Abdominal pain is one of the most common complaints that lead us to see a doctor. It can be dull, sharp, cramping or stabbing, and can be caused by a number of factors, ranging from simple digestive problems to serious conditions requiring immediate medical attention. As the abdominal cavity contains numerous organs, determining the exact cause of the pain can be challenging. This article will help you better understand the possible causes of abdominal pain, recognise the warning signs, and learn about diagnostic and treatment options. The information provided here is intended to guide you, but it is not a substitute for a professional medical diagnosis, which should be carried out by a Endomedix Gastroenterology Centre its specialist doctors also provide this service.
Possible causes (aetiology) of abdominal pain
Abdominal pain can take many different forms, as it can be caused by a condition affecting any of the organs within the abdominal cavity. The causes can range from mild, temporary problems to serious, life-threatening conditions. Below, we have categorised the most common causes.
Inflammatory conditions
Inflammation is one of the most common causes of pain.
- Appendicitis (appendicitis): Typically, pain that starts around the navel and then radiates to the lower right abdomen, becoming more intense.
- Pancreatitis (inflammation of the pancreas): Severe pain in the upper abdomen radiating across the back in a belt-like pattern.
- Inflammation of the gallbladder (cholecystitis): Severe pain beneath the right rib cage, often radiating into the back and beneath the shoulder blade.
- Inflammatory bowel diseases (IBD): Crohn’s disease and ulcerative colitis can be associated with chronic abdominal pain and diarrhoea.
- Diverticulitis: Inflammation of small pouches (diverticula) in the wall of the large bowel, which typically causes pain in the lower left abdomen.
- Pelvic inflammatory disease (PID): It is a common cause of lower abdominal pain in women.
Blockages
When a hollow organ becomes blocked, the fluid that builds up behind it causes tension and cramp-like pain.
- Intestinal obstruction (ileus): It is characterised by severe, cramp-like abdominal pain, vomiting, bloating and an inability to pass stools.
- Gallstones (choledocholithiasis): A stone in the bile duct can cause cramp-like pain under the right rib cage (biliary colic).
- Kidney stones: A stone passing from the kidney into the ureter causes extremely severe, cramping pain that radiates from the lower back towards the lower abdomen.
Gastrointestinal ulcers and functional disorders
- Stomach and duodenal ulcers: Epigastric (upper abdominal) pain, which may change after eating: it worsens in the case of a gastric ulcer, but eases in the case of a duodenal ulcer.
- Irritable bowel syndrome (IBS): Recurrent abdominal pain associated with changes in bowel habits (diarrhoea, constipation or alternating between the two), accompanied by bloating.
- Functional dyspepsia: An unpleasant feeling of fullness, pain or a burning sensation in the area around the upper part of the stomach, for which no organic cause can be identified.
Vascular problems
- Mesenteric ischaemia: A disruption to the blood supply caused by a blockage in the blood vessels of the intestine, which is accompanied by sudden, extremely severe, diffuse abdominal pain.
- Rupture of an abdominal aortic aneurysm: A life-threatening condition, characterised by sudden, stabbing pain in the abdomen and back.
Other reasons
- Cancer: Tumours of the abdominal organs (e.g. the stomach, pancreas, large intestine) can cause dull, persistent or worsening pain.
- Infections: Viral or bacterial gastroenteritis is characterised by cramp-like abdominal pain, vomiting and diarrhoea.
- Injuries, trauma: A blow to the abdomen can cause internal organ damage.
Types and characteristics of abdominal pain
The nature, location and duration of the pain can reveal a great deal about the possible causes. It is important to note the following:
- Localisation (the site of the pain):
- Below the right costal arch: Problems with the gallbladder and liver.
- Epigastrium: Problems relating to the stomach, duodenum, pancreas and heart.
- Below the left costal arch: Problems with the liver, pancreas and large intestine.
- Around the eyebrows: Small intestine, early part of the caecum.
- Right alhas: Appendicitis, ovaries, the terminal section of the small intestine (Crohn’s disease).
- Bal alhas: Large bowel (diverticulitis), ovaries.
- Diffuse (covering the whole abdomen): Peritonitis, intestinal obstruction, mesenteric ischaemia.
- Nature and intensity:
- Spasmodic: This suggests an obstruction in hollow organs (intestines, bile duct, ureter).
- Dull, aching: Characteristic of inflammatory processes and tumours.
- Sharp, piercing, like a knife stab: This may indicate a perforation (a hole in an organ) or a ruptured aneurysm.
- Burner: Problems relating to stomach acid (reflux, ulcers).
- Radiation:
– Pain radiating to the back, beneath the shoulder blade, may be caused by a problem with the bile ducts or the pancreas.
– Pain radiating to the lower back and groin may indicate kidney stones.
