Abdominal pain: when you need to see a doctor

Abdominal pain is an unpleasant feeling that can range from mild discomfort to severe and intense pain. It can be either paroxysmal or chronic, acute or dull, aching or cutting.

Causes of abdominal pain can be very diverse and include gallbladder disease, stomach ulcer, food poisoning, diverticulitis, appendicitis, cancer, gynecological diseases (such as fibroids, cysts, infections) and problems with the cardiovascular system. Sometimes women experience abdominal pain during pregnancy.

In determining the causes of abdominal pain, the doctor will be interested in the patient’s medical history, conduct a physical examination and offer to undergo tests (for example, blood and urine) and be examined (for example, tomography, endoscopy, X-rays).

Treatment of abdominal pain depends on the cause that caused it, and may include medication under the supervision of a doctor, inpatient treatment, and even surgery.

What is pain

The role of pain for a person is dual. On the one hand, despite all the discomfort it delivers, pain plays an important role in signaling the presence of problems in the body. On the other hand, pain is an integral part of the disease, and severe and intense pain often becomes more dangerous than the condition that gave rise to it. From this point of view, chronic pain caused by damage to nerve fibers is particularly unpleasant. Although the cause of the disease itself can be eliminated many years ago, the person continues to suffer from pain. In some particularly severe cases, pain can be relieved only by removing the corresponding parts of the brain responsible for its appearance.

Why exactly pain occurs is not completely clear. According to some, the pain can be perceived by any receptors, and its occurrence depends only on the degree of intensity of the sensation. On the other hand, only special receptors that react to stimuli of particular strength take part in the formation of the feeling of pain.

It is believed that abdominal pain can occur due to spasm of smooth muscles, stretching of the walls of internal organs or inflammation. Doctors believe that both pain and spasm of internal organs are usually caused by one common cause.

The strength of the pain experienced depends on the individual characteristics of the person – some people feel the pain more acutely, others suffer it more easily. The strength of the pain also depends on the emotional background and the environment in which the person suffering from abdominal disease is located.

Types of abdominal pain

Determining the type of pain and its location can help the doctor find the cause of the disease. The following factors are usually taken into account when making a diagnosis:

• How the patient feels pain. Abdominal pain can be sharp, dull, stabbing, deep, squeezing, cutting, burning, and so on.
• How long the pain lasts. In the stomach, the pain can last for a couple of minutes, or continue for several hours or more. The feeling of pain itself can vary from severe and acute to poorly perceptible and aching.
• Does the stomach ache constantly? Sometimes the pain, at first being acute and severe, subsides and resumes after a while.
• What exactly causes pain? Abdominal pain can both alleviate and aggravate certain events, such as eating, going to the toilet, vomiting, taking a certain body position (for example, the pain becomes stronger if a person lies).
• How does a person feel after eating certain foods? Does he get better or worse? For example, in stomach ulcers, eating an orange can affect abdominal pain, and in gallbladder disease, a fatty chop can affect it.

What is acute stomach pain?

This is an unexpected severe and sharp pain, the strength of which may increase with time. As a rule, it becomes stronger when walking, when a person coughs, sighs, changes body position. If the pain is acute, the abdominal muscles can strain, which is easily determined by the doctor during the examination. Acute pain indicates the possibility of the appearance of diseases that pose a danger to human life, often requiring urgent medical attention, including hospitalization and surgery. Acute pain in the abdomen is caused by such diseases as perforation of the ulcer, euterocolitis, inflammation of the intestinal diverticulum, acute cholecystitis, spleen rupture, ectopic pregnancy, etc.

What is chronic abdominal pain?

Unlike acute, chronic pain can last for a long time – a week, several months and even more. The pain is dull, it can sometimes increase, then be almost invisible. Her frequent companions are nausea, vomiting, perspiration. Persistent abdominal pain is a symptom of functional disorders in the body, such as irritable bowel syndrome, as well as diseases of the digestive tract: reflux esophagitis, colitis, diverticulitis, gastric ulcer and duodenal ulcer, and others.

