What Causes Abdominal Pain?

Abdominal pain is a common complaint that almost everyone meets at some point in life. It can arise from causes as varied as simple wind or indigestion, through to conditions requiring urgent assessment such as appendicitis, gallbladder disease or pancreatitis.

Abdominal pain is not a disease in itself. Where the pain is, how it began, how long it has lasted, how severe it is and what other symptoms accompany it are all important in understanding its cause.

What are the common causes of abdominal pain?

A great many diseases of the digestive system can give rise to abdominal pain:

• Wind and bloating
• Indigestion
• Gastritis and ulcer
• Gastroenteritis and food poisoning
• Constipation
• Irritable bowel syndrome (IBS)
• Gallstones and diseases of the bile ducts
• Diseases of the pancreas
• Diverticulitis
• Inflammatory bowel diseases
• Appendicitis
• Bowel obstruction

Abdominal pain does not always arise from the digestive system. The kidneys and urinary tract, the female reproductive organs, the blood vessels, and even certain diseases of the chest can present with abdominal pain.

Does the site of the pain matter?

Yes. The site of the pain can give important clues, but on its own it does not make the diagnosis.

Pain in the upper right abdomen

This can be seen in problems arising from the liver and neighbouring organs, and above all in diseases of the gallbladder and bile ducts.

Pain that starts after fatty meals in particular, and that may radiate towards the back or the right shoulder, can be seen in gallbladder disease.

Pain in the upper middle abdomen

Diseases of the stomach and duodenum, functional dyspepsia and diseases of the pancreas can cause pain in this region.

In pancreatitis the pain is generally severe and may radiate through to the back.

Pain in the lower right abdomen

Appendicitis is one of the important causes. Diseases of the bowel and the urinary tract, and gynaecological disease in women, can also produce pain in the same region.

Pain in the lower left abdomen

In older people in particular, diverticulitis may be one of the causes. Constipation and certain bowel diseases can also give rise to pain in this region.

Pain around the navel

This can be seen in a variety of diseases arising from the bowel. The pain of appendicitis may also be felt around the navel at first and then settle in the lower right abdomen.

Pain across the whole abdomen

Generalised abdominal pain can occur in gastroenteritis, in wind, in disturbances of bowel movement and in a range of other diseases.

Very severe pain of sudden onset spreading across the whole abdomen may, however, require urgent assessment.

Why does abdominal pain occur after eating?

Pain that comes on after a meal may be related to many causes, such as:

• Indigestion
• Functional dyspepsia
• Gastritis or ulcer
• Gallbladder disease
• Food intolerances
• Irritable bowel syndrome

Which foods the pain starts after, how long it lasts, and whether or not it is related to opening the bowels are important in the assessment.

Can wind cause abdominal pain?

Yes.

Gas collecting in the bowel can cause pain in the form of cramp, a stabbing sensation, pressure or bloating.

Wind pain mostly comes and goes, and may lessen after passing wind or opening the bowels.

It is not correct, however, to put every abdominal pain down to “wind”.

Which symptoms can accompany abdominal pain?

Depending on the cause, there may be:

• Nausea and vomiting
• Diarrhoea
• Constipation
• Wind and bloating
• Fever
• Loss of appetite
• Weight loss
• Jaundice
• Blood in the stool
• Black stools
• Urinary symptoms

The accompanying symptoms provide important clues in determining the cause of the pain.

When can abdominal pain be dangerous?

Medical assessment is required without delay if any of the following is present:

• Very severe abdominal pain of sudden onset
• Pain that is steadily worsening or will not settle
• Hardening of the abdomen, or very severe pain on being touched
• Persistent vomiting
• Vomiting blood
• Black, tar-coloured stools
• Obvious blood in the stool
• High fever
• Jaundice
• Fainting or marked weakness
• Marked swelling of the abdomen together with an inability to pass wind or stool
• Severe abdominal pain developing during pregnancy

Abdominal pain of sudden onset that is more severe than the person has ever experienced before should be taken seriously in particular.

How is the cause of abdominal pain established?

The doctor first assesses:

• Where the pain started
• Whether it radiates to another region
• How long it has been going on
• Its relationship to meals
• Whether it changes with opening the bowels
• The other symptoms accompanying it
• The medicines being taken

Depending on the examination findings, blood and urine tests, ultrasound, computed tomography, gastroscopy, colonoscopy or other investigations may be required.

Gastroscopy or colonoscopy is not needed for every abdominal pain. Which investigation is carried out is determined by the character of the pain and the patient’s other findings.

Remember

Abdominal pain is not a disease; it is a symptom.

The region in which the pain lies can suggest a cause, but a diagnosis cannot be made by looking at the site of the pain alone.

In abdominal pain that is recurrent, long-standing or steadily increasing, or that is accompanied by alarm symptoms, the cause needs to be investigated.