Introduction
The upper abdomen comprises the area between the lower ribcage and the navel. Pain in this area can be the cause of numerous illnesses, which in the majority of cases are harmless and usually easily treatable.
Symptoms
The symptoms of upper abdominal pain occurring at night are as varied as their causes. The quality of the pain, i.e. how the pain feels, the intensity of the pain, i.e. how strong the pain is felt, duration, localization and time of occurrence are also important clues for the cause of the corresponding pain.
Furthermore, the pain can occur with other symptoms such as a feeling of fullness, flatulence, loss of appetite, acid burping, diarrhoea, vomiting, skin changes in the sense of rashes, weight changes, fever, chills and general changes in stool and urine. Burning pain extending from the upper abdomen to behind the breastbone is typical of heartburn. When lying down, even at night, the pain often intensifies because the stomach acid responsible for the inflammation of the mucous membranes can more easily pass through the way into the esophagus.
The symptoms are intensified, for example, by previous fatty meals. Cramp-like pain that occurs after, with and sometimes completely independently of meals can be symptoms of an irritable stomach or a gastrointestinal infection (gastroenteritis). Accompanying symptoms of irritable stomachs are a feeling of fullness, flatulence and nausea, which can also last into the night, especially if too large portions of food have been eaten before going to bed.
Gastroenteritis is typically accompanied by diarrhoea, vomiting and loss of appetite. As a rule, viruses are the trigger of the disease, which is why one has to “sit it out” to a greater or lesser extent. Particularly in the case of an acute infection, those affected also feel pain at night and the urge to go to the toilet, but this decreases as the disease progresses.
Pressing or stabbing pain that occurs immediately or during food intake and decreases during the day or night can be an indication of a stomach ulcer. Fasting pains, which occur particularly at night or in the early hours of the morning, are typically associated with inflammation of the lining of the stomach (gastritis). The quality is pungent accompanied by loss of appetite, occasionally nausea.
The pain is increased by external pressure on the stomach area. In rare cases, the cause of the nocturnal fasting pain can also be a cancerous ulcer in the duodenum. Typical is the improvement of the pain through food intake.
Very strong, contraction-like (flaring up and down) spasmodic pain, which is like a belt around the upper abdomen, occurs in the context of pancreatitis. The pain can be so severe that the affected person cannot rest at night. Other typical symptoms of this disease are bluish-greyish spots on the flank and around the navel, as well as flatulence with a feeling of fullness.
Cramping abdominal pain, accompanied by diarrhea and constipation, as well as darker stool discoloration (tarry stools), can be signs of intestinal cancer. However, this type of abdominal pain also occurs in chronic inflammatory bowel diseases, which include Crohn’s disease and which often torture those affected into the night. Diffuse dull pain that cannot be localized exactly and is accompanied by a performance kink, loss of appetite, yellow discoloration of the skin and eye-clera are possible symptoms of liver destruction, known as cirrhosis of the liver.
Due to the sleep disturbances, those affected also feel the oppressive pain, especially at night. Pain radiating from the back into the upper abdomen can be a sign of an aortic aneurysm. The pain occurs very suddenly and can be coupled with sensation in the legs.
(Important : there is a need for quick action and if in doubt, do not hesitate to consult a doctor). Oppressive chest pain radiating into the left arm or stomach in the late night and especially in the early morning hours out of complete well-being are possible indications of an acute heart attack. Especially women suffer from untypical symptoms, such as abdominal pain, when having a heart attack.
Here too, there is a need for quick action and it should not be hesitated to consult a doctor if there is any suspicion.Cramp-like pain in the upper abdomen is caused by tension of the muscles in the abdominal area. Already existing pain is intensified by the tension. This happens reflexively, i.e. automatically in response to an internal stimulus, such as an inflammation of the gastrointestinal tract.
Short-lasting, cramping pain at night with an additionally inflated abdomen is usually the cause of too many gases in the stomach and intestines, especially if bloated food, such as cabbage, has been eaten during the day or before going to bed. After the wind has gone, the pain quickly disappears again. Cramp-like pain that occurs more frequently at night can indicate a passage disorder in the gastrointestinal tract.
