Abdominal pain, one of the most common forms of pain is used to refer to pain felt in the abdomen or for the sake of simplicity, the belly. Several conditions can lead to abdominal pain. Even though, the most common causes are not serious, it can be distressing and difficult to tell the mild from the serious causes. For this reason, knowing the characteristics of abdominal pain, including location, frequency and nature are indispensable in finding causes and best treatments.
Abdominal Pain Characteristics
The abdomen can be divided into nine (9) regions. Two imaginary lines divide the abdomen horizontally into the upper, middle and lower regions, while two additional vertical lines sub-divide each into the left, center, and right sub-regions. Consequently, the nine (9) regions are
- 3 Upper regions : left hypochondriac (upper left), epigastric (upper center), right hypochondriac (upper right)
- 3 Middle Regions : left lumbar (middle left), umbilical (middle center), right lumbar (middle right)
- 3 Lower Regions : left iliac (lower left), suprapubic (lower center), right iliac (lower right)
These Nine (9) Regions In Turn Map To Various Organ
- Left hypochondriac (upper left) : pancreas, left kidney, colon, spleen
- Epigastric (upper center) : adrenal glands, spleen, pancreas, duodenum, liver, stomach
- Right hypochondriac (upper right) : small intestine, right kidney, gallbladder, liver
- Left lumbar (middle left) : left kidney, descending colon
- Umbilical (middle center) : duodenum, ileum, descending colon
- Right lumbar (middle right) : right colon, liver, gallbladder
- Left iliac (lower left): sigmoid colon, descending colon
- Suprapubic (lower center): sigmoid colon, urinary bladder, ovaries
- Right iliac (lower right):
Nature Of Pain
Pain may be felt differently with different diseases. Being able to describe what we feel can provide important clues for identifying the specific cause of an episode of abdominal pain. The nature of pain is usually categorised as sharp/cramping, pulsating, dull or aching. There are other technical categories but they can still be described using one or a combination of these basic terms.
- Sharp or cramping pain is often severe and piercing.
- Pulsating pain, just as its name suggest, comes and goes with timing similar to a heartbeat.
- Dull pain is mild and often persists longer.
- Aching pain is somewhat between sharp and dull pain. It is moderate, may feel like a sore and persists for a while.
How an abdominal pain starts is another important clue doctors use to assess its cause. Pain onset can be sudden, rapid or progressive. Sudden pain is sporadic and severe. Rapid pain may start moderately and quickly become severe. Progressive pain starts out mild and gradually increases in intensity.
Abdominal pain can also have variable frequency depending on the cause. It can be constant or intermittent. Constant abdominal pain is present continously for a period of time. Intermittent pain on the other hand may repeatedly come and go.
Depending on how long abdominal pain persists, it may be categorised as acute or chronic. Acute abdominal pain usually lasts for a couple of minutes, hours, or days and does not extend beyond a month. Chronic abdominal pain on the other hand, is generally reserved for any type of pain which lasts beyond three months. In-between, clinicians generally reserve the name sub-acute.
While the focus has been on the primary characteristics of abdominal pain, accompanying symptoms are equally important for finding specific causes. Common symptoms which may accompany abdominal pain include
- Abdominal Tenderness and
- Difficult or Painful Urination or Stool.
Common Conditions Which Cause Abdominal Pain
The food we eat must be broken down into nutrients before the body can use them for its activities. The process which ensures this is called digestion. Digestion requires certain conditions in order to complete successfully. If these conditions are not met, food is not broken down adequately, and may undergo fermentation. This can lead to pain, in association with gas, diarrhea, and nausea.
Acid Reflux Disease
When we eat, food travels from the mouth through a tube called the oesophagus into the stomach before it goes to the intestines. The stomach contains an acid which it uses to break down food into nutrients which the body can use. Acid reflux disease occurs when this acid supposed to stay in the stomach get pushed into the oesophagus and results in burning sensation in the chest area, nausea, a feeling of bitterness or sourness in the throat, and sometimes pain. Eating spicy foods, eating in excess, abdominal obesity, pregnancy, abnormalities of the muscles at the opening of the stomach are among the factors which can cause acid reflux disease.
Even though gas is something we deal with everyday, it can set us thinking with the severe pains it presents with. Intestinal gas commonly results when we swallow air during eating or drinking or when bacteria ferment food that was not well digested. Pain resulting from intestinal gas may be associated with a feeling of fullness in the abdomen called bloating and usually goes away after flatulence or belching. Intestinal gas can be worsened by talking while eating, eating too quickly, eating certain foods which include high fibre foods, dairy foods and some plant protein-rich foods like beans.
Abdominal strain refers to an injury such as a tear or stretch on any of the abdominal muscles. It can be caused by excessive exercise, strenous tasks like lifting heavy objects, sudden quick movements or twists of the abdomen. It can cause severe abdominal pain, inhibit movements, and cause tenderness or swelling in the abdominal region where the affected muscle is located. While it can resolve on its own, after adequate periods of rest and relaxation, it is advisable to report to your doctor or healthcare provider if it is keeping long in going away. This will help in ruling out any serious underlying conditions.
Gastritis is an inflammation of the stomach. Inflammation is a way the body fights injuries, harmful substances and diseases. The processes involved in inflammation result in swelling, pain and redness. In consequence, gastritis may be caused by bacteria, drugs like aspirin and diclofenac, alcoholism, stress or other diseases of the digestive system. Although symptoms may not always be present, a feeling of fullness in the abdomen, nausea, vomiting, and pain is commonly reported. While it may resolve on its own, it can lead to peptic ulcers if not treated well.
