Abdominal Pain

The discomfort felt anywhere between the chest and groin (the junction between the abdomen and the thigh) region is known as abdominal pain. It is also known as stomach ache or tummy ache. Abdominal pain affects almost everyone at some point in their lives. However, abdominal pain that increases in severity and is accompanied by fever and breathing difficulties demands immediate medical attention. Based on the cause of the pain, it can be treated with either medication or surgical intervention.

Signs and Symptoms

Depending on the duration of the pain, abdominal pain can be either acute or chronic.

• Acute abdominal pain: Acute abdominal pain refers to a brief period of discomfort that began recently.
• Chronic abdominal pain: When pain in the abdomen lasts for more than three months, it is known as chronic pain.

Abdominal pain can also be described in the following ways:

• Localised pain: This is an ache that exclusively affects one part of your stomach. Issues with a particular organ such as the gall bladder, appendix or stomach could lead to this kind of pain.
• Generalised pain: This type of pain is felt in more than half of the abdominal area. Some of the common causes of this type of pain include indigestion, gas, or a stomach virus. In severe cases, it could point towards a blocked intestine.
• Cramp-like pain: In most cases, gas and bloating can lead to cramp-like pain. However, when this pain is accompanied by fever, goes on for more than 24 hours or occurs more frequently, it could be attributed to a more severe underlying problem.
• Colicky pain: This kind of pain begins and ends abruptly and is most severe. It is frequently caused by kidney stones, gallstones and intestinal obstruction.

Causes

Acute abdominal pain could be caused by various conditions, ranging from a benign and self-limiting sickness to a surgical emergency. Chronic abdominal pain could be caused by a chronic disorder such as irritable bowel syndrome (IBS) that can last for a long time.

The following conditions could cause sudden and severe abdominal pain:

• Appendicitis: This condition arises due to inflammation (swelling) in the appendix, which will require surgical removal.
• Kidney stones: These are stones of calcium or other substances that form in the kidney. The small stones are easily passed through urine. However, larger stones may obstruct the renal tubes, necessitating hospitalisation.
• Acute cholecystitis: The gallbladder develops a swelling in this condition. Acute cholecystitis may require surgical removal of the gall bladder.
• Diverticulitis: A condition wherein one or more tiny pouches in the colon become inflamed or infected.
• Gallstones: The presence of stones in the gall bladder can also cause acute abdominal pain.
• Gastroenteritis: It is the inflammation of the small intestine caused by a viral or bacterial infection.
• A bleeding aneurysm: Leakage from the aorta (main artery from the heart) can cause severe abdominal pain.
• Hernia: A hernia in the abdominal region can also cause pain.

The following conditions cause recurring or long-term abdominal pain:

• IBS: It is a condition of the large intestine causing spasms (contractions) of the bowel muscles. In most cases, the pain is relieved after passing stools.
• Inflammatory bowel disease (IBD): Ulcerative colitis and Crohn’s disease (swelling of the digestive tract) are the two forms of IBD that cause abdominal pain.
• Menstrual pain: Monthly periods tend to cause cramp-like pain in the abdomen.
• Heartburn and acid reflux (backflow of acid from the stomach to the food pipe)
• A recurrent urinary tract infection (UTI)
• Ulcer (open sore) of the stomach
• Constipation

In children, the most likely causes of abdominal pain are:

• Constipation
• Lactose Intolerance or milk allergy
• Gastroesophageal reflux disease (stomach acid or bile flows into the food pipe and irritates its lining)
• UTI 
• Appendicitis

When To See A Doctor?

Get medical help right away if your stomach pain becomes unbearable or is accompanied by any of the following symptoms:

• Fever
• Difficulty breathing
• Pain in your neck, chest, or shoulder
• The stomach is tender, hard, or rigid to touch
• If you are unable to pass stool
• Nausea and vomiting
• Blood in vomit or stool

Abdominal pain requires investigation by a doctor if it is associated with:

• Unexplained weight loss
• Discomfort in the abdomen that lasts a week or more
• More than five days of diarrhoea
• Burning sensation during urination
• Fever with pain
• Loss of appetite
• Pregnancy
• Recent injury to the abdominal area
• Bloating for more than two days

What Investigations May Be Done?

Once you visit a doctor for abdominal pain, they will conduct a thorough physical examination. After thoroughly reviewing your medical history and symptoms, the doctor may ask for the following investigations to know the reason for the pain:

• The doctor may order various imaging tests such as computed tomography (CT) scan, ultrasonography of the abdomen and X-ray. These tests can help detect diverticulitis, cholecystitis, gall stones, kidney stones, and abnormal calcification and perforation of the gastrointestinal tract according to the location of the pain.
• Upper gastrointestinal endoscopy is done to detect problems with the upper gastrointestinal tract. A tube will be inserted into the oesophagus, stomach, and upper small intestine through the mouth.
• Complete blood test and urine and stool culture if an infection is suspected
• Sigmoidoscopy (a tube is inserted into the colon through the rectum) or colonoscopy may be done to detect changes in the large intestine
• Urinalysis in patients with UTI and haematuria (blood in urine)
• Electrocardiogram 
• Barium enema

How To Proceed?

Treatment of abdominal pain depends on determining the exact cause of the pain. However, in case of mild discomfort, taking the following steps may help provide some relief:

• Keep yourself hydrated with a lot of water & other fluids
• Avoid the consumption of tea, coffee or alcohol that can make the pain worse
• Antacids may provide relief if the pain occurs after meals and is high up in your abdomen. These are beneficial if you experience heartburn along with the pain
• Take proper rest
• Medications such as antispasmodics can help provide some relief from the pain. Antibiotics are prescribed if the infection is confirmed

Certain medical conditions that cause abdominal pain may necessitate surgery. These include:

• Appendicitis: An appendectomy is conducted to remove the appendix.
• Gallstones: The gall bladder is removed by laparoscopic cholecystectomy, which is a minimally invasive procedure
• Hernia: Severe pain caused by hernia requires surgery to repair the hernia.
• Kidney stones: Stones that are larger and cannot pass through urine require surgery to break them up.

Lifestyle changes can prevent or lower the frequency of abdominal pain. These changes include:

• Regular exercise
• Eating small but more frequent meals
• Avoiding food items that can produce gas (such as milk, beans and chickpeas)
• Drinking plenty of water daily
• Consuming a variety of fruits and vegetables and eating foods rich in fibre