What are the common causes of abdominal pain. How can you differentiate between functional and structural abdominal issues. When should you seek medical attention for stomach discomfort. What are the symptoms of various digestive disorders causing abdominal pain.

The Complexity of Abdominal Discomfort: More Than Just a “Stomachache”

Abdominal pain is a frequent concern that prompts many individuals to seek medical attention. However, the term “stomach pain” often encompasses discomfort throughout the entire abdominal region, which may not necessarily originate from the stomach itself. To properly address and treat abdominal pain, it’s crucial to understand its diverse causes and manifestations.

The abdominal cavity houses numerous vital organs and structures, including:

• Stomach
• Liver
• Gallbladder
• Pancreas
• Small and large intestines
• Kidneys
• Spleen
• Appendix
• Major blood vessels (aorta and inferior vena cava)
• Core abdominal muscles

Given this complexity, pinpointing the exact source of abdominal pain can be challenging. Physicians typically begin by determining whether the pain stems from a structural or functional problem within the digestive system.

Structural vs. Functional Abdominal Issues: Understanding the Difference

Abdominal pain can result from two primary categories of problems: structural and functional. Understanding the distinction between these types can help in diagnosis and treatment.

Structural Problems

Structural issues arise when there’s an abnormality in the physical structure of an organ. These problems are often visible through medical imaging techniques such as CT scans or MRIs. The affected organ may appear abnormal and function improperly.

Functional Problems

Functional problems, also known as motility disorders, occur when the digestive tract’s nervous system fails to control muscle contractions properly. These issues can be more challenging to diagnose as the organs often appear normal on imaging tests but don’t function correctly.

Can functional disorders be detected through standard medical imaging? Typically, functional gastrointestinal disorders do not show up on CT scans or MRIs, making them more difficult to diagnose compared to structural issues.

Common Causes of Abdominal Pain: From IBS to Diverticulitis

Abdominal pain can stem from various conditions, ranging from minor digestive issues to more serious medical problems. Here are some common causes:

Irritable Bowel Syndrome (IBS)

IBS is a functional gastrointestinal disorder characterized by abdominal pain, bloating, and changes in bowel habits. The pain associated with IBS often worsens after meals or during periods of stress. While IBS can cause significant discomfort, it doesn’t lead to more serious conditions like bleeding or weight loss.

Constipation

Constipation can cause sharp gas pains throughout the abdomen. People experiencing constipation often feel bloated and full, and their abdomen may become visibly distended. Regular bowel movements are crucial for preventing this type of abdominal discomfort.

Ulcers

Ulcers are sores that develop on the lining of the stomach or the first part of the small intestine (duodenum). They often cause a burning sensation similar to hunger pangs. Additional symptoms may include nausea, vomiting, or heartburn.

Pancreatitis

Inflammation of the pancreas, known as pancreatitis, can cause severe and sharp pain in the upper middle abdomen. This pain may radiate to the back or chest. Pancreatitis can occur as an acute attack or develop into a chronic condition.

Diverticulitis

Diverticulitis occurs when small pouches in the colon become infected or inflamed. It typically causes pain and tenderness in the lower left abdomen. Additional symptoms may include low-grade fever, nausea, vomiting, or constipation.

Beyond Digestive Issues: Other Potential Causes of Abdominal Pain

While digestive problems are the most common source of abdominal pain, other conditions can also cause discomfort in this region. Some additional causes include:

• Urinary tract infections
• Kidney stones
• Appendicitis
• Gallstones
• Hernias
• Ovarian cysts or other gynecological issues
• Abdominal aortic aneurysm
• Certain cancers

Is abdominal pain always a sign of a serious condition? Not necessarily. While abdominal pain can indicate serious issues, it’s often caused by less severe problems like gas, indigestion, or minor infections. However, persistent or severe pain should always be evaluated by a healthcare professional.

Recognizing Red Flags: When to Seek Immediate Medical Attention

While many cases of abdominal pain resolve on their own or with basic treatment, certain symptoms warrant immediate medical attention. These red flags include:

1. Severe, sudden onset of pain
2. Pain accompanied by fever
3. Persistent vomiting
4. Blood in vomit or stool
5. Abdominal swelling or tenderness
6. Pain that radiates to the chest, neck, or shoulder
7. Difficulty breathing
8. Persistent constipation or diarrhea
9. Unexplained weight loss
10. Pain during pregnancy

Should you ignore mild abdominal pain? While mild pain often resolves on its own, persistent or recurrent pain, even if mild, should be discussed with a healthcare provider to rule out underlying conditions.

Diagnostic Approaches: How Doctors Uncover the Cause of Abdominal Pain

When a patient presents with abdominal pain, doctors employ various diagnostic tools and techniques to identify the underlying cause. These may include:

Physical Examination

A thorough physical exam allows the doctor to check for areas of tenderness, swelling, or abnormal sounds in the abdomen.

