Abdominal pain

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

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

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, stomach, small and large intestines, liver, gallbladder, and 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.

Other ways of describing pain in your abdomen include:

•Pain may be generalized, meaning that it is present 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 one of your organs, such as the appendix, gallbladder, or stomach (ulcers).
•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 longer (more than 24 hours), or has a fever with it.
•Colicky pain is pain that comes in waves, usually starts and ends suddenly, and is often severe. Kidney stones and gallstones are common causes of this type of belly pain.
CausesMany 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 blockage or obstruction
•Cholecystitis (inflammation of the gallbladder) with or without gallstones
•Chronic constipation
•Dissecting abdominal aortic aneurysm
•Diverticulitis
•Food allergy
•Food poisoning (salmonella, shigella) or viral gastroenteritis (stomach flu)
•Heartburn, indigestion, or gastroesophageal reflux
•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
•Ischemic bowel
•Kidney stones
•Lactose intolerance
•Mesenteric insufficiency or infarction (lack of enough blood supply to the gut, sometimes resulting in the failure or death of part of the bowel or intestines)
•Pancreatitis (inflammation of the pancreas)
•Tumors or cancers
•Ulcers
•Urinary tract infections
When an inflamed organ (such as the appendix) in the abdomen ruptures or leaks fluid, the pain is not only excruciating, but the abdomen becomes stiff and very tender to the touch. There is also 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), or pelvic inflammatory disease (PID) (infection of the reproductive organs, usually from a sexually transmitted disease). An ectopic pregnancy, or a pregnancy outside the normal location in the uterus, may mimic menstrual cramping and bleeding. However, symptoms are usually more intense than those usually experienced during a menstrual period.

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.

Sickle cell disease crisis may cause abdominal pain. It sometimes may be mistaken for the pain of appendicitis or conditions of other abdominal organs.

Shingles (an infection of the nerves associated with a skin rash, which is caused by the chicken pox virus) may cause pain in the abdomen. However, because the rash comes several days after the start of the pain, it can be mistaken for appendicitis or other conditions of the abdominal organs.

Home CareFor 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. Avoid dairy products.
•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 ProfessionalSeek 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
•Your belly is rigid, hard, and tender to touch
•You are pregnant or could be pregnant
•You have had a recent injury to your abdomen
•You are having 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 is becoming more severe and frequent
•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
•Prolonged poor appetite
•Unexplained weight loss
What to Expect at Your Office VisitFrom 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 pattern 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 the past? How long has each episode lasted?
•How often do you have the pain? Is it constant or does it come and go?
•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 eating 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
•CT scan
•Colonoscopy or sigmoidoscopy (direct viewing of the lower bowel)
•Blood, urine, and stool tests
•Endoscopy of upper GI (gastrointestinal) tract (EGD)
•Ultrasound of the abdomen
•Upper GI and small bowel series
•X-rays of the abdomen
PreventionFor prevention of many 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.
For prevention of symptoms from heartburn or gastroesophageal reflux disease:

•After eating, stay upright for at least 30 minutes.
•Elevate the head of your bed.
•Finish eating at least 2 hours before you go to bed.
•Lose weight if you need to.
•Quit smoking.
Alternative NamesStomach pain; Pain - abdomen; Belly ache; Abdominal cramps

ReferencesEbell 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.

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.

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.

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.

Update Date: 10/7/2009Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm