STOMACH PAIN CAUSES & TREATMENT

Abdominal Pain in Adults Overview

Abdominal pain can range in intensity from a mild stomach ache to severe acute pain. The pain is often nonspecific and can be caused by a variety of conditions. Many organs are found within the abdominal cavity. Sometimes the pain is directly related to a specific organ such as the bladder or ovary, while other times it is more diffuse or non-specific.. Usually, abdominal pain originates in the digestive system. For example, the pain can be caused by appendicitis, diarrheal cramping, or food poisoning.

The type and location of pain may help the physician find the cause. The intensity and duration of pain must also be considered when making a diagnosis. A few general characteristics of abdominal pain are as follows:

• Character of Pain: Abdominal pain can be sharp, dull, stabbing, cramp-like, knifelike, twisting, or piercing. Many other types of pain are possible.
  
• Duration of Pain: Abdominal pain can be brief, lasting for a few minutes, or it may persist for several hours and longer. Sometimes abdominal pain comes on strongly for a while and then lessens in intensity for a while.
  
• Triggering Events: The pain may be worsened or relieved by certain events, such as worse after meals, better with a bowel movement, better after vomiting, or worse when lying down.

Abdominal pain can make a person want to stay in one place and not move a muscle. Or the pain can make them so restless they want to pace around trying to find "just the right position."

The health care practitioner will try to pinpoint the area of the abdomen where the pain originates when determining the cause of abdominal pain. This is done by combining questions such as - "When you first had the pain, where did you feel it?" - with examination of the abdomen. Softly pressing on certain areas to elicit the pain and perhaps palpating other areas to examine the size and exact location of an organ are other parts of the physical examination.

When this is combined with general questions about the pain such as "Is the pain dull or sharp?" "How long have you had the pain?" and questions about your state of health - "Did you have to vomit?" - the health care practitioner can narrow down the possible causes of the pain.

Once the questions and physical exam are completed, the health care practitioner will either give the patient a diagnosis and advise on follow-up recommendations or order blood tests, and possibly X-rays and imaging studies to further help identify why the patient is in pain.

Abdominal Pain in Adults Causes

Many acute (short-term) and chronic (long-term) diseases cause abdominal pain.

• Diseases people worry about most are appendicitis, gallbladder disease, duodenal and gastric ulcers, infections, and pregnancy-associated problems.
  
• Doctors also worry about the following conditions: ruptured blood vessels, heart attack, liver and pancreas inflammation, kidney stones, problems with the blood circulation to the intestine, diverticulitis, and other diseases.

Abdominal pain may not arise from the abdomen.

• Some heart attacks and pneumonias can cause abdominal pain.
  
• Diseases of the pelvis or groin can also cause a pateint's abdomen to hurt.
  
• Certain skin rashes, such as shingles, can feel like abdominal pain, even though the person has nothing wrong inside their body.
  
• Even some poisonings, such as a black widow spider bite, can cause severe abdominal pain.

From the above it is apparent that abdominal pain can have many causes, some linked directly to the abdomen and others caused by non-abdominal disease. Sometime the cause of abdominal pain is not found by the patient's health care practitioner during the initial evaluation. In some cases, no specific cause is determined, and the pain gets better in hours or days.

Abdominal Pain in Adults Symptoms

Abdominal pain is a symptom. It may mean that the person has a medical problem that needs treatment.

Abdominal pain may go along with other symptoms. Try to keep track of the symptoms, because this will help the health care practitioner's find the cause of the person's pain.

When to Seek Medical Care

Call or see a health care practitioner if the affected person has any of the following:

• Abdominal pain that lasts more than six hours or continues to worsen
  
• Pain that stops the person from eating
  
• Pain accompanied by vomiting more than three or four times
  
• Pain that worsens when the person tries to move around
  
• Pain that starts all over, but settles into one area, especially the right lower abdomen
  
• Pain that wakes the person up at night
  
• Pain with vaginal bleeding or pregnancy, even if the person only thinks she might be pregnant
  
• Pain accompanied by fever over 101 F (33.3 C)
  
• Pain along with inability to urinate, move the bowels, or pass gas
  
• Any other pain that feels different from a simple stomach ache
  
• Any other pain that alarms the person, or concerns them in any way

If the person has any of the following, or cannot reach their health care practitioner, go to a hospital emergency department:

• The "worst pain of your life" or very severe pain
  
• Pain so bad the affected person passes out or almost passes out
  
• Pain so bad the affected person cannot move
  
• Pain and vomiting blood, or any vomiting that lasts more than six hours
  
• Pain and no bowel movement for more than three days
  
• Pain the person thinks might be in their chest, but they aren't sure
  
• Pain that seems to come from the person's testicles

Abdominal Pain in Adults Diagnosis

Diagnosing the cause of abdominal pain is one of the hardest tasks for a health care practitioner. Sometimes all that the practitioner can do is be sure that the pain does not require surgery or admission to the hospital.

