

However, the severity of the pain does not always reflect the seriousness of the underlying condition. For instance, severe abdominal pain can be caused by gas or stomach cramps due to viral gastroenteritis. On the other hand, life-threatening conditions such as colon cancer or acute appendicitis may only cause mild pain or even be painless.

Abdominal pain – Felt in a larger area of the stomach. This type of pain is more typical of stomach viruses, indigestion, or gas. If the pain becomes more intense, the cause may be related to bowel obstruction.
Localized pain – This is pain that is confined to a specific area of the stomach. It often indicates issues with a specific organ, such as the appendix, gallbladder, or stomach.
Cramp-like pain – This type of pain, although uncomfortable, is usually not a cause for major concern. It often arises due to gas and bloating and is frequently accompanied by diarrhea. More worrisome signs are more frequent or prolonged pain lasting more than 24 hours or occurring with a fever.
Colic – This type of intense pain comes in waves and often starts and ends suddenly. Kidney and gallbladder stones are common causes of this type of stomach pain.

The most common causes of abdominal pain

Digestive problems

Indigestion – In case of poor digestion, there is pain, burning sensation or discomfort in the upper abdomen.

Gases and pain due to gases – Gases occur when bacteria in the small intestine break down food that the body cannot tolerate. Increased gas pressure in the intestines can cause sharp pain. Gas can also cause cramping, bloating, or belching.

Constipation – When too much waste material accumulates in the intestines, it puts pressure on the colon, which can cause pain. There are several reasons for this, such as insufficient fiber or fluids in the diet, the use of certain medications, lack of physical activity, or it may also be a sign of a neurological disorder or bowel obstruction. If constipation persists and causes discomfort, the person should see a doctor.

Diarrhea – Stomach cramps accompanied by diarrhea are often caused by gastroenteritis, a viral or bacterial infection of the stomach and intestines, or the intake of certain medications. Symptoms usually pass within a few days.

Food allergies and intolerance – When the body is unable to digest certain substances in food, it can lead to allergic reactions such as rash, itching, and swelling. When large amounts of undigested substances are present, a lot of gas is produced, causing pressure and pain, and other symptoms like nausea, vomiting, bloating, diarrhea, and abdominal pain may also occur. A person with food intolerance will experience these symptoms of hypersensitivity to certain foods.

Food poisoning often leads to sharp, stabbing abdominal pain that can be accompanied by painful bloating and gas, high fever, diarrhea, and muscle aches.

Inflammatory processes

Viral Gastroenteritis (Stomach Flu) – In this case, abdominal pain is often accompanied by nausea, vomiting, and diarrhea. Bacteria or viruses are the causes of this infection, and the symptoms usually disappear within a day or two. Symptoms lasting longer than two days may be a sign of more serious health issues, such as infections or inflammatory conditions (inflammatory bowel disease).

Peptic Ulcer – Ulcers or sores that do not heal can cause severe and persistent abdominal pain. They can also lead to bloating, poor digestion, and weight loss. The most common causes of stomach and peptic ulcers are Helicobacter pylori bacteria and excessive or continuous use of nonsteroidal anti-inflammatory drugs (NSAIDs).

Heartburn – Occasional lifting of stomach acid to the throat causes a burning sensation and sometimes pain.

Gastritis – When the stomach lining becomes inflamed or swollen, it can cause pain. Nausea, vomiting, gas, and bloating are other common symptoms of gastritis.

Gastroesophageal Reflux Disease (GERD) – GERD is a chronic condition that involves persistent acid reflux. It can cause abdominal pain, heartburn, and nausea. Over time, it can lead to complications such as esophagitis (inflammation of the esophagus).

Crohn’s Disease – It causes inflammation of the digestive tract lining, leading to pain, gas, diarrhea, nausea, vomiting, and bloating. It is a very serious condition that can be kept under control with certain treatments.

Irritable Bowel Syndrome (IBS) – People with this condition have a reduced ability to digest certain foods. Abdominal pain is the primary symptom for many people with irritable bowel syndrome, which is often relieved after bowel movements. Other common symptoms include gas, nausea, cramps, and bloating.

Conditions that cause pain

Stress (psychosomatic pain) – People with abdominal pain caused by stress or anxiety most often complain of a feeling of knots, cramps, bloating, digestive issues, nausea, or diarrhea.

Visceral hypersensitivity – Visceral hypersensitivity refers to pain or discomfort in the visceral organs – soft, internal organs located in the chest, abdomen, and pelvic cavity.

Abdominal bloating – occurs in cases of food intolerance, as a result of poor digestion, and is sometimes accompanied by nausea.

Traumatic injuries – injuries to the abdominal region can cause abdominal pain.

Muscle strain – Since many daily activities require the use of abdominal muscles, injuries or strains are common. Many people also focus on abdominal exercises, increasing the risk of damage. For example, overdoing abdominal exercises can lead to pain in the abdominal muscles.

Vomiting – often causes stomach pain as stomach acid travels backward through the digestive tract, irritating tissues along the way. Vomiting can also cause pain in the abdominal muscles. A wide range of factors can cause vomiting, ranging from intestinal obstruction to alcohol poisoning.