What diseases can cause abdominal pain?

If a person has pain in the abdomen of a aching nature, the likely cause is irritation of the nerve receptors of the mucous membrane of internal organs during inflammation, for example, inflammation of the peritoneum. When periodic pain occurs in a certain time period and then disappears, the likely cause is an increased secretion of gastric juice. When the pain is sharp, similar to contractions, it means that the patient has a spasm of smooth muscles of hollow organs, for example, the intestines. If the pain is aching and pulling, it may be caused by stretching of the walls of the internal organs – for example, with increased gas emission. Another pain in the abdomen is seasonal, usually aggravated in spring or autumn.

What diseases cause abdominal pain in certain places?

To make it easier for the doctor to diagnose, the stomach is usually divided into four parts. If you mentally draw a vertical line from the base of the chest to the pubis, and a horizontal line through the navel from left to right, it turns out that the stomach is divided into four segments. They are called quadrants (upper left, lower right, lower left, and upper right). Below is a list of diseases associated with certain quadrants.

Upper left quadrant: rupture of the spleen, pancreatitis, pyelonephritis, pneumonia, etc.

Upper right quadrant: gallbladder diseases (stones, cholecystitis), hepatitis, pancreatitis, esophagitis, intestinal obstruction, pneumonia, heart failure and other diseases.

Lower left quadrant: diverticulitis, diseases associated with the female reproductive system (cyst of the left ovary, torsion of the left ovary), irritable bowel syndrome, etc.

Lower right quadrant: diseases of the uterus, appendicitis, inflammation or torsion of the right ovary, right ovarian cyst, bowel disease, abscess, hernia, etc.

Pain in the upper abdomen: stomach ulcer, gastritis, pancreatitis, functional dyspepsia, malignant tumors, myocard infarction, etc.

Pain in the middle of the abdomen: kidney disease, colitis, hernia, intestinal obstruction, etc.

Pain in the lower abdomen: ureter infections, uterine diseases (fibroids, cancer), irritable bowel syndrome (especially if accompanied by constipation or diarrhea), diverticulitis, intestinal obstruction, colitis, cystitis, etc.

If pain cannot be localized in any one area of ​​the abdomen, it serves as a symptom of the possible presence of infectious gastritis and enterocolitis, peritonitis, an infection of the ureters and bladder.

It is worth noting that the diagnosis of diseases only by the nature and location of pain can not be absolutely true. A person may have a stomach ache in one quadrant, although in reality the disease struck an internal organ located in a completely different place. Moreover, the cause of abdominal pain may not be in the abdominal area at all – for example, in certain diseases, including pneumonia, pain may be projected into the stomach.

Often the feeling of abdominal pain occurs in heart and lung diseases (coronary disease, pericarditis, pneumonia and pulmonary embolism). Diseases of the internal organs located in the pelvic region, can cause a feeling of pain in the abdomen, as well as testicular torsion in men. Shingles can also cause abdominal pain, although there may be no malfunctioning of the internal organs in this area.

Poisoning, bites of poisonous animals or insects also sometimes cause abdominal pain.

Symptoms accompanying abdominal pain

By itself, abdominal pain is already a symptom – it means that the person is sick, and treatment is necessary. She may be accompanied by other phenomena, for example, high fever, chills, perspiration, bleeding. It is recommended to pay special attention to conditions when severe pain occurs, is it combined with eating, and does abdominal pain occur when a person suffers from diarrhea.

Causes of abdominal pain

Many acute (short-term) and chronic (long-term) diseases cause abdominal pain. Most people believe that abdominal pain can be associated with gastritis, appendicitis, kidney stones, gallbladder disease, gastric ulcer and duodenal ulcer, infections and pregnancy. All of these conditions are common and well known. However, pain in the abdomen can also be caused by more rare diseases, such as rupture of a blood vessel, visceral vein thrombosis, inflammation of the liver and pancreas, impaired intestinal circulation, cancer and other diseases.