Medical History

Understanding the patient’s medical history, including past illnesses, surgeries, and current medications, can provide valuable clues about the source of pain.

Laboratory Tests

Blood tests, urine analysis, and stool samples can help detect infections, inflammation, or other abnormalities.

Imaging Studies

X-rays, ultrasounds, CT scans, and MRIs can visualize the abdominal organs and identify structural problems.

Endoscopic Procedures

Procedures like colonoscopy or upper endoscopy allow direct visualization of the digestive tract to identify ulcers, inflammation, or other issues.

How long does it typically take to diagnose the cause of abdominal pain? The time frame for diagnosis can vary widely depending on the complexity of the case. Some causes may be identified during the initial visit, while others may require multiple tests and follow-up appointments.

Treatment Approaches: Addressing Abdominal Pain Based on Its Cause

The treatment for abdominal pain varies depending on its underlying cause. Some common approaches include:

Lifestyle Changes

For many functional disorders, dietary modifications, stress reduction techniques, and regular exercise can significantly improve symptoms.

Medications

Various medications may be prescribed to address specific causes of pain, such as antacids for ulcers, antibiotics for infections, or anti-inflammatory drugs for conditions like diverticulitis.

Surgical Interventions

In some cases, such as appendicitis or severe gallbladder disease, surgery may be necessary to resolve the issue causing abdominal pain.

Pain Management Techniques

For chronic conditions, pain management strategies including medication, physical therapy, or alternative therapies like acupuncture may be recommended.

Can abdominal pain be managed at home? Many cases of mild abdominal pain can be managed with over-the-counter medications, rest, and dietary changes. However, persistent or severe pain should always be evaluated by a healthcare professional.

Prevention Strategies: Minimizing the Risk of Abdominal Discomfort

While not all causes of abdominal pain can be prevented, certain lifestyle choices can help reduce the risk of developing digestive issues:

• Maintain a balanced diet rich in fiber
• Stay hydrated
• Practice good food hygiene to prevent foodborne illnesses
• Manage stress through relaxation techniques or exercise
• Avoid known trigger foods if you have identified sensitivities
• Quit smoking and limit alcohol consumption
• Exercise regularly to promote digestive health
• Get regular check-ups and screenings as recommended by your healthcare provider

Is it possible to completely eliminate the risk of abdominal pain? While it’s impossible to prevent all instances of abdominal pain, adopting healthy lifestyle habits can significantly reduce the frequency and severity of digestive issues.

Understanding the complexities of abdominal pain is crucial for effective management and treatment. By recognizing the diverse causes, knowing when to seek medical attention, and implementing preventive strategies, individuals can better navigate the challenges of abdominal discomfort. Remember, persistent or severe abdominal pain should always be evaluated by a healthcare professional to ensure proper diagnosis and treatment.

Why Does My Stomach Hurt

Why Does My Stomach Hurt | Johns Hopkins Medicine

Tummy troubles are a common cause for a visit to the doctor’s office. When patients complain of “stomach pain,” they are sometimes describing pain that is throughout the abdomen area and may not actually be directly related to the organ known as the stomach.

Doctors first try to determine if a patient’s abdominal pain is caused by a structural or functional problem.

Sometimes the digestive tract does not function properly due to an abnormality with the structure of an organ. Medical imaging will show that the organ does not look normal and is not working properly.

The gastrointestinal system has its own nervous system to control the muscle contractions that digest the food you eat. Functional problems, also called motility disorders, result from poor nerve and muscle function in the digestive tract. Gastrointestinal (GI) organs with motility problems will usually look normal on medical imaging tests, such as CT scans or MRI scans, but the organs do not work like they should. Because functional disorders are hard to see in imaging, they can be challenging to diagnose.

1. Irritable Bowel Syndrome (IBS)

   IBS related abdominal pain may become worse after you eat a meal or if you are stressed. If you have IBS, you will have symptoms such as diarrhea or constipation and bloating, but they will not cause bleeding or weight loss.

2. Constipation

   You may experience sharp gas pains that occur throughout the abdomen area if constipation is the reason for your abdominal pain. People who are constipated often have a feeling of being bloated and full, and their abdomen may even become visibly distended.

3. Ulcers

   An ulcer is a sore on the lining of your stomach or first part of the small intestine. Ulcers may cause a burning sensation similar to hunger pangs. Other symptoms include nausea, vomiting or heartburn.

4. Pancreatitis

   Abdominal pain caused by pancreatitis, which is inflammation in the pancreas, is a severe and sharp pain occurring in the upper middle of the abdomen that can sometimes radiate to your back or chest. You may also experience other symptoms such as nausea, vomiting and fever. Pancreatitis may occur as either a sudden acute attack or a chronic condition.

