Hi, My name is Sophie. I am a certified health coach with JH. I coach people towards a whole range of health goals. Today I’m going to explain stomach & abdominal pain, which is a common problem in our life.
Abdominal pain largely indicates our daily habits, lifestyle, eating habits, and mental condition. Most of the abdominal pain depends on our food habits and mental health. Our brain is the primary driver of our body, like the abdomen and stomach. If you are stress or overthinking, your brain fails to deliver the proper digestion signal and others.
On the other hand, our food habits primarily affect our abdomen and create abdominal pain frequently. Our stomach has several kinds of rules for working correctly. So if you break the rules, you must feel the pain, which is stomach or abdominal pain. Now I explain the full guidelines with abdominal pain causes, types, identification, and prevention process. Let’s start our abdominal class!
How abdominal & stomach work?
The role of the stomach is to break down the food that you eat. The stomach will primarily break down the protein and extract the minerals when carbohydrates hit the stomach. The amylase enzymes have already worked on them in your mouth, and also, the belly is tasked with killing off bacteria and viruses from getting into your system.
- Now to break down your food and kill off any potential bacteria, these stomach needs to be very acidic in terms of pH levels. It needs to be in the range of one to three. If your stomach acid is any higher than this, it won’t trigger the liver to release bile. Now boil is the thing that is going to help you break down these fats and also extract the fat-soluble vitamins.
- It also helps you absorb fatty acids, and just remember the liver produces bile. The bile was thought in the gallbladder, and all of this is responsible for fat metabolism in the body. So if your stomach isn’t acidic enough, then the liver won’t release enough oil, and then you can potentially become deficient embalm.
- This is one of the primary mechanisms that will trigger bloating symptoms, but we will get to this shortly then we have the pancreas. And the pancreas’ role in the body is to produce enzymes, and the enzymes are types of proteins that will help you break down your food.
- So you have specific enzymes to break down carbs, fats, and proteins, so the stomach and liver, and gallbladder all work together to break down the food before it is sent to these small intestines where the gut microbiome further breaks it down. All of the other different types of microbes in your gut, so again, just to reiterate.
If your stomach isn’t specific enough, the liver won’t release enough bile, and your pancreas won’t release sufficient quantities of digestive enzymes. So then you’re going to have a lot of undigested food hitting your small intestines, and in this scenario, you will be getting a lot of bloating constipation, in my suggestion.
What causes abdominal pain?
Stomach pain is pretty broad and can originate from many different causes. One main reason is the stomach itself, where the organ is blocked and backed up. And it doesn’t move like open and close.
Sometimes the nerves get pinched as well and can also leave you in a cramped feeling. That’s no fun, and sometimes even the spine is compressed and can give you those symptoms as well. Whatever the reason, it’s not fun.
When we look at our abdomen, many structures or organs are associated predominantly with the digestive system. If we were to break up the abdominal cavity into nine regions, we could locate particular structures or organs within each specific area.
For example, at the top right, you’re going to have the liver and the gallbladder, and right at the very top, you will have the stomach and pancreas. Then the top left, you’re going to the stomach, pancreas, and spleen.
- Right in the middle, you’re going to have the majority of the small intestines. And a little bit of the transverse portion of the colon. Then towards the bottom right, you’re going to have where these small intestines turn to the large intestines. So this includes the appendix.
- Then right in the middle and towards the right, you’re going to have a sending colon transverse colon and then descending colon towards the left. And then it turns into the sigmoid colon. You can see this is basically how it broke up into these nine regions.
Appendix pain: The way that these structures manifest their pain depends on their embryological development. You can see the appendix while it may sit down in the bottom right area. When you first get appendicitis or appendix-related pain, it tends to present itself.
Visceral pain: As though it’s coming from the umbilical region. Why because of its embryological development being the midgut in the central area. So that is called visceral pain.
Colicky pain: The other thing is some of these structures are hollow. Some of them are solid. Now, these hollow structures are going to be filled with liquids and gases. And they need to be moving around. They move around because the muscles surrounding these tubes contract and relax now often. The pain associated with hollow organs in the abdomen is called colic.
