What is the meaning of pain in the upper abdomen? Why is there pain in the lower abdomen? What causes abdominal pain with gas? When to see a doctor? Our expert makes order and gives coping tips
Abdominal pain is a common occurrence and a serious nuisance for many of us. They can strike without any prior warning, causing many of us to immediately cringe and storm the medicine cabinet in search of pills to ease the pain.
There are many causes of abdominal pain, and most of the time they do not require special treatment or medical supervision. Conversely, sometimes abdominal pain may indicate a serious problem that requires medical attention.
The abdominal area includes the following main organs: the stomach, the small intestine, the large intestine, the liver, the gallbladder and the pancreas. Any problem in any of these organs can be the cause of abdominal pain.
So let’s make some order in the mess.
Causes of abdominal pain
Viral diseases
what do you feel?
Viral diseases may manifest as generalized abdominal pain or pain accompanied by vomiting and diarrhea. It is usually vomiting of stomach contents and watery diarrhea. Such stomach aches will usually go away within a few days.
How are you treated?
• When it comes to viral diseases, their symptoms are mainly treated and not their causes, for example with drugs that relieve stomach aches or anti-nausea and vomiting pills
• The main complication of such a stomach ache is dehydration due to the diarrhea and vomiting, so it is important to drink plenty of water.
• Probiotics may help, and it is recommended to use them in these cases (can be bought without a prescription).
• Since the body loses salts in cases of diarrhea, it is recommended to drink liquids with salts. You can buy such salt solutions for self-preparation and drink a small amount often.
• Anti-diarrhea compounds can also be made at home: to a liter of water add a glass of citrus fruit juice, a teaspoon of salt and half a spoon of honey or a spoon of sugar. Sometimes the family doctor may recommend medications that stop diarrhea
• There is no point in taking antibiotic drugs in the case of viral diseases, since these drugs have no effect on the viruses. Antibiotics only kill bacteria.
Food Poisoning
It is usually a toxin that a bacterium secretes into the food or into the stomach after eating spoiled food.
what do you feel?
Food poisoning is often manifested by vomiting, stomach aches and diarrhea that lasts up to 24 hours and then simply passes.
How are you treated?
Drink plenty of water to avoid dehydration.
Bacterial diseases
Sometimes the cause of diarrhea is a bacterium. The bacteria that can cause abdominal pain are usually E. coli, Shigella, Salmonella or Campylobacter.
what do you feel?
Their stomachaches caused by bacteria are often more severe. They are often accompanied by a high fever.
How are you treated?
In most healthy children and adults, the disease will go away on its own even without antibiotic treatment (and in the same period of time), so it is better not to take antibiotics automatically.
On the other hand, there is a place to give antibiotic treatment to babies, pregnant women, the elderly, those with a weak immune system and in cases of serious illness (such as bloody diarrhea) and prolonged diarrhea.
Even in the case of bacterial diarrhea – as in the case of viral diarrhea – the main complication is dehydration, so it is important to drink plenty of water.
Parasites
The amoeba (known by its scientific name Entamoeba histolytica) lives mostly in the intestine without doing any harm, so most amoeba carriers are actually asymptomatic. Sometimes the status quo is broken, and the amoeba invades the intestinal lining.
what do you feel?
Bloody and acute diarrhea. The diarrhea can last a long time and resemble inflammatory bowel disease. Usually the disease appears after traveling in developing countries or after close contact with people who have returned from there.
Giardia lamblia is another parasite that can cause diarrhea.
what do you feel?
The infection can be without any symptoms and can also manifest itself in chronic acute diarrhea and even cause malabsorption (a condition characterized by extreme weight loss and nutritional deficiencies). There is usually mucus in the diarrhea, but rarely blood.
How are you treated?
The treatment is antibiotics.
Stomach ulcer and duodenal ulcer
what do you feel?
The ulcer is actually a wound on the inner wall of the stomach or the duodenum or the intestine, and it manifests itself in pain in the central upper abdomen. There is usually a connection between the pains and eating: food may worsen the pains or relieve them. These are usually chronic pains that last more than a month. This type of stomach ache is called “dyspepsia”.
