Stomach ache

Mild stomach pain usually lasts for a day or two and generally goes away on its own due to the constant clearing out of the waste from the digestive system. However, a long-lasting stomach pain should not be ignored and you should consider seeking medical help to ensure that there is no underlying serious problem. If there is, we urge you to have a complete and timely treatment of your condition in favour of your physical, mental and social health.

The treatment of stomach pain depends on the diagnosis.

Mild to moderate pain usually goes away in a day or two with painkillers and a regular intake of fluids (for example ORS solution) and a semi-solid diet.

Medication

Painkillers provide pain relief to some extent. In case of acidity, over-the-counter antacids give immediate pain relief. The doctor prescribes anti-emetic medicines which help reduce vomiting. Fluid replacement is done through intravenous fluids (drips) or orally through oral rehydration salt (ORS) solution depending upon the severity of fluid loss from the body. Antibiotics are prescribed in cases of infection or abscess (pus).

Surgery

If symptoms persist, your physician will advise for further hospitalization, or investigations, or a surgery (if needed) in emergency cases in the best interest of restoring your health.

Since prevention is better than cure, abdominal pain can be prevented by following a healthy lifestyle. A few things that can help you maintain a good and healthy gut are:

• Drink plenty of water
• Eat a fiber-rich diet. In case you have an underlying medical condition, we urge you to see a nutritionist for a better diet plan.
• Avoid eating stale and contaminated street food.
• Have a balanced diet.
• Reduce stress by regular meditation, or yoga, or any other physical exercise.
• Avoid spicy, fat-rich, oily, and junk food.
• Quit or reduce the frequency of smoking, alcohol, tea, and coffee.

We highly recommend visiting a physician for a thorough examination and diagnosis of your condition. Provide your doctor with a detailed history of your pain such as its onset, duration, frequency, intensity, site of pain and associated symptoms, appetite, eating habits, bowel habits, micturition (urination) and menstrual history, aggravating and relieving factors, etc. followed by a complete physical examination. Based on the findings, the physician may prescribe any of the following diagnostic tests. These tests include laboratory investigations and radiologic examination such as X-ray, ultrasound, CT scan etc.

Lab Investigations:

• CBC (Complete Blood Count): In this test, the blood of the person is drawn and collected, and the number of red blood cells, white blood cells, platelets, haemoglobin levels, etc. are measured. This helps to rule out conditions like infections, cancer, anaemia, which may or may not have abdominal clinical manifestations.
• Hb (Hemoglobin) estimation: Anemia is a major cause of irritable bowel disease with other symptoms like diarrhoea and vomiting. Hence, haemoglobin estimation is done to measure whether the levels are within the normal range and to rule out anaemia as the underlying cause.
• WCC (White Cell Count): A high WCC is suggestive of infection of the digestive system.
• Serum Amylase and Lipase test: These are the confirmatory tests as the serum amylase and lipase levels are elevated in acute pancreatitis.
• Urea, Serum Creatinine, and electrolytes: These tests evaluate whether the kidneys are functioning normally and are able to filter wastes effectively. An imbalance of this suggests a possible kidney disease.
• Liver Function Tests (LFT): LFT is performed in order to rule out cholecystitis and liver dysfunction.
• ECG (Electrocardiogram) and cardiac enzymes: ECG is a test which records the activity of the heart and is done to rule out any heart disease such as damage, inflammation, or irregular heart rhythms (cardiac arrhythmia).Tests for cardiac enzymes include measuring the levels of creatine phosphokinase (CPK), creatine kinase (CK), proteins (Troponin I and Troponin T), etc. to look for any damages to the muscles of the heart.
• Urine Test: This test is done by taking the urine sample of the person as described by the physician to rule out urinary tract infections, kidney stones, pregnancy etc.

