Rectal bleeding can be due to piles or a fissure but may be a serious problem like a cancer. You should consult your doctor...

Pain in the Gut

Sorting out 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.

  • These comments below are simply a start to a process that may need specialist advice as well as your family doctor.

  • The diagnosis still depends heavily on a careful history by an experienced doctor.

  • High-tech imaging is only a back-up - not an easy way out!
  • 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.
    • suggests a problem with the oesophagus.
    • Relief by not eating could suggest a "blockage" of the intestines.
    • Abdominal pain may be affected by postural change, passing urine, changes with the menstrual cycle, may be associated with vomiting, may be aggravated by deep breathing or cough, stretching of the legs.
    • These are all potentially important features of the pain that can give clues to the cause.
  • Abdominal pain that is of sudden onset and severe requires urgent medical attention  will not be covered here.
  • Abdominal pain that comes and goes and is of mild to moderate severity can be from wide range of causes.

  • The position of the pain in the abdomen helps to some extent.
    • Upper abdomen – related to meals - may be reflux heartburn or peptic ulcer (related to Helicobacter infection).
    • Right side - under the right ribs - through to the back - could be gallstones or rarely pancreatitis.
    • Lower abdomen particularly left--sided pain  – some association with variable bowel habit or better after passing bowel motion - could be irritable bowel, diverticular disease, constipation.
    • Pain associated with new onset of diarrhoea might be due to inflammatory bowel disease particularly if there is blood or mucus with the bowel motions.
    • Pain that seems to come from the back or is aggravated by changes in posture might be muscle strain, referred from the spine or due to nerve entrapment.
    • Pelvic or lower abdominal pain may be related to diseases of the uterus and ovary (gynaecological problem).
    • Kidney disease and kidney stones may cause abdominal pain or back pain - usually one side or the other rather than midline.

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