Reviewed By: Pramod Kerkar, MD, FFARCSI

Intestinal pain, commonly called lower abdominal pain can result from many causes. The intensity of intestinal pain can vary from mild to severe, depending on the cause and the condition of the person. Let us look at the types, causes, symptoms, diagnosis and treatment of intestinal pain.

What is Intestinal Pain?

Intestinal pain is one of the commonest digestive problems faced by many people including kids. Intestinal pain can appear in various forms and can last for a short period or may be present for even longer in certain cases. Stomach is connected to small intestine, which then runs up to the large intestine and the digestive tract then ends at the rectum. Food passes through this tract for digestion and further absorption of nutrients, after which the waste matter is formed and eliminated through the rectum. Any disruption in the structure or function of the abdominal organs, such that the intestines are affected can cause intestinal pain.

What is Intestinal Pain?

Types of Intestinal Pain

Intestinal pain can appear in mainly two forms:

Acute Intestinal Pain - Acute intestinal pain usually begins suddenly, may be mild, moderate or severe, but lasts for a short time; may be few hours or days. While most of the causes of acute pain are related to digestive problems, certain causes can be serious, leading to a medical emergency.

Chronic Intestinal Pain – Chronic intestinal pain lasts for long; for more than 3 months. There may be pain that stops and recurs or it may continue as a dull ache. This too needs proper evaluation and treatment to avoid further complications.

Abdomen has vital organs, like intestines, liver, pancreas, gall bladder, which are surrounded by muscle, tissue, blood vessels and nerves. Problems in any of the organs or the supporting structures can cause intestinal pain. Intestinal pain can be mild discomfort, slight pain or sharp, severe and sudden pain in the lower abdomen. It is usually accompanied by digestive problems and affects the person depending on the severity of the cause. It is important to know the possible causes of intestinal pain and the relevant treatment. The treatment is aimed at relieving symptoms and curing the underlying cause. Sudden, severe intestinal pain can be an emergency that calls for immediate medical attention.

Causes and Symptoms of Intestinal Pain

Intestinal pain is a symptom in itself, which presents due to some underlying medical condition. Let us look at some of the most important causes of intestinal pain, their symptoms and treatment.

Indigestion

One of the commonest causes of intestinal pain is indigestion, which often leads to bloating, crampy abdominal pain, nausea and even vomiting. It can also be accompanied by diarrhea or sometimes constipation or both may alternate. The common symptoms of intestinal pain due to indigestion include feeling of fullness, burning sensation in stomach, belching. Indigestion can be a result of faulty diet and lifestyle, gastritis, hormonal changes, infection or serious underlying gastrointestinal conditions.

Treatment of intestinal pain caused due to indigestion includes medications to relieve the symptoms. Rest, medicines and appropriate diet usually helps, however, some cases may need investigations, if intestinal pain persists for long.

Food Intolerance & Allergies

Lactose intolerance is the commonest causes of intestinal pain. Some people are intolerant to lactose, a sugar present in milk and milk products. Some people may also experience intolerance to other forms of sugars or proteins present in certain foods. All these food intolerances are common causes of intestinal pain.

Food allergies, in which the immune system reacts abnormally to certain foods, too are one of the important causes of intestinal pain. The foods that people are commonly allergic to include peanuts, shellfish, eggs, cow’s milk, wheat and soy.

Inability to digest the substance leads to intense pain in the bowel, which is a common cause of intestinal pain. The symptoms of intestinal pain may vary with food intolerance and food allergies. Intestinal pain is associated with crampy pain, bloating, diarrhea or constipation, sometimes nausea and vomiting. In allergic reactions, skin rashes, breathing problems, chest tightness is also present sometimes.

Treatment of intestinal pain due to food intolerance is often symptomatic and dietary control. Following specific diet which eliminates the intake of the substance that is not well tolerated helps to a great extent.

Irritable Bowel Syndrome (IBS)

Another common cause of intestinal pain is irritable bowel syndrome. It presents with intestinal symptoms that are seen on most days of the week and usually last for more than 3 months. Intestinal pain due to irritable bowel syndrome presents with cramping abdominal pain, often relieved by passing stools, frequent changes in stools. Treatment of intestinal pain due to IBS includes lifestyle changes, appropriate diet, use of probiotics and medicines, if necessary.