Radiological examinations:

Sometimes, the laboratory investigations are unable to help the physician to come to a final diagnosis of the condition. In such cases, the doctor may advise radiological examination (chest X-ray, CT scan, ultrasound, etc) to find out the underlying cause of the pain. Following are the commonly prescribed radiological examinations in abdominal pain:

• Chest and abdominal X-ray: Chest X-rays are helpful and often confirmatory in identifying any perforation and obstructions of the gut, lung diseases such as pneumonia, abnormal enlargement of an abdominal organ, etc.
• Abdominal ultrasound: The ultrasound scan is done by asking the patient to lie down. A gel is applied on the part of the abdomen to be scanned, and the probe is moved over the skin to produce live images of the organs on the screen. This test helps in identifying kidney stones, abnormal or cancerous growth (tumours), injury and swelling in any organ, pregnancy, appendicitis, etc.
• IVP (Intravenous Pyelogram): Kidneys are deep-seated organs and are difficult to asses on routine abdominal X-rays. Intravenous Pyelogram is a test which uses a dye or contrast medium to be injected into the person’s blood. After a while, X-rays are taken on regular intervals. As the dye filters through the kidneys, a clear-contrasting image appears on the X-rays which shows detailed structures of the kidney, ureters and the urinary bladder. This test helps in detecting kidney stones.
• Diagnostic Laparoscopy: It is a procedure by which doctors use a medical telescope through the abdominal wall and are able to view the organs inside the abdomen and female reproductive organs in the pelvic area.
• Endoscopy: In this procedure, an instrument is inserted through your mouth to check any abnormalities in the digestive system.

Stomach or abdominal pain can be classified in three ways, depending upon its severity, location, and duration as follows:

Based on severity:

• Mild pain is characterized by a pain that typically comes and goes and is usually tolerable in nature.
• Moderate pain is characterized by a pain that begins to interfere with and distract you from conducting daily activities.
• Severe pain is characterized by an unbearable event which needs immediate medical attention.

Based on location:

The abdomen is divided into nine parts and the pain can occur anywhere. Sometimes the pain is of a diffused origin (generalized, or shifting) and cannot be localized.

• Upper: left, center, and right
• Middle: left, center, and right
• Lower: left, center, and right
• Referred pain (originating from one region and perceived or felt at another)

Based on duration:

• Acute pain is when you are experiencing sudden and severe pain (mostly requiring urgent medical attention) for example, acute appendicitis, diverticulitis, acute pancreatitis etc.
• Chronic pain is when you are experiencing the pain for a period of time (for more than three months, either continuously or intermittently) for example, chronic cholecystitis (inflammation of the gallbladder), chronic cholelithiasis (gallstones), peptic ulcer disease, etc.

When to seek medical advice?

However, it is always advisable to seek medical help from a doctor on experiencing a discomfort of any kind, you are urged not to delay the same when you experience sudden and severe pain along with nausea and vomiting. You may also consider taking help if experiencing loose stools or diarrhoea, blood in stools, weight loss, blood in cough, unexplained vaginal bleeding when it’s not the expected date of menstrual cycle, blood in vomit, irregular bowel motions, missed or irregular menstrual cycles, pain during urination, pain in or around male reproductive organs, chest and stomach pain during exercise or while performing daily activities. Kindly do not ignore as they may be strong indicators of deep underlying medical conditions along with stomach pain.

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The most common causes of stomach pain include muscle stretch due to intense physical activity, sports or accidental injury, food poisoning, food allergy, menstrual cramps (period pain) in females, bloating, constipation, trapped wind or gas, ulcers, infection, and inflammation. Less commonly, tumours and cysts could be the cause of abdominal pain.

Causes of stomach pain in different groups of people

• In infants:
  Infants express their stomach pain through crying, being fussy, not eating properly, being sleepless, etc. Stomach pain in infants is very common is mostly due to colic, gas pain, acid reflux, lactose intolerance (inability to digest milk), other infections, etc.
   
• In children:
  Children below 12 years of age are playful and very much prone to accidents and infections. A habit of chewing and sucking on things while playing, suddenly engulfing small objects, eating contaminated food or soil,  drinking contaminated water are some of the very common reasons for stomach pain in children.
  