The health care practitioner may ask these or similar questions to try to determine what is causing the patient's pain. Some may seem unrelated to the patient's current condition, but try to answer them as completely as possible. The answers to these questions can help the health care practitioner find the cause of the patient's pain more quickly and easily.

• How long have you had the pain?
  
• What were you doing when it started?
  
• How did you feel before the pain started?
  
• Have you felt OK over the last few days?
  
• What have you tried to make the pain better? Did it work?
  
• What makes the pain worse?
  
• Does the pain make you want to stay in one place or move around?
  
• How was the ride to the hospital? Did riding in the car hurt you?
  
• Is the pain worse when you cough?
  
• Have you thrown up?
  
• Did throwing up make the pain better or worse?
  
• Have your bowel movements been normal?
  
• Are you passing gas?
  
• Do you feel you might have a fever?
  
• Have you had a pain like this before? When? What did you do for it?
  
• Have you ever had surgery? What surgery? When?
  
• Are you pregnant? Are you sexually active? Are you using birth control?
  
• Have you been around anyone with symptoms like this?
  
• Have you traveled out of the country recently?
  
• When did you eat last? What did you eat?
  
• Did you eat anything out of the ordinary?
  
• Did your pain start all over your stomach and move to one place?
  
• Does the pain go into your chest? Into your back? Where does it go?
  
• Can you cover the pain with the palm of your hand, or is the hurting area bigger than that?
  
• Does it hurt for you to breathe?
  
• Do you have any medical problems such as heart disease, diabetes, or AIDS?
  
• Do you take steroids? Pain medicine such as aspirin or Motrin?
  
• Do you take antibiotics? Over-the-counter pills, herbs, or supplements?
  
• Do you drink alcohol? Coffee? Tea?
  
• Do you smoke cigarettes?
  
• Do you use cocaine or other drugs?

Physical examination will include a careful examination of the patient's abdomen, heart, and lungs in order to pinpoint the source of the pain.

• The examiner will touch different parts of the abdomen to check for tenderness or other signs that indicate the source of the pain.
  
• The examiner may do a rectal exam to check for small amounts of blood in the stool or other problems such as a mass or internal hemorrhoids.
  
• If the patient is a man, the doctor may check the penis and testicles.
  
• If the patient is a woman, the doctor may do a pelvic exam to check for problems in the uterus, Fallopian tubes, and ovaries.
  
• The doctor also may look at the patient's eyes for yellow discoloration (jaundice) and in the mouth to be sure the patient is not dehydrated.

Laboratory tests may not help to find the cause of the abdominal pain. However, if combined with the information gained from the questions the patient was asked and the physical examination performed by the health care practitioner, certain blood or urine tests may be ordered and could assist in determining the diagnosis.

• One of the most important tests is to see if a woman is pregnant.
  
• A raised white blood cell count may mean infection or may just be a reaction to the stress of pain and vomiting.
  
• A low blood count (hemoglobin) may show that the patient is bleeding internally, but most conditions that involve bleeding are not painful.
  
• Blood in the urine, which may not be visible to the eye, may suggest the patient may have a kidney stone.
  
• Other blood tests, such as liver enzymes and pancreas enzymes, can help determine which organ is involved, but they do not point to a diagnosis.

Radiology studies of the patient's abdomen can be useful, but are not always necessary or helpful.

• Occasionally, an X-ray will show air outside of the bowel, meaning that something has ruptured or perforated.
  
• An X-ray also can help diagnose bowel obstruction.
  
• Sometimes X-rays can show a kidney stone.

Ultrasound is a painless procedure useful in finding some causes of abdominal pain.

• This may be done if the health care practitioner suspects problems with the gallbladder, pancreas, liver, or the reproductive organs of women.
  
• Ultrasound also assists in the diagnosis of problems with the kidneys and the spleen, or the large blood vessels that come from the heart and supplies blood to the lower half of the body.