Abdominal pain during pregnancy

In the absence of other symptoms, heaviness in the abdomen and pelvic region is not a reason for anxiety. Women in the first trimester often feel it. This phenomenon is associated with increased blood circulation, the growth of the uterus, in later terms – with the increasing weight of the child. The pelvic floor muscles are stretched, the uterus puts pressure on the bladder and rectum, which can cause pain in the abdomen.

But if the feeling of heaviness is accompanied by pain, spasms, vaginal discharge (with blood or watery) appear, you should immediately consult a doctor. These symptoms may indicate a miscarriage, an ectopic pregnancy or (in later periods) the onset of preterm labor.

The second reason for the appearance of pain in the abdomen during pregnancy – so-called. diastasis, when under the influence of the pressure of the growing uterus, the abdominal muscles can disperse. This is usually painless, but some women may experience pain in the navel or back. Medical care in this condition is not required; usually after birth, everything returns to normal.

When in case of abdominal pain it is necessary to seek medical help

Go to the doctor immediately if the patient observes the following symptoms:

• If the abdominal pain lasts more than six hours in a row and / or becomes more severe.
• For any acute abdominal pain.
• When abdominal pain occurs after eating.
• If the pain is so severe that the person is not able to eat.
• When, for pain in the stomach of a person, vomits three or four times or more in a row.
• For abdominal pain during pregnancy.
• If the pain increases when a person tries to change the position of the body.
• When pain is first felt near the navel, and then shifted to one place, especially in the lower right quadrant. This may be a sign of appendicitis.
• If a person wakes up at night in pain.
• When abdominal pain is accompanied by vaginal bleeding during pregnancy. You must consult your doctor even if the woman does not think she is pregnant.
• For abdominal pains with high fever.
• If a person has pain when urinating, defecating, or trying to release gases.
• For any pain that is different from the simple feeling of discomfort in the stomach.

In general, it is recommended to consult a doctor in case of any pain that makes a person fearful.

Emergency medical care for abdominal pains

It is recommended that you call an ambulance or go to the hospital yourself in the following cases as soon as possible:

• When the pain is so strong that the person experiencing it loses consciousness, it suffocates. This condition is characteristic of abdominal bleeding, perforation of the intestinal wall or stomach, acute pancreatitis and liver failure.
• In acute pain, when a person is unable to move.
• If abdominal pain is accompanied by vomiting of blood or vomiting lasts more than a few hours.
• When acute abdominal pain is accompanied by a complete absence of intestinal activity for several days (this may indicate obstruction of the digestive tract).
• If abdominal pain is accompanied by rectal bleeding. In acute pain, ischemia of the intestines or bleeding into it (for example, at a rupture of the abdominal aorta), ulcer perforation or hemorrhagic gastropathy are likely. If the pain is chronic, then bleeding along with abdominal pain may indicate cancer.
• If a person has pain in the chest and abdomen, but not exactly sure where exactly (it can be an indicator of heart disease).
• In men, if the pain is in the groin area (torsion of the testicle; if it is not adjusted, tissue necrosis may begin after a few hours).

Which doctor is better to contact for abdominal pain

The doctor’s specialization depends on the cause of the pain. It is preferable to start with a general practitioner, who will conduct a preliminary diagnosis and refer to a specialist by its results. Depending on the final diagnosis, it will be a therapist (injuries, bruises), a surgeon (appendicitis, ovarian torsion), a gastroenterologist (gastric ulcer or duodenal ulcer), a nephrologist (kidney stones) or a gynecologist (myoma). If the pain is severe, the patient may be in the hospital of a specialized department of the hospital.

Diagnosis of Abdominal Diseases

Determining the cause of abdominal pain is one of the most difficult tasks for a doctor. Sometimes it happens that the only thing that remains to a qualified specialist is to eliminate the need for surgical intervention or hospitalization. Sometimes no specific cause of pain can be found, and it gradually disappears by itself.