Inflammatory Bowel Disease

Intestinal pain due to colitis, inflammatory bowel diseases like Crohn’s disease and ulcerative colitis can be quite troublesome. These are caused due to inflammation of the intestine and results in digestive problems, difficulty in passage of stools, diarrhea, bloody stools, fatigue and sometimes fever and weight loss.

Peptic Ulcer

Peptic ulcers, caused by erosion of lining of stomach and small intestine, is one of the leading causes of intestinal pain. It may be caused due to inflammation, H.pylori infection, faulty diet or use of certain medications like aspirin or anti-inflammatory drugs. The symptoms of intestinal pain caused due to peptic ulcer include indigestion, vomiting, pain in abdomen and chest, bloody stools, appetite changes and weight loss.

Complications of peptic ulcers are also one of the common causes of intestinal pain. Intestinal perforation, the commonest one results in sudden, acute intestinal pain that often needs emergency treatment.

Other Causes of Intestinal Pain

Other causes of intestinal pain that may call for an immediate treatment also need to be considered.

Gastroenteritis: Contaminated food can cause infections affecting the gastrointestinal tract. Food poisoning and gastroenteritis are one of the commonest causes of intestinal pain. Gastroenteritis is the inflammation of the stomach intestinal lining, mostly caused due to bacteria or viruses. Infections like typhoid can cause ulcers in intestine and cause intestinal pain. Viral gastroenteritis is also called stomach flu, are more common in children, elderly adults and those with a compromised immune system. Norovirus and rotavirus infection is a common viral infections causing intestinal pain. Gastroenteritis of any origin presents with crampy intestinal pain, diarrhea, vomiting and fever.

Parasitic Infections – Parasitic infections like giardiasis and amebiasis affect the digestive tract and are the leading causes of intestinal pain. The symptoms include crampy pain, bloating, vomiting, appetite changes, watery or painful stools, sometimes mixed with blood. These infections are common among travelers and can cause complications if not treated in time. Treatment includes appropriate medications like metronidazole to fight the infections.

Appendicitis – Appendicitis causes severe, sharp intestinal pain, in the right abdominal region. Appendix is a small structure extending from the colon and its inflammation leads to appendicitis. It presents with sudden pain that worsens with movement or cough, vomiting constipation or diarrhea and fever. Severe cases may need surgical treatment to remove the appendix.

Hernia – Hernia is a condition in which the structures in the peritoneum bulge or herniate through a weak area in the muscular wall. There are various types of hernia and symptoms are based on the types, however, most hernias lead to pressure feeling and pain. When hernia affects the intestinal region, it causes intestinal pain. Pain often worsens on coughing or any activity that increases the intra-abdominal pressure. Severe cases often need surgical treatment for intestinal pain from hernia.

Intestinal Obstruction – This is one of the important causes of intestinal pain and need immediate attention due to the risk of complications. Intestinal obstruction can be caused due to underlying problems like adhesions, inflammation, twisting of intestines, hernias or cancer. It causes severe crampy intestinal pain, constipation, abdominal swelling. The underlying cause must be treated appropriately with use of medications of surgery, if needed.

Intussusception – One of the many causes of intestinal pain is intussusception, commonly seen more in younger children. Children present with severe intestinal pain, diarrhea, vomiting and fever. There may be feeling of lump in abdomen and with blood and mucus in stool. It may rarely occur in adults, which may be difficult to identify as the symptoms are similar to any other gastrointestinal problems.

Cancer – Growths in the intestines, bowel and colon cancer can cause severe intestinal pain. Cancers in the adjoining areas too can cause pressure on the intestines, or spread of cancer from other areas, which results in intestinal pain. It can cause constipation, pressure feeling, dull or severe pain, blood in stool, loss of appetite and weight loss.

Other conditions, like acid reflux, constipation, celiac disease, diabetic ketoacidosis, infection, injury, strained abdominal muscles, pressure on the intestine due to or conditions affecting normal blood flow to the intestines like mesenteric ischemia too can be some of the causes of intestinal pain.

Warning Signs of Intestinal Pain

Intestinal pain can be serious some serious and emergency cases, hence it is important to know the warning signs of intestinal pain. These include

  • Sudden, sharp, twisting or very severe pain in abdomen
  • Passage of blood while vomiting or in stool
  • Hard abdomen
  • Difficulty in passing stool or urine
  • Excessive diarrhea, fainting, dizziness or confusion, cold, sweaty skin, collapse or shock

Diagnosis of Intestinal Pain

Diagnosis of intestinal pain is mainly based on the symptoms and history of the person. Investigations are ordered based on the complaints and severity of intestinal pain. The common investigations that help in the diagnosis of intestinal pain include:

Blood Tests – To assess blood cell counts, presence of anemia and infection that could have caused intestinal pain.

