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Chronic Abdominal Pain

Everyone child or adult, male or female experiences abdominal pain at different times of life. Many other terms which are used to express abdominal pains are stomachache, bellyache, gut ache, tummy ache etc. Abdominal pain may be severe or mild, continuous or episodic, short-staying (acute) or long-staying (chronic). It is better not to ignore any abdominal pain of significant intensity or duration and seek medical help rather than take over-the-counter symptomatic treatment

What are the causes of chronic abdominal pain?
Abdominal pain has various potential causes. Some of them are common like indigestion and food poisoning which isn’t serious and can be treated with simple medications. Some of them are acute and some are chronic. Chronic abdominal pains are often difficult to treat.
Various causes of chronic abdominal pain in children are

  • Constipation
  • Lactose intolerance
  • Gastroesophageal reflux disease (GERD)
  • Celiac disease
  • In case of adults
  • Gallstones
  • Endometriosis
  • Gastroesophageal reflux disease (GERD)
  • Enlarged spleen
  • Gastritis
  • Inguinal hernia
  • Peptic ulcer
  • Ulcerative colitis
  • Sickle cell anemia
  • Irritable bowel syndrome
  • Ovarian cysts
  • Pain related to ovulation
  • Pelvic inflammatory disease (PID) of the female

Symptoms of progressive abdominal pains which steadily over time become more serious are:

  • Hepatitis
  • Crohn’s disease
  • Lead poisoning
  • Enlarged spleen
  • Liver cancer
  • Stomach cancer
  • Gallbladder cancer
  • Pancreatic cancer
  • Kidney cancer
  • Uremia (due to kidney failure)
  • Tubo-ovarian abscess

When to see doctors for chronic abdominal pain?
Patients with chronic abdominal pain may develop following general signs and symptoms:

  • Severe pain with or without fever
  • Continuous nausea and vomiting
  • Blood in stool
  • Yellowing of skin and eyes
  • Swelling of belly
  • Pain sensitivity of the abdomen when you touch it
  • Loss of appetite
  • Loss of weight

You should not think twice to consult with your doctor when you are facing any of the signs and symptoms.
Approach to chronic abdominal pain
The Doctor first takes the medical history of the patient with chronic abdominal pain. He takes on record as regards dietary habit, bowel habit, constipation if any, urinary symptoms, vomiting or nausea tendency, diarrhea, tolerance to milk or milk products, drugs used for any previous pain or abdominal surgery to assess the root cause of the pain. The Doctor also clinically tries to understand whether there is any a mass, tender area or enlarged organ in the abdomen. The Doctor checks the skin and eye whites whether they have turned the color to yellow or there is any swelling or rash in the legs of the patient. Then he suggests for some medical investigations to check the blood in the stool, urine analysis, the blood test to evaluate how the pancreas and liver are functioning, complete blood cell count etc. If a patient is over 50, sometimes a colonoscopy and even computed tomography are recommended. Additional tests and investigations are required when any of the tests fail to identify the exact cause of abdominal pain.

What are treatments for chronic abdominal pain?
Treatment always depends on the cause.Most cases of chronic abdominal pain can be treated medically.Certain problems need surgery. If it is found that the patient is intolerant to lactose, a lactose-free diet is suggested. If a patient is constipated a laxative for few days with fiber-rich food is suggested. If the pain is triggered by anxiety and stress, a doctor may prescribe drugs to reduce anxiety.

Authored By Dr G Parthasarathy - Surgical Gastroenterologist, Hyderabad