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Your abdomen is the part of your body between the bottom of your ribs and your pelvis. When people talk about abdominal pain, they could be talking about pain anywhere in between these two parts. You might think of it being around your stomach, or your belly button, or your gut.
Because there are so many organs inside your abdomen, pain in this area can be caused by many different things.
Sometimes, pain can be caused by something just outside your abdomen, for example, your lungs or heart. For this reason, it can be very difficult to tell what is causing someone’s pain, and how your doctor approaches the problem will be different depending on several factors.
The first thing a doctor will do when you go to see them with any kind of abdominal pain is to take a 'history'. This is really important because it can help the doctor reach a diagnosis and direct investigations.
A few things the doctor needs to know that will help are:
If your pain is at the top of your tummy on the right, this is where your liver sits. You might be more likely to get pain here if something is going on in your liver, like gallstones. If the pain is at the bottom of your right lung, it might be pneumonia. If the pain is in the bottom right, then this might have something to do with your appendix, or it could be a hernia.
Different types of conditions have different locations of pain associated with them. It isn’t a hard and fast rule, because everyone experiences things differently. Still, it can be a really helpful indicator as to what might be going on. Examples are:
* Your aorta is a large artery which runs through the centre of your tummy, pretty much from top to bottom. This takes blood from your heart to the rest of your body and splits into lots of different arteries on the way. In some people, the artery can bulge, and in rare cases burst. This causes a sudden onset, severe pain which goes from the centre of the tummy through to the back. For more information on this, visit the NHS website on aortic aneurysm.
** Diverticulitis is a condition which tends to be seen in older people. As we get older, some of us will develop little 'pockets' on the side of our normal bowel. These 'pockets' are known as diverticular, and can sometimes become infected. If this happens, you can get pain, generally in the left lower part of your abdomen, and it is usually associated with a fever.
Some conditions have classic ways in which the pain might start or feel. This doesn’t mean that because your pain isn’t like this, that you don’t have that condition, but it can help your doctor to figure out what is going on.
A pain which comes on suddenly after eating fatty meals and lasting a few hours. It is usually described as severe, and felt in the right upper part of the abdomen and radiates through to the back.
A pain which comes on relatively quickly. The pain is in the centre of the abdomen and can radiate through to the back. It is often so severe that people find it difficult to move and breathe, preferring to lie very still.
The pain starts centrally in the tummy and then moves to the bottom right part of the abdomen.
A dull pain is felt in the top left part of the abdomen, and is often slightly better after eating.
A constant ache in the left lower part of the abdomen. It might be made slightly better after going to the toilet.
Pain which is chronic in nature and comes and goes. It is usually associated with bloating, often after eating, and is crampy in nature. People sometimes describe that it is made better by going to the toilet.
If you can eat and drink as usual, even with the pain, then it is less likely to be something serious going on with your intestines. It can be a helpful indicator as to how serious the underlying condition causing the pain is.
If you have been unable to eat or drink anything, because it makes the pain worse, or you are vomiting, then you will probably need blood tests and further investigations.
Some conditions are associated with vomiting more than others, such as pancreatitis and bowel obstruction whereas, conditions like appendicitis is less associated with being sick.
This is really important. If you have watery diarrhoea, this could mean that you have an infection in your bowels.
Pancreatitis can cause smelly diarrhoea with yellow lumps, known as steatorrhea.
If you haven’t been to the toilet for a week, perhaps the pain is caused by constipation. It could also mean that you have a bowel obstruction.
Another important thing to tell your doctor is if there is any blood in your stools. Most of the time, this symptom is caused by something which isn’t serious, like piles, but it could also be a sign of other serious health conditions.
If you are experiencing abdominal pain, it can be difficult to tell how serious the problem is. Should you wait and see your GP, or should you go to A&E?
If you are currently experiencing abdominal pain which is new for you, and are not sure what to do, call NHS 111.