5. Diverticulitis

   Abdominal discomfort and tenderness in the lower left abdomen area may be caused by diverticulitis. This is when the small pouches inside the large intestine become infected or inflamed. Other symptoms may include a low-grade fever, nausea, vomiting or constipation.

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Abdominal pain: Common and uncommon causes

Abdominal pain refers to discomfort in the space between the chest and pelvis. It can happen for many reasons, including gas, ulcers, and a urinary infection.

Symptoms often resolve quickly on their own or with basic treatment. Abdominal pain, especially with severe or chronic symptoms, can also be a sign of more serious underlying medical conditions, including cancer or organ failure.

Sudden and severe or long-lasting abdominal pain may require immediate medical treatment.

Digestive problems are considered the most common cause of abdominal pain. Discomfort or irregularities in any organ or part of the abdomen can cause pain that radiates throughout the entire area.

Many people refer to abdominal pain simply as a stomachache. However, the abdomen contains many vital organs, muscles, blood vessels, and connective tissues that include:

• stomach
• kidneys
• liver
• small and large intestines
• the appendix
• pancreas
• gallbladder
• spleen

The main artery of the heart (aorta) and another heart vein (inferior vena cava) pass through the abdomen too. The abdomen is also home to the core muscles, the four groups of abdominal muscles that give the trunk stability and keep organs in place and protected.

Because there are a lot of areas that can be affected, abdominal pain may have many causes.

Abdominal pain is a common complaint and can be caused or complicated by a variety of factors.

Common causes include:

1. Gastroenteritis (stomach flu)

In this case, the abdominal pain is often accompanied by nausea, vomiting, and loose, fluid-filled stools that occur much sooner and more frequently than normal after eating.

Bacteria or viruses cause most cases, and symptoms usually resolve within a few days. Symptoms that last longer than 2 days may be a sign of more serious health problems, such as infection or inflammatory conditions, such as inflammatory bowel disease.

Common symptoms include:

• nausea
• vomiting
• fever
• abdominal cramping
• bloating
• gas

Get some tips here on how to tell the difference between a stomach virus and food poisoning.

2. Gas

Gas occurs when bacteria in the small intestine break down foods that the body finds intolerant.

An increased pressure of gas in the intestine can cause sharp pain. Gas can also cause tightness or restriction in the abdomen and flatulence or belching.

Certain foods can cause gas. Click here to find out which foods might be causing gas.

3. Irritable bowel syndrome (IBS)

For unknown reasons, those with IBS are less able to digest certain foods or types of foods.

Abdominal pain is the primary symptom for many people with IBS and is often relieved after a bowel movement. Other common symptoms include gas, nausea, cramping, and bloating.

Would you like to know more about IBS? Find out five important facts about this condition.

4. Acid reflux

Occasionally stomach acids travel backward, moving up into the throat. This reflux almost always causes a burning sensation and accompanying pain.

Acid reflux also causes abdominal symptoms, such as bloating or cramps.

Learn more here about the causes, symptoms, and treatments of acid reflux.

5. Vomiting

Vomiting often causes abdominal pain as stomach acids travel backward through the digestive tract, irritating tissues along the way.

The physical act of vomiting also may cause abdominal muscles to become sore. A wide range of factors can trigger vomiting, ranging from an intestinal blockage to alcohol poisoning.

Click here to find out more about the many possible causes of vomiting.

6. Gastritis

When the stomach lining becomes inflamed or swollen, pain may occur. Nausea, vomiting, gas, and bloating are other common symptoms of gastritis.

Click here to learn more about the why inflammation of the stomach occurs.

7. Food intolerances

When the body is unable to digest food materials, they are broken down by intestinal and stomach bacteria, which release gas in the process.

When large amounts of undigested materials are present, a lot of gas is produced, causing pressure and pain.

Nausea, vomiting, bloating, diarrhea, and abdominal pain are other symptoms.

A person with a food intolerance will have a hypersensitivity to certain foods. Find out more here about the symptoms and causes of food intolerance, and how to prevent a reaction.

8. Constipation

When too much waste collects in the bowel, this increases the pressure on the colon, which may cause pain.

It can happen for many reasons, including:

• too little fiber or fluid in the diet
• the use of certain medications
• low levels of physical activity

It can also be a sign of a neurological disorder or a blockage in the intestine. If constipation persists and is uncomfortable, the person should see a doctor.

Click here to learn more about constipation, what causes it, and how to resolve it.

9. Gastroesophageal reflux disease (GERD)

Gastroesophageal reflux disease (GERD) is a long-term condition that involves persistent acid reflux.

It can cause abdominal pain, heartburn, and nausea. In time, it can lead to complications, such as inflammation of the esophagus.

