The many nerve interconnections in the abdomen and adjacent organs mean that not only pain of the actual abdominal organs such as the stomach, intestines, gallbladder, pancreas or female reproductive organs are localized in the abdomen, but also diseases adjacent to the abdomen:
- Above the diaphragm, which is the natural boundary between the abdomen and chest, for example, a heart attack, pleurisy or esophagitis with heartburn can cause abdominal pain in the upper abdomen.
- Pain that actually originates in the spine or back muscles can also manifest in the upper and middle abdomen.
- On the side of the abdomen, pain is common, originating from the kidneys, and in the case of pain in the
- Middle and lower abdomen must be considered in older people, in addition to intestinal, ovarian or uterine problems, aortic outpouching (aneurysm).
Pain originating from the abdominal organs must also be examined closely, because although it is often possible to narrow down the painful area, but due to the close positional relationship of the organs to each other, a clear assignment to a particular organ fails. For example, pain in the upper abdomen can originate from the gallbladder or – because of the stomach, the small intestine – as well as from the pancreas or the large intestine. Without further examination methods, a diagnosis is not possible.
How can the causes of abdominal pain be narrowed down?
With a careful palpation examination, the pain can often be narrowed down. With certain hand movements, the pain can be intensified, for example, in acute appendicitis. In addition, a thorough medical history provides information about the organ from which the pain most likely originates. For example, some pains occur in relation to food intake – in the case of gallbladder complaints, pain occurs after eating, and in the case of a stomach ulcer, the pain is often worse when the patient is fasting.
The type of food can also provide clues: pain after high-fat meals suggests problems with the gallbladder or pancreas. Stool behavior, e.g., diarrhea, constipation, stool color, is also helpful, and a stool examination for blood or infectious agents can rule out an intestinal tumor or gastrointestinal infection, for example.
Abdominal pain in the elderly
The age of the affected person also plays an important role. While abdominal pain in children may be a very common and nonspecific symptom of even a flu-like infection or headache, other conditions must be ruled out in elderly patients:
- In someone with known cardiovascular disease, for example, a heart attack or aortic aneurysm,
- In patients known to have a “sensitive” stomach, perhaps a food intolerance, as this can worsen with age,
- In middle-aged people with new onset of frequent abdominal pain, also an intestinal tumor.
Abdominal pain: further investigations
These initial results will prompt the doctor to conduct further investigations. A blood test can clarify whether there is inflammation in the body and whether, for example, the liver, gallbladder or pancreas are involved in the disease process, urine examination will check the kidney and draining urinary tract. Ultrasound shows changes in the liver, gallbladder and ducts, pancreas and kidneys. Even some intestinal diseases can be detected with today’s ultrasound equipment.
X-rays and, above all, endoscopic gastroscopy or colonoscopy are used to track down diseases in the abdominal cavity. If a gynecological disease is suspected, the internal genital organs are palpated and examined with ultrasound. If heart disease is suspected, an ECG and ultrasound examination of the heart are usually helpful.
If the pain can neither be triggered by hand movements nor is related to food intake, muscle tension or spinal problems can be clarified with functional movement exercises. If all methods fail to find an organic cause for the abdominal pain, irritable bowel syndrome may be present.
