My son woke up this morning and for the 7th time this month complained of abdominal pain. The nurse in me takes over and immediately I run through a list of abdominal pain symptoms that I worry about. Where is the location of the pain, how long has he been in pain, is the pain sharp or dull, does the pain come and go or is it constant, is it severe pain or mild pain, does he have a fever, is he doubled over or moving easily, when was his last bowel movement, what did he last eat, does he have nausea, etc, etc. Of course, it doesn’t take a nurse to do that, any parent worried about their child will come up with that list all by themselves. But, when it comes to abdominal pain, it is a good idea to know what you are looking for.
Even though my son has complained to me several times this month that he has a “tummy ache” and in my head I know he just wants to stay home from school, I still run through that same assessment routine. Why? Because sometimes abdominal pain symptoms can be severe and life threatening. So, I make sure my son is full of baloney before I dismiss his complaints.
Why am I having abdominal pain?
Abdominal Pain, like most pain, is a symptom. It is a red flag that something is going on inside our bodies. The question is, what? What could it be that is causing that pain.
There are three main reasons why someone might be having abdominal pain:
- Inflammation: Examples of inflammatory conditions which might cause stomach pain are appendicitis, diverticulitis or colitis.
- Stretching: Stretching of an organ such as the colon during a blockage, distension related to gas, swelling of the liver with hepatitis, or gallstones blocking and stretching the bile duct, or uterine fibroids stretching the uterus.
- Poor Blood Supply: Ischemic colitis is an example where blood is not flowing to part of the bowel and the tissue begins to die.
There are other additional causes of abdominal pain that are not related to inflammation, stretching or poor blood supply. For example Irritable Bowel Syndrome, for which a cause has not been found. Muscle spasms or spasmodic colon can also cause severe discomfort.
What signs should I look for?
The question is really when should I write my child’s complaints off as hooey and send them packing their books back to school or when should I call the doctor because he or she has symptoms to worry about. There are some signs to watch for:
- Fever: Fever accompanied by a stomach ache is an indicator of inflammation and/or infection. This is potentially a serious event. Often an indicator of colitis or appendicitis.
- Diarrhea: Diarrhea can be contributed to any number of factors including diet. When assessing diarrheal symptoms first look at what you have eaten and then look at associated symptoms such as fever, blood in the stool, nausea, etc. Sometimes loose stools will pass uneventfully (sorry for the pun) and other times it persists. Watch symptoms closely to determine whether symptoms warrant a call to your doctor.
- Blood in the stool: Blood in the stool can look different dependent on the location. You may see bright red frank blood or dark tarry stools. Either symptom could be a serious disease resulting in a GI bleed, cancer, or trauma.
- Vomiting: vomiting could mean that there is an intestinal blockage. Vomiting accompanied by diarrhea could be an infectious problem such as food poisoning.
- Guarding/doubling over: These behaviors are representative of severe pain.
- Right lower quadrant pain: often an indicator of appendicitis.
- Left lower quadrant pain: often an indicator of diverticulitis.
- Is the pain worse with movement: pain that is worse with movement is often a sign of an inflammatory process like appendicitis or pancreatitis. People suffering from an inflammatory process prefer to stay still and avoid things like sneezing, coughing or jostling.
- Persistent unrelieved abdominal pain or associated symptoms.
- Fever of 100.5 or greater associated with abdominal pain of any kind.
- Guarding or doubling over is a sign of sever pain and your doctor should be notified immediately.
- Any time there is blood in the stool.
- Persistent nausea, vomiting and/or diarrhea
- Any time you are unsure or in doubt, call your doctor for further orders.
Diagnosing Abdominal Pain
Abdominal pain is often difficult to diagnose. As you can see from the above list there are many variant symptoms that mean many things. There are tests you doctor may prescribe to find the cause of your abdominal pain. Colonoscopy and Endoscopy are the two most common tests that your doctor may order as well as fecal samples for lab evaluation. Most often, abdominal pain is transient and will quickly resolve. However, persistent symptoms could be serious and any complaints of abdominal pain should be watched closely. All abdominal pain symptoms are something to worry about….even if it is your 9-year-old son who is trying to get out of going to school!