The pain may worsen after eating particularly spicy foods and after drinking alcohol or coffee. While in the past an ulcer was considered a chronic disease that one suffers from for a long period of time, today it is known that it is an infectious disease caused by the bacterium Helicobacter pylori, and that the eradication of the bacterium cures the ulcer once and for all.
A distinction must be made between dyspeptic abdominal pain, which indicates a stomach ulcer or inflammation of the stomach or intestine, and pain in the abdomen that radiates towards the chest (heartburn) caused by the reflux disease and is not related to Helicobacter pylori.
How are you treated?
The treatment of gastric ulcer or duodenal ulcer is based on treatment of Helicobacter pylori.
Sometimes, after 10 to 14 days of combined antibiotic treatment to eradicate the bacteria, it is necessary to continue treatment that includes the administration of drugs that suppress the production of acid in the stomach (such as Ompredex, Lansoprazole, Controlloc, Nexium or Dexilant) for a few more weeks.
If Helicobacter pylori was not detected, treatment with drugs that suppress the production of stomach acid is recommended.
Gallbladder problems
Gallstones
Gallstones are formed as a result of the crystallization of bile salts and cholesterol. The main risk factors for the appearance of gallstones include: gender (women), multiple births, obesity and genetics.
what do you feel?
The symptoms are usually spasmodic pains in the upper right abdomen. The pains appear after meals, and usually nausea also comes with them.
How are you treated?
The treatment is surgical: removal of the gallbladder, if the attacks are repeated several times. And there is no need to worry, it turns out that you can manage without it.
Gallbladder inflammation
Sometimes bacteria settle on gallstones and cause inflammation in the gallbladder.
what do you feel?
The inflammation involves extremely severe pains centered in the right upper abdomen and radiating to the right shoulder. Sometimes they are accompanied by vomiting or fever and attack in waves – every few hours.
How are you treated?
Treatment is with antibiotics that are usually given intravenously as part of hospitalization. After that, it is recommended to remove the gallbladder surgically.
inflammation of the pancreas
what do you feel?
Pancreatitis is characterized by upper left abdominal pain radiating around the abdomen in the form of a belt. The pain appears in fits and sometimes it is accompanied by fever and vomiting. It is usually severe pain.
The main causes of pancreatitis include: gallstones, drinking too much alcohol and high blood lipids.
How are you treated?
The treatment of pancreatitis is usually done in a hospital and is based on rest, fasting and connecting to an infusion to receive fluids.
Gases in the digestive system
Sensitivity to certain foods or digestive problems can cause a lot of gas in the digestive system.
what do you feel?
The feeling is of fullness and swelling in the abdomen along with scattered pains over the entire abdomen.
The feeling of bloating, by the way, does not necessarily indicate a lot of gas, but mainly a higher sensitivity to normal amounts of gas in the digestive tract (when it is written in the abdominal ultrasound report that “gas in the intestine” was observed, this is a completely normal phenomenon).
How are you treated?
Gas is a common problem that usually does not indicate any disease.
• The phenomenon can be mitigated and alleviated by adopting a suitable diet. Legumes are a well-known factor that causes gas formation, but there are other factors such as cruciferous vegetables (for example, cauliflower, broccoli and Brussels sprouts). It is recommended to consult a nutritionist regarding a suitable diet, for example a low FODMAP diet.
• Another tip: “Don’t talk during dinner.” This is the best way to prevent air from entering the digestive system and thus reduce the gas problem.
• It is also important to avoid tension, which in many cases is accompanied by irregular, fast or particularly deep breathing.
• It is also advisable to avoid carbonated drinks and chewing gum as these also contribute to swallowing air. Sweets containing the sugars mannitol and sorbitol, which are foreign to the body, also contribute to the formation of gas, since the breakdown of these sugars is accompanied by the release of gas.
