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Abdominal Pain

A pain in the belly (abdomen) is a very common symptom, and disorders of any of the organs (liver, spleen, intestine, bladder, uterus, ovaries, pancreas), glands, lymph nodes, arteries, veins or nerves may be responsible, as well as the structures around the area such as the muscles, ligaments, skin or the vertebrae in the back.

The doctor may make a diagnosis depending on the nature of the pain (sharp, ache, dull), whether it is constant or intermittent, if it is affected by eating or passing urine or faeces, if it starts in one area then moves to another, what tends to make the pain better or worse, and the presence of associated symptoms such as vomiting, diarrhea, constipation, loss of appetite, fever, pain on passing urine and menstrual period problems.

Investigations to further aid a doctor may include blood tests, x-rays (but these show only bones, and unless a dye is injected, not soft tissue), CT scans (computerized cross sectional x-rays which show some soft tissues), ultrasound scans (using high frequency sound waves to examine organs), endoscopy (passing a flexible telescope tube in through the anus,

mouth or urethra), and as a last resort, surgery. A very large number of conditions may be responsible for pain in the belly. These include: -

•  Constipation may cause discomfort anywhere in the belly, but most commonly in the lower left abdomen.

•  Colic in children is an intermittent, painful spasm of the gut. It is common in babies at about six weeks of age, but may occur in older children and adults as a result of overeating, swallowing air (eg. With rapid eating or crying), anxiety and stress, or due to toxins in the food.

•  Inflammation or infection of the gall bladder (cholecystitis) and gall stones (cholelithiasis) will cause an intermittent pain that is made worse by eating, particularly fatty foods. Gall stones moving down the duct from the liver or gall bladder to the intestine will cause severe pain whenever they are pushed along by the pressure of bile behind them.

•  Infections of the gut by a virus (gastroenteritis) or bacteria (eg. typhoid, tuberculosis, shigellosis, brucellosis), or infestations by parasites (eg. giardiasis, bilharzia) may cause generalized abdominal pain, diarrhea, vomiting and fever.

•  A tear of a muscle in the belly wall, straining one of the ligaments in the groin, or inflammation of cartilages at the end of the ribs may result in pain and tenderness in the abdomen that may be difficult to differentiate from pain that is coming from inside the belly. Pain in these cases is usually aggravated by movement, and other bodily functions are unaffected.

•  Inflammation (gastritis) or ulceration (peptic ulcer) of the stomach causes burning pain, that may be temporarily eased by eating food, but worsens after eating.

•  Infections of the liver such as hepatitis, and cysts in the liver caused by parasites (eg.Hydatid cyst from eating poorly cooked pork).

•  Cancer of the colon is a serious cause of discomfort and ache that gradually worsens to a severe pain. Alterations to the normal bowel habits, loss of appetite and blood in the faeces are other symptoms.

•  Appendicitis may start as a dull ache in the central abdomen, but as the infection worsens, the pain will quickly increase and move to the right lower abdomen. It may be associated with nausea, loss of appetite, fever and diarrhea.

•  The irritable bowel syndrome causes painful spasms of the large intestine that are aggravated by stress and anxiety, and associated with diarrhea and excess wind.

•  Adhesions after surgery to the abdomen, particularly for the treatment of infections (eg. appendicitis, pelvic inflammatory disease), leave raw areas behind on the surface of organs that may adhere to each other and form bands that become twisted and inflamed.

•  A stone in the kidney will cause a constant dull ache, but also excruciatingly severe pain that runs down into the groin (and testes, in men) every time it moves along with the pressure of urine behind it.

•  Diverticulitis causes abdominal pain and diarrhea.

•  Infections of the bladder (cystitis) are far more common in women than men, and result in passing urine very frequently, pain when passing urine, blood in the urine and an ache in the lower abdomen.

•  Nerves pinched in the back may cause pain along the course of that nerve as it runs around the belly.

•  Cysts or tumors in the ovary, infections in the fallopian tubes (salpingitis), or an ectopic pregnancy (pregnancy developing in the fallopian tube or beside the ovary).

•  Pelvic inflammatory disease is an infection of the fallopian tubes and other organs in the pelvis of a woman, often as a result of a sexually transmitted disease. A constant dull ache will be felt, that worsens with sex or menstrual periods.

•  Muscular cramps of the uterus are responsible for the pain felt by women in this lower abdomen during menstrual periods. Fibroids (balls of fibrous scar tissue in the muscular wall of the uterus) may worsen these cramps.

•  Shingles is an infection of a spinal nerve caused by the virus Herpes zoster.

•  Tumors of the small intestine may cause pain anywhere in the belly, as the intestine wanders loosely throughout the belly cavity.

•  Some medications (eg. anti-inflammatories) may have abdominal discomfort or pain as a side effect.

•  Peritonitis is an infection of the membrane (peritoneum) that lines the belly cavity.

•  Patients with coeliac disease (sprue) are unable to digest the protein gluten, which is found in cereal grains such as wheat, rye, barley and oats, but not in rice or corn. Eating any foods containing gluten will cause diarrhea, belly discomfort, weight loss, excess wind and bloating.

There are many less common causes of abdominal pain including enlargement and inflammation of the spleen (eg. with glandular fever), intussusception, anemia, psychiatric conditions, pneumonia, pleurisy (infection of the membrane around the lungs), pancreatitis, Crohn's disease, disorders of the heart, aortic aneurysm, Meckel's diverticulum, mesenteric adenitis, torsion of the testis, obstructions in the large bowel, endometriosis and ulcerative colitis.