  Home remedies are a very common source of worsening the child’s condition. For example, giving food rich in fats, forcing the child to eat, taking them to unqualified quacks for superstitious beliefs, giving charcoal or ash to eat, etc. can make the condition even more difficult to control. Children can barely express their pain through words. Hence, we urge you to please seek medical advice from a paediatrician (a qualified doctor for newborns, infants, and children).
   
• In pregnant women (gestational):
  In early pregnancy, stomach pain might occur due to normal contractions of the uterus (called Braxton Hicks contractions). However, these are not usually perceived until mid-pregnancy. Other causes include abortion, ectopic pregnancy, etc.
  
  In late pregnancy, abdominal pain may occur because of ligament pain, pain due to pressure of the growing foetus on other abdominal organs, abruptions in placenta (a cord that connects the mother to the foetus for nutrition, waste removal, etc.), rupture of uterus, preterm labor (contractions in the uterus before completion of the full pregnancy period).
  
  On completion of the full pregnancy term, the strong contractions of the uterus to deliver the baby out cause severe abdominal pain.

Abdominal pain causes based on location:

• Upper central (epigastric region):
  If you are experiencing pain in the epigastric region, you might be suffering from:
  • Acidity: It is the most common reason for epigastric pain. It occurs due to reflux of stomach acid into the food pipe or oesophagus.
  • Peptic ulcer or peptic ulcer disease: open sores or break in the inner lining of the stomach, which leads to stomach pain after eating food.
  • GERD (Gastroesophageal reflux disease): a digestive disorder in which the stomach contents frequently flow back into the food pipe or the tube that connects the mouth to the stomach. Read more: (GERD treatment)
  • Myocardial Ischemia: This occurs due to a reduction in the blood flow to the heart, due to which it may not receive sufficient oxygen.
  • Abdominal aortic aneurysm: a disease in which the walls of the aorta (the major blood vessel that supplies blood to the body) become weak, swell and bulge out like a small balloon
  • Pancreatic pain
  • Gallbladder and common bile duct obstruction
     
• Upper right region:
  If you are experiencing pain in the upper right region, the causes could be:
  • Acute cholecystitis: pain due to inflammation of gallbladder lining.
  • Biliary colic: pain due to gallstones obstructing the bile duct.
  • Acute hepatitis: inflammation of the liver caused by infection, alcohol or drug abuse, adverse effect of certain medications, toxins etc. or abscess (pus formation)
  • Hepatomegaly: abnormal enlargement of the liver due to alcoholism, a side effect of certain medications, etc.
  • Duodenal ulcer: ulcer in the upper part of the small intestine.
  • Herpes zoster (occurs due to reactivation of the virus in patients who have had a prior infection with Varicella zoster virus)
  • Myocardial ischemia: There is a slight possibility of suffering from this disease in which the blood flow to the heart is reduced. A fatty substance accumulates on the walls of the arteries which hardens over a period of time and reduces the blood flow to the heart. When this hardened fat called “plaque” completely blocks the artery supplying to the heart, it causes severe pain. Other features that you may experience include shortness of breath, pain in the neck, arm or shoulder, sweating without physical exertion, etc.
  • Right lower lobe pneumonia: pneumonia in the lower region of the right lung.
  • Right Kidney stones: pain often gets referred to the right side of the back also.
     