Menstrual pain, pain during ovulation – Menstruation can cause inflammation and pain in the abdomen. Bloating, gas, cramps, and constipation can also occur during menstruation, causing discomfort in the stomach. Pain in the lower abdomen occurs during ovulation.

Kidney stones – Causes symptoms such as pressure and pain in the lower back, fever, frequent urination, discomfort during urination, and bloody urine. However, kidney stones can sometimes cause gastrointestinal symptoms such as nausea, vomiting, and discomfort.

Urinary tract infection (UTI) – Urinary tract infections are most commonly caused by bacteria, primarily Escherichia coli, which colonize the urethra and bladder, causing a bladder infection or cystitis. Symptoms may include pain, pressure, and bloating in the lower abdomen. Most of these infections also cause painful urination and cloudy, foul-smelling urine.

Pelvic inflammatory disease – The symptoms of this disease are usually pain, ranging from mild to severe, in the lower abdomen and pelvis.

Heart problems, such as a heart attack, angina, or heart failure – Heart attack symptoms can also be similar to indigestion. For example, a feeling of heaviness in the chest, stomach pain, or heartburn may occur. If chest pains last longer than 15 minutes, it may be the onset of a heart attack.

Pneumonia – Severe abdominal pain sometimes occurs in people with pneumonia in the lower lobes of the lungs.

Some medications can cause abdominal pain (anti-inflammatory drugs)

Herpes zoster – Chronic, unexplained abdominal pain is the most common manifestation of zoster. Herpes zoster infection should always be kept in mind when diagnosing in patients with acute abdominal pain.

Diagnosis and tests for abdominal pain

Examination – The doctor will palpate the abdomen and try to identify the location of the pain in the abdominal region. In women, this may also involve a pelvic examination, and in men, an examination of the penis and scrotum.

The doctor will examine the abdomen to possibly detect bruises, scars, and other skin marks that may help in identifying potential issues. The doctor will use a stethoscope to listen to different areas of the abdomen. The sounds emitted or not emitted by the intestines can also help in identifying problems. The doctor will then palpate various parts of the abdomen and press on specific areas to determine if they are painful and sensitive.

Additionally, the doctor will ask the patient detailed questions about the type, location, intensity, and frequency of the pain. Long-lasting pain may indicate an ulcer or heartburn. Sudden, intense pain may indicate very serious conditions, such as ulcer perforation or appendicitis. Besides abdominal pain, the doctor will check if there has been recent weight loss, if the patient is anemic, whether he has regular stool, what illnesses the patient has, and what medications they are using.

Diagnostic procedures for abdominal pain

In addition to taking a detailed medical history, the doctor may include diagnostic tests such as:

blood test (liver function tests)
urine tests
stool tests
Abdominal ultrasound
Abdominal X-ray
Upper endoscopy
Colonoscopy
CT scanner
MRI (magnetic resonance imaging)
Other procedures that may be suggested, depending on gender, are a pregnancy test and/or pelvic ultrasound (for women) scrotum ultrasound (for men)

Relief and control of abdominal pain

Abdominal pain has a wide range of causes and treatments. Some conditions, such as gallstones or appendicitis may require surgery. Others, like ulcers or infections, can be alleviated by medication, a tailored diet. An attack of stomach flu or kidney stones generally passes with therapy and bed rest. If the cause of abdominal pain is not known, it is important to go to the doctor as soon as possible and find out, especially if the pain does not go away. Sometimes even mild symptoms can be a sign of a serious illness.

Available medications and treatments

Treatment of abdominal pain depends on its underlying cause. Mild abdominal pain may resolve on its own within a few hours or days. Types of medications that may be recommended for treating stomach pain include:

-Antidiarrheal agents

-Laxatives

-Antiemetic drugs (for nausea)

-Anti-flatulence drugs (for bloating)

-Antacids

-Antibiotics

-Antispasmodics

For mild pain and symptoms, over-the-counter medications from a pharmacy can be helpful. Aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen should not be used to treat abdominal pain (except for menstrual pain). These medications can cause or irritate stomach or intestinal issues.

For gas relief, a medication containing simethicone can be helpful.

For constipation, laxatives are used.

Antacids, which neutralize stomach acid, can relieve pain and heartburn in the chest in cases of gastroesophageal reflux disease (GERD).

Cramps in the intestinal wall can be relieved by antispasmolytics.

Pain due to stomach or duodenal ulcers – This type of pain is usually treated by attempting to heal the ulcer, which will alleviate symptoms. This may involve medications to reduce acid production and antibiotics prescribed by a doctor.

Inflammatory bowel disease (such as Crohn’s disease and ulcerative colitis) – The occurrence of these conditions can be treated with various medications to prevent future exacerbations.

In some cases, such as appendicitis perforation or bowel obstruction, emergency surgery may be necessary.

Home remedies and self-help tips

If you know the origin of your abdominal pain, especially in case you have a digestive problem, you can help yourself with these tips:

Rest your intestines – Stop eating large meals or eat only easily digestible foods such as crackers or bananas.

Hydration – Drink plenty of water or oral rehydration solutions. Limit your alcohol and caffeine intake.