During the examination, the doctor may ask many questions, some of which may not be directly related to the current state of the patient. Nevertheless, it is important to try to give them the fullest possible answer – so the doctor will quickly find the cause of the disease.

Questions may be as follows:

• How long have you been in pain?
• What did you do when you felt pain?
• How did you feel before the pain started?
• How have you felt in the last few days?
• What did you try to do to ease the pain? Did these actions help?
• What causes increased pain? What weakens her?
• Where is the painful focus? Right, left, top, bottom?
• Does the pain decrease or, on the contrary, increase if you stand in one place?
• And if you move?
• How did you get to the hospital? Did you get hurt while traveling by public transport or by car?
• Does the pain cough up?
• makes you sick? Was vomiting?
• Does vomiting cause deterioration or improvement?
• Did your intestines function normally?
• When was the last time you visited the toilet?
• Do you get to release gases?
• Do you have high temperatures?
• Have you ever felt the same pain?
• When exactly? Under what conditions did it occur?
• Did you have exacerbation of pain during menstruation?
• Did you have a surgery, what kind and when was it done?
• Are you pregnant? Do you have a sex life? Do you use contraception?
• Have you recently been to a person with similar symptoms?
• Have you traveled outside the country in the near past?
• When was the last time you ate? What exactly did you eat?
• Have you eaten any food that is different from your usual diet?
• Was there such a thing that your stomach ached at the navel first, and then the pain moved to some other place? If so, which one?
• Does chest pain cause pain? In the back? Anywhere else?
• Can you close the hearth of pain with your palm, or is it larger in size?
• Does it hurt to breathe?
• Do you suffer from diseases such as heart disease or diabetes?
• Do you take painkillers, steroids, aspirin?
• Do you take antibiotics? Over-the-counter drugs? Supplements? Medicinal herbs?
• Do you smoke?
• Do you drink alcohol? How often do you drink coffee? Tea?

Of course, the doctor is unlikely to force the patient to answer all questions at once without exception. But depending on the symptoms, additional questions may be asked.

Medical examination for abdominal pain

Medical examination is to assess the general condition of the patient, movements, skin color, activity, breathing patterns, adopted posture, and so on. Then the doctor usually asks the patient to expose the abdomen and chest and palpation and percussion, that is, will touch different places of the abdomen and tap on them to check the degree of tension and other signs indicating abdominal diseases. In addition to the abdomen, the doctor must also listen to the patient’s lungs and heart.

A doctor may conduct a rectal examination to determine if there is blood in the rectum, if there are other diseases, such as hemorrhoids.

If the patient is male, the doctor may examine the penis and testicles. If the patient is a woman, the doctor may conduct a pelvic examination to determine if the cause of the pain is related to the uterus, fallopian tubes and ovaries.

Also, the doctor can check the color of the proteins of the patient’s eyes (if they are not yellowed), as well as the oral cavity (if it is dry, if dehydration has not started).

Abdominal pain tests

According to the results of the information received from the patient, the doctor may offer to do blood tests, urine and feces, as well as an ultrasound of the abdominal cavity. If the patient is a woman, she will be advised to do a pregnancy test.

Blood test

Blood will be checked for morphology, electrolyte levels, glucose, creatinine. If, after the first analysis, the diagnosis cannot be made, a biochemical analysis may follow, checking for the level of amylase, bilirubin, etc. An increased white blood cell level may indicate an infection in the body or just a reaction to stress and pain. A low level of red blood cells (hemoglobin) can mean internal bleeding; however, usually most bleeding does not cause abdominal pain. Biochemical analysis of blood for enzymes of the liver and pancreas, will help determine which particular organ is out of order and can cause a sensation of pain in the abdomen.

Urine Analysis

Urinary infection is one of the most common causes of abdominal pain. The presence of infection can be determined by visual inspection of the urine test – if it is cloudy, it smells strong and unpleasant, then the presence of infection is more than likely. Blood in the urine, not noticeable by visual inspection, may indicate kidney stones. A microscopic examination of the sediment will show whether there is protein in the urine, sugar, ketone bodies, etc.