It’s a colicky pain, and it’s intermittent. It’s coming and going, and it’s because the muscles are surrounding something that’s eliciting pain. Also, it could be some obstruction. It could be a mass of some sort, but now this can even happen in the kidneys. When the ureters of the kidneys surround a stone, and it causes this colicky pain again. It could happen in the intestines if there’s an obstruction.
- Pain can be elicited if some blood accumulates or the mass is putting some kind of pressure on and again when this visceral pain presents. It’s often quite diffused and hard to localize as I said, you would often say it’s upper abdomen, mid or lower abdomen.
- When appendicitis starts to manifest, though, you can now feel it as though. It’s the bottom right area. This is usually now the inflammation is spread to the wrapping around the entire around the digestive organs. So this wrapping is called the peritoneum. Once that starts to get irritated in particular areas, you can more specifically localize where this pain is coming from is called somatic pain.
- You have the visceral pain from the organs relatively diffuse intermittent, and then you’re going to have the somatic pain, which is the inflammation of the peritoneum. The wrapping that’s more direct in more localized, and then the third is referred to pain, which is where. So referred pains difficult where a specific pain comes from a particular structure. But your brain interprets results coming from somewhere else.
For example, a myocardial infarction is a heart attack of the heart’s lower part. As though it’s coming from the epigastric region like heartburn. Sometimes you can get hip pain, and it manifests. It’s coming from areas within the lower abdomen. Sometimes diaphragmatic issues can present as though. It’s coming from the shoulder.
So this is all referred pain the reason why is because different structures actually up into the spinal cord at the same level. And when it goes to the brain, the brain has difficulty knowing which structure came from what pain a signal came from what particular structure. So this is abdominal pain.
Some common bad habits for stomach pain are given below:
- Dehydration or lack of drinking water.
- Poor sleeping habits a trauma itself.
- Overthinking and irregular food habits.
- Too much eating and junk food.
- Lack of exercise and laziness.
Types of abdominal pain
There are three types of pain. They are:
- Somatic pain.
- Visceral pain.
1. Somatic pain: Somatic pain has a somatic nerve that innervates the organ appropriately. When it gets hurt, the organ tells the nerve I’m injured that type of pain is pinpoint. You can easily localize it, and it’s what happens when you get a laceration or burn. Somatic nerves innervate your skin.
2. Neuropathic pain: Neuropathic pain is where the person is innervated has no problem, but the nerve is damaged. So the nerve is telling the brain that there’s pain even though there’s nothing wrong. This is usually in the way of tingling or burning. Think for diabetic neuropathy or radiculopathy.
3. Visceral pain: The visceral organs don’t have their somatic nerves. So when the visceral organs get injured, they hijack the somatic nerves. So when an organ in the abdomen feels, the patient will experience that pain on the skin or abdominal wall above the organ embryologic origin. You must remember the embryologic source.
Visceral organs, especially the hollow ones, experience pain when they become:
There are three types of Visceral pain. They are:
1. Obstructive: Obstructive abdominal pain is colicky. You have at a low two-bit obstructed peristaltic wave is coming. It hurts more and as the peristaltic wave passes by the obstruction. The pain is alleviated, thus colicky, because there is no inflammation.
It’s only an obstruction. You have no fever and no leukocytosis. When that pain comes, it’s not because of contact with the perineum. The patient is going to attempt to find a position of comfort. They’ll be restless, but they’ll find no comfort in moving.
2. Inflammatory: This real pain is when that colicky pain becomes constant, and now there is inflammation. You’ll see a low-grade fever and an elevation in the white blood cell. This pain will be restless as well, but they’ll find no position of comfort using the cholelithiasis and never lettuce. Pyelonephritis solid organs can also become inflamed, which is why pancreatitis hurts.
3. Perforation: If the inflammation goes on long enough or has a different diagnosis, it can rupture. But a hollow viscus perforation causes contents of whatever was in the tube to spill out into the abdomen. The peritoneum does not like being touched by anything but the organs themselves, stool air, blood.
