When to worry about abdominal pain?

The abdomen is the most crucial organ in your body. While most people pay attention to the heart, the abdomen houses many basic organs that are essential to the normal functioning of the body. Furthermore, many health conditions are associated with organs located around the abdomen. Since the abdomen plays an important role in the body, it is important to understand its anatomy, what causes pain in the abdomen, and when one should worry about it.

The Anatomy of the Abdomen

The abdomen is the region above your pelvis and below your chest. It consists of nerves, muscles, ribs, vertebrae, blood vessels, vital organs like the liver, kidneys, small and large intestines. The muscles of your abdomen protect the vital organs below and give structure to your spine. These muscles allow your body to bend around the waist.

Abdominal Muscles

Your abdominal wall is divided into the back (posterior), sides (lateral), and front (anterior) walls. Your abdominal muscles have varying functions. They are essential in breathing, since they act as accessory respiration muscles and protect the inner organs. The back muscles offer postural support and define your form. When your pelvis and thorax are fixed and the glottis is closed, they are crucial in vomit, cough, singing, defecation, urination, and childbirth. When your pelvis is fixed, your trunk can move forward. The pelvis also prevents hyperextension. When your thorax is fixed, you can pull your pelvis up, bend your vertebral column to the side, and rotate your trunk.

Your abdominal muscles are also crucial for body posture. The transverse abdominus muscle is situated deep in the abdomen and greatly affects your body posture. The transverse abdominus, together with the internal obliques, help in rotation, bending, and supporting the spine. The external obliques also help in lateral flexion and rotation, and stabilize your spine when you are upright. The abdominal muscle that fit people turn into 6-pack abs is the rectus abdominus. Although it should be a 10 pack because the body has five vertical sections on either side, the two sections at the bottom are slightly above your pubic bone and are not visible. The function of the rectus abdominus is to bend your back forward.

The Divisions of the Abdomen 

The abdomen can be divided into five regions. Doctors are able to diagnose your condition by determining the region causing the pain. The main regions are the upper right and left quadrants, the upper middle region, and the lower right and left quadrants. The gall bladder and liver are situated in the upper right region. The stomach and spleen are found in the upper left region whereas the upper middle section (epigastrium) houses most of your stomach, a section of your small intestine, and your pancreas. The lower right quadrant houses a large part of your colon and small intestines. In women, the region secures one ovary. The lower left quadrant houses the other ovary as well as the rear end of the colon.

The digestive organs of the abdomen are the small and large intestines, and the stomach. These organs are essential for turning nutrients into energy and disposing of waste.

The abdominal region also has accessory and urinary organs responsible for filtering contaminants from the body. These include the kidneys, pancreas, and liver. The liver is positioned at the upper right section of the abdomen, under your ribs. The liver is crucial for blood processing, and the separation of nutrients and waste. The gall bladder is under your liver and holds bile that is synthesized by the liver before it passes through the small intestine. Bile is essential for breaking down fat. The pancreas produces enzymes that are necessary for the digestion of fats, carbohydrates, and proteins. It also synthesizes hormones used for distributing nutrients. Your body consists of two kidneys situated close to the back, under your ribs, one for each side of your spine. Kidneys are responsible for filtering waste from the blood and out of your body in form of urine. Kidneys also regulate electrolyte levels such as potassium and salt, and aid in the production of certain important hormones. Above your kidneys are adrenal glands crucial for secreting and synthesizing hormones that enable your kidneys conserve water. The adrenal glands also support your body's sexual abilities.

The main bones in your abdominal area are those under the lumbar spine and rib cage in your lower back. Many causes of pain in the abdomen are derived from the organs in this region. Some include:

  • Peptic ulcers
  • Digestive problems
  • Various cancers
  • Colon cancer
  • Liver cirrhosis
  • Strained abdomen muscles

What Causes Abdominal Pain?

Everyone has come across stomach pain at some point in their life. Some of the forms of stomach pain include bellyache, gut ache, tummy ache, and stomach ache. Pain in the abdomen area can be severe or mild. It could be persistent or seasonal. It may either be acute or chronic.

Stomach pain is not attributed to a single problem but may be caused by various things. The common causes of stomach pain include indigestion, gas pains, or a muscle pull. The location of stomach pain provides clues to the cause of the problem. The main organs associated with stomach pain are the appendix, gall bladder, stomach, pancreas, and colon.

