Abdominal pain is pain or discomfort that a person feels anywhere between the lower chest to the distal groin. Some health care professionals include the diaphragm, pelvis (and genitals) and the retroperitoneal space. Chest and abdominal pain are the two top reasons why people go to emergency rooms, according to the CDC.
What are the ways to describe abdominal pain?
There are three general categories that are often used to describe abdominal pain:
- The location of pain,
- The quality or type of pain and
- The intensity of the pain.
Other qualifiers and questions are often used to describe these features:
- Does the pain radiate anywhere?
- Does the pain come and go?
- What makes the pain better or worse?
The health-care professional will ask the patient many other questions about the abdominal pain they are experiencing.
Abdominal pain is common, and a person can help their doctor diagnose the source of abdominal discomfort or pain by simply focusing on the location, type, and intensity of pain. Moreover, there are a variety of the reasons why some causes of abdominal pain are often difficult to diagnose initially. It is important to understand that although many times abdominal pain does not represent a serious problem, at other times the pain indicates a medical emergency. Discerning the difference between serious and non-serious causes of abdominal pain is sometimes a difficult challenge that you and your doctors face.
First, to understand the complexity of the diagnosis, a basic knowledge of the abdomen and its contents is needed. The illustration below is a diagram of the abdomen and most of its contents (diaphragm, pelvis, genitals, mesentery and retroperitoneal space are not shown). The diagram also shows the various areas of the abdomen that help define the location of pain and discomfort.
Location of the Pain
The abdomen can be roughly subdivided several ways; all of these ways (terms) have appeared in the medical literature:
- Upper abdomen (horizontal line about the level of the umbilicus), lower,
- Right upper and lower,
- Left upper and lower, and
- Pelvis (right and left).
Using the illustration, most of the organs in the abdominal area can be seen. Those that are not shown can be localized easily (for example, the kidneys, ureters and bladder located mainly in the lower abdomen, both left and right kidneys in the retroperitoneal space, behind the intestines with the bladder located in the central pelvis area in front of the lower intestines). Using this type of diagram, you and your doctor may more easily localize abdominal pain and its potential source.
Type of Pain
The type of pain may also give some clues as to the cause of abdominal pain. Unfortunately, sometimes the pain is diffuse; this can complicate the diagnosis. However, there are some types of pain that can help narrow the diagnosis.
There are several types of pain:
- pressure, and
Some individuals may describe many other types of pain. The type of pain may be further described as:
- variable, and
- modified by movement, eating, bowel movements, walking, or
- changed by other situations like stress or certain medications.
The doctor often enquires about the intensity of the pain, usually on a scale of 1 to 10, with 10 as the most pain (causes crying and inability to function or move, for example). Just as the type of pain may be further described, the intensity of pain may be characterized as constant, intermittent, variable, and changed by movement, eating, bowel movements, walking, or modified by other situations like stress or certain medications.
Possible Causes of Abdominal Pain
There are several causes of abdominal pain or discomfort. The following are lists of causes of abdominal pain (not all inclusive), grouped into the area of the abdomen were patients often say their pain is mainly localized.
Upper Abdominal Pain
Upper abdominal pain (right, left, both sides, center, or pelvic indicated by R, L, B, C or P)-
- Angina (reduced blood flow to the heart) - RLBC
- Cholangitis (bile duct inflammation) - RC
- Cholecystitis (gallbladder inflammation) - RC
- Duodenitis (upper small intestine inflammation) - RC
- Food poisoning - C
- Gallstones - R
- GERD (gastro-esophageal reflux disease) - C
- Heart attack - RLBC
- Hepatitis - RC
- Hiatal hernia - C
- Intestinal obstruction - RLBC
- Injury - RLBC
- Liver cancer - RC
- Mesenteric ischemia (decreased blood flow to the intestines) - RLBC
- Non-Hodgkin's lymphoma - RLBC
- Non-ulcer stomach pain - C
- Pancreatitis (pancreas inflammation, cysts) CRLB
- Peptic ulcer - C
- Pericarditis (inflammation of the heart's covering tissue) - C
- Pleurisy (inflammation of the lung's membrane) - RLBC
- Pneumonia - RLB
- Pneumothorax (collapsed lung) - RL
- Pyloric stenosis (in infants) - RC
- Shingles - RL
- Thoracic aortic aneurysm - LC
Please note that many causes of perceived abdominal pain do not come from sites in the abdomen. This is especially evident with upper abdominal pain that occurs in an organ and/or organ system close to the upper abdomen like the lower part of lungs (pneumonia) or occasionally heart problems (angina, heart attack) especially in women).