• If changing the menu does not help, you can also help by taking gas-absorbing tablets
• Consumption of probiotic bacteria may change the bacterial balance in the stomach and also help in solving the problem
Urinary tract infections
Infections of this type are more common in women, and often (but not always) occur after intercourse.
what do you feel?
In this case, the pain is concentrated in the lower abdomen and is accompanied by pain or burning when urinating. Often there is a constant feeling of needing to urinate, and there is difficulty holding back.
How are you treated?
Treatment is mainly with antibiotics.
An important tip for women who want to prevent recurrent urinary infections after intercourse: it is recommended that they urinate after intercourse to flush the bladder.
Another way to prevent and treat such infections is to eat foods rich in vitamin C such as cranberries and citrus fruits. These foods make the urine more acidic, thus making it difficult for the bacteria to exist.
Drinking a lot is also important for flushing the entire urinary system.
Diverticulitis
The Pockets or pouches that are found along the large intestine, these pouches are called diverticula. Sometimes these pouches become contaminated and become inflamed and this condition is called Diverticulitis.
Diverticulitis is caused by an infection of one or more of the diverticula. It is thought an infection develops when a hard piece of stool or undigested food gets trapped in one of the pouches. This gives bacteria in the stool the chance to multiply and spread, triggering an infection.
what do you feel?
Abdominal pain and sometimes fever. The common location of such sections is in the left intestine, so the pain will usually be on the left side of the lower abdomen. These pains may appear even without inflammation.
How are you treated?
The diagnosis is based on an abdominal CT scan.
The treatment is with antibiotics, sometimes through the vein in hospitalization – depending on the severity of the inflammation.
Stones in the kidneys or urinary tract
what do you feel?
The pains caused by stones in the kidneys or urinary tract are sharp and very severe, appear in the waist and lower back area and radiate to the groin on the same side. Sometimes these pains are accompanied by blood in the urine, nausea and vomiting.
How are you treated?
• The treatment of kidney stones is based on drinking a lot and giving pain relievers to relieve the pain.
• Smooth muscle relaxants can also be given, which cause the urinary tract to expand, thus making it easier for the stone to come out through the urinary tract.
• Another treatment option is to crush the stones using shock waves.
In extreme cases of particularly large stones, they can be removed through surgery
It is important to know: the chances are high that those who suffered from stones in the urinary tract will continue to suffer from them in the future, and therefore it is mandatory for such patients to drink more and be under medical supervision. Depending on the type of stone, additional drug treatment or the adoption of a special diet is sometimes recommended
Gynecological problems
Pain resulting from gynecological problems is characterized by feelings of pain and discomfort in the lower abdomen, and the pain is often radiated to the back as well. Abdominal pain is sometimes caused by irritation of the ovaries or the uterus.
Abdominal pains often appear during ovulation (usually in the middle of the menstrual period) or in the period before the menstrual bleeding. If it is menstrual pain, they are felt close to it. Anti-inflammatory pain relievers can be given for menstrual and ovulation pain
Another gynecological cause of pain is pelvic inflammation. It is an inflammation that causes an infection that requires antibiotic treatment.
Also, one should always take into account the possibility that the patient is pregnant and therefore feels in her stomach and vomits.
Inflammatory bowel diseases
There are two types of inflammatory bowel diseases: Ulcerative Colitis and Crohn’s Disease.
Ulcerative colitis is an inflammatory disease that affects the mucosa lining the wall of the large intestine and causes superficial wounds (ulcers). The disease begins near the anus and spreads continuously upwards in the large intestine, in part or all of it, without damage to the small intestine.
Crohn’s is an inflammatory disease that penetrates all layers of the intestinal wall and can appear in all parts of the digestive system – from the mouth to the anus – without sequence or continuity (alternating healthy and infected areas).
what do you feel?
The abdominal pain in patients with inflammatory bowel diseases is chronic.
In Crohn’s disease, the pain is often located in the lower right part of the abdomen. In patients suffering from ulcerative colitis, the pain is accompanied by bloody diarrhea, while in Crohn’s patients the pain is accompanied by a change in bowel habits and sometimes also by lack of appetite, malnutrition and weight loss.
