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.

See also: Abdominal pain-children under 12

Alternative Names

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

Considerations

Almost everyone has pain in the abdomen at one time or another. Most of the time, it is not caused by a serious medical problem.

How bad your pain is does not always reflect the seriousness of the condition causing the pain.

For example, you might feel severe abdominal pain if you have gas or stomach cramps due to a viral gastroenteritis.

Sometimes, life-threatening conditions such as colon cancer or early appendicitis may only cause mild pain or no pain.

Other ways of describing pain in your abdomen include:

• Pain may be generalized, meaning that you feel it in more than half of your belly. This is more typical for a stomach virus, indigestion, or gas. If the pain becomes more severe, it may be caused by a blockage of the intestines.
• Pain that is localized is found in only one area of your belly. This type of pain is more likely to be a sign of a problem in an organ, such as the appendix, gallbladder, or stomach.
• Cramp-like pain is usually not serious, and is more likely to be due to gas and bloating. It is often followed by diarrhea. More worrisome signs include pain that occurs more often, lasts than 24 hours, or occurs with a fever.
• Colicky pain is pain that comes in waves. It usually starts and ends suddenly, and is often severe. Kidney stones and gallstones are common causes of this type of belly pain.

Causes

Many different conditions can cause abdominal pain. The key is to know when you need to get immediate medical care. Sometimes you may only need to call a doctor if your symptoms continue.

Less serious causes of abdominal pain include:

• Constipation
• Irritable bowel syndrome
• Food allergies or intolerance (such as lactose intolerance)
• Food poisoning
• Stomach flu

Other possible causes include:

• Appendicitis
• Abdominal aortic aneurysm
• Bowel blockage or obstruction
• Cancer of the stomach, colon, and other organs
• Cholecystitis (inflammation of the gallbladder) with or without gallstones
• Decreased blood supply to the intestines (ischemic bowel)
• Diverticulitis
• Heartburn, indigestion, or gastroesophageal reflux (GERD)
• Inflammatory bowel disease (Crohn's disease or ulcerative colitis)
• Kidney stones
• Pancreatitis (swelling or infection of the pancreas)
• Ulcers

Sometimes, abdominal pain may be due from a problem somewhere else in your body, such as your chest or pelvic area. For example, you may have abdominal pain if you have:

• Heart attack
• Severe menstrual cramps
• Endometriosis
• Muscle strain
• Pelvic inflammatory disease (PID)
• Pneumonia
• Tubal (ectopic) pregnancy
• Urinary tract infections

Home Care

If you have mild abdominal pain, the following tips might be helpful:

• Sip water or other clear fluids.
• Avoid solid food for the first few hours.
• If you have been vomiting, wait 6 hours, and then eat small amounts of mild foods such as rice, applesauce, or crackers. Avoid dairy products.
• If the pain is high up in your abdomen and occurs after meals, antacids may help, especially if you feel heartburn or indigestion. Avoid citrus, high-fat foods, fried or greasy foods, tomato products, caffeine, alcohol, and carbonated beverages.
• 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 currently being treated for cancer
• 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, or between, your shoulder blades with nausea
• Have tenderness in your belly, or your belly is rigid and hard to the touch
• Are pregnant or could be pregnant
• Had a recent injury to your abdomen
• Have difficulty breathing

Call your doctor if you have:

• Abdominal discomfort that lasts 1 week or longer
• Abdominal pain that does not improve in 24 - 48 hours, or becomes more severe and frequent and occurs with nausea and vomiting
• Bloating that persists for more than 2 days
• Burning sensation when you urinate or frequent urination
• Diarrhea for more than 5 days
• Fever (over 100°F for adults or 100.4°F for children) with your pain
• Prolonged poor appetite
• Prolonged vaginal bleeding
• Unexplained weight loss

What to Expect at Your Office Visit

Your health care provider will perform a physical exam and ask questions about your symptoms and medical history. Your specific symptoms, the location of pain and when it occurs will help your health care provider diagnosis the cause.

You may be asked the following questions:

• Where do you feel the pain?
• Is the pain all over or in a specific location?
• Does the pain move into your back, groin, or down your legs?
• Is the pain severe, sharp, or cramping?
• Do you have it all the time or does it come and go?
• Does the pain wake you up at night?
• Have you had similar pain in the past? How long has each episode lasted?
• When does the pain occur? For example, after meals or during menstruation?
• What makes the pain worse? For example, eating, stress, or lying down?
• What makes the pain better? For example, drinking milk, having a bowel movement, or taking an antacid?
• What medications are you taking?
• Have you had a recent injury?
• Are you pregnant?
• What other symptoms do you have?

Tests that may be done include:

• Barium enema
• Blood, urine, and stool tests
• CT scan
• Colonoscopy or sigmoidoscopy
• EKG (electrocardiogram) or heart tracing
• Ultrasound of the abdomen
• Upper GI and small bowel series
• X-rays of the abdomen

Prevention

The following steps may help prevent some types of abdominal pain:

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

References

Ebell MH. Diagnosis of appendicitis: part 1. History and physical examination. Am Fam Physician. 2008;77:828-830.

Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE. Does this child have appendicitis? JAMA. 2007;25:438-451.

Millham FH. Acute abdominal pain. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 10.

Postier RG, Squires RA. Acute abdomen. In: Townsend CM Jr., Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 45.

Rimon, N, Bengiamin RN, Budhram GR, King KE, Wightman JM. Abdominal pain. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 21.

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