Sorting out Abdominal Pain

• Sorting out abdominal pain is often a challenge for the doctor and patient.
• No amount of reading material can give an accurate self-diagnosis.


• These comments below are simply a start to a process that may need specialist advice as well as your family doctor.


• The diagnosis still depends heavily on a careful history by an experienced doctor.


• High-tech imaging is only a back-up - not an easy way out!
  
• Different parts of the abdomen do give a "signature" with particular types of pain - but sometimes the distinction can be subtle.
• Pain is a subjective experience and can be difficult to describe but a good description is the beginning of solving the problem.

• The onset, progression and duration of symptoms give important clues.


• The abdominal contents are dynamic and subject to change.
  • The relationship of pain to meals, passing bowel motions or passing flatus is important.
  • suggests a problem with the oesophagus.
  • Relief by not eating could suggest a "blockage" of the intestines.
  • Abdominal pain may be affected by;
    • Postural change.
    • Passing urine.
    • Changes with the menstrual cycle.
    • Association with vomiting.
    • Aggravated by deep breathing or cough, stretching of the legs.
    • These are all potentially important questions that can give clues to the cause.
      

• Abdominal pain that is of sudden onset and severe requires urgent medical attention (this situation will not be covered here).
• Abdominal pain that comes and goes and is of mild to moderate severity can be from wide range of causes.


• The position of the pain in the abdomen helps to some extent.
  • Upper abdomen – related to meals - may be reflux heartburn or peptic ulcer (related to Helicobacter infection).
  • Right side - under the right ribs - through to the back - could be gallstones or rarely pancreatitis.
  • Lower abdomen particularly left--sided pain  – some association with variable bowel habit or better after passing bowel motion - could be irritable bowel, diverticular disease, constipation.
  • Pain associated with new onset of diarrhoea might be due to inflammatory bowel disease particularly if there is blood or mucus with the bowel motions.
  • Pain that seems to come from the back or is aggravated by changes in posture might be.
    • Muscle strain.
    • Referred from the spine.
    • Nerve entrapment.
  • Pelvic or lower abdominal pain may be related to diseases of the uterus and ovary (gynaecological problem).
  • Kidney disease and kidney stones may cause abdominal pain or back pain - usually one side or the other rather than midline.