Lower Abdominal Pain
Lower abdominal pain (right, left, both sides, center or pelvic indicated by R, L, B, C, P)
- Appendicitis - RC
- Cancer - RLCP
- Crohn's disease - LC
- Diverticulitis - RLB
- Ectopic pregnancy - RL
- Endometriosis - CRLBP
- Inguinal hernia - RLB
- Intestinal obstruction - RLC
- Injury - RLBCP
- Kidney infection - RL
- Kidney stones - RLBP
- Painful ovulation (mittelschmerz) - RLCP
- Ovarian cysts - RL
- Pelvic inflammatory disease (PID) (infection of the female reproductive organs) - CRLP
- Pregnancy - CP
- Salpingitis (inflammation of the Fallopian tubes) - RL
- Seminal vesiculitis (inflammation of the seminal vesicles) - RLBP
- Shingles - RL
- Thoracic aortic aneurysm - LC
Unfortunately, some of the above causes are not well localized and the patients only say the pain is "'everywhere." A significant number of patients have this diffuse pain and yet may have a cause that is usually localized in other patients (for example, appendicitis, diverticulitis and others). However, there are causes that result in diffuse abdominal pain:
- Aortic aneurysm
- Irritable bowel disease (IBD)
- Mesenteric ischemia
- Mesenteric lymphadenitis
- Pregnancy (unknown to patient but delivering!)
- Sickle cell anemia
- Ulcerative colitis
The above lists are examples of many (not all) causes of abdominal pain. The doctor makes use of the location, type, and intensity of pain to try to arrive at a diagnosis. For example, if an older patient has acute pain (a few hours) that is relatively constant, located in the left and or center of the lower abdomen with pain score of 9 out of 10, that is sharp or tearing, the doctor would likely place a thoracic aortic aneurysm high on the list of suspected causes.
What are the less serious causes of abdominal pain?
The key to determining less serious causes of abdominal pain is the definition of "less serious." There is little or no agreement among patients about what constitutes "less serious" abdominal pains; however, doctors have a general consensus of what constitutes "less serious" abdominal pain.
If the cause of the pain is likely short lived possibly treatable, and the patient does not have an emergent condition, does not need to be hospitalized or should be worked up or further diagnosed by outpatient tests, then the cause(s) of the pain are considered "less serious" by many doctors. A large number of causes of abdominal pain may fit the doctor's definition of "less serious" abdominal pain. However, even though a cause may generally fit these subjective requirements, there can be instances where they will not. The reader is urged to examine the following section to see what constitutes "serious" causes of abdominal pain. Consequently, the following is a list of potential less serious causes of abdominal pain (many health care professionals may add or subtract from this list):
- Angina (recurrent known symptoms)
- Chronic recurrent diseases (cancers, colitis, and others)
- Food poisoning (the majority of viral and bacterial causes of gastroenteritis)
- GERD (reflux)
- Hiatal hernia
- Gallstones (intermittent symptoms)
- Inguinal hernias (reducible)
- Irritable bowel syndrome
- Painful ovulation
- Ovarian cysts
- Pneumonia (treatable with oral antibiotics)
There is one more diagnosis that is frequently given in the emergency room as a presumptive or "working" diagnosis. The diagnosis is "abdominal pain, nonspecific or not specified." This diagnosis is given when, after history, physical exam, blood tests and CT scan evidence for a cause of abdominal pain can be identified. Usually, the patient is given a small supply of pain medications and is encouraged to have follow-up with their primary doctor and, if needed, other outpatient tests. Almost all of such patients have "less serious" or unknown, but resolved causes of abdominal pain, especially when they arrive with a complaint of mild to abdominal pain for the previous few hours.
What are more serious causes of abdominal pain?
Unfortunately, the more serious causes can be almost any cause, including most of the ones listed above as "less serious" causes. Consequently, the subjective requirements that most doctors consider as serious causes of abdominal pain are any causes that may generate at least one or more of the following signs or symptoms:
- Penetration (injury) of an object into the abdomen or back
- Blunt object injury to the abdomen or back
- Intractable nausea and vomiting
- Bloody or tar-like stools
- Abrupt cessation of bowel movements
- Abdominal and/or pelvic or flank tenderness to hand pressure
- Increased pain when hand pressure is quickly taken off the abdomen (rebound tenderness)
- Severe abdominal pains (can't move without pain)
- Moderate to severe pains lasting for days
- No urination or bloody, painful urination
Alexandraki, Irene, and Gerald W. Smetana. "Acute Viral Gastroenteritis in Adults." UpToDate. Updated Aug. 1, 2016. <http://www.uptodate.com/contents/acute-viral-gastroenteritis-in-adults?source=search_result&search=Management+of+acute+viral+gastroenteritis+in+adults.&selectedTitle=1~150>.
Fass, Ronnie. "Approach to Refractory Gastroesophageal Reflux Disease in Adults." UptoDate.com. June 7, 2016. <http://www.uptodate.com/contents/approach-to-refractory-gastroesophageal-reflux-disease-in-adults?source=search_result&search=Acid+reflux+gastrointestinal+-+gastrointestinal+reflux+in+adults+the+basics.&selectedTitle=1~150>.
Rabinowitz, S. "Abdominal Examination." Medscape. Nov. 26, 2017. <https://emedicine.medscape.com/article/1909183-overview>.
UpToDate. "Differential diagnosis of abdominal pain in adults."