Abdominal pain

Sorting out abdominal pain is often a challenge for the doctor and patient. No amount of reading material can give an accurate self-diagnosis.

The diagnosis depends heavily on a careful history by an experienced doctor. Different parts of the abdomen do give a "signature" with particular types of pain - but sometimes the distinction can be subtle. Pain is a subjective experience and can be difficult to describe but a good description is the beginning of solving the problem.

The onset, progression and duration of symptoms give important clues. The abdominal contents are dynamic and subject to change. The relationship of pain to meals, passing bowel motions or passing flatus is important.

Abdominal pain may also be affected by postural change, passing urine, changes with the menstrual cycle. An association with vomiting or aggravation by deep breathing or cough may be important observations.

Abdominal pain that is of sudden onset and severe requires urgent medical attention.

Abdominal pain that comes and goes and is of mild to moderate severity can be from a wide range of causes. The position of the pain in the abdomen helps to some extent. The following are some examples:

• Pain in the upper abdomen that is related to meals may be due to reflux (heartburn) or peptic ulcer (related to Helicobacter infection).
• Pain in the right upper abdomen could be due to gallstones or rarely pancreatitis.
• Pain in the lower abdomen, particularly left-sided pain, with some association with variable bowel habit or better after passing bowel motion - could be due to irritable bowel syndrome or diverticular disease.
• Kidney disease and kidney stones may cause abdominal pain or back pain - usually one side or the other rather than midline.