Abdominal pain refers to pain in the stomach region or in the abdominal area.

Abdominal pain is a nonspecific symptom that may be associated with a multitude of conditions. Some do not occur within the abdomen itself but cause abdominal discomfort; an example would be the abdominal pain associated with strep throat. Some originate within the abdomen but are not related to the gastrointestinal tract, such as a dissecting aortic aneurysm. Other pain is related directly to the gastrointestinal tract.

The severity of the pain does not always reflect the severity of the condition causing the pain. Severe abdominal pain can be associated with mild conditions such as gas or the cramping of viral gastroenteritis, while relatively mild pain (or no pain) may be present with severe and life-threatening conditions such as cancer of the colon or early appendicitis.

Possible Causes of Stomach Pain

Abdominal pain can be cause by toxins, infection, biliary tract disease, liver disease, renal disease, bladder infections, menstruation, ovulation, female and male genitourinary disease, vascular problems, malignancy, ulcers, perforation, pancreatic disease, hernias, trauma, and metabolic diseases. The list is so extensive that it would be impossible to name all the possible diseases in each of the above groups.

Because abdominal pain is nonspecific, the health care provider will require much more information regarding the time of onset, duration of pain (minutes, hours, days, or even months), location of pain, nature of pain (dull, sharp, steady, crampy, off and on), severity of pain and relationship to normal functions such as menstruation and ovulation.

The location of pain and its time pattern may be helpful in suggesting its cause. During physical examination, the health care provider will try to determine if the pain is localized to a single area (point tenderness) or diffuse and if the pain is related to inflammation of the peritoneum or of the abdomen. If the health care provider finds evidence of peritoneal inflammation, the abdominal pain may be classified as an “acute abdomen” which often requires prompt surgical intervention.

Symptoms of Stomach Pain

In addition the health care provider will try to relate the abdominal tenderness to other general symptoms such as fever, fatigue, general ill feeling (malaise), nausea, vomiting, or changes in stool. Then the provider will ask about increasingly specific symptoms as the diagnostic considerations are narrowed.

Abdominal Pain Found in Infants

In infants, prolonged unexplained crying (often called “colic”) may be caused by abdominal pain that often ends with the passage of gas or stool. Usually, colic begins around the 3rd week of life and peaks at about 3 to 4 months. Colic is often worse in the evening. Cuddling and rocking the child may bring some relief.

Severe abdominal pain that occurs during menstruation may indicate a problem in a reproductive organ. This includes conditions such as endometriosis, uterine fibroids, ovarian cysts, ovarian cancer (rare), or pelvic inflammatory disease (PID).

Abdominal pain that may indicate a potential emergency condition includes:

• severe abdominal pain with nausea and a fever (it may indicate appendicitis or complications of diverticulitis
• abdominal pain, nausea, fever, and bloating or constipation (may indicate a bowel obstruction)
• abdominal pain that is accompanied by a stiff (“board-like”) abdomen (may indicate vomiting blood). Gastrointestinal bleeding from any cause can be dangerous

Common Causes of Abdominal Pain

The following is a list of the most common causes of abdominal pain. It is important to note that among this list there are relatively few serious diseases.

• bladder infections
• cholecystitis and/or gallstones
• colic in infants (infants to 4 months)
• excessive gas
• endometriosis
• food allergy
• food poisoning (salmonella, shigella)
• hernia
• indigestion
• kidney stones
• lactose intolerance (milk intolerance)
• menstrual cramping
• ovarian cysts
• pelvic inflammatory disease (PID)
• pneumonia (in children)
• recurrent abdominal pain (usually in children and adolescents; a type of somatization disorder where emotional upset is reflected as physical discomfort)
• streptococcal pharyngitis (strep throat, in children this can cause abdominal pain)
• ulcers
• uterine fibroids
• viral gastroenteritis (stomach flu)

Less common, but serious:

• ovarian cancer
• colon cancer or other abdominal cancer

Abdominal pain that may indicate a potential emergency condition includes:

• severe abdominal pain with nausea and fever may indicate appendicitis, cholecystitis (infected gall bladder) or complications of diverticulitis.
• abdominal pain, nausea and bloating or constipation may indicate a bowel obstruction.
• abdominal pain that is accompanies by a stiff, “board like” abdomen may indicate peritonitis due to an infection spreading in the abdominal cavity or to a hole in the stomach or intestine.
• abdominal pain is accompanied by bloody stools, vomiting blood, or gastrointestinal bleeding from any cause can be dangerous.
• persistent upper abdominal pain and vomiting may indicate pancreatitis (inflammation of the pancreas).
• abdominal pain followed by nausea/ vomiting and fever may indicate appendicitis.
• dissecting abdominal aortic aneurysm.

Home Care

For mild pains, sip water or other clear fluids. Avoid solid food. Antacids may provide some relief. AVOID narcotic pain medications, aspirin, and NSAIDs unless the health care provider prescribes them.

Call your health care provider if:

• the pain is very severe
• an abdominal injury was sustained in the last 2 or 3 days
• pain develops during pregnancy (or possible pregnancy)
• the pain persists for a prolonged period of time.
• pain is accompanied byfever, nausea, or an inability to keep down food or liquids for several days
• nausea, fever, and bloating or constipationaccompanies the pain
• the abdomen is tender to touch, or it feels rigid or hard
• the patient has been vomiting blood or there are bloody stools

What to expect:

The medical history that focuses on type, frequency and quality of pain will be obtained A physical examination with a focus on the abdomen will be performed. Observation in the hospital may be required in severe cases. If pain persists, re-evaluation will be necessary.

Diagnostic tests that may be performed include:

• barium enema
• upper GI and small bowel series
• blood, urine, and stool tests
• endoscopy of upper GI (gastrointestinal) tract (EGD)
• ultrasound of the abdomen
• X-rays of the abdomen

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