Sometimes inflammatory bowel diseases also have additional symptoms such as eye infections, joint pain, skin rash and gallstones.
How are you treated?
The treatment of these diseases is through drugs that suppress the mechanism for producing the inflammation that damages the intestinal mucosa.
Celiac disease
Celiac is a disease characterized by intolerance to gluten, a protein found in wheat, barley and rye.
what do you feel?
The exposure to gluten causes a prolonged inflammatory reaction of the small intestine, and the manifestation of the disease can be abdominal pain, prolonged diarrhea, weight loss and sometimes also nutritional deficiencies such as a lack of iron that causes anemia. Sometimes the anemia is discovered following a routine blood test or following a blood test designed to diagnose other problems.
How are you treated?
The only treatment for this disease is a lifelong gluten-free diet.
In case of suspicion of celiac disease, it is recommended not to start a gluten-free diet before the final answer from the biopsy is received. The reason: a diet may prevent a repeat biopsy if it is needed due to the failure of the first biopsy for some reason.
Lactose intolerance
what do you feel?
The small intestine is supposed to secrete the enzyme lactase whose function is to break down the lactose (milk sugar) and thereby help its absorption. A complete or partial lack of this enzyme can cause symptoms similar to those of irritable bowel syndrome such as abdominal pain, gas and diarrhea.
How are you treated?
If you are indeed lactose intolerant, there are two ways to treat it: avoid eating dairy products or take – before a dairy meal – a tablet or capsule containing the missing enzyme. The tablets and capsules can be purchased without a doctor’s prescription.
Malignancies
Pancreatic cancer can cause severe and persistent abdominal pain that radiates to the back. Other symptoms of a pancreatic tumor are loss of appetite, weight loss, jaundice (because the tumor blocks the bile ducts).
Conversely, abdominal pain is not considered a typical symptom of colon cancer. The distinct symptoms of this cancerous tumor are changes in bowel habits, rectal bleeding and iron deficiency anemia. Colon cancer may cause abdominal pain only in its advanced stages when it causes intestinal obstruction.
Colorectal cancer can be prevented by following a healthy diet, rich in dietary fiber, and by making sure to perform periodic colon cancer screening tests: a fecal occult blood test once a year or a colonoscopy once every five years starting at the age of 50.
Those who have first-degree relatives who were diagnosed with colon cancer before the age of 50 should have the colonoscopy before the age of 50.
Irritable bowel syndrome
Irritable bowel syndrome is one of the most common gastroenterological disorders (related to the digestive system). Women suffer from the disease more often than men. The onset of symptoms begins already in adolescence and maybe even before that. As you get older and older, the symptoms tend to be milder, and the first appearance of this disorder in old age is extremely rare.
what do you feel?
Irritable bowel syndrome is characterized by pain or chronic discomfort in the abdomen accompanied by a feeling of relief or aggravation around bowel movements. Other characteristics of the syndrome are irregular stools and sometimes gas and abdominal swelling.
This syndrome has a fluctuating nature, but those who suffer from it report its symptoms during at least 3 days each month.
Those suffering from irritable bowel syndrome often report that the intensity of the symptoms tends to worsen when under stress. However, mental stress, even if it aggravates the symptoms, does not cause them. Some patients begin to experience the symptoms after a bacterial or parasitic disease of the intestine.
How are you treated?
The fact that there are no findings in the conventional tests can cause a feeling of frustration and helplessness in both the therapist and the patient, but there is a treatment for sensitive bowel syndrome: maintaining a healthy lifestyle that includes drinking plenty of water and making sure to exercise regularly. These may improve symptoms.
Research shows that a diet called the “low FODMAP diet” may also lead to an improvement in symptoms.
If there is no benefit after a change in lifestyle and diet, the doctor may recommend medication.
Complementary medicine can also be used: biofeedback is a technique that helps reduce muscle tension and slow the heart rate to achieve relaxation. Hypnosis and relaxation exercises (such as yoga and meditation) also have a place in the treatment of this syndrome.