Stool Analysis

It will help determine whether the pain in the stomach is caused by parasites or infection, as well as provide information on the work of the pancreas and stomach. The presence of blood in the feces will indicate cracks, ulcers and disorders of the mucous membrane of the stomach and intestines, and checking for dysbacteriosis doesn’t cause abdominal pain from this disease.

Surveys for abdominal pains

If the cause of abdominal pain is already clear at the initial medical examination, additional examinations are not required. But when the diagnosis fails immediately, the doctor may suggest that the patient conduct the following studies.

Gastroscopy

If you suspect damage to the mucous membrane of the esophagus, stomach and duodenum, the doctor may advise you to do a gastroscopy. The patient swallows a long tube with a tiny video camera at the end, with which the doctor can examine the condition of the surface of the organs of the patient’s digestive tract. Gastroscopy is indispensable for suspected gastric ulcer and duodenal ulcer. In addition to the examination, the doctor can use an endoscope for biopsy and determine the level of acidity and infection of the inner surface of the stomach with microbes.

Colonoscopy

By its principle, colonoscopy is very similar to gastroscopy, only the endoscope is now used to inspect the condition of the inner surface of the large intestine and rectum.

Biopsy

A biopsy takes a sample of the tissue lining the inside of the digestive tract and examines it under a microscope. A biopsy is indispensable if you want to find out whether a benign tumor or not, and whether pathological changes have occurred in the epithelium of the mucous membrane of internal organs.

Gastric probing

A special probe is introduced into the esophagus and then, with which the doctor collects gastric juice or the contents of the duodenum. With this operation, it is possible to determine the composition and level of acidity of the stomach content, and whether there are protozoan parasites in it.

Medical Radiological Research

In some cases, the doctor may offer a patient a series of radiological examinations.

X-ray

Usually, in case of acute abdominal pains, the patient is asked to take a chest X-ray in a standing position. It can see the state of the organs of the chest cavity, diseases of which can cause abdominal pain, as well as the presence of air under the diaphragm.

In some cases, the patient does an x-ray of the abdomen in a standing position and lying on his back. X-rays may reveal air accumulations outside the intestines, which may indicate rupture or perforation. The absence of air in some parts of the intestines may be a sign of intestinal obstruction. You can also determine the presence of gallstones and urinary stones and large formations in the abdominal cavity.

Ultrasound

Ultrasound examination is a painless and safe procedure. A doctor can prescribe it if he believes that the cause of the pain lies in diseases of the abdomen – problems with the gall bladder, pancreas, liver, or female reproductive system. Also, an ultrasound examination helps to diagnose diseases of the kidneys, spleen, large blood vessels that supply blood from the heart to the lower part of the body, and in the case of a volume formation in the abdominal cavity – its nature.

Computed Tomography (CT)

This method is used to study the state of the liver, pancreas, kidneys, ureters, spleen, and small and large intestines. CT scan can also help identify abdominal inflammation.

MRI

Magnetic resonance imaging is usually less useful in the study of the abdominal cavity than computer, but the doctor may prescribe it in connection with certain symptoms.

Angiography

Angiography is a method of researching blood vessels, in which a radiopaque substance is injected into the patient’s body (usually an iodine preparation). It allows you to detect the presence of blood clots and embolism in the arteries.

Irrigoscopy

An analogue of angiography is an irrigoscopy, when a radiopaque preparation is injected into the colon. It allows you to determine the presence of intestinal obstruction and its cause, as well as the presence of intestinal perforation.

Cholescintigraphy

Conducted with suspected acute cholecystitis, violation of patency of the bile duct and other diseases of the biliary tract.

Abdominal Pain Treatment

Treatment depends on the diagnosis and can range from simple medication and diet to surgery under general anesthesia.

The doctor may prescribe a painkiller to the patient. If the pain is caused by an intestinal spasm, the doctor may give a painkiller shot to the patient’s thigh, leg, or arm. If there is no vomiting, the patient is able to take painkillers in combination with an antacid or alone.

