Abdominal Pain

Pain in the tummy (abdomen) is common. Usually it doesn’t last long and is often due to a gut infection or a small upset – but there are many other possible causes. Pain that is severe or doesn’t settle quickly may need attention from a doctor.

Comprehending abdominal pain

The abdomen is that part of our body which is below our ribs and above our hips. Some people call it the tummy, trunk, belly or gut. However, other popular terms for abdominal pain include tummy pain, tummy ache, stomach ache, stomach pain, gut ache, belly ache and gut rot.

Usually, pain that one feels here will be caused by a problem in the gut. Sometimes it can be caused by problems in other organs.

Understanding the gut

The gut (gastrointestinal tract) starts at the mouth and ends at the anus. When we eat or drink, the food and liquid travel down the gullet (oesophagus) into the stomach. The stomach churns up the food and then passes it into the small intestine.

The small intestine – sometimes called the small bowel – is several metres long and is where food is digested and absorbed. Undigested food, water and waste products are then passed into the large intestine – sometimes called the large bowel. The main part of the large intestine is called the colon, which is about 150 cm long. This is split into four sections: the ascending, transverse, descending and sigmoid colon. Some water and salts are absorbed into the body from the colon. The colon leads into the back passage (rectum) which is about 15 cm long. The rectum stores stools (faeces) before they are passed out from the anus.

Kinds of pain

Very broadly, pains may be sharp or stabbing, crampy, colicky or a general dull ache. Colicky means gradually becoming worse, then easing off again. This may happen repeatedly.

Sometimes pain seems to be travelling (radiating) in a certain direction. Having this information and putting it together with other information (such as whether you have been being sick (vomiting) or have had diarrhoea, etc) will help the doctor work out what is wrong.

Pain that comes on suddenly may be called acute. Longer-standing pain is called chronic.

Causes of pain in the gut

This list does not include all the possible causes of gut pain but some of the more common causes include the following.

Wind

Crampy pains across the abdomen after eating may be wind. The abdomen may feel swollen or bloated. If one is able to go to the toilet and open one’s bowels or pass wind the pain usually goes.

Indigestion

Indigestion means different things to people. One might feel a discomfort in the top of one’s tummy (abdomen) or behind one’s breastbone. This happens usually after eating certain types of food. The foods might be fatty or very rich. One may feel like burping a lot or have a nasty acid taste coming into the mouth. It usually goes in a few hours.

If one is older, or is known to have heart disease, indigestion-type pains that come on with exertion or stress is worrying. Sometimes it can be difficult to tell angina or a heart attack from indigestion. If one has pain that goes into one’s jaw or down one’s left arm, it might be angina.

Constipation

Constipation is common. It means either going to the toilet less often than usual to empty the bowels or passing hard or painful stools (faeces). Sometimes crampy pains occur in the lower abdomen. One may also feel bloated and sick if one has severe constipation.

This can be avoided by three simple things

1. Consume adiquate fibre (Fruits/vegetable/green leafs)
2. Excecesie
3. Atleast 2.5- 3lt water/day

Irritable bowel syndrome (IBS)

IBS is a common gut disorder. The cause is not known. Symptoms can be quite variable and include abdominal pain, bloating, and sometimes bouts of diarrhoea and/or constipation. Symptoms tend to come and go. There is no cure for IBS but symptoms can often be eased with treatment.

Appendicitis

Appendicitis means inflammation of the appendix. The appendix is a small pouch that comes off the gut wall. Appendicitis is common. Typical symptoms include abdominal pain and being sick (vomiting) that gradually get worse over 6-24 hours. The pain usually starts in the middle of the abdomen but over time seems to move towards the right hip. Some people have less typical symptoms.

Standard treatment is surgery which now a days it is mostly done as laparoscopic (Key hole). Sooner the surgery is done lesser the complications. Ideally surgery should be done within 24 hours to preventfurther complications. Treating with anitibiotics might help small proportion of patients but when that fails surgery will be high risk.

Kidney stones

Pain that starts in one’s back and seems to travel around the side of one’s abdomen to the groin, may be a kidney stone. The pain is severe and comes and goes. This is called renal colic. The pain goes when the stone is passed. Sometimes the stone cannot be passed and one may need to have the stone broken into small pieces either by surgery or lithotripsy. There may be blood in one’s urine too.

Urine infection

This is a common cause of aching pain that is low down in the abdomen in women. It is much less common in men. Along with pain, one may feel sick and sweaty. There may be a sharp stinging when we pass urine and there may be blood in the urine.