It doesn’t matter the peritoneal wall feels pain and the peritoneal wall is has somatic innervation. When anything touches it, they hurt a lot, and perforations present sick as there will be a very high fever and a very high leukocytosis.
Abdominal pain is not all created equal. There are different ways that patients will explain pain, and it all has to go back to embryology. So it all has to go back to how the organ is developed.
There are two common types of pain signs. They are:
1. Parietal pain: Parietal pain is due to stretching or irritation of the parietal peritoneum. So that’s the lining of the parietal purge of the peritoneal cavity. This pain is generally sharper. So it’s more like a sharp or stabbing kind of pain than the referred pain.
2. Referred pain: Referred pain is felt at a site far from the diseased organ. The classic thing when we think about referred pain is gall bladder pain felt in the right shoulder. So when someone has cholecystitis or potentially biliary colic, that pain may radiate to the right shoulder.
How to examine abdominal pain?
Before examining the abdominal pain, you need to follow 5 steps. You should follow these step by step to identify the abdominal pain correctly. Here are the 5 steps:
Step 1: The physical exam is vital signs. Sometimes it can be comfortable that one may be overlooked a little bit but having an accurate temperature, reading blood, pressure reading pulse oximeter, a heart rate, and a respiratory rate. All will benefit you in this situation, and you want to make sure you’re paying attention to all of those vital signs.
Step 2: When someone comes in with respiratory distress, there’s a lot of information by looking at them. If they’re laying still, that could potentially indicate that they have peritoneal signs that moving around might make their pain a little bit worse. If they are restless, that might support renal colic or a kidney stone diagnosis. Classically those are very restless.
Some people also aren’t very good at remembering what procedures. They’ve had on their abdomen. They say no, and then you look at their belly, and there are lots of scars. Suppose you see surgical scars or look in the medical record to try and figure out what happened.
Surgical scars are becoming harder and harder to notice, especially with more and more people getting laparoscopic surgery. Those laparoscopic surgical scars are minimal and are often try to do in less noticeable areas. So one classic place is just around the umbilicus, and those can be a little harder to pick up on.
Step 3: Listen historically. Everyone’s taught to listen before you palpate. So we’ll go ahead and go with that for now, you want to listen for two minutes, and you’re listening for bowel sounds.
If you don’t hear any bowel sounds after a full two minutes, the patient does not have bowel sounds. So make sure you’re listening for that appropriate period and hearing if the bowel sounds are overactive, underactive, not present at all, or potentially in the normal range.
Step 4: It is palpation. You want to start in the area away from the pain. So if the pain is on the right side in the lower abdomen, go ahead and start on the left upper abdomen and then work your way around to that area. You’re going to want to palpate lightly and then go ahead and push a little more deeply depending on the exam you’re getting for the patient.
Step 5: When you’re palpating, you also want to go ahead and assess for rebound tenderness. So rebound tenderness is pain that occurs when you let go. You push down on the abdomen, and when you release your hand, I tell people to try and focus.
Does it hurt more when I push down, or does it hurt more when I let go rebound? Tenderness is that you can sometimes shake the bed. This was a tip that I learned actually when I was a medical student.
There are some additional examiners and signs that you want to think about doing.
Murphy’s sign: It is taking a closer look at the gallbladder or indicating. If there’s a disease in the gallbladder for cholecystitis and what you do in that situation, you feel in the right upper quadrant.
And when you’re palpating deeply in the right upper quadrant, the patient stops inspiring, and that’s indicating that that pain is so severe or intense or localized to that area that the patient will stop encouraging.
This can be done on a physical exam and can be done during an ultrasound exam. So when you’re doing the ultrasound for the patient, you can see if they have a positive Murphy’s.
Palpate aorta: The other thing you can do, generally done in the abdomen’s center, is to palpate the aorta. You want to think about a triple-a in older patients.
So as patients are older is when this disease process generally does start to develop. You want to go ahead and feel in the center of the belly and see for those patients. If you feel any enormous palpable mess, anyone’s skinny younger people, and you actually may be able to feel their aorta. Because they’re generally slim and more youthful, and you’re able to feel it in the center of their abdomen.