Warm your stomach – Use a warm compress or lie down in a bathtub with warm water.

Home remedies – Try using licorice tea for gas relief, ginger tea for digestive issues, or peppermint to help relax the intestinal muscles.

In addition to self-help measures, certain alternative therapies can help you reduce or cope with abdominal pain. These are acupuncture, meditation, relaxation techniques.

When to seek professional help

However, acute (sudden and severe) or chronic (long-term) abdominal pain are often signs of a condition requiring medical attention and treatment. Symptoms that require medical help include:

Unexplained weight loss
Unexplained exhaustion
Changes or disorders in bowel movements such as chronic constipation or diarrhea
Occasional bleeding or blood in the stool
Unusual vaginal discharge
Chronic pain that persists after taking over-the-counter medications or returns after stopping prescribed medications
Symptoms of urinary tract infection

When to seek emergency medical help

Symptoms that require immediate help are:

Sudden, severe pain, accompanied by high fever
Uncontrolled vomiting
Vomiting blood
Extremely painful abdomen upon touch
Inability to urinate
Fainting or loss of consciousness
Rapidly and dramatically worsening chest pain, especially around the ribs
Pain that spreads through the abdomen
Blood in the stool

Prevention of abdominal pain

Consuming enough fiber and exercising regularly can help prevent constipation and maintain good bowel function, which will prevent some forms of abdominal pain. It will also reduce your long-term risk of some diseases, such as diverticular disease or bowel cancer.

Drinking an adequate amount of plain water but not carbonated beverages will reduce the chances of bloating-related pain and keep your body healthy. Following a specific diet can help reduce pain caused by lactose intolerance, gallstones, irritable bowel syndrome, and gases.
Drink alcohol only in moderation.
Drink at least 1.5 liters of water per day, depending on your activity level and size.
Eat 25 to 35 grams of fiber daily, depending on age and gender.
Limit the intake of processed foods.
Control stress with healthy coping strategies, such as meditation.
Quit smoking or using tobacco products.

Prognosis and outcome

Abdominal pain can be short-lived or long-lasting, depending on its underlying cause. It may be continuous or occur intermittently, or it may be triggered by specific activities or behaviors. Severe pain that suddenly occurs requires immediate medical attention. You should also seek medical help if you have persistent pain that worsens with movement or coughing, or if the pain becomes increasingly intense throughout the day.

Factors affecting the prognosis of abdominal pain

The duration and improvement or worsening of the abdominal pain depend on the underlying cause of the pain and the response to treatment. Many pains go away on their own or can be relieved with simple home remedies (e.g., constipation, food allergies or intolerance, stomach flu). However, stomach pain caused by severe acute or chronic conditions may require extensive diagnosis and treatment, sometimes even surgical intervention (e.g., pain caused by appendicitis, bowel obstruction, peptic ulcers, cancer, or inflammatory bowel diseases – Crohn’s disease and ulcerative colitis).

How long does the recovery from abdominal pain last?

Acute abdominal pain develops and often disappears in a few hours to a few days. Chronic abdominal pain can be intermittent, which means that it occurs at intervals. This type of pain can be present for weeks to months and even years. Some chronic conditions cause pain that gets worse over time.

Life with abdominal pain

Most abdominal pains are not serious, and the symptoms are resolved with basic home care, such as rest and hydration, within a few hours to a day. Many over-the-counter medications or medications such as antacids and gas medications also help reduce and control symptoms.

You should also take measures to prevent abdominal pain:

Eat several smaller meals instead of three large ones.
Chew your food slowly
Avoid foods that bother you (spicy or fried foods)
Manage stress with exercise, meditation or yoga

Tips for controlling abdominal pain

To relieve abdominal pain, you can take the following steps:

Take water or tea in sips
Avoid solid foods for the first few hours.
If you have been vomiting, wait 6 hours and then eat small amounts of bland foods such as rice, baked apples, or crackers.
Avoid dairy products.
If the pain occurs in the upper abdomen after a meal, an acid-neutralizing remedy may help, especially if the pain is accompanied by heartburn or poor digestion.
Avoid citrus, high-fat foods, fried or fatty foods, tomato products, caffeine, alcohol, and carbonated drinks.
Do not take any medication without consulting your doctor.

How to take care of yourself after abdominal pain

Recurrent abdominal pain can be prevented by adopting a healthier lifestyle and a balanced diet. Constipation, indigestion and even abdominal injuries can often be prevented. The following steps can help you prevent abdominal pain:

Stay adequately hydrated, especially with water: Hydration can help prevent constipation.

Develop a regular habit of emptying the intestines. Many people try to try to have regular bowel movements to avoid constipation.

Eat a balanced and fiber-rich diet: Consuming a variety of fruits, vegetables, and fiber-rich foods like whole grains can promote healthy digestion and reduce constipation.
Eat regularly and slowly, with moderate-sized meals.
Exercise regularly. Physical activity can help prevent constipation and strengthen abdominal muscles.
Avoid foods that cause bloating and create gases.
Avoid alcohol, carbonated beverages, and caffeine.
Quit smoking.