Ususlly treated with course of antibiotics. Only if is recurrent then investigations are needed.

Period pain

Most women have some pain during periods. The pain is often mild but, for some women, the pain is severe enough to affect day-to-day activities. The pain can be so severe that they are unable to go to school or work. Periods tend to become less painful as you get older. An anti-inflammatory painkiller often eases the pain.

Pelvic inflammatory disease (PID)

PID is an infection of the womb and/or Fallopian tubes. Treatment is with antibiotics. Pain in the lower abdomen (pelvic area) is the most common symptom. It can range from mild to severe. Pain during sex can also occur. Women commonly also have vaginal discharge with PID.

This can easily be treated with antibiotics but in some might lead to infertility or long term pain.

Stomach and duodenal ulcers

The pain from an ulcer may come and go. It is in the top part of one’s gut but may also feel like it goes through into one’s back. The pain usually comes at night and wakes one up. Food may make it better in some types of ulcer or may make it worse.

Treatment with simple antacids (Proton pump inhibiotrs) for 6 weeks will cure most of ulcers.

Gallstones

Many people do not know they have gallstones. Symptoms include severe pain in the upper right side of the abdomen. This is called biliary colic. The pain is usually worst to the right-hand side, just below the ribs. The pain eases and goes if the gallstone is pushed out into the bile duct (and then usually out into the gut) or if it falls back into the gallbladder.

Pain from biliary colic can last for just a few minutes but, more commonly, lasts for several hours. A severe pain may only happen once in one’s lifetime or it may flare up from time to time. Sometimes less severe but niggly pains occur now and then, particularly after a fatty meal when the gallbladder contracts most.

Surgery will be simple and usually done as laparoscopic (key hole). It can even be done as day cases in most cases when they are asymptomatic or causing pain without infection.

Food poisoning

When we think of food poisoning, we usually think of the typical gastroenteritis – an infection of the gut (intestines) – that usually causes diarrhoea with or without vomiting. Crampy pains in your tummy (abdomen) are common. Pains may ease for a while each time one passes some diarrhoea.

Usually symptoms settle with in 24-48 hours and some might need anti spasmodics. Patients need to make sure they drink plenty of water so that they do not get dehydrated.

Gastritis

Gastritis (inflammation of the stomach lining) may cause pain in the upper abdomen (just below one’s breastbone). The pain is often described as a burning feeling. There are usually other symptoms as well, such as feeling sick (nausea), vomiting and feeling full after eating.

Treatment with simple antacids (Proton pump inhibiotrs) for 6 weeks will suffice.

Crohn’s disease

Crohn’s disease is a condition which causes inflammation in the gut. The disease flares up from time to time. Symptoms vary, depending on the part of the gut affected and the severity of the condition. Common symptoms include bloody diarrhoea, abdominal pain, and feeling unwell

The list does not include every condition that causes abdominal pain. These are just some of the most common causes. People often worry that gut pain is because of cancer. Most often the most common types of cancer in the gut, such as bowel (colonic) cancer, will have other symptoms. These may include weight loss, blood loss or a change in bowel habit.

Recommended tests

Some conditions may not need any investigations. Otherwise, the type of investigation will depend on which part of the gut is affected

Doctoring Abdominal pain

Again, this will depend on what the likely cause of one’s pain is. Some types of pain can be treated simply pain killers (Analgesics). Others may need treatment at a hospital.

Maintaining a healthy gut

Consuming lots of fruit and vegetables

It is recommended that we eat at least five portions of variety of fruits and vegetables everyday. If we eat a lot of fruit and vegetables then our chances of developing heart disease, a stroke or bowel cancer are reduced. In addition, fruit and vegetables:

Contain lots of fibre, which helps to keep your bowels healthy. Problems such as constipation and diverticular disease are less likely to develop.

Contain plenty of vitamins and minerals, which are needed to keep us healthy.

Are naturally low in fat.

Are filling but are low in calories.

Making food bulky by adding roughage (fibre)

Fibre is the part of the food that is not digested. It is filling but has few calories. It helps our bowels to move regularly, which reduces constipation and other bowel problems. Fibre may also help to lower one’s cholesterol level.

Starchy foods, and fruit and vegetables contain the most fibre. So the tips above on starchy foods and fruit and vegetables will also increase fibre. If one switches to wholemeal rice and pasta and wholemeal bread, this can significantly increase one’s fibre intake. Pulses like lentils and beans are also full of fibre.

One needs to drink plenty of water roughly 2.5 to 3lts unless advised othersise by doctors. ​