Pain felt anywhere in the area above the pelvis but under the ribs can be considered as abdominal pain. It is a common symptom experienced by people of all ages, and typically originates in one of the abdominal organs. Abdominal pain can be caused by a myriad of medical and surgical conditions, ranging from simple discomfort to the most complicated, life-threatening diseases. Approximately 3% of adult consults to family physicians are due to abdominal pain.
There are many organs in the abdomen including the liver, kidney, stomach, small and large bowels, and blood vessels like the abdominal aorta, to name a few. Any damage or disease in any one of these organs can produce abdominal pain. In general, abdominal pain is typically caused by distention of the bowels, inflammation of abdominal organs, traumatic injury, and lack of blood supply or ischemia of an organ. Uncommonly, pain from nearby organs, such as the lungs and the diaphragm, may be felt as abdominal pain. The cause of abdominal pain is not identified in approximately one-third of cases.
Majority of cases of abdominal pain are minor and can be managed conservatively. The most common cause of pain in the abdomen remains to be gastroenteritis, which occurs in approximately 13% of cases. This is followed by irritable bowel syndrome or IBS, a condition involving hypersensitivity of the intestines, which is experienced by 8% of patients. Other common causes include indigestion, gastritis, constipation, and lactose intolerance.
In approximately 10% of cases, abdominal pain is caused by a serious condition. The term acute abdomen is described as severe, sudden onset abdominal pain that necessitates surgical intervention. The usual diseases presenting with acute abdomen include gallbladder disease and appendicitis. Other serious causes include bowel obstruction frequently from postoperative adhesions, mesenteric ischemia, bowel perforation, gastric ulcers, pancreatitis, hernia, diverticulitis and tumors of the different organs. Problems in the urinary tract, such as acute pyelonephritis, and gynecologic pathologies can likewise present with abdominal pain.
Some diseases producing abdominal pain are also more common in certain age groups. For example, intussusception, where the bowel folds upon itself, is quite common in children; while abdominal aortic aneurysms mostly occur in the elderly population.
Abdominal pain can present in different ways. Based on the specific location, abdominal pain may either be generalized or localized. Generalized abdominal pain is the type that occurs in more than one quadrant of the abdomen. Indigestion and gastroenteritis usually present with generalized pain. Localized abdominal pain, meanwhile, is the type that is felt in a specific area in the abdomen and is usually due to a disease or inflammation of an abdominal organ found in that location. For example, appendicitis typically presents with pain in the right lower quadrant, peptic ulcer disease presents with pain in the epigastric area, and cholecystitis presents with pain in the right upper abdomen, below the ribs. Abdominal pain radiating to the back may be due to pancreatitis or an aortic aneurysm.
Abdominal pain may also have different characteristics. Pain may be described as crampy, which is usually due to gas, or in women, menstruation. Bowel obstruction can also be a cause of cramp-like abdominal pain. Another description of pain is colicky, occurring intermittently but is usually severe, such as the kind associated with gallstones and kidney stones.
Abdominal pain is typically associated with other symptoms in the digestive tract. Usual symptoms include being bloated, vomiting and changes in bowel movements, such as diarrhea. Many other symptoms may accompany abdominal pain, depending on the cause, and may include fever, jaundice or yellowing of the skin and painful urination, among others.
Abdominal pain can be usually managed at home. However, in cases where the pain is unrelenting and severe, it is recommended that you consult your physician. It may be prudent to go to the emergency department if, together with abdominal pain, you are unable to defecate for several days, and you are unable to keep any food down. You should also consult a specialist if the pain is persistent or progressive over several days to a week, if your abdomen is painful when touched, if you vomit blood and if you develop bloody stools. Also, you should seek immediate medical assistance if you experience any traumatic injury to the abdomen.
A careful history is needed when determining the cause of abdominal pain. You will need to characterize the pain you feel – the kind of pain, the location and any radiation, its relation to food intake, activities that trigger or worsen it, and maneuvers that relieve the pain. Your physician will then conduct a physical examination, which may include a rectal exam. You may then have to undergo several examinations, which could include blood examinations, X-rays, abdominal ultrasound, and possibly a computed tomography (CT) scan. Your physician may also refer you to a gastroenterologist, who can perform an endoscopy to check for lesions in your digestive tract.
The management of abdominal pain is primarily dependent on the cause of the pain. Most abdominal pain resolves with adequate bowel rest and proper hydration. Some require medications, such as antibiotics for abdominal infections, antacids for heartburn, proton pump inhibitors for gastric protection, laxatives for constipation, anti-inflammatory medications and pain relievers. In certain cases, surgery may be needed. In general, patients with acute abdomen have to undergo an exploratory laparotomy to determine and manage the cause of the abdominal pain adequately.