Abdominal Pain

Please note that before reading my suggestions, see your doctor and this website is not a substitute for medical advice. Especially for abdominal pain, which requires a consult with a health care provider.

There are many causes of abdominal pain. See below for Diverticular disease – common over the age of fifty.

Red flags for abdominal pain – weight loss, vomiting, waking in the middle of the night because of abdominal pain, fever, blood in the stool, diarrhoea, constipation not responding to fibre or stool softeners.

Irritable bowel disease is common and the cause unknown. Some people have celiac disease or a fibromyalgia kind of problem. Fibromyalgia. Adjusting your diet can help. Upper irritable bowel can give you heartburn, nausea, reflux. Lower irritable bowel upsets the colon. You could try a FODMAPS DIET. 

Diverticulosis or diverticular disease is a problem in your colon that can cause diarrhoea, bloating, and/or pain. This problem needs to be assessed and managed by your doctor. Below is a video explaining diverticulosis. If my patients have a low grade diverticulitis, no fever, almost no abdominal pain, just diarrhoea for a day or two and they suspect it’s their diverticuli, I suggest fluid diet, clear fluids or meal replacement liquids for a day or two and if it improves, then a soft diet to calm the bowel for another day or two. 

Pancreatitis

Chronic pancreatitis is extremely painful and difficult to treat. Surgeries like distal pancreatectomy or lateral pancreaticojejunostomy can have long term side effects. 

ERCP – endoscopic retrograde cholangiopancreatography – basically as scope (camera) from your mouth down your throat and through the hollow of your stomach and upper small intestine – can be used to:

remove stones in ducts

and even used to treat strictures (scarring) in your ducts (sphincterotomy)

 Some surgeons will use ultrasound to perform celiac (nerve) blocks. 

Gall bladder disease is common. Gallstones don’t always have to be removed. Often they can be watched. Be careful for symptoms like nausea. Vomiting, yellow eyes or yellow skin and fever and severe abdominal pain need to be seen urgently. Sometimes the gall stone can lodge in the bile duct. 

Below is a link with a good diagram. The liver has ducts draining into the common bile duct and if this gets blocked it can be very dangerous and affect the functioning of the liver. Liver Disease and picture of the gall bladder

A commonly underdiagnosed cause of lower abdominal pain, even pain higher up, is endometriosis. Here is a good video to watch.

If a stone moves up into the common bile duct, or blocks pancreas drainage you can get very sick. If you have fever, yellow eyes or skin, severe nausea or vomiting, see a physician urgently.

Acid reflux is very common. Symptoms: pain behind breast bone; can feel acid coming up to the throat. You can have a cough or feel nausea or queasy; vomiting is a red flag – see specialist. Also loss of weight is a red flag. 

Smoking can cause GERD – Gastroesophageal Reflux disease. Smoking weakens the sphincter – muscles of the diaphragm which close the stomach from the esophagus. Smoking causes inflammation and poor healing. If you have GERD, smaller meals are better, healthier. We used to say, sleep with the bed elevated – that doesn’t often help. Usually less stress is better. Stress produces acid and inflammation. If you have a lot of abdominal fat, that can cause some pressure. A little chubby doesn’t make that much difference. 

Damage – strictures – which make the food difficult to swallow – red flag. Very very rarely does it ever cause cancer. 

Antacids can help. If you use too many, you may need another medication, like famotidine or proton pump inhibitors. They do have long term side effects, but untreated severe inflammation in the esophagus can lead to complications – damage – as mentioned above. Weigh risks. 

Quitting smoking – try Alan Carr and other techniques. Lifestyle

Symptoms need to be treated. In the ‘olden days’ we used to scope – camera down the throat into the stomach – used to scope everyone. But now we treat you with meds and if the symptoms go away easily, then you usually don’t need a scope unless you have red flag. Again – consult with your health care provider. 

I usually suggest full treatment until the symptoms are completely resolved. After a while, you can take PPI’s – proton pump inhibitors like pantoprazole, omeprazole, all the oles – can take them every other night. If no symptoms, then every 3rd night, until finally not taking them. Wean slowly or you get rebound GERD.