Introduction
Abdominal pain can have many different causes. The causes of abdominal pain can be found in the abdomen itself, outside the abdomen or even in the mental state of the patient. If the abdominal pain occurs only or mainly at night, then the psychological condition of the patient is probably not the main cause, but physical causes are likely.
Causes of nocturnal abdominal pain
Abdominal pain at night can have quite harmless causes, but abdominal pain at night can also have causes requiring urgent treatment, including appendicitis, biliary or renal colic or HELLP syndrome in pregnant women. – Flatulence,
- Constipation,
- A food intolerance or
- Too big a dinner the day before. Even though abdominal pain in children is a rather unspecific and usually harmless symptom, severe nocturnal abdominal pain, from which the child wakes up or because of which it cannot fall asleep at all, should be taken seriously.
If a fever occurs at the same time, an inflammatory cause is likely. Appendicitis is often the cause of sudden and severe stomach pains at night. The typical abdominal pain in appendicitis begins around the navel and then moves to the right lower abdomen.
The pain is very severe, and smaller children also cry because of it. A test for home is to let the child bounce on the right leg. Children with appendicitis have a lot of pain or will not want to jump on the right leg at all.
If you suspect that your child has appendicitis, you should go to the doctor quickly to have the child examined. Of course, children may also have other reasons for stomach pain at night: Flatulence, stomach flu, urinary tract infection, constipation are just a few examples. Abdominal pain during pregnancy, which can occur at night, can have various, mostly harmless causes.
Often the stomach hurts because it is not supported when lying on its side and pulls on the body. A flat pillow under the belly or a change of position can help. With increasing duration of the pregnancy, the uterus presses the internal organs against the costal arch, which causes problems especially on the right side, because the liver is located here.
This can be remedied by sleeping on the left side. Exercise and down pains are common, especially towards the end of pregnancy. At the beginning of the pregnancy, the implantation of the fertilised egg can cause pain and the rapid growth of the uterus can cause pulling pain.
Abdominal pain during pregnancy can also have dangerous causes: These include premature contractions, which cause cramping pain in the lower abdomen, and HELLP syndrome, a metabolic disorder that causes pain in the right upper abdomen towards the end of pregnancy and disrupts blood clotting. In these cases, it is very important to see a gynaecologist. A common cause of nightly abdominal pain while lying down is reflux disease.
In reflux disease, acid stomach contents reflux into the oesophagus. The reflux can be more pronounced when lying down than when sitting, for example, which is why the symptoms are more pronounced. Symptoms include abdominal pain in the upper abdomen, heartburn, acidic belching or pain behind the breastbone.
Remedial action can be taken by abstaining from sumptuous and fatty foods in the evening, serious forms must be treated with medication. Inflammation of the stomach lining can also be the cause of night-time stomach pain. An ulcer of the mucous membrane of the small intestine triggers abdominal pain in sober phases, i.e. also at night.
Some adults have adhesions in the abdominal cavity that can narrow intestinal loops. This makes it difficult for intestinal gases to pass through the intestines and sometimes leads to very painful flatulence with a distended stomach. Severe constipation can also cause flatulence because the intestinal gases can no longer pass through the intestinal contents.
Other possible causes of nocturnal abdominal pain are a stomach flu, constipation, gallstones or kidney stones. Abdominal pain in the eveningDuring the night, abdominal pain on the right side of the upper abdomen can be a symptom of biliary colic. In biliary colic, a gallstone from the gallbladder has settled in the bile ducts and “clogs” them.
The pain is attack-like and very severe, and can last from a few minutes to hours. Inflammation of the gallbladder can cause similar problems, but can also be accompanied by dull, long-lasting pain and fever. Ureteral stones also trigger sudden, severe cramp-like pain, which is felt in the back or lower abdomen of the affected side with radiation into the genital area.
Abdominal pain in the right lower abdomen can be caused, for example, by Crohn’s disease or appendicitis. Abdominal pain at night on the left side can be caused by, for example, an inflammation of the gastric mucosa, which causes pressing and burning pain accompanied by nausea; an ulcer of the gastric mucosa causes similar symptoms. – an inflammation of the gastric mucosa,
- An ulcer of the stomach lining or
- Are caused by a renal or ureteral stone.
Abdominal pain in the lower abdomen, which occurs mainly at night, usually indicates an organic cause and less often a purely psychological one. In both men and women, nocturnal pain in the lower abdomen can possibly indicate a trigger localised to the intestine (appendicitis, diverticulitis, trapped intestinal gases due to a bent intestinal loop) or the ureteral organs. In women, gynaecological triggers such as weak pelvic floor muscles causing the bladder or uterus to descend should also be considered.
Cysts on the ovaries can also exert painful pressure on neighbouring organs as a result of altered gravity conditions when lying down. Other possible causes are spasms (arbitrary contraction of individual muscles or muscle groups) due to hormonal fluctuations or chronic muscle tension in the lower abdomen. After the insertion of a contraceptive such as the copper coil, abdominal pain can occur at night.
In general, sudden, severe nocturnal lower abdominal pain is a warning symptom that requires immediate clarification. Abdominal pain in the morning can be caused by an ulcer of the mucous membrane of the small intestine. The pain of the small intestinal ulcer typically gets worse during fasting, especially in the morning after waking up, this can cause pain.
Typical is an oppressive, burning pain that disappears or improves significantly after breakfast. A feeling of fullness, nausea and vomiting are also common. Abdominal pain that begins in the morning after breakfast can be an indication of food intolerance.
For example, if breakfast consists of cereals with a lot of milk, lactose intolerance may be the cause. If the pain occurs after a carbohydrate-rich breakfast, it may be due to celiac disease. Pain after a breakfast with lots of fruit may indicate fructose malabsorption.
Abdominal pain in the morning, which improves immediately after getting up, can also be caused by the spine. Other explanations for abdominal pain in the morning are a high-fat meal in the evening that is still heavy in the stomach and causes nausea, or a gastrointestinal infection that starts with abdominal pain in the morning after waking up. Patients with irritable bowel syndrome often have abdominal pain in the morning, which improves after bowel movements, but still accompanies them all day and only disappears in the evening or at night.