Peptic ulcer is another common condition that results in abdominal pain. Peptic ulcers are sores that can occur in the wall of the stomach or the small intestines. It commonly results from an infection caused by bacteria called Helicobacter Pylori, and continued use of drugs like Non-Steroidal Anti-inflammatory Drugs (NSAIDs), steroids and anticoagulants. It is important to only use these drugs when they have been prescribed by a qualified healthcare provider.Peptic ulcers recover best if they are detected early. Treatment may involve antibiotics, antacids, or proton pump inhibitors like omeprazole.
Urinary Tract Infection
Common urinary tract infections which cause abdominal pain are kidney infections and bladder infections.
- Kidney Infection – It is the most serious form of urinary tract infection, caused when bacteria move into the kidney from the bladder or the urethra, the tube through which urine passes. Although it may show no symptoms, it may present with severe abdominal pain, headache, frequent and forceful urination, fever, chills, and urine that is bloody, smelly or cloudy.
- Bladder Infection – This is another urinary tract infection which affects the bladder and can be caused by bacteria or rarely fungus. It may present with the same symptoms as a kidney infection.
Urinary tract infections are treated with antibiotics. Additionally increased water intake is recommended to help with flushing out causative bacteria.
Constipation is a common experience many people have occasionally. It refers to the inability to pass stool, as frequently as is normally required. Clinically it may be reserved for frequency that is less than thrice in a week. It is caused when the large intestines take too much water out the stool leaving it hard and dry. Symptoms may include painful, lumpy or hard stool, straining when passing stool and sometimes abdominal pain. Causes and risk factors of constipation include pregnancy, tight clothing, inadequate water intake, inadequate fibre intake, diseases and abonormalities of the large intestines, diseases of the nervous system like stroke and certain drugs. Constipation may go away on its own, else doctors may recommend high fibre diets, exercise and increased water intake. Sometimes drugs like laxatives, or surgery may be required.
Menstrual pains are common forms of abdominal pain among women. Once every month, the ovaries release an egg which must fuse with a sperm and grow into a baby. Prior to the release of the egg, the body prepares the womb to hold the baby that will be formed. When the egg does not get fused with a sperm, the body reverses the preparations made by shedding the lining of the womb. The body does this by contracting the walls and this is what causes pain. Menstrual pains usually go away without treatment. Doctors may recommend drugs or other home remedies like placing warm water bottle or towel on the painful abdominal area, to minimise pain.
Ulcerative colitis is believed to result when the walls of the large intestines are attacked by the body’s disease-fighting system. The immune system fights foreign substances and organisms, and prevents them from causing diseases. When a disease has already been caused, the immune system helps with repair of tissues, healing and recovery. Sometimes, this system gets confused and attacks parts of the body, in what is called an autoimmune reaction. Ulcerative colitis may cause abdominal pain, diarrhea, fever, painful and bloody stool. Treatment is necessary to avoid complications like perforation of the large intestine walls, cancer of the colon, and blood clots. Treatment may involve antibiotics, corticosteroids or surgery.
Even though angina is a term which refers to pain in the chest, it can present symptoms which are similar to those caused by indigestion or acid reflux disease. This is why it is worth mentioning as part of the list of causes of abdominal pain. Angina results when the heart does not receive adequate supply of blood. It is recommended that any severe chest pain should be reported to and examined by a doctor as it may be the only sign of life-threatening diseases like heart attack.
Kidney stones refer to small lumps of crystals which form in urine in the kidneys. They may result from inadequate water intake, eating foods which are high in protein and salt and urinary tract infections.
There is a higher likelihood of occurrence with these factors:
- Surgery of the digestive system
- Diseases of the intestines
- Certain diseases of the kidney
Symptoms include moderate to severe pain in the abdomen, nausea, pain and difficulty in urinating, blood in urine, fever and chills. Some kidney stones may pass out with urine and resolve with increased drinking of water. In certain cases and especially when they get large, they may cause blockages along the urinary tract and surgery may be required to remove them manually.
Pelvic Inflammatory Disease
This is a collective term for any infection of the female reproductive organs. Sometimes bacteria may move from the vagina into the womb and further spread into the fallopian tubes, ovaries and in consequence cause an infection. Just like urinary tract infections they may not present with any symptoms even though these are commonly reported: lower abdominal pain, painful sex, fever, painful urination, bleeding which may not be associated with menstruation and vaginal discharge. It may lead to infertility and ectopic pregnancy and requires urgent care. Treatment for pelvic inflammatory disease involves antibiotics to kill causing bacteria.
Investigations And Diagnosis
The specific cause of abdominal pain can often be made out from patients’ descriptions of how they feel. However, due to the diverse conditions which can cause abdominal pain, it is often important for doctors to physically examine the abdomen and order tests for accurate diagnosis.
These Are Some Common Tests A Doctor May Request
- Blood Tests : A sample of blood is drawn and examined for abnormalities. Usually an assessment of the various types of cells through a complete blood count test is enough to detect a cause. Changes in size and quantity of some cells may confirm infection, reduced immunity and other disorders.
- Urine Tests : Urine tests are among the common tests doctors use to investigate abdominal pain. It is often very useful in detecting urinary tract infections and abnormalities of the reproductive system.
- Stool Examination : Laboratory analysis of stool is particularly useful for conditions of the digestive tract.
- Radiologic Tests : Depending on the nature of pain, a doctor may request a radiologic exam to get an image of the organs and other structures within the abdomen. Radiologic tests include X-ray, Ultrasound scans, Computed Tomography (CT) Scan, and Magnetic Resonance Imaging (MRI).