Urgent cases
In general, an urgent abdominal pain is an intense abdominal pain that develops or worsens sharply within minutes or within a few hours and does not let up.
Such pain may result from a serious intra-abdominal event such as perforation of an ulcer, intestinal obstruction or acute appendicitis and usually requires urgent surgery. Surroundings of an ovary or a testicle as well as an ectopic pregnancy can cause acute abdominal pain and require urgent treatment
Appendicitis
what do you feel?
Inflammation of the appendix (appendicitis) usually causes severe pain in the lower right side of the abdomen. At first the pains are dull and focus on the navel area (in the center of the abdomen), but later they migrate to the lower right side of the abdomen. Usually a few hours pass from the beginning of the inflammation until the pain reaches such intensity that it is necessary to go to the hospital quickly.
Pressing on the lower right part of the abdomen often causes a sharp pain because this is the inflamed area. In addition to that, during the attack there is no activity of the intestines, therefore there is no desire to eat, and there are no bowel movements at the same time. Those whose appendix is inflamed may suffer not only from abdominal pain but also from nausea, vomiting and fever.
How are you treated?
Appendicitis that is not treated in time may end in perforation of the appendix and dispersal of the intestinal contents in the abdominal cavity. This is a life-threatening condition. The treatment is resection of the appendix in emergency surgery. And don’t worry: you can live without the appendix since it has no importance in the digestive process.
Intestinal obstruction
Constant contractions that characterize the hollow intestine and are responsible for moving the contents inside are not felt. However, increasing the strength of the contractions to overcome a partial or complete blockage as well as the expansion of the intestine in the part before the blockage cause symptoms.
Blockage of the large intestine can occur due to a cancerous tumor, due to segmental disease or due to volvulus (the intestine turns in a loop around itself).
Small bowel obstruction can occur for many reasons including tissue adhesions after abdominal surgery, an incarcerated hernia and Crohn’s disease. The treatment for the blockage is usually surgery to remove it.
what do you feel?
Spasmodic stomach pains in the stomach that are accompanied by swelling of the stomach, vomiting and the absence of stools and passage of gases. In patients who suffer from partial intestinal stenosis, the pain worsens after eating, while when the stomach is empty of food, they feel comfortable.
Intestinal obstruction sometimes occurs following an incarcerated hernia. Brief explanation: A hernia is formed when an opening is created in an area of weakness in the abdominal wall through which a section of intestine, wrapped in the peritoneum, may exit the abdominal cavity. The areas prone to hernia formation are the scrotum, the groin, the navel and scars from previous surgeries.
As long as the intestine penetrating through the hernia is not trapped and receives a normal blood supply, it is not an emergency situation, and it is possible to correct this with a pre-planned operation. However, sometimes a situation arises where the intestine becomes trapped in the hernia, and the result is a stoppage of the blood supply to that penetrating intestinal loop.
An incarcerated hernia is a dangerous condition that causes severe pain and requires urgent surgery.
Hernias that are not closed may also cause pain, but in such cases it is usually mild pain or discomfort.
Testicular torsion
The testicle is wrapped in several envelopes, and usually – if it is not a congenital defect – it cannot turn on its axis inside the scrotum. There can be many reasons for such a shift: a slight injury to the scrotum, exposure to extreme cold, physical exertion, sexual contact, and more.
what do you feel?
In cases of scrotal entanglement, the patient usually suffers from acute one-sided pain in the scrotum, generalized abdominal pain, nausea and vomiting. Sometimes the pain is preceded by a slight injury. The entwined testicle is very sensitive to the touch, and the area is somewhat red.
When the testicle rotates on its axis, the blood flow to it stops, first in the vein and then also in the artery. If the patient is not operated on within six hours of the onset of pain, the result will be devastating: necrosis of the testicle.
How are you treated?
At the hospital, the diagnosis is confirmed with imaging devices that show the testicular tissue and the blood flow inside it, and the patient is urgently operated on. During the operation, the testicle is rotated back, and blood flow to it is restored.