Acute Abdominal Pain Due to Lactose Intolerance

There can various reasons for acute abdominal pain and distension. One of the commonly occurring conditions, known as the lactose intolerance is one major culprit for acute abdominal pain. Lactose intolerance is a lactose malabsorption disease. It means that the patient cannot digest food items which contain lactose, which is a common sugar found in the milk and other milk products. People who lack enzymes helping in lactose digestion develop lactose intolerance. It can occur at any age. Everyone from younger ones to the older people are susceptible to the deficiency disease, however, it is more commonly seen in older age group.

In a healthy person, the dietary lactose passes from stomach to the small intestine where it is acted upon by certain enzymes that divide the large sugar moiety into smaller units which are then absorbed and are used by the body to produce energy. In patients with lactose intolerance, this natural digestion process gets interrupted. They are unable to convert or breakdown lactose sugars which causes stagnation of lactose in small intestine and colon. This leads to the attack by microbes which are responsible for the bloating and acute abdominal pain.

Acute pain in the abdomen is usually stimulated via pain receptor, also known as the noci-receptors. When a patient ingests lactose-containing food items, there occurs activation of noci- receptors which causes various pathological changes like inflammation of bowel, ischemia, and acidosis. These receptors produce noxious stimulus and transmit the information to the brain causing production and the sensation of pain in the abdomen.

The patient may experience the abdominal pain stimulus for few seconds to many minutes or even for hours together!

1. Osmotic imbalance:

   When any, milk product is ingested, it contains dietary fibres which must be hydrolysed in order to get digested from the intestine. A deficiency of intestinal lactase enzyme causes prevention of hydrolysis of ingested lactose thus leading to an osmotic imbalance.

   Osmotic load of unabsorbed lactose causes secretion of an excessive amount of fluids and electrolytes that cause intestinal dilation and hence stimulating the pain receptors.

2. Bacterial Causes:

   On the passage of lactose-containing food items to colon intestinal bacteria when acting on lactose containing food items cause the production of gases and toxic products leading to hypersensitivity reactions, impaired gas production, excessive fermentation and at last altered microbial flora hence causing bloating hence causing irritation of bowel nerves which causes acute abdominal pain.

3. Bloating:

   The fermentation of carbohydrates and lactose-containing food items can cause production of gases that can lead to abdomen distension and constipation and other associated symptoms like nausea, vomiting etc. hence causing bloating and stimulation of noci- receptors and causes acute pain in abdomen.

There can be a multitude of reasons behind acute abdominal pain, the pain in lactose intolerance can be differentiated on various parameters. Some of the characteristics associated with acute abdominal pain in lactose intolerant patients are:

• Pain in abdomen starts immediately after consumption of milk or some milk product. Abdominal pain usually ranges from mild to moderate or severe in intensity depending upon the amount of ingested milk and its product.
• A characteristic feature of acute abdominal pain due to lactose intolerance includes being sudden in onset and is gradually progressive in nature.
• The onset of abdominal pain can vary from person to person and from intensity to intensity. In some people, pain in the abdomen due to lactose intolerance can be sudden in onset that is it begins as soon as the allergen food item enters the gut while in others the pain can be of an insidious type that is it begins slowly and gradually and progresses causing increased severity.
• It’s mostly a dull aching pain involving the whole abdomen, but in some cases, it can be shooting type, beating type, crushing type or stabbing type of abdominal pain.
• It is usually non-specific in nature and non-focal i.e. it can’t be localised and is often associated with other symptoms like nausea, cramping etc.
• It is mostly present throughout the time till the symptoms are not relieved.
• Acute abdominal pain is mostly aggravated by factors like more intakes of allergen food items, spices, or any milk or its products and in severe cases by ingestion of food itself.
• Pain in some cardiac cases may increase with palpitation and then may be associated with rebound tenderness.

On examination of the patient; acute abdominal pain, rebound tenderness and guarding symptoms are seen as the serious signs of complications.

1. The relief from acute abdominal pain and other accompanying symptoms can only be provided once there occurs gastric emptying and medications like analgesics like paracetamol; mefenamic acid etc. induce some relief.
2. In the case of an acute attack, the patient should be rushed to the hospital and supervised properly and medications can be started.
3. Probiotics are also used which helps to stimulate the digestion of lactose in people who are lactose intolerant.
4. For acute abdominal pain and distension, antispasmodics and analgesics like nice (nimesulide), paracetamol, acidic, metals spass (mefenamic acid) etc. can be given. They help to reduce the gut motility and hence provide relief from abdominal pain and distension.
5. Anti-diarrheal drugs are also given in the case of acute diarrhea.
6. Regular exercising can improve bowel movement leading to lesser cramps and abdominal pain in patients with lactose intolerance.
7. Changing dietary habits and incorporating products with predigested lactase enzyme can be helpful for the patients.

Lactose intolerance induced acute abdominal pain can be severe and cause discomfort to the patient. Thus, taking appropriate measures is a preliminary to avoid fatal symptoms and cramps.

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