Appendix

The appendix is a small tube inside the lower right quadrant of your abdomen. Appendicitis pain starts as a minor aching near the naval but settles in the lower right quadrant.

Gall bladder

This organ is responsible for storing bile juice before it is released into the small intestine. When the gall bladder is infected or has stones, you will experience sharp and intermittent pain on right quadrant of your abdomen. The pain could extend to your back or shoulder due to ingestion. You will experience this sort of pain when your gall bladder exerts pressure on the obstructing stone in the bile duct. The pain experienced in the gall bladder is similar to childbirth labor pains for women.

Stomach

Ulcers in the stomach can cause bleeding and pain. You will experience a cramping or burning sensation in the mid-section above your belly button. In most cases, food ingestion exasperates the pain.

The Pancreas

The juice produced by your pancreas helps to break down food. If this concentrated juice passes to the wrong area, it could digest the abdominal organs. Excessive intake of alcohol can lead to pancreatitis. This pain occurs in the mid section of the stomach above the belly button.

The colon

Pain from your colon can affect any part of the abdomen. However, an infection of the colon lining leads to a condition known as diverticulitis. The pain affects the lower left quadrant.

Stomach pain can be further categorized depending on the level of pain. Acute pain resolves itself after a few hours or days; chronic pain is intermittent and may persist for weeks to years. In some cases, the pain is progressive - gradually increasing. The following are some of the conditions associated with acute, chronic, and progressive pain.

Acute Pain

The conditions attributed to acute stomach pain vary from minor conditions to life-threatening conditions. These include:

  • Appendicitis
  • Heart attack
  • Kidney infection
  • Pneumonia

Chronic Pain (Intermittent)

The cause for chronic stomach pain is hard to determine. Some of the conditions associated with chronic stomach pain are:

  • Ovarian cysts
  • Gall stones
  • Sickle cell anemia
  • Enlarged spleen
  • Angina

Progressive

If your stomach pain is worsening over time, there is cause for alarm. The main reasons for progressive stomach pain are:

  • Cancer
  • Crohn's disease
  • Liver cancer
  • Pancreatic cancer
  • Stomach cancer

How is the Cause of Abdominal Pain Determined?

Physical Examination

In mild cases, your doctor will use a stethoscope to listen to the abdominal region and determine the cause of pain. In some cases, an upper endoscopy is performed. In this procedure, a flexible tube that features a camera will be inserted in your mouth. The endoscope is used to examine your duodenum and stomach. A lower endoscopy involves inserting an endoscope through your anus into the colon. This procedure, also called colonoscopy, is used to identify bleeding or cancer in the colon and rectum.

Computerized Examination

An x-ray of the abdominal region helps the doctor to identify conditions affecting your belly such as intestinal perforation and obstruction. Your practitioner may also use computed tomography (CT) scan to view the inside of the abdomen and identify conditions like cancer and appendicitis.

When your doctor uses Magnetic resonance imaging, he/she utilizes radio waves, a magnetic field, and a scanner to create images of your abdomen. MRI is mainly used to identify pancreas, gallbladder, and liver conditions.

An abdominal ultrasound relies on sound waves off your abdominal organs to create an image on a computer screen. Ultrasounds detect problems in many organs including the liver, kidney, and gall bladder.

Other Procedures

Endoscopic retrograde cholangiopancreatography employs an endoscope through the intestine. The tube passes through the duct of the pancreas and a fluid is passed through tubes that feed into the liver, pancreas, and gall bladder. The doctor will take an x-ray to identify if there are problems with these organs causing the stomach pain.

When the doctor uses Ph testing, he/she will pass a tube through a vent in your esophagus or nose, to monitor the esophagus's acid levels. This procedure is used to diagnose the cause of stomach pain or to confirm whether a treatment is working.

An Upper GI series is another invasive procedure that utilizes a barium solution that is swallowed by the patient to produce x-ray images of the stomach and esophagus. The Upper GI series is used to diagnose ulcers and stomach conditions that may be the cause of stomach pain.

In a biopsy, the doctor will cut a tiny piece of your tissue to check for cancer or determine whether your liver or other organs are the cause for stomach pain.