- Duration and course:
- Acute, with a sudden onset: It often indicates a serious condition (e.g. perforation, obstruction).
- Chronic, recurrent: It may indicate functional disorders (e.g. IBS) or chronic conditions (e.g. IBD).
Accompanying symptoms to look out for
Abdominal pain rarely occurs on its own. Accompanying symptoms help to narrow down the diagnosis.
- Nausea, vomiting: It is a common symptom associated with digestive problems. It is particularly common in cases of intestinal obstruction.
- Diarrhoea or constipation: A change in bowel habits suggests an intestinal cause.
- Fever: It indicates an inflammatory or infectious process.
- Bloating, abdominal distension: It may indicate gas build-up, indigestion or a blockage.
- Bleeding: The presence of fresh red blood in the stools (haematochezia) or digested, black blood (tarry stools, melena) is a serious warning sign.
- Jaundice (icterus): A yellowish discolouration of the skin and the whites of the eyes indicates a problem with the liver or the bile ducts.
- Weight loss: Unintentional, significant weight loss may be a sign of chronic inflammation or cancer.
When should you see a doctor straight away?
In certain cases, abdominal pain requires emergency treatment. Call an ambulance immediately or go to the nearest A&E department if you experience any of the following:
- Sudden, unbearable, knife-like abdominal pain.
- The abdomen becomes as hard as a board and is extremely tender to the touch (a sign of peritonitis).
- Vomiting a significant amount of blood or passing bloody stools.
- High fever, chills, sweating, rapid pulse, low blood pressure.
- Cessation of bowel movements and flatulence, accompanied by abdominal bloating and vomiting (suspected bowel obstruction).
- Pain following a severe abdominal injury.
- Severe, cramp-like abdominal pain occurring during pregnancy.
Diagnosis of abdominal pain
An accurate diagnosis requires a comprehensive assessment, which begins with taking a medical history. The Endomedix Gastroenterology Centre Its specialists also follow these steps.
- Medical history and physical examination: The doctor asks the patient in detail about the nature and location of the pain, any accompanying symptoms and any previous illnesses. The doctor then carries out a physical examination of the abdomen, assessing its condition by palpation, percussion and auscultation.
- Laboratory tests: Blood tests (complete blood count, inflammatory markers, liver and kidney function, amylase, lipase) and a urine test provide essential information about inflammatory processes, anaemia and organ function. A stool test may also be carried out to detect occult bleeding or infection.
- Imaging techniques:
- Abdominal ultrasound: The imaging technique of first choice, which is quick and painless and provides a clear view of the abdominal organs (liver, gallbladder, kidneys, pancreas).
- CT (computed tomography) and MRI (magnetic resonance imaging): They provide a more detailed, layer-by-layer view of the abdominal organs, particularly where tumours, inflammation, abscesses or vascular problems are suspected.
- Endoscopic examinations:
- Gastroscopy (gastroscopy): It is used to examine the oesophagus, stomach and duodenum. It can be used to diagnose ulcers, inflammation and tumours, and also allows for the taking of tissue samples (biopsies).
- Colonoscopy (colonoscopy): It is suitable for examining the entire large intestine and the final section of the small intestine. It is essential for the detection and screening of polyps, tumours and inflammatory bowel diseases.
Treatment options for abdominal pain
Treatment always depends on the underlying cause. Whilst in some cases home care and lifestyle changes are sufficient, in others medication or even surgery may be required.
- Lifestyle changes and diet: In cases of functional disorders (e.g. IBS, dyspepsia), dietary changes (e.g. a low-FODMAP diet), regular exercise and stress management can lead to significant improvement.
- Medication:
- Painkillers and antispasmodics: They provide relief from symptoms.
- Acid-reducing medicines (PPIs, H₂ blockers): For reflux disease and ulcers.
- Antibiotics: For the treatment of bacterial infections and inflammation (e.g. diverticulitis).
- Anti-inflammatory drugs: In cases of inflammatory bowel disease (IBD).
- Surgical intervention: It is unavoidable in emergency cases (e.g. appendicitis, perforation, bowel obstruction) or in certain chronic conditions (e.g. severe gallstones, tumours).
Summary
Abdominal pain is a complex symptom that can have numerous underlying causes. It is important to pay attention to your body’s signals and not to ignore persistent or sudden, severe pain. Be aware of the warning signs and, if necessary, do not hesitate to seek medical help. An accurate diagnosis is essential for starting the right treatment and preventing more serious complications.
If you are also experiencing recurring abdominal symptoms or symptoms of unknown origin, please do not hesitate to contact the Endomedix Gastroenterology Centre its experienced specialists, who use the very latest diagnostic techniques to help identify the cause of the problem and draw up a personalised treatment plan for you.
