Dr. Khalid is a physician, a researcher, a health writer, and holds a Ph.D. in clinical research.
The Definition of Abdominal Pain
Abdominal pain is the discomfort felt anywhere across the diaphragm, lower rib margins, flanks, and pelvis (1). The abnormalities in the abdominal wall tissues (including muscles and skin) and abdominal organs often trigger abdominal pain that requires immediate medical attention based on its quality and duration (2). The abdominal organs (in the abdominal cavity) include the pancreas, spleen, gallbladder, liver, colon, small intestine, and stomach. The inflammation of these organs impacts their blood circulation that eventually triggers different types of abdominal pain patterns. The hypersensitivity to various food items or contraction of the muscles (of the intestine) due to irritable bowel syndrome also triggers abdominal pain in the affected individuals. The commonly reported manifestations of abdominal pain include pelvic discomfort, chest heaviness, heartburn, gastroesophageal reflux disease, diarrhea, constipation, indigestion, bloating, flatus, and belching.
Should You Ignore Abdominal Pain?
The appropriate investigation of abdominal pain is necessary to identify and understand its causative factors. The abdominal pain often changes its patterns that makes its diagnosis increasingly challenging. The delayed assessment of atypical pain increases the risk of deleterious complications. It is important to evaluate the complete medical history (of the patients) for clinically correlating abdominal pain patterns with their pathological processes.
What are the Causes of Abdominal Pain?
The abdominal pain/stomach pain/belly pain often develops due to various complications including dehydration, reduced urination, reduced bowel movements, difficulty/pain in urination, and tarry/black/bloody stools. Moderate to severe pain also develops due to embolism (abdominal vessel), ruptured aortic aneurysm, mesenteric infarction, or ruptured ectopic pregnancy (3).
What is Pelvic Pain?
The pelvic pain transmits from the uterus/ovaries/fallopian tubes (in females), prostate (in males), rectum, or urinary bladder. The significant causes of pelvic pain include lumbosacral arthritis, pelvic inflammatory disease, adenomyosis, endometriosis, dysmenorrhea, and diverticulitis/other gastrointestinal complications (4).
What is a Referred Pain?
Sometimes the patients feel belly pain even when it does not arise from the abdominal cavity. The reverse also happens, at times, when the patients feel back pain despite its origin in the abdominal cavity. The physicians call such types of pain as referred pain based on its distance from the point of origin. The connectivity of intra-abdominal organs with deep visceral sensory fibers from the musculoskeletal structures often shifts abdominal pain to the upper/lower back regions (5).
Causes of Abdominal Pain
Some of the commonly reported causes of abdominal pain include the following (6).
- Inflammatory bowel disease
- Irritable bowel syndrome
- Gynecologic pain
- Iatrogenic pain
- Peptic ulcer
- Renal colic
- Non-specific abdominal pain
Abdominal Pain Mechanisms
- An interruption in the bile duct or a decrease in the blood supply (of the intestine) triggers biliary colic and ischemia.
- The conditions like cholecystitis or biliary colic trigger moderate pain in the right upper/middle abdomen.
- The development of chronic diverticula induces severe pain in the left lower abdomen.
- The middle abdominal pain often corresponds to a condition known as appendicitis.
- The patients who develop appendicitis often report radiating pain between the right lower and middle abdominal regions.
The Quality of Abdominal Pain Patterns
The patients with abdominal pain many times experience marked changes in the severity and location of their pain (7). These changes attribute to the increase in inflammatory processes or diminishment of blood supply to the affected organs. A shift in pain from the umbilical region to the right lower quadrant of the abdomen occurs due to the increase in inflammation across the appendix. Patients with acute pancreatitis often experience strong and consistent upper back/abdominal pain. Severe upper belly pain usually develops due to gallstones that completely obstruct the bile duct (pathway of bile). An unrelenting contraction in the intestine triggers severe abdominal cramps that settle down for short spurts, while their periodic aggravation causes extreme discomfort to the affected patients.
The Timeline of Abdominal Pain
- The pain related to duodenal ulcers and gastroesophageal reflux disease often continues for several weeks.
- The pain patterns of patients with pancreatitis usually survive for few days.
- The patients with biliary colic experience a sudden onset of severe abdominal pain that may continue for some hours.
- Patients with irritable bowel syndrome often experience chronic pain patterns that impact their daily activities and health-related quality of life for several years.
Pain Relieving Factors
- Vomiting temporarily relieves pain by reducing abdominal distension for some time.
- The use of laxatives relieves constipation and its associated pain by increasing bowel movements.
- A healthy diet based on green leafy vegetables and fruits helps minimize the severity of abdominal pain in many scenarios.
- The physician-guided administration of nonopioids or opioid analgesics also assists in controlling the intensity or severity of abdominal pain.
Diagnostic Interventions for Abdominal Pain
The following diagnostic modalities help investigate the causes/etiology of abdominal pain and its complications.
- Balloon-assisted enteroscopy
- Endoscopic ultrasound
- Capsule enteroscopy
- CT (computerized tomography) abdomen
- Barium X-rays
- MRI (magnetic resonance imaging) abdomen
- Abdominal ultrasound
- Plain abdominal X-ray
- Stool examination
- Liver function test
- Complete blood count
- Marks, J. W.; Davis, C. P.; Anand, B. S. What Causes Abdominal Pain? Treatment & Relief.
- Mehta, H. Abdominal Pain. Clinical Pathways in Emergency Medicine 2016, 329–345.
- Sherman, R. Abdominal Pain. Butterworths, 1990.
- Long, W. N. Pelvic pain. In Clinical Methods: The History, Physical, and Laboratory Examinations, 3rd ed.; Butterworths, 1990.
- Macaluso , C. R.; McNamara, R. M. Evaluation and management of acute abdominal pain in the emergency department. International Journal of General Medicine 2012, 5, 789-797.
- Cervellin, G.; Mora , R.; Ticinesi, A.; Meschi, T.; Comelli, I.; Catena, F.; Lippi, G. Epidemiology and outcomes of acute abdominal pain in a large urban Emergency Department: Retrospective analysis of 5,340 cases. Ann Transl Med 2016, 4 (19).
- Jones , B.; Brzezinski, W. A.; Estrada, C. A.; Rodriguez, M.; Kraemer, R. R. A 22-Year-Old Woman with Abdominal Pain. J Gen Intern Med 2014, 1074–1078.
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2021 Dr Khalid Rahman