There are some things which should always prompt you to seek help. If you or someone you know are experiencing any of these symptoms, then you should immediately call 999:
The kind of tests your doctor will do depends on what they think might be wrong. The first thing everyone is likely to get are blood tests. These can be pretty non-specific when it comes to abdominal pain. For example, if you have appendicitis, then the only thing your blood tests will show is that you might have an infection somewhere.
If, however, the problem is in your liver, then your liver tests might be abnormal. For certain diseases, like coeliac disease, there may be a specific blood test which can be done to help with the diagnosis.
If you are a woman of childbearing age, you should always have a pregnancy test, and most people will have their urine checked for infection.
There are plenty of other tests which your doctor may, or may not, feel that you need, and these include:
If you have chronic diarrhoea or chronic pain, then your GP might send a sample of your stool for testing. Tests look for infections, or specific tests can be done for things like inflammatory bowel disease*.
* Inflammatory bowel disease is a group of conditions which cause chronic inflammation of the bowel. They include Crohn’s disease and ulcerative colitis.
This is also known as a 'jelly scan'. It is the same scan that pregnant women get to check their babies, but it can also be used to look at several other different things. For example, ultrasound can be used to look at your gallbladder to see if there are any stones which could be causing pain. It can also be used to look at the ovaries or testicles, to look for problems there.
This is where a camera is inserted through your back passage and into your colon. If you have had bleeding, it can be used to look for where the bleeding is coming from. It is also used to look for inflammatory bowel diseases.
If an abnormal area of the bowel is found, biopsies can be taken which are sent to the laboratory for further testing. This can be used to find early cancers and definitively diagnose Crohn’s disease or ulcerative colitis.
This is like a colonoscopy, but this time, the camera is inserted through your mouth instead. The camera then travels down to your stomach and can look at the first part of your bowels for things like stomach ulcers.
CT scanners use radiation to take pictures of the inside of your body. They can show some conditions very well, like kidney stones. The scans aren’t very good at showing things like small tumours, such as those around the pancreas.
If you go into hospital with new, severe abdominal pain, are very unwell, and your doctors aren’t sure about what is going on, this is likely to be the investigation they use to look for the problem.
Some people will have abdominal pain which is either there all of the time or comes and goes. If you have had pain like this for over 6 months, it is classed as chronic abdominal pain. If you have not already, you should see your GP to make sure that there isn’t a serious underlying health condition.
Chronic abdominal pain can be frustrating because, frequently, people feel as though they never get an answer. The longer someone has been suffering with abdominal pain, the less likely it is that any test will come back showing an abnormality.
Treatment will likely be painkillers to manage the pain. Some people will benefit from making lifestyle changes, such as eating more fibre and losing weight.
Photo by EtiAmmos on iStock
There are various UK based charities for a number of different medical conditions which affect the abdomen. For example, Crohn’s and Colitis UK is a charity dedicated to people with inflammatory bowel disease.
For people without a firm diagnosis, Guts UK is a charity dedicated to helping people with any kind of abdominal condition. You can contact them online for support and information.
Photo by Pixabay from Pexels
Medical terms are often baffling and difficult to fully understand. To help, we have listed some frequently used terms below.
Abdomen – the part of your body between your ribs and your pelvis. It includes everything in the front part of your body, between these two borders
Appendicitis – your appendix is a small piece of bowel which sits in the lower right part of your abdomen. When it becomes inflamed or infected, this is known as appendicitis
Hepatitis – this is where you have inflammation of your liver. This could be due to infection, drinking too much alcohol, or even certain drugs
Hernia – a condition where one part of your body moves into a different space that it would not normally be in. For example, when your gut pokes out of your abdomen, this is a hernia. You could also have a 'hiatus hernia', which is where your stomach pokes out of your abdomen into your lung. Hernias are often not emergency conditions and don’t need immediate management. If, however, they cause severe pain, then you should call NHS 111
Piles – also known as haemorrhoids. These are dilated blood vessels sitting around your back passage. They can be on the outside, or on the inside, and can bleed or be painful
Pneumonia – an infection on the lung