Especially during the resting phases the body is busy with digestion. If there is an obstacle in the course of the bowel, such as a kink in a bowel loop, often in the context of adhesions after abdominal operations (bride), constrictions in the context of chronic inflammatory bowel diseases, such as Crohn’s disease or due to a tumor growing into the bowel, the stool can only pass through the constricted bowel with difficulty. The intestinal muscles work harder to push the stool past the obstacle, which explains the cramping pain.
The disease is known as ileus in technical terms. Children can also be affected by an ileus and the accompanying sudden cramping abdominal pain, although the causes are different from those of adults. For example, in small children, an intussusception, in which a section of the intestine is turned upside-down in the previous one, leads to an obstacle to passage in the digestive tract.
A harmless cause of (upper) abdominal cramps during the night is gastro-intestinal inflammation. Especially at the beginning of the disease, the affected persons are plagued by pain accompanied by diarrhea, nausea and vomiting. Occasionally, fever also occurs in the affected persons.
The cramp-like pain and diarrhea are caused by increased intestinal activity, as a reaction of the body to “flush out” the responsible pathogen. Since the stomach is also located in the upper abdomen, this can also be the cause of cramp-like pain at night. Cramp-like pain on an empty stomach indicates an inflammation of the stomach lining, which is called gastritis.
If the inflammation of the gastric mucosa is of long duration, it can develop into a gastric ulcer, which presents itself with similar symptoms. Sudden cramp-like pain in the left upper abdomen, which is colicky (the intensity of pain increases and alternately decreases), is often associated with gallstones, especially in middle-aged women, which have slipped into the bile duct and become stuck there. The muscles of the bile duct try to transport the stone out by increasing contractions.
The friction of the stone causes inflammation of the affected bile duct mucosa, which increases the intensity of the pain. The cramps typically increase after ingestion of food, as the bile is needed for digestion. However, since the pain is often experienced as very severe, it often lasts into the night, which keeps the affected person awake.
Severe cramping pain in the upper abdomen, with its maximum in the left lower abdomen, also occurs in the context of pancreatitis (inflammation of the pancreas). Typical is the feeling of the patient that the pain is like a belt around the abdomen. Often the affected person has been drinking alcohol for many years in this context.
Stinging pain in the upper abdomen, which occurs at night, can indicate food intolerances. Among the most frequent incompatibilities are those against the milk sugar lactose, the gluten protein gluten and against the fruit sugar fructose. Most of those affected also suffer from additional stool changes in the form of diarrhoea or constipation, and very often nausea.
The inflammation of the mucous membrane of the stomach can present itself in addition to the cramping, often in combination with stabbing pain. Typical is the occurrence on an empty stomach, especially at night. If the gastritis is not treated, it can develop over the years into a stomach ulcer with the same nocturnal cramping and stabbing symptoms.
The irritable bowel also often presents with combined, stabbing pain in the upper and lower abdomen, which recurs at different intervals. In addition, diarrhea or constipation also frequently occur here.The cause is largely unclear; however, it is typical that it increases or occurs during stress and the symptoms improve after bowel movements. Nausea is a frequent accompanying symptom of nocturnal upper abdominal pain.
A cause cannot always be found, because upper abdominal pain often occurs with nausea in the context of an irritable stomach or intestine. Women are particularly often affected, usually in stressful times. It is assumed that the body does not really settle down due to stress and that digestion is sluggish, resulting in delayed gastric emptying.
In addition to the stabbing, cramping pain and nausea in the upper abdomen, the irritated stomach presents itself with a feeling of fullness and belching. Sudden nausea that lasts into the night is also a frequent accompanying symptom of a gastrointestinal infection (gastroenteritis). Children are particularly frequently affected.
At certain months of the year, various pathogens are typical triggers. The norovirus infection, for example, which is one of the most common and best-known, occurs throughout the year, while an infection with rotaviruses occurs mainly in the spring months of February to April. Nocturnal pain in the upper abdomen in combination with nausea also occurs in the not uncommon inflammation of the stomach mucosa. It is caused by excessive production of gastric acid, which is increased by stress, alcohol, excessive coffee consumption and smoking, among other things.
