What is abdominal pain?
Everyone knows what hunger feels like. We know what it feels like when we have overeaten. We also know when we need to have a bowel movement. Other than those instances, we are usually unaware of our digestive process or our digestive organs. When the process of digestion or our abdominal organs cause an uncomfortable or unpleasant sensation, we refer to that as abdominal pain.
When should I see a doctor about my pain?
Bothersome abdominal pain should be discussed with your family doctor. This discussion can wait for a routine visit if the pain is mild or has been going on for a long time without change. If however, if you have severe pain or pain associated with fever, chills, nausea, vomiting, diarrhea, rectal bleeding, persistent constipation, jaundice, abdominal swelling, or weight loss, you should consult your doctor or a gastroenterologist immediately. Often patients with severe pain must be evaluated in the emergency room.
What causes abdominal pain?
Abdominal pain can be caused by any condition that irritates the nerves of the abdominal organs, abdominal muscles or even the skin over the abdomen. Sometimes, the pain can even be “referred” from adjacent organs like the lung (pneumonia or pleural effusion) or the heart (myocardial ischemia or angina).
- Some causes of upper abdominal pain include gastroesophageal reflux disease (GERD), peptic ulcer disease, gastritis, gas, bloating, gallstones, pancreatitis, pancreatic cancer and hepatitis (due to liver swelling).
- Lower abdominal pain can be caused by diverticulitis (left lower quadrant), appendicitis (right lower quadrant), constipation, diarrhea, irritable bowel syndrome, inflammatory bowel disease (ulcerative colitis and Crohn’s disease) and colon cancer.
- Unusual conditions like poor circulation to the bowel (mesenteric ischemia) or abdominal aortic aneurysm can cause abdominal pain.
- Non digestive conditions such as kidney stones and bladder infections can cause abdominal pain. Gynecologic problems like endometriosis, ovarian cysts, and ovarian cancer can cause pain as well.
Please note: The above is not an all-inclusive list of the causes of abdominal pain.
You should discuss your particular symptoms with your doctor.
How does a gastroenterologist diagnose abdominal pain?
One of the most important parts of the evaluation of abdominal pain is the history. You gastroenterologist will want to know the following:
- Location of the pain – upper abdomen, lower abdomen, right or left side
- Nature of the pain – sharp, dull, burning, boring, twisting, cramping, aching
- Timing of the pain – brief or fleeting, constant, intermittent
- Relationship to eating – better or worse with food), the relationship to bowel movements (better or worse with a bowel movement
- Associated symptoms – nausea, vomiting, diarrhea, fever, chills, rectal bleeding and weight loss are also important symptoms.
Next a physical exam will be performed. Your doctor will feel for tender areas, organ enlargement and abdominal masses. He will listen to your bowel sounds and will look for abdominal distension.
Common tests that may order to help diagnose your abdominal pain are blood, urine and stool tests. Also, an X-ray or an ultrasound may be ordered depending on your symptoms.
Other tests that are used to diagnose abdominal pain include barium studies (barium swallow, upper gastrointestinal series small bowel follow through, and barium enema), computer tomography (Cat scan), magnetic resonance imaging (MRI) and ultrasound examination (sonogram). Nuclear medicine studies are also done to determine the cause of abdominal pain.
Endoscopic tests are performed by your gastroenterologist to help determine the cause of your pain. These can include:
- Upper Endoscopy (EGD) – for examination of the esophagus, stomach, and duodenum and colonoscopy for examination of the large intestine and terminal ileum. Biopsies are performed for tissue sampling when necessary. Polyps are removed using a variety of techniques.
- Endoscopic Retrograde Cholangiopancreatography (ERCP) – helps evaluate the bile ducts and pancreatic ducts, and endoscopic ultrasound which gives and internal image of the digestive organs being viewed.
- Capsule Endoscopy – patients are asked to swallow a small capsule that takes pictures as it passes through the gastrointestinal tract.
- Special endoscopes are also used to reach the small intestine when needed.
It should be noted that in most cases the cause of abdominal pain can be determined by your gastroenterologist quickly and accurately using your history, physical exam and a few selected tests.
How is abdominal pain treated?
The answer to this question depends on the cause of the pain. Here is a list of the more common digestive conditions gastroenterologists see patients for and possible treatments:
- Acute Appendicitis and Acute Cholecystitis are surgical emergencies requiring admission to the hospital and emergency surgery.
- Diverticulitis on the other hand in most cases can be treated with antibiotics and often surgery can be avoided.
- Gastrointestinal reflux disease (heartburn) is treated with medications and dietary changes.
- Peptic ulcer disease is treated with acid reducing medications and avoidance of irritating agents like alcohol, aspirin and non-steroidal anti-inflammatory medications. Some patients are found to have a bacterial infection (H. pylori) which makes them more susceptible to ulcers. Those patients are treated with antibiotics.
- Inflammatory conditions like Crohn’s disease and ulcerative colitis usually require anti-inflammatory or immunosuppressive medications. The medications used to treat these conditions have improved considerably over the years.
- Functional bowel diseases like non ulcer dyspepsia, gas, bloating, and irritable bowel syndrome respond well to dietary manipulation. Several new medications are used with good success for these conditions.
- Chronic constipation responds well to non-prescription laxatives, but it is important to avoid stimulant laxatives which can be harmful in the long run. Several prescription laxatives are available which are safe and effective.
- Over the counter medications are used for most cases of diarrhea. Newer prescription medications are also available and may be prescribed by your gastroenterologist.
Sometimes analgesics are used for pain, but narcotics should be avoided. Some cases of chronic abdominal pain are managed win antidepressant medications that can modulate the pain response. Occasionally patients may be referred to a pain management specialist.