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Abdominal Pain
Have you ever experienced pain in your abdomen? Of course, all of us have experienced a "belly ache" sometime in our lives, but how can you decide when abdominal pain is serious?

Here is a list of common questions your doctor will need to ask about your pain:
	What does the pain feel like?
	How long does the pain last and when did it first occur?
	When does the pain occur?
	Where is the pain located?
	What causes the pain?
	What relieves the pain?
	What other symptoms are associated with the pain?

The sensation and interpretation of how pain feels varies from one person to another. There are two predominant types of pain.

Cramping Pain
Cramping pain is also referred to as colic. It occurs in a repeating cyclic or wave pattern with a build up in intensity followed by a gradual easing in intensity. Gas pain is a common description used to describe cramping pain. A stretching or squeezing of the intestines will cause this type of pain. It arises from hyperactivity of normal intestinal peristalsis (muscle contractions) and may be due to excess gas, irritation of the intestines from infection or inflammation, blockage, and even stress.

Constant Abdominal Pain
There may be some variation in the intensity but, overall, this type of pain is distinctively steady. Other descriptions which have been used include "aching, burning, gnawing, hunger, or sharp" pain. This type of pain can arise from deep inflammation involving any of the abdominal organs and the abdominal cavity. Ulcers, blockage of the gallbladder by stones, and local areas of infection called abscesses can cause this type of pain. Irritation of the inner lining of the esophagus by gastric acid and irritation of the outside of the intestines and body cavity by leakage of blood, intestinal contents, and bile can also cause this type of pain.

How long does the pain last?
Pain which lasts for only seconds or a minute usually does not have a specific cause. Many people will experience a rare brief spell of abdominal pain, which is not serious.
Pain which lasts for hours or days should be considered potentially serious and medical attention should be obtained.

When does the pain occur?
Pain may occur spontaneously, at any time. Pain which awakens someone from sleep is regarded as potentially serious. It may occur before or after meals and before or after bowel movements. The "hunger" pain of peptic ulcers may occur just prior to mealtime. Gallbladder pain may develop after meals as can pain from the pancreas and intestinal obstruction. The irritable bowel syndrome is a common gastrointestinal problem which typically is associated with gaseous or crampy pain after meals along with a sensation of bloating. Inflammatory diseases of the intestine associated with diarrhea often cause crampy pain before or after bowel movements.

Where is the pain located?
The place where the pain is initially felt and where it may travel (radiate) is very important in determining the cause of the pain. Pain located in the center of the upper abdomen may arise from the esophagus, stomach, duodenum, liver, pancreas, or bile ducts. Pain from the gallbladder and an inflamed liver will more often be located toward the right side of the upper abdomen. Gallbladder pain may also radiate through the right shoulder blade. Pain from an ulcer or irritation of the pancreas may radiate through to the back. Pain arising from the small intestine can localize around the belly button. Pain arising from the large intestine may localize to either the right, left, or middle of the abdomen below the belly button. Pain developing from inside the pelvis will often be experienced as a pressure-like discomfort in the rectal area.

The most common locations of minor pain, often gas-like, are in the middle to upper abdomen and in the lower and left abdomen.

What causes the pain?
There may be some helpful clues from this observation. Chest pain arising from the esophagus (swallowing tube) may be related to certain foods, solid foods, or extreme temperature of foods (hot or cold). Meals stimulate the gallbladder to release bile and in the presence of gallstones may induce the pain of a gallbladder attack. Narrowed or blocked areas of the intestine will be worsened after eating solid foods, especially fibrous vegetables. An excessive intake of certain foods such as beans can cause abdominal cramps. Some individuals are intolerant of certain foods, such as the milk sugar, lactose. For example, after drinking a milk shake or lots of milk, persons intolerant to milk sugar (lactose) may experience excessive gas, cramping, and eventually diarrhea.

What relieves the pain?
Whether the pain is new or has been recurring for some time, most people will try to relieve it or will notice what makes the pain feel better. Belching is a common maneuver used to relieve upper abdominal discomfort. The belch is created by swallowing air and immediately expelling it. It is a learned response which can become a habit. Belching does not provide much, if any, clue to the origins of upper abdominal pain. Flatus, the expulsion of gas from the rectum, may relieve crampy abdominal pains due to distension or stretching of the colon and rectum. Some individuals naturally have more gas than others which may cause discomfort, create cramps, and be relieved by the passage of flatus. Certain foods, such as beans, can create excess gas and cramping which is relieved by the passage of flatus.

The pain of peptic ulcer disease has been commonly referred to as hunger or gnawing pain which is typically relieved by eating. This pain may awaken a person from sleep. These individuals will often keep antacids, water or crackers on their bed stand to help relieve the night time pain.

More serious pain will cause restlessness, the need to be still, or to assume a certain position. An obstructed organ such as the intestine or gallbladder typically causes restlessness with a need for movement such as rocking or pacing. A perforation or leakage of intestinal contents will cause one to be very still to minimize irritation of the abdominal cavity and outer lining of the intestines. With inflammation in the lower abdomen, such as appendicitis, the pain may be relieved by lying down with the legs drawn up. Deep inflammation of the upper abdomen, as can occur with inflammation of the pancreas, may feel better by leaning forward or curling up in a ball on one side or the other.

What other symptoms are associated with the pain?
Severe pain of any kind may be associated with sweating. This is not a specific observation. Nausea and vomiting may be important responses to pain and may indicate a blocked organ such as the stomach, intestine or gallbladder. Nausea and vomiting are common symptoms associated with inflammation of the pancreas.

The abdomen may become swollen or distended with gas when there is blockage of the intestine. Blocked intestines may also be associated with loud grumbling sounds which usually occur at the same time as the crampy waves of pain. These grumbling sounds may also occur normally and most often between meals. Blockage of the stomach may be due to an ulcer at the very end of the stomach. In addition to the steady pain of an ulcer, the individual may be aware of a sloshing sound of fluid in the blocked stomach. This is most noticeable when lying down and changing positions.

Fever, with or without shaking chills, can accompany intestinal infections, blockage of the bile ducts, and localized areas of infection called abscesses. The presence of shaking chills suggests serious infection with passage of bacteria into the bloodstream.

A change in the color of the urine and stool may accompany the pain from a blocked bile duct. In this setting, the urine becomes very dark, like strong tea, and the stool becomes light in color. With a prolonged blockage of the bile duct, the eyes and skin will turn yellow which is called jaundice.

Crampy pain accompanied by black or bloody stool is a combination of symptoms indicating severe bleeding which requires prompt attention.

Pain arising from the esophagus may be due to irritation and blockage. Individuals with this type of pain problem will describe difficulty swallowing foods, especially solids. When there is a complete blockage of swallowed food, the individual will have trouble swallowing saliva.

When should I see a doctor?
If you answer YES to any of the following questions concerning your abdominal pain, you should contact your doctor.

	Is your pain steady, severe, or regularly recurring?
	Does your pain impair your ability to work or perform your routine activities?
	Have you lost weight or your appetite?
	Is your pain associated with nausea and vomiting?
	Do you experience fever?
	Have your bowel habits changed?
	Do you experience difficulty in swallowing?
	Does your pain awaken you from sleep?
	Do you have a previous history of ulcers, gastroesophageal reflux, gallstones, inflammatory bowel disease (ulcerative colitis, Crohn's disease), and intestinal surgery?
	Are you taking any medicines that can cause ulcers, such as aspirin or other medications commonly used or prescribed for arthritis or headaches?

Information Courtesy of
The American College of Gastroenterology