Is surgery required for the treatment of abdominal pain?

It happens that abdominal pain is caused by diseases or conditions that require surgery (for example, inflammation of the appendix or gall bladder). In this case, the patient will be sent to the hospital where he will undergo surgery.

Occasional bowel obstruction also requires surgical intervention. The need for surgery due to the severity of the patient’s condition and the availability of the opportunity to remove the obstacle by non-surgical means. If the abdominal pain is caused by a rupture or perforation of an internal organ, such as a stomach or intestines, the patient requires immediate surgery.

Should I see a doctor after stopping abdominal pain?

If the reasons that caused the stomach soreness do not require inpatient treatment, the doctor explains to the patient what medicines he should take, how to eat, what to refrain from, and which regimen to follow. If, under all conditions of treatment, the pain continues or resumes, you should make an appointment to reapply.

You should also see a doctor immediately in one of the following cases:

• Severe abdominal pain, over time its intensity only increases
• High temperature
• Inability to urinate or defecate
• Or for any other symptoms that cause anxiety in a patient.

How to relieve abdominal pain at home?

Abdominal pain, not complicated by high fever, vomiting, bleeding from the rectum and vagina, fainting or other symptoms of serious diseases, often goes away by itself without medical treatment.

They will help relieve abdominal pains at home, a warming compress, a hot-water bottle on your stomach or a bath with hot water. Antacids that can be bought without a prescription (for example, Almagel, Fosfalyugel, Maalox) can also reduce pain if the patient is sure that it is associated with diseases of the digestive system. Also for pain caused by food poisoning or overdose of certain drugs, activated charcoal tablets can help.

Avoid aspirin or ibuprofen – if the cause of the pain is a gastric ulcer or duodenal ulcer or liver disease, both of these drugs will cause irritation of the mucous membrane and only increase the pain.

If the cause of the pain is gas that has accumulated in the intestine, you can lie down on your back, press your knees to your stomach and slightly rock back and forth. This reduces the pressure on the abdominal area, the muscles relax and gas separation is less painful.

Muscle tension in the abdomen can be reduced with a massage. Move your hands slowly, smoothly and either clockwise or up and down. A combination of deep-breathing massage helps relieve pain.

What is a pain in the abdomen?

One of the key features in the treatment of pain in chronic diseases of the abdomen is diet. As a rule, for diseases of the stomach, intestines, gallbladder, the doctor tells in detail what kind of diet the patient needs. If there are no detailed instructions, you can follow the following diet.

If the patient’s appetite is awake, it is worth starting with liquids – broth, very liquid soups, and so on. If the stomach of the patient accepts them, you can gradually introduce new foods into the diet, such as white bread croutons, rice without salt, bananas and baked apples. If the recovery rate is positive for several days, you can return to your normal diet.

Can abdominal pain be prevented?

If the doctor has diagnosed, the cause of the pain is identified and the disease is named, in some cases the patient is required to adhere to the regimen. For example, in case of gastric ulcer and duodenal ulcer, you should refrain from drinking alcohol, coffee, and reduce smoking to a minimum or quit. And for diseases of the gallbladder should avoid fatty and fried foods.

What is the prognosis for abdominal pain?

In general, many diseases that cause abdominal pain, pass without inpatient treatment or surgery. Often, a person only needs to alleviate the symptoms.

As a rule, if the disease is mild or moderate, the prognosis is favorable (with some exceptions). And if the disease is more severe and requires surgical intervention, the prognosis depends on the severity of the disease, and the general condition of the person. For example, if the cause of abdominal pain is uncomplicated appendicitis or gallbladder stones, as a rule, people quickly recover from the operation and recover completely. If the appendix is ​​broken, and the gallbladder is inflamed, then recovery may take much longer. And in case of perforation of an ulcer or intestinal obstruction, more time is required. In general, the older the person, the longer the recovery takes.