Stool Examination – To determine the presence of blood, mucus, infection, parasitic infections causing intestinal pain.

Physical Examination – Clinical examination for evaluation of intestinal pain

Depending on the severity and symptoms of intestinal pain, investigations may be ordered, which include

Abdominal X-ray – To detect the presence of intestinal obstruction or narrowing, which is often a medical emergency.

Abdominal Ultrasound – To detect abnormality swelling in abdominal organs like liver, pancreas, gall bladder to find relevant problems causing intestinal pain. It can also detect intestinal obstruction and related abnormalities.

CT Scan or MRI – Complications of certain medical conditions or changes from severe infections can be detected with these. Intestinal pain caused due to fistula, abscesses, tumor or cancers can be diagnosed with these tests.

Upper GI Studies – This is a barium swallow test, in which barium drink is given and X-rays of the esophagus, stomach and small intestine are taken. This helps to identify the presence of abnormality in the tract like, peptic ulcers.

Upper Endoscopy – In this test, a scope is inserted into the stomach and small intestine to view the area for ulcers. A sample of tissue can also be taken, particularly in cases suspicious of stomach cancer.

Barium Enema – Barium enema is done to for imaging study of the colon to determine intestinal obstruction and intussusception.

Colonoscopy – Colonoscopy helps to diagnose various disorders of the intestines. It allows visualization of the intestines and a sample of tissue can be taken for detailed examination.

Treatment of Intestinal Pain

As the causes vary, treatment of intestinal pain too differs based on the underlying cause and severity. Certain conditions can be managed with medications needed to treat the cause, while some may need surgical management. Some conditions may also be treated with complementary therapies like self-care, nutritional therapy and stress management techniques.

Some of the commonest medications used for treatment of intestinal pain include:

Antacids – There are various types of antacids and the precise type of antacids is prescribed depending on the cause. Acid blockers like ranitidine are used to control intestinal pain due to peptic ulcer and excess acid production. Proton pump inhibitors (PPIs) like omeprazole may be used in some cases, while sucralfate, which helps to coat the mucous lining may be needed for certain cases of intestinal pain.

Antibiotics – Depending on the infections, antibiotics that fight the infections may be prescribed.

Anti-inflammatory drugs – In cases of severe intestinal pain, anti-inflammatory drugs may be useful.

Corticosteroids – Corticosteroids may be sometimes used in treatment of intestinal pain, particularly those related to autoimmune disorders like inflammatory bowel disease.

Immunosuppressive drugs and Biological agents – Certain causes of intestinal pain, like tumors, cancers or may need.

Other medications to improve digestion, mobility of colon, improve blood flow, prevent blood clots may be needed, depending on the causes of intestinal pain.

Surgical Treatment of Intestinal Pain

Surgical treatment of intestinal pain may be needed in case of emergency or to manage complications of conditions like ulcers, appendicitis, perforations or torsions. Certain conditions may call for surgery, where in a part of intestine has to be removed. Conditions affecting blood flow to the intestines, like mesenteric ischemia may need surgical treatment for intestinal pain, e.g. stenting or mesenteric artery bypass surgery.

Lifestyle Modifications to Treat Intestinal Pain

While the specific nutritional requirement may vary with every person and the condition, some general dietary tips can help. These tips are of great use in chronic intestinal pain, irritable bowel syndrome, peptic ulcers and inflammatory bowel disease.

Some of the effective lifestyle modification measures include

Eat Right - Drink plenty of water and electrolytes, if needed and stay hydrated. Include all kinds of fruits, more of citrus fruits, melons and berries. Take fresh green vegetables, include greens in daily diet.

Avoid Junk – Avoid junk, refined, processed foods and ready-made meals. Limit intake of spices and chilies or any food item that worsens your complaints. Quit smoking, refrain from taking alcohol and caffeinated beverages.

Eat slowly and take small quantity at regular intervals. Avoid late night dinners and do not sleep immediately after eating. Take probiotics that aid in digestion. Go for walks or do regular exercises to promote better digestion. Take rest when there is pain and follow medical advice given to manage intestinal pain.

Also Read:

Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: June 2, 2018

This article does not provide medical advice. See disclaimer

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