• Upper left region:
  Following are a few listed health conditions which may cause pain in the upper left stomach area:
  • Acute pancreatitis (mild to severe pain that occurs due to inflammation of the pancreas). Pain becomes sudden and severe after eating and may last for several days)
  • Gastric ulcer (occurs due to bacterial infection, alcohol abuse, certain medications used in fever, certain painkillers, stress, eating spicy food etc.)
  • Gastritis (inflammation of stomach lining)
  • Enlargement, rupture or infarction (obstruction of blood supply) of spleen
  • Myocardial ischemia
  • Left lower lobe pneumonia
  • Kidney stones (pain often gets referred to the left side of the back also)
     
• Lower right region:
  If you are experiencing lower right abdominal pain, it may be due to the following health conditions:
  • Appendicitis: inflammation of the appendix which is a finger-shaped tubular pouch extending from the colon on the lower right side of the abdomen. The pain is severe and often requires emergency treatment.
  • Ruptured ectopic pregnancy: a medical emergency in which a fertilized egg implants itself at a place other than the uterus, grows and ruptures the fallopian tube.
  • Small bowel/intestinal obstruction: areas or bands of healing/scar tissue that may occur after a surgery.
  • Regional enteritis or Crohn’s disease: a long-term condition in which the gut is inflamed. It usually affects the small intestine and colon.
  • Pelvic Inflammatory disease/ disorder: an infection of the organs of a woman’s reproductive or sex organs.
  • Twisted ovarian cyst: partial or complete rotation of the ovary and the fallopian tube along its blood supply.
  • Hernia: occurs when an organ such as the small intestine or fatty tissue pushes through a weak spot in its surrounding muscle or connective tissue called fascia
  • Ureteral calculi: stones lying within the ureter
     
• Lower left region:
  If you have pain in the lower left region, following are the possible health conditions that you might be suffering from:
  • Diverticulitis: inflammation or infection of small pouches called diverticula that develop along the walls of the intestine.
  • Leaking aneurysm: a lethal event in which an aneurysm ruptures and leaks blood within the wall of the blood vessel.
  • Ruptured ectopic pregnancy
  • Pelvic inflammatory disease/ disorder
  • Twisted ovarian cyst: partial or complete rotation of the ovary and the fallopian tube along its blood supply.
  • Ureteral calculi: stones lying within the ureter.
  • Hernia: occurs when an organ such as the small intestine or fatty tissue pushes through a weak spot in its surrounding muscle or connective tissue called fascia.
  • Regional enteritis or Crohn’s disease: a long-term condition in which the gut is inflamed. It usually affects the small intestine and colon.
     
• Middle central (Periumbilical) region:
  • Disease of transverse colon: middle part of colon extending from right to left in the abdomen.
  • Gastroenteritis: inflamed stomach and intestines which is characterized by diarrhoea, vomiting and abdominal pain.
  • Appendicitis
  • Early bowel obstruction: obstruction of the bowel as a complication of abdominal surgery.
     
• Diffused pain:
  If the pain is occurring in almost everywhere in the abdominal region, or continuously shifting, or cannot be localized, it is called diffuse pain. In such cases, the patient gets confused and finds it difficult to locate the site of the origin of the pain. The possible reasons for such kind of a pain are:   
  • General peritonitis: inflammation of the peritoneum, the tissue that lines the inner wall of the abdomen and covers most of the abdominal organs, caused by bacterial or fungal infection.
  • Acute pancreatitis
  • Sickle cell crisis: occurs in patients with Sickle cell disease. The sickle-shaped or curved red blood cells block the small blood vessels and may cause severe pain.
  • Mesenteric thrombosis: blood clot in one or more major veins that drain blood from the intestines.
  • Gastroenteritis
  • Metabolic disturbances
  • Dissecting or rupturing aneurysm
  • Intestinal obstruction
  • Psychogenic causes: stress, anxiety, depression, etc. can also cause abdominal pain. It usually goes away as the patient recovers from the underlying psychological trauma.
     
• Referred pain:
  Sometimes the site of origin and the site of perception of pain is different. This is known as referred pain. Certain respiratory disorders such as pneumonia, pulmonary infection (lung infection), and heart diseases such as myocardial infarction (heart attack) cause a referred pain to the upper abdominal area.

We advise you do not try to self-diagnose the cause of your abdominal pain, only a doctor can do so accurately. A physical examination along with the prescribed diagnostic tests are required to find the underlying cause of your stomach pain.