CT scan is a special type of x-ray that provides useful information about the liver, pancreas, kidneys and ureters, spleen, and small and large intestine, including diseases such as appendicitis and diverticulitis.

You and your health care practitioner should discuss the diagnostic needs for an X-ray, and the potential radiation exposure before proceeding with any X-ray examination.

The health care practitioner may perform no tests at all. The cause of the patient's pain may be clear without any tests and may be known not to be serious. If the patient does undergo tests, the practitioner should explain the results to them.

Abdominal Pain in Adults Treatment

Self-Care at Home

Abdominal pain without fever, vomiting, vaginal bleeding, passing out, chest pain, or other serious symptoms often get better without special treatment.

• If the pain persists or if the person believes the pain may represent a serious problem, they should see a health care practitioner.
  
• A heating pad or soaking in a tub of warm water may ease the person's pain.
  
• Over-the-counter antacids, such as Tums, Maalox, or Pepto-Bismol, also can reduce some types of abdominal pain. Activated charcoal capsules also may help.
  
• Acetaminophen (common brand names are Arthritis Foundation Pain Reliever, Aspirin Free Anacin, Panadol, Liquiprin, Tylenol) may help. This product should be avoided if liver disease is suspected. Try to avoid aspirin or ibuprofen (common brand names are Advil, Motrin, Midol, Nuprin, Pamprin IB) if stomach or ulcer disease is suspected. These drugs can make some types of stomach ache worse.

Medical Treatment

The patient's treatment will depend on what the doctor thinks is causing the abdominal pain.

The patient may be given IV (intravenous) fluids. The health care practitioner may ask the patient not to eat or drink anything until the cause of the pain is known. This is done to avoid worsening certain medical conditions (for example adding food to the stomach if there is a ruptured ulcer) or to prepare the patient in case they need to have surgery (an empty stomach is better when general anesthesia is needed).

The patient may be given pain medication.

• For pain caused by bowel spasm, they may be given a shot in the hip, arm, or leg.
  
• If the patient is not throwing up, they may receive a drink that has antacid in it or pain medication.
  
• Although the patient's pain may not go away completely, they have the right to be comfortable and should ask for pain medicine until they are made comfortable.

Surgery

Some types of abdominal pain require surgical treatment.

• If the patient's pain comes from an infected internal organ, such as the appendix or gallbladder, they will be admitted to a hospital and will need surgery.
  
• Bowel obstruction sometimes requires surgery, depending on what is causing the obstruction.
  
• If the patient's pain comes from a ruptured or perforated organ, such as the bowel or stomach, they will need immediate surgery and will be taken directly to an operating room.

Follow-up

If the person is allowed to go home after their evaluation, they may be given instructions about what they can and cannot eat and drink and which medications they may take. The person may be told to return to the emergency department if certain conditions occur.

If the person is given no specific instructions, then follow these recommendations:

• As soon as you feel like eating, start with clear liquids.
  
• If clear liquids cause no further pain or vomiting, progress to bland foods such as crackers, rice, bananas, applesauce, or toast.
  
• You may return to a normal diet in a few days if your symptoms do not return.

Go back to the emergency department or to your doctor in the following situations:

• Your pain worsens or if you start vomiting, get a high fever, or cannot urinate or move your bowels.
  
• You have any symptom that seems worse or alarms you.
  
• Your abdominal symptoms are not better in 24 hours.

Abdominal Pain in Adults Prevention

If the diagnosis is determined, the person should follow the instructions specific for that diagnosis.

• If, for example, an ulcer causes the pain, the person must avoid nicotine, caffeine, and alcohol.
  
• If it is caused by gallbladder disease, the person should avoid greasy, fatty, and fried foods.

Abdominal Pain in Adults Prognosis

Overall, many types of pain go away without surgery, and most people need only relief from their symptoms.

Medical causes of abdominal pain generally have a good outcome, but there are exceptions.

Surgical causes of abdominal pain have varying outcomes depending on the severity of the condition and the person's underlying medical condition.

• If the patient has uncomplicated appendicitis or uncomplicated gallstones, they should recover from the surgery with no long-term problems.
  
• If the patient has a ruptured appendix or infected gallbladder, recovery may take longer.
  
• Abdominal pain from a perforated ulcer or blocked bowel may mean major surgery and a long recovery.

For problems with a major blood vessel, such as rupture or blood clot, the prognosis may be poor.

In general, the older the patient and the more underlying conditions the patient has, the worse the outcome of a surgical intervention.