Psoas, Obturator, and Raphson sign: Those are indicative of appendicitis. The other things to focus on are our agenda urinary exams. The testicular exam and the pelvic exam. The testicular exam is essential for the patient. He or their concern may not necessarily be able to report to you whether they’re having testicular pain accurately.
In the pelvic exam, I always tell women when they come to the IDI with abdominal pain that they’re quite tricky because, in addition to having your intestines and the normal stuff in your belly.
You also have your reproductive organs, so you have the uterus and the ovaries. And those are sometimes a source of pain. So doing the public exam for all women who have uterus and ovaries is key when presenting abdominal pain.
You don’t want to miss a pelvic infection or some ovarian mass presenting in that way. You also want to look for any extra-abdominal findings, which means the herpes zoster rash was discussed.
It means listening to the patient’s lungs and seeing if there’s any concern for pneumonia, looking at the respiratory rate, and seeing if the respiratory rate is elevated might make you support diabetic ketoacidosis.
How to know if abdominal pain is serious?
The first thing to do when they develop abdominal pain is to characterize the pain type. There are 3 things that you should look for the doctor.
1. Number one is what type of pain is it? Is it a dull, achy pain that is constant? Or is it more of a sharp stabbing pain that comes and goes?
2. Number two is you should realize where the pain is arising from. Is it in the upper part of the abdomen, the lower part of the abdomen, the abdomen’s right side, or the left side? Because the abdomen has multiple different organs, and as such, any organ can cause abdominal pain.
So if you recognize the pain location, you can identify the origin of the pain and give you information if you need to seek medical attention.
3. Number three is you have to know if the pain is associated with any other symptoms. Typically, abdominal pain is associated with other nonspecific symptoms like nausea, vomiting, diarrhea, constipation, and you feel bloated, you might have a little bit of indigestion.
So if any of these symptoms are associated with it, you have to consider it.
Prevention of abdominal pain
Your regular habit and food habit is the key to preventing abdominal pain. Here is some advice that helps you to relieve it.
- Firstly, you can take one or two tablespoons of apple cider vinegar before each meal to increase your stomach acidity. This will help improve the amount of bile and pancreatic two enzymes being released. And if it’s purely a stomach issue, then taking apple cider vinegar and increasing your stomach acid will trigger the swing too close. It will help alleviate your GERD and reflux type symptoms.
- Now what you can also take after each meal is a bottle supplement because you can find that when you start increasing the stomach acid with apple cider vinegar. It takes a while for the liver and gallbladder to stop motoring. Especially if you’ve had digestive issues for a1, so if you take a supplement, this can help the gallbladder until it can stand on its own two feet. And finally, you can take a digestive enzyme supplement before each meal, which will give your body a boost to help further break down your food.
- You need to drink lots of water throughout the day to help with this overall process next up. Don’t drink water too much that you feel uneasy. Drink water after 1-2 hours and avoid drink before and after meals for at least 30 minutes.
- You have to exercise daily and keep your health running. When you run or move, your abdomen or stomach also gets the energy to move fast. When it moves fast, then it breaks down the food quickly and make good digestion.
- Avoid junk food or street food. Eat homemade food. If you eat fatty food, then exercise to burn it properly because the stomach can not burn fatty food quickly.
I already make an article to stop stomach pain naturally with the explanation. Please read it and make your stomach healthy.
Frequently ask question
If you have an overpopulation of harmful bacteria in your guts or even good bacteria that migrates into your small intestines and area, you’d have very minimal bacteria. Then what can happen is that the food starts to ferment in your school intestines instead of being correctly absorbed. This fermentation of food is caused by a condition called small intestinal bacterial overgrowth or SIBO.
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Dickerson, Lori M.; Mazyck. “Premenstrual Syndrome.” American Family Physician.
National Institute of Allergy and Infectious Diseases. “Food Allergy An Overview.”
Levitt MD, Furne J, Aeolus MR. “Evaluation of an extremely flatulent patient: case report and proposed diagnostic and therapeutic approach.”