Mr Sanjay Purkayastha
BSc MBBS MD FRCS
Laparoscopic, General and Bariatric Surgeon
Private Medical Care:
General & gastroenterological surgery
Bariatric / weight loss surgery
Emergency abdominal conditions / surgery
The abdomen is that part of your body which is below your ribs and above your hips. Some people call it the tummy, trunk, belly or gut. When you have a pain in that area doctors will call it abdominal pain. However, other popular terms for abdominal pain includes tummy pain, tummy ache, stomachache, stomach pain, belly ache.
Usually, pain that you feel here will be caused by a problem in your bowels or related organs, such as the gallbladder, liver, or pancreas.
The digestive tract (gastrointestinal tract) starts at the mouth and ends at the anus. When we eat or drink, the food and liquid travel down the gullet (oesophagus) into the stomach. The stomach churns up the food and then passes it into the small intestine.
The small intestine, consisting of duodenum, jejunum and ileum, is several metres long and is where food is digested and absorbed. Undigested food, water and waste products are then passed into the large intestine - sometimes called the large bowel. The main part of the large intestine is called the colon, which is about 150 cm long. This is split into four sections: the ascending, transverse, descending and sigmoid colon. Some water and salts are absorbed into the body from the colon. The colon leads into the back passage (rectum), which is about 15 cm long. The rectum stores stools (faeces) before they are passed out from the anus.
Doctors have different words to describe the different types of pain you can feel in the abdomen. Very broadly, pains may be sharp or stabbing, crampy, colicky or a general dull ache. The term ‘colicky’ means gradually becoming worse and then easing off again. This may happen repeatedly. The pain seems to be travelling (radiating) in a certain direction and may be associated with other problems like nausea, vomiting, diarrhoea, etc. Pain that comes on suddenly may be called acute. Longer-standing pain is called chronic.
This list does not include all the possible causes of gut pain but some of the more common ones.
You might feel a discomfort in the top of your abdomen or behind your breastbone. This happens usually after eating certain types of food. The foods might be fatty or very rich. You may feel like burping a lot or have a nasty acid taste coming into your mouth. It usually goes in a few hours. Most people will find relief from simple remedies they can buy at the chemist.
If you are older, or are known to have heart disease, indigestion-type pains that come on with exertion or stress are worrying. Sometimes it can be difficult to tell angina or a heart attack from indigestion. If you have pain that goes into your jaw or down your left arm, it might be angina. If it goes off quickly, try to see your GP to discuss it. If it doesn't settle and you feel unwell, phone 999 for an ambulance.
Crampy pains across the abdomen after eating may be wind. Your abdomen may feel swollen or bloated. If you are able to go to the toilet and open your bowels or pass wind the pain usually goes. If not, a chemist may be able to recommend some medication to ease the pain.
Constipation is common. It means either going to the toilet less often than usual to empty the bowels or passing hard or painful stools (faeces). Sometimes crampy pains occur in the lower abdomen. You may also feel bloated and sick if you have severe constipation.
Irritable bowel syndrome (IBS)
IBS is a common gut disorder. The cause is not known. Symptoms can be quite variable and include abdominal pain, bloating, and sometimes bouts of diarrhoea and/or constipation. Symptoms tend to ease with treatment.
Appendicitis means inflammation of the appendix. The appendix is a small pouch that comes off the gut wall. Appendicitis is common. Typical symptoms include abdominal pain and vomiting that gradually get worse over 6-24 hours. The pain usually starts in the middle of the abdomen but over time seem to move towards the right hip. Some people have less typical symptoms.
Pain that starts in your back and seems to travel around the side of your abdomen to your groin may be a kidney stone. The pain is severe and comes and goes. This is called renal colic. The pain goes when the stone is passed. Sometimes the stone cannot be passed and you may need to have the stone broken into small pieces at the local hospital. There may be blood in your urine too.
This is a common cause of aching pain that is low down in the abdomen in women. It is much less common in men. Along with pain, you may feel sick and sweaty. There may be a sharp stinging when you pass urine and there may be blood in the urine.
Pelvic inflammatory disease (PID)
PID is an infection of the womb and/or Fallopian tubes. Treatment is with antibiotics. Pain in the lower abdomen (pelvic area) is the most common symptom. It can range from mild to severe. Pain during sex can also occur. Women commonly also have vaginal discharge with PID.
Many people do not know they have gallstones. Symptoms include severe pain in the upper right side of the abdomen. This is called biliary colic. The pain is usually worst to the right-hand side, just below the ribs. The pain eases and goes if the gallstone is pushed out into the bile duct (and then usually out into the gut) or if it falls back into the gallbladder.
Pain from biliary colic can last for just a few minutes but more commonly, lasts for several hours. A severe pain may only happen once in your lifetime or it may flare up from time to time. Sometimes less severe but niggly pains occur now and then, particularly after a fatty meal when the gallbladder contracts most.
Most women have some pain during periods. The pain is often mild but, for some women, the pain is severe enough to affect day-to-day activities. The pain can be so severe that they are unable to go to school or work. Periods tend to become less painful as you get older. An anti-inflammatory painkiller often eases the pain.
When we think of food poisoning, we usually think of the typical gastroenteritis - an infection of the gut (intestines) - that usually causes diarrhoea with or without vomiting. Crampy pains in your tummy (abdomen) are common. Pains may ease for a while each time you pass some diarrhoea.
Stomach and duodenal ulcers
The pain from an ulcer may come and go. It is in the top part of your gut but may also feel like it goes through into your back. The pain usually comes at night and wakes you up. Food may make it better in some types of ulcer or may make it worse.
Crohn's disease is a condition, which causes inflammation in the gut. The disease flares up from time to time. Symptoms vary, depending on the part of the gut affected and the severity of the condition. Common symptoms include bloody diarrhoea, abdominal pain, and feeling unwell.
Diverticular disease and diverticulitis
Diverticula of colon are small pouches with a narrow neck that sticks out from the wall of the colon. They are common in older people. They commonly cause no symptoms, and in most cases no treatment is needed. However, a high-fibre diet is usually advised to help prevent complications. In some cases, diverticula cause pain and other symptoms. Sometimes a diverticulum may bleed and cause a sudden, painless bleed from the back passage, which can be heavy. In some cases, one or more diverticula become infected to cause diverticulitis. This can cause severe abdominal pain and raised temperature. A course of medicines called antibiotics may be required. Complications caused by diverticulitis, such as a collection of pus (abscess) or a perforated bowel, are uncommon, but are serious.
The list does not include every condition that causes abdominal pain. These are just some of the most common causes. People often worry that gut pain is because of cancer. Most often the most common types of cancer in the gut, such as bowel (colonic) cancer, will have other symptoms. These may include weight loss, blood loss or a change in bowel habit.
What investigations might be advised?
Some conditions may not need any investigations. Otherwise, the type of investigation will depend on which part of the gut is affected. Common investigations include blood tests, x-rays of chest and abdomen, and ultrasound scan. In few cases, CT scan, or multiple x-rays, may be required.
Again, this will depend on what the likely cause of your pain is. Some types of pain can be treated simply with over-the-counter remedies you can buy at the chemist. Acute pain not settling with regular over-the-counter painkillers require assessment at the hospital and may warrant hospital admission, especially if the pain is associated with other signs of infection like fever, nausea and dehydration.