COMMON CAUSES
Abdominal pain can have causes that aren't due to underlying disease. Examples include constipation, wind, overeating, stress or muscle strain.
What causes abdominal pain?
Abdominal pain is caused by inflammation of an organ (for example, appendicitis, diverticulitis, colitis), by stretching or distention of an organ (for example, obstruction of the intestine, blockage of a bile duct by gallstones, swelling of the liver with hepatitis), or by loss of the supply of blood to an organ (for example, ischemic colitis).
To complicate matters, however, abdominal pain also can occur without inflammation, distention or loss of blood supply. An important example of the latter is the irritable bowel syndrome (IBS). It is not clear what causes the belly pain in IBS, but it is believed to be due either to abnormal contractions of the intestinal muscles (for example, spasm) or abnormally sensitive nerves within the intestines that give rise to painful sensations inappropriately (visceral hyper-sensitivity). This often is referred to as functional pain because no recognizable specific abnormality to account for the cause of the pain has been found - at least not yet.
How did the pain begin?
- If it comes on suddenly, this may suggest a problem with an organ within the belly; for example, the interruption of the supply of blood to the colon (ischemia) or obstruction of the bile duct by a gallstone (biliary colic).
Where is the pain located?
- Appendicitis typically causes discomfort in the middle of the abdomen, and then moves to the right lower abdomen, the usual location of the appendix.
- Diverticulitis typically causes discomfort in the left lower abdomen where most colonic diverticula are located.
- Discomfort from the gallbladder (biliary colic or cholecystitis) typically is felt in the middle, upper abdomen, or the right upper abdomen near where the gallbladder is located.
What is the type and pattern of the pain?
- Is it severe, crampy, steady; or does it wax and wane? Obstruction of the intestine initially causes waves of crampy pain due to contractions of the intestinal muscles and distention of the intestine. True cramp-like pain suggests vigorous contractions of the intestines.
- Obstruction of the bile ducts by gallstonestypically causes steady (constant) upper belly pain that lasts between 30 minutes and several hours.
- Acute pancreatitis typically causes severe, unrelenting, steady pain in the upper abdomen and upper back.
- The pain of acute appendicitis initially may start near the umbilicus, but as the inflammation progresses, it moves to the right lower abdomen.
- The character of pain may change over time. For example, obstruction of the bile ducts sometimes progresses to inflammation of the gallbladder with or without infection (acute cholecystitis). When this happens, the characteristics change to those of inflammatory pain.
How long does the pain last?
- The discomfort of IBS typically waxes and wanes over months or years and may last for years or decades.
- Biliary colic lasts no more than several hours.
- The pain of pancreatitis lasts one or more days.
- What makes the pain worse?
- Pain due to inflammation (appendicitis, diverticulitis, cholecystitis, and pancreatitis) typically is aggravated by sneezing, coughing, or any jarring motion. Individuals with inflammation prefer to lie still.
- What health conditions make abdominal pain worse or better?
SELF-TREATMENT
Taking an antacid or anti-wind medication and eating smaller meals may help to relieve heartburn or wind. It's best to avoid taking aspirin or ibuprofen as these medications can worsen some abdominal pain.
SEEKING MEDICAL CARE
See a doctor immediately if you:
Feel severe pain that worsens with movement
Develop a fever
Vomit or have bloody diarrhoea
Experience abdominal swelling
Have chest pain or pressure
Make an appointment to see a doctor if you
Have recurring or persistent pain
Can't sleep because of pain.
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