Go With Your Gut: When Abdominal Pain Is Something More...

IMAGE Because we all experience abdominal discomfort or pain at some time or other, deciding whether or not to see a doctor for these symptoms can be perplexing. If the symptoms are intermittent and not present during a physical exam, they may also be difficult to describe. Fortunately, there are some general rules of thumb that can be helpful.

When Should You Seek a Professional Opinion?

You're in pain. Maybe you ate too much. Or maybe you have food poisoning. How can you be sure that nothing is seriously wrong?

You should see a doctor if you are experiencing abdominal symptoms AND any of the following:

  • Pain that is steady, severe in intensity, located in a specific area, or recurring
  • Persistent pain that is sharp or burning
  • Inability to perform routine activities
  • Weight loss or loss of appetite
  • Nausea and vomiting (with or without bleeding)
  • Rectal bleeding—can occur with blood that moves through the gastrointestinal tract quickly
  • Vaginal bleeding in females
  • Fever
  • Changes in bowel habits, including constipation, or blood in your stool or black, tarry stools
  • Difficulty in swallowing
  • Nighttime awakening due to pain
  • A previous history of stomach disorders or intestinal surgery
  • A medical condition which requires the use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Breathing problems
  • Severe sore throat

Single episodes of mild pain that goes away within 24-48 hours may not warrant further medical treatment. However, if you are ever concerned, make sure you call or see your doctor.

The Exam: What to Expect

First your doctor will review your history in detail. They will be especially interested in any previous gastrointestinal problems or heart problems, as certain symptoms can overlap. Be prepared to tell your doctor about any medications you are taking, particularly NSAIDs, such as ibuprofen. It is also important to be candid with them about any herbal remedies you may be taking, as some herbal medications can affect the liver and the gastrointestinal tract. You will be asked whether you have been treated before for the same symptoms, or if the pain is new. Be sure to let your doctor know if there is a history of gastrointestinal disease in your family.

To determine whether your symptoms may be gynecological in nature, your doctor will most likely ask whether you are sexually active, what type of birth control you use, the regularity of your cycle, and if there is any possibility you may be pregnant.

IMAGE You'll then be asked about the nature of your pain such as:

  • Is it constant?
  • Does it come and go, and is it crampy?
  • How long does it last?
  • What time of day does it occur, is it random, or does it occur after meals, etc.?
  • Where is the pain located?
  • Are there any measures that cause the pain or that relieve it?
  • Are you experiencing any other symptoms?

Do the best you can to describe it in detail and in your own words. It is often helpful to write down what you've experienced before seeing the doctor, as you may leave out important details if you get nervous during the examination.

Next, your doctor will perform a general examination, including an abdominal exam. The exam will include listening for bowel sounds, looking at the overall appearance of your abdomen, and performing different maneuvers to examine for the location and type of pain. Your doctor may perform a rectal exam, or order blood or imaging tests. A pelvic exam may also be performed. In some cases, especially if abdominal pain is high up, or related to exertion, your doctor may perform tests to check on the health of your heart and lungs.

What's Next?

Most gastrointestinal disorders can be readily treated by your primary care doctor. Some recurring or more serious problems may require the care of a gastroenterologist who has been specially trained to treat such disorders.

  • American College of Gastroenterology

    http://www.acg.gi.org

  • National Institutes of Health

    http://www.niddk.nih.gov

  • The College of Family Physicians

    http://www.cfpc.ca

  • Health Canada

    http://www.hc-sc.gc.ca

  • Abdominal pain. American College of Gastroenterology website. Available at: http://s3.gi.org/patients/cgp/pdf/abdomi.pdf. Accessed July 17, 2014.

  • Abdominal pain—differential diagnosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 7, 2013. Accessed July 17, 2014.

  • Abdominal pain, short-term. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/health-tools/search-by-symptom/abdominal-pain-short-term.html. Accessed July 17, 2014.

  • Abdominal pain, long-term. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/health-tools/search-by-symptom/abdominal-pain-long-term.html. Accessed July 17, 2014.

  • Acute upper gastrointestinal bleeding. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 21, 2013. Accessed July 17, 2014.