When you should seek treatment for abdominal pain

April 2, 2014 Katherine A. Mandell, MD

As a general surgeon, the majority of my practice is spent evaluating patients with abdominal pain and deciding whether the cause of their pain requires surgical treatment. These patients are only a small fraction of the number of people who seek medical attention for abdominal pain. Abdominal pain is fairly common and something almost all of us have experienced. Usually it is not cause for alarm and resolves on its own after a limited course if we wait and treat symptomatically. We have all had a moment however when we wondered whether this time was more serious, and how would we know if it was?

Every organ in the abdomen and pelvis (including the muscles and skin of the abdominal wall) has nerve endings and can cause pain. While nearly everyone has experienced abdominal pain, it is usually self limited and mild. Think antacids for heartburn symptoms, diet modifications for food intolerances, fluids and time for gastroenteritis, stool softners for constipation. While more severe causes of abdominal pain are rare, it is important they are recognized as they may have more severe consequences to health.

Only 15%-20% of people with abdominal pain require surgical treatment (this number increases with age). The most common reasons for surgery are gallbladder problems, appendicitis, hernias, bowel obstructions, and diverticulitis. These problems can often be fully resolved with timely recognition and appropriate surgical therapy.

The main concern (after wanting to feel better) of patients with abdominal pain is when/if to seek medical attention. You should consider seeking medical attention if you have:

  • Inability to tolerate oral intake, especially fluids, for more than a day
  • Ongoing vomiting or vomiting blood
  • A severely painful or firm abdomen or difficulty breathing or moving due to pain
  • Fever
  • Passing blood in urine or stools or painful urination
  • Recent traumatic injury
  • A history of abdominal cancer or prior abdominal surgeries and severe pain
  • Jaundice (turning yellow)
Diagnosing the cause of abdominal pain may be difficult as there are a wide variety of potential problems. It is worth noting that of all the patients who present with abdominal pain to the emergency room the number one diagnosis is non-specific abdominal pain and the majority (over 80%) improve with no further therapy. Even among patients admitted to the hospital with abdominal pain the diagnosis of non-specific abdominal pain is most common (30-40%). 

Your health care provider will start with a history, which will narrow down possible causes using location, duration, and other details of your symptoms. A physical exam is performed providing clues to the urgency and severity of the problem.  While in some cases this is enough to suggest a diagnosis, often your health care provider will obtain laboratory work (blood or urine tests) and imaging (X-rays, CT scans, or ultrasound) to help make a final diagnosis and offer treatment options. More rarely invasive testing may be needed (such as endoscopy).

Treatment options are specific to the cause of abdominal pain. They can range from minimal interventions such as fluids or diet modification, to new medications, to surgical or other interventional therapies.  Since the majority of causes are not life threatening, treatment is often simple. 

If you develop abdominal pain which is severe, persistent, or associated with any of the above symptoms please speak with your health care provider.

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