When to Worry About Abdominal Pain

If you experience recurrent or severe stomach pain, or it is followed by any of these symptoms, you should be concerned:

Severity: Pain that is so intense that you cannot sleep or engage in any activity is cause for alarm.

Persistence: If you are experiencing pain that lasts for over 10 minutes, you ought to seek medical attention.

Fever: If you are experiencing night sweats or a high fever accompanied by stomach pain, this should be high warning signs.

Tenderness: When stomach pain gets worse as you move or exert pressure on a certain spot, this should be enough reason to be worried.

Loss of appetite: Stomach pain is also associated with loss of appetite. When there is a problem with your abdomen, digestion is hampered. Food no longer moves through your digestive tract, and you tend to feel nauseated and lack interest in food. For example, someone suffering from appendicitis looses their appetite. Weight loss accompanies this loss of appetite and should be treated as a warning sign.

Dizziness: If you are feeling light-headed or dizzy as well as stomach pain, this means you have low blood pressure. Seek medical attention before your body starts shutting down.

Bloody bowel: If your stomach pain is accompanied by blood in bowel movements, you need to consult a doctor.

Vomiting: When your vomiting is continuous or intractable, you should be alarmed. When vomiting is severe, your body becomes dehydrated since you are unable to replace the body fluids. If you are unable to take any fluid to hydrate the body after vomiting, you need to be deeply concerned about your health.

Melena: This is the black-like bowel that one experiences when suffering from stomach pain. It is an indication of gastrointestinal tract bleeding. The blood turns black before arriving at the rectum. If internal bleeding causes melena, you are likely experiencing a bleeding ulcer or some severe condition that needs urgent attention.

Other worrisome factors include:

  • If you have difficulty breathing
  • If you are a cancer patient
  • If you cannot pass stool or experience severe diarrhea that lasts for over 5 days
  • If you are pregnant
  • If you feel pain when urinating or have severe vaginal bleeding

Which Treatments Should You be Worried About

Even after consulting a physician, you may find that your condition is more serious than you expected. You should worry depending on the kind of treatment that your physician recommends to relieve the stomach pain. The main treatments provided for stomach pain include:

Abdominal Surgery

This option is recommended for serious conditions such as appendicitis, stomach or colon cancer, aneurysm, or cholecystitis. Your physician may use laparoscopic surgery ( involves small body incisions) or open surgery (involves large incisions- a typical surgical operation).

Histamine blockers

If your doctor uses histamine blockers, it is an indication that you had serious acid production. Histamine blockers are used to block histamine, thereby reducing the production of acid.

Proton Pump Inhibitors

These medications inhibit acid pumps in your stomach. Your doctor will direct you to take them daily. Although these pump inhibitors should not worry you, if taken for several months, you should be concerned.

Endoscopy

These are endoscopic tools inserted in the body to treat cancer or bleeding organs. You should be alarmed if your doctor recommends an endoscopic procedure.

If your doctor recommends motility agents, laxatives, or anti-biotics, there is little need for concern. Motility agents and laxatives are used to increase stomach contractions and help relieve constipation or gastroparesis. Antibiotics are given to treat bacterial infections such as H. pylori.

Stomach pain is a broad topic that cannot be exhausted by a single article. However, the complexity of the condition requires a clarification of all the factors that may contribute or are associated with stomach pain. To understand stomach pain, one must learn about the anatomy of the abdomen. The abdomen consists of many organs, each with its distinct function. Any of these organs is likely to contribute to stomach pain. Therefore, depending on the location of the pain, your physician is able to determine the what to deal with.

Another important thing to note is that some of these conditions are indicators of whether you are facing a serious problem or not. In addition, it is important to beware of all the signs and symptoms associated with stomach pain. In some cases, stomach pain could be fatal if not attended to in time. Learning about the signs or symptoms to be worried about is important. Furthermore, the kind of treatment the doctor recommends for your situation will tell you whether the condition is serious or not. Educating yourself about the anatomy of your abdomen, the causes of stomach pain, and the warning signs is necessary in case you or a loved one is afflicted with stomach pain.


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Patricia K.

She is our health expert (medical student), with a little bit of over-meticulousness and precision. She has an unquenchable desire to help others.