It is a common problem, but treatment is available.

Find out more here about GERD, and how to prevent and treat it.

10. Stomach or peptic ulcers

Ulcers or wounds that will not heal tend to cause severe and persistent abdominal pain. It can also lead to bloating, indigestion, and weight loss.

The most common causes of stomach and peptic ulcers are the bacteria H. pylori and the overuse or continued use of non-steroidal anti-inflammatory medications (NSAIDS).

If you would like to know more about stomach ulcers, click here.

11. Crohn’s disease

Crohn’s causes inflammation of the digestive tract lining, which results in pain, gas, diarrhea, nausea, vomiting, and bloating.

Given its chronic nature, the condition may lead to malnutrition, causing weight loss and exhaustion.

It can be a serious condition, but symptoms may not be present all the time, as there will be times of remission. Treatment is available to help people manage the symptoms.

Find out more about Crohn’s disease in our article here.

12. Celiac disease

Celiac disease happens when a person has an allergy to gluten, a protein found in many grains, such as wheat and barley. It causes inflammation in the small intestine, resulting in pain.

Diarrhea and bloating are also common symptoms. Over time, malnutrition can occur, resulting in weight loss and exhaustion.

People with this condition need to avoid gluten.

Learn more here about celiac disease, including what to eat and what to avoid if you have this allergy.

13. Pulled or strained muscles

Because many daily activities require the use of the abdominal muscles, injury or strain is common.

Many people also focus heavily on abdominal exercises, increasing the risk of damage. Doing more sit-ups than usual, for example, may lead to muscle pain in the abdominal area.

14. Menstrual cramps or endometriosis

Menstruation can cause inflammation and pain in the abdomen. Bloating, gas, cramping, and constipation can also occur during menstruation, causing abdominal discomfort.

Women who have endometriosis may experience more severe or chronic inflammation and pain. Endometriosis is a condition in which tissue that normally grows in the uterus develops in other parts of the body, usually in the pelvic area but sometimes elsewhere.

Learn more about menstrual pain and endometriosis in our main articles on these topics.

15. Urinary tract and bladder infections

Urinary tract infections are most often caused by bacteria, primarily E.coli species, that colonize the urethra and bladder, causing a bladder infection or cystitis.

Symptoms include pain, pressure, and bloating in the lower abdominal area. Most infections also cause painful urination and cloudy, strong-smelling urine.

Find out more about urinary tract infections, why they happen, and how to treat them.

In some cases, abdominal pain is a sign of a medical condition that can be fatal without immediate medical care.

Less common causes of abdominal pain include:

• appendicitis (ruptured appendix) or any other ruptured abdominal organ
• kidney infection, disease, or stones
• hepatitis (inflammation of the liver)
• gallbladder stones (hard deposits in the gallbladder)
• food poisoning
• parasitic infections
• abdominal organ infection or infarction (when the organ dies due to lack of blood supply)
• cardiac conditions, such as atypical angina or congestive heart failure
• organ cancer, notably stomach, pancreatic, or bowel cancer
• hiatal hernia
• cysts that have become invasive or compromise organ space or function

Most cases of abdominal pain are not serious, and symptoms resolve with basic home care, such as rest and hydration, within hours to days.

Many medications available over-the-counter or online, such as antacids and gas medications, also help reduce and manage symptoms.

Acute (sudden and severe) or chronic (long-lasting) abdominal pain, however, are often signs of conditions that do require medical attention and treatment.

Symptoms that require medical attention include:

• unexplained weight loss
• unexplained exhaustion
• changes or disturbances in bowel movements, such as chronic constipation or diarrhea, that do not resolve within a few hours or days
• minor rectal (anal) bleeding or blood in stool
• unusual vaginal discharge
• chronic pain that continues after taking over-the-counter medications or returns after stopping prescribed medication
• signs of urinary tract infection

Symptoms that require emergency care include:

• sudden, severe pain, especially if accompanied by a fever over 102°F
• severe pain that is very concentrated
• bloody or black stool that may be sticky
• uncontrollable vomiting, especially if vomit includes blood
• the abdomen is extremely painful and sensitive to the touch
• being unable to urinate
• fainting or becoming unconscious
• pain that gets dramatically worse quickly
• pain in the chest, especially around the ribs, extending into the abdomen
• severe abdominal pain that improves with lying very still

Though rare, it is important for people experiencing these symptoms to seek emergency medical attention.

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What to do if your stomach hurts during pregnancy

Pregnant women experience hormonal changes that can exacerbate chronic diseases or introduce new diseases. The digestive system is also being rebuilt. Therefore, many complain that the stomach hurts during pregnancy, although there was no such symptom before. In order not to miss a serious pathology and start treatment on time, you can learn to distinguish between different painful conditions and eliminate their causes.

How to understand that it is the stomach that hurts

If you put three fingers in the midline on the area just below the xiphoid process, which connects the right and left halves of the ribs, you can find the approximate position of the stomach. This is a hollow muscular organ, which is usually located almost vertically. Its glands produce hydrochloric acid and mucus, which does not allow the walls of the organ to be digested and prevents damage.

If the mucous membrane becomes inflamed, pain occurs. It can be sharp, cutting, burning, aching and is localized in the intercostal region, slightly below and to the left of the xiphoid process of the sternum. Hungry pains during pregnancy are not uncommon, sometimes they are accompanied by nausea, belching, appear at night in a dream. In some diseases, pain increases after eating.

But gastric pathology is not characterized by girdle pain, a feeling of fullness in the right hypochondrium, bitterness in the mouth, cramps in the lower abdomen. These are signs of diseases of the pancreas, liver or intestines.

Causes of stomach pain in pregnant women

After pregnancy, progesterone is intensively synthesized in the ovaries, and from the 12th week it is produced by the placenta. One of the functions of this hormone is to reduce the tone of the smooth muscles of the internal organs so that the uterus does not contract and reject the embryo. But at the same time, the muscles of the digestive tract also fall under the influence of progesterone. Therefore, in pregnant women, peristalsis slows down, the muscular sphincter located between the stomach and esophagus relaxes.

As the gestation period increases, the uterus grows and displaces the organs. Therefore, the stomach moves from a vertical position to a horizontal one. At the same time, intra-abdominal pressure increases, gastric juice during the digestion of food can be thrown into the esophagus and burn the mucous membrane. This process is more pronounced after thirty weeks, but the first signs may appear early.

The nature of pain during exacerbation of gastritis

Causes of severe pain in the abdomen may be associated with acute gastritis or exacerbation of chronic. Various factors lead to it:

• malnutrition – lack of protein, iron or vitamins;
• irritant effect of drugs – antibiotics, non-steroidal anti-inflammatory drugs;
• infections – more often the presence of the bacterium Helicobacter pylori;
• the influence of harmful substances – alcohol abuse, smoking, as well as work in hazardous industries.

The disease can be exacerbated by stress, lack of diet or gout, chronic kidney pathologies.

In case of exacerbation of gastritis, the stomach begins to hurt after eating, the sensations increase when overeating due to stretching of the walls of the stomach. Often the symptoms are associated with the use of spicy, fried, fatty foods or carbonated drinks. The pregnant woman feels that she has pain in the right hypochondrium, under the pit of the stomach. She is sick, there is an eructation sour, sometimes vomiting. Protracted gastritis disrupts the digestion of food, so there is flatulence, rumbling in the abdomen and a violation of the stool.

If the secretion of hydrochloric acid is reduced in chronic inflammation of the stomach, then the symptoms of the disease are less pronounced.

Features of pain in gastric ulcer or mucosal erosion

In most pregnant women, the symptoms of peptic ulcer disappear due to a decrease in acidity and an increase in mucus production. But in 1 out of 4,000 women, the pathology worsens. This occurs in the autumn-spring period in the 1st or 3rd trimester.

An ulcer is characterized by severe hunger pains that bother between meals or at night. A woman is often sick, sometimes vomiting appears, which alleviates the condition. Additional symptoms are heartburn, sour belching, constipation.

If the ulcer is left untreated, anemia develops and, in severe cases, gastrointestinal bleeding. In the latter case, the pregnant woman will vomit clotted blood that resembles coffee grounds, the pain in the abdomen will become severe, blood pressure will drop, and the skin will turn pale.

Sometimes, after overeating or physical exertion, the ulcer perforates and a through hole is formed in the wall of the stomach. At the same time, the stomach hurts very badly and unbearably sharply, sticky sweat appears on the skin, dry mouth, and thirst intensifies. Vomiting with perforation of the ulcer is rare. Then flatulence appears and after two hours the condition improves, but this is the appearance of well-being. Later, the pregnant woman develops peritonitis.

Bleeding and perforation of the ulcer are dangerous for the pregnant woman and the fetus. When the first symptoms appear, you need to call an ambulance. Otherwise, the likelihood of death from complications is high.

Other causes of stomach pain

In the later stages, stomach pain is more common and is not always associated with gastritis or ulcers. Sometimes other diseases or lifestyle habits are to blame:

• overeating;
• eating stale food;
• irritant effect of spicy, salty, sour or fatty foods;
• stress or nervous tension;
• long break between meals;
• concomitant diseases of the liver, gallbladder or intestines;
• chronic constipation;
• toxicosis;
• acute infections, including food poisoning.

Sometimes inflammation of the duodenum, or duodenitis, is masked behind gastric pain. Pathology often occurs in the 1st trimester or 4-5 weeks before delivery. For duodenitis, nocturnal hungry pains are characteristic, which decrease after eating. Pregnant women have reduced appetite, nausea, vomiting, a feeling of fullness in the upper abdomen.

Pain in the stomach in early pregnancy

According to statistics, from 21 to 80% of women experience a pathology of the digestive tract for the first time during pregnancy, and symptoms appear already at an early stage of gestation. They may be associated with toxicosis. Why it develops is not exactly known, but it is associated with a violation of the hormonal and nervous regulation of metabolism in the body. This leads to nausea, vomiting, salivation, gradual dehydration and deterioration. In severe cases, the metabolism of fats and carbohydrates is disturbed in a pregnant woman, body weight decreases.

If a woman is often sick and vomits, the lining of the esophagus becomes irritated and inflamed. Therefore, from the first weeks there is pain in the stomach.

Due to toxicosis, a pregnant woman develops an aversion to certain types of food or smells, and her appetite decreases. Irregular eating can increase pain in the stomach, and later lead to gastritis.

Treatment of stomach pain during pregnancy

Caution must be exercised in the choice of treatment in pregnant women. Many drugs are dangerous for the fetus, so the therapist should select the therapy regimen. He will also conduct an examination to distinguish early toxicosis from exacerbation of gastritis, peptic ulcer or other pathology.

A pregnant woman is prescribed a diet. All spicy, irritating foods are excluded from the diet. You can not drink coffee, strong tea, carbonated drinks, chocolate, fatty and fried foods that relax the esophageal sphincter. Recommend food in small portions, but at least 5 times a day.

Coating preparations are used to reduce pain. They are not absorbed into the bloodstream, so they will not harm the fetus, but they protect the gastric mucosa and alleviate the condition. In addition to them, doctors recommend drinking tea from chamomile flowers or alder seedlings, which has astringent and anti-inflammatory properties.

Pregnant women with exacerbation of chronic gastritis or ulcers are additionally prescribed antispasmodics based on drotaverine or papaverine to relieve pain. Drugs that increase intestinal tone, which include metoclopramide, also help.

How can I reduce or prevent stomach pain?

In order not to get sick during pregnancy or to prevent digestive problems, you need to eat right. For this, dishes are boiled, stewed, baked, cooked from vegetables, cereals, dairy products and lean meat. Spicy seasonings, fried and fatty foods, other heavy foods during pregnancy should be excluded.

To relieve the condition, do not overeat during the day, it is better to eat 5 times, but in small portions. Sleeping on an empty stomach is bad, but late dinner is also harmful. Therefore, it can be replaced with a glass of unsweetened yogurt or kefir.

Doctors do not recommend lying down immediately after eating, as there is a higher risk of stomach contents entering the esophagus and heartburn. To avoid this, you need to sit in a comfortable chair for an hour or go for a walk.

Stomach pain caused by an ulcer or gastritis can be avoided by being tested before pregnancy. To do this, you need to consult a doctor, take an analysis for Helicobacter pylori and do fibrogastroduodenoscopy. Upon confirmation of the diagnosis, the therapist will prescribe a treatment that will prevent heartburn and severe complications for the expectant mother.

What kind of pain occurs during pregnancy, when is it normal and what to do for pain during pregnancy – advice from an obstetrician-gynecologist – April 13, 2021

1

Previously, any kind of pain that pregnant women complained about was perceived as a pathology. Now, with the advent of new studies, ideas about the features of the course of pregnancy are changing, and today in our work we use the clinical recommendations “Normal pregnancy”, approved by the Ministry of Health of Russia, formed on the basis of world medical experience. They indicate that not every pain in the expectant mother requires hospitalization. We usually divide pain into several subspecies depending on their localization, but most often a pregnant woman experiences abdominal pain. Let’s dwell on them in more detail.

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2

Which symptoms require urgent hospitalization?

• The pain becomes nagging (like before menstruation), occurs every 15 minutes or more, lasts 15–20 seconds and subsides. This may be a sign of a threatened abortion and the onset of preterm labor. It is especially dangerous if such pains are accompanied by bleeding from the genital tract of any intensity.

• Sharp pains that do not go away even after the woman has taken a free position lying down, and which cause a deterioration in her general condition: dizziness, severe weakness, cold sweat, fainting. It can also indicate serious pregnancy complications.

• A rapid pulse and low blood pressure combined with uterine pain may indicate the development of obstetric complications, such as placental abruption or ectopic pregnancy (if the pregnancy is short term and it is not clear where the ovum is located).

• Women who have a scar on the uterus after a caesarean section or removal of fibroids, it is very important to monitor their condition, because any constant discomfort in the lower abdomen – bursting and aggravated by the movement of the fetus – requires examination and ultrasound for the viability of the scar, in order to prevent complications, such as, for example, uterine rupture.

• A pregnant woman must pay attention to the pain that occurs in the epigastrium (upper abdomen). This is not always a symptom of a disease of the stomach, liver or pancreas, as patients themselves and even doctors often believe. In late pregnancy, such pain may indicate the development of a severe complication – preeclampsia.

• Periodic headaches. There is a tendency that expectant mothers very often suffer from headaches, do not complain about them, but this can also be a harbinger of severe obstetric complications. It is very important that women consult a doctor with such symptoms, especially if they are combined with edema, high blood pressure, and increased levels of protein in the urine. A headache is unbearable.

• Of particular note is the increase in blood pressure in pregnant women (over 140/90 mmHg Art.). Even if a woman has hypertension, to which she was accustomed before pregnancy, does not feel worse when the pressure rises, the fetus and placental vessels are designed for a pressure of no more than 140/90 mm Hg. Art. Anything above this level causes vasospasm, fetal malnutrition, the risk of placental abruption and other hemorrhages, including cerebral hemorrhages in the patient herself.

Important! In any case, when the woman lay down, rested, but the pain in the abdomen did not go away or it is very strong, constant and excessive and causes disturbances in the condition, a quick response is required, calling an ambulance or seeking medical help. If timely help is not provided to the mother and child, the outcome can be very unfavorable. A pregnant woman should not refuse hospitalization recommended by doctors! All this is done only in the interests of mother and child.

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3

What kind of pain can you endure?

• Rare pain in the lower abdomen, pulling or indefinite, not more than 2-3 times a day. It should be recalled that the uterus, which is smaller than a fist in a non-pregnant woman, increases significantly in size in an expectant mother, and as it grows, pushes neighboring organs apart to take its position. This mechanical squeezing of other organs by the growing uterus can give unpleasant painful sensations. Also, the consequences of this can be frequent urination and discomfort when urinating in early pregnancy (up to 14 weeks, when the uterus is in the small pelvis) and later, when the fetal head descends and presses against the mother’s pelvis.

• A woman may occasionally experience spasms and pain in the intestinal area, especially with constipation, which is typical for pregnancy. But all these infrequent functional pains are acceptable and do not require medical intervention.

• Pain in the lumbosacral spine is not considered dangerous if they do not have a periodic cramping character (pulled – got sick – let go) every 15 minutes or more. According to statistics, back pain during pregnancy occurs in 35-60% of women. Among women with back pain, 47% to 60% of women experience back pain for the first time between 5 and 7 months of pregnancy. The most common cause of back pain during pregnancy is an increase in the load on the spine due to an increase in the abdomen and a shift in the center of gravity, as well as relaxation of the ligaments under the influence of relaxin. As a rule, such pains pass in the supine position, rest or wearing a bandage.

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4

How can you relieve non-urgent pain yourself?

• The most important advice: give the pregnant woman the opportunity to lie down and rest, especially if the pain is associated with fatigue or overexertion.

• If your back hurts, a light massage in the lumbar region will help, it can be done by a pregnant woman’s spouse or someone close to her. Warming procedures and ointments should not be used. The mode of physical activity is important, including a change of loads and rest, swimming, physical exercises.

• A light sedative antispasmodic herbal tea can help with various types of pain, it is allowed for pregnant women. These are chamomile, valerian, motherwort, mint, lemon balm and others. Herbal tea for pregnant women also helps to cope with functional disorders of the gastrointestinal tract and early toxicosis (nausea and vomiting).

• We do not prohibit pregnant women from bathing or swimming, if it is pleasant and enjoyable for a woman, then this is permissible. But we do not recommend taking a hot bath: you can overdo it with the temperature of the water, which can increase blood circulation and cause complications during pregnancy. It is allowed to take a light warm shower.

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What to do if the pain does not go away?

If a pregnant woman has a deterioration in her general condition, we recommend that you seek medical help and be examined. For this, no one will scold! If the general condition is severe, contractions have begun, amniotic fluid has broken, bleeding has appeared, a severe headache is bothering you, call an ambulance. In other cases, you can contact your own or the doctor on duty at the antenatal clinic where you are being observed. It happens that women go to the emergency room of the maternity hospital on their own – we do not refuse anyone to be examined and examined. For example, in our Republican Clinical Perinatal Center, we perform ultrasound, cardiotocography (we examine the fetal heartbeat), fully examine the patient, assess the situation, and after a complete examination, if the pathology is detected, we accompany to the hospital or, if there are no complications, for each pregnant woman who comes to us with pain, sent home for outpatient follow-up. And then the women, with the confidence that everything is fine with them, leave. Other institutions of obstetrics work in the same way. And, of course, it’s right to make sure that everything is fine with the baby if there were worries and pains. Many expectant mothers fear that “I will still be admitted to the hospital, regardless of whether I have health problems or not.” This position is fundamentally wrong! Today we are moving away from unnecessary hospitalization and offer inpatient treatment to a pregnant woman only if there are serious grounds for this after a full examination.

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I don’t want to go to the hospital, but the doctor insists. How to proceed?

But at the same time, the obstetrics service has another serious problem: pregnant women often hide their complications, pain, and thus cross the threshold of a serious complication. And then they categorically refuse to provide medical care, and their spouses and relatives support them in this. If the doctor insists on hospitalization, relatives should release the expectant mother from all problems and affairs, let her go to the hospital calmly, and husbands should not convince their spouse that she does not need medical help! We are constantly faced with such a problem, and we have to persuade not only worried expectant mothers, but also all their relatives. In emergency situations, when minutes count, such lengthy persuasion is simply unacceptable!

If a pregnant woman feels unwell, no matter what it is, or you see that she is close to passing out, she has a severe headache, muscle twitching, sharp pains in the abdomen, any discharge, not you need to do Internet diagnostics or help a pregnant woman with improvised means! This is an occasion to send a pregnant woman to the hospital as quickly as possible by calling an ambulance.

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What should I do if I start bleeding?

One of the most dangerous complications that a pregnant woman can experience is bleeding. In this case, the woman must be placed on a horizontal surface and an ambulance should be called immediately. In no case do we wait until it passes by itself!

• Until the ambulance arrives, a woman must remain in a horizontal position – not on her back, but on her side, because blood circulation in the uterus is disturbed on her back. Under no circumstances should she walk.

• It is undesirable to take the patient to the hospital on your own, because blood loss can be large and fast, and, accordingly, moving in your own car, without medical equipment and without special systems that are in the ambulance, can lead to worsening condition of the pregnant woman. It is better to wait for the arrival of specialists, because bleeding is a very serious pathology during pregnancy.

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8

Can a pregnant woman take painkillers while she is waiting for the doctor?

While waiting for the doctors to arrive, do not experiment with pregnant women! Even a glass of water, tea, pain pills can interfere with further medical care. For example, a pregnant woman became ill due to placental abruption (but she does not know about this yet). Upon arrival at the maternity hospital, if an emergency caesarean section is necessary, taking food, water, and medicines will make it difficult to choose and perform anesthesia for the operation. Therefore, when it comes to an incomprehensible condition that suddenly developed in an expectant mother, it is better not to take any unnecessary actions and be aware that some of these conditions may require an emergency delivery. The doctor should understand the situation, not others.

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9

What should I do if I have seizures?

Emergency care may be required for convulsions in pregnant women . We are talking about a convulsive attack, which is manifested by a violation of consciousness, twitching of facial and skeletal muscles, involuntary convulsive movements and arching of the trunk and limbs, respiratory disorders. Such an attack may be a manifestation of epilepsy, intracerebral hemorrhage, or a severe complication of pregnancy for a period of more than 20 weeks – eclampsia. You should immediately call an ambulance, even if the attack did not last long and completely passed. Unfortunately, it may happen again in the near future. You can not forcefully hold a woman and try to stop the convulsions with mechanical efforts, this can lead to injury. It is necessary, in the supine position on the left side, to carefully protect the head and limbs from blows, to ensure the patency of the respiratory tract – to make sure that there is not a large amount of mucus or vomit in the oral cavity: when breathing is restored after a convulsive seizure, a woman can inhale this content. If necessary, clean the oral cavity with a tissue, handkerchief. All other assistance will be provided by ambulance specialists.

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10

What should I do if my water breaks?

Amniotic fluid discharge requires immediate response . The woman should take a horizontal position and call an ambulance. It is desirable that the expectant mother does not get to the maternity hospital on her own – by taxi or by her husband’s car – but accompanied by ambulance workers, because here there are certain risks for the health of mother and baby. On average, the first birth in women occurs within 8-12 hours, the second – 6-8 hours. This time is enough to get to the hospital. Today we are faced with such problems as waiting at home for the onset of labor when the amniotic fluid breaks. This is a very dangerous phenomenon, since with an increase in the duration of the anhydrous period, the risk of infection in the fetus increases, and if the woman’s birth canal is not ready, then delaying with the use of special methods of preparing for natural childbirth can lead to a forced caesarean section.

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11

What should I do if I have contractions?

If a woman feels that regular contractions have begun during a premature pregnancy, she must go to the hospital, there is no need to wait for it to “go away by itself”. In case of premature birth, it is especially necessary to rush to the maternity ward, because in some cases doctors can stop the process: special drugs are used that restrain labor, and sometimes doctors manage to prolong the pregnancy. Or doctors do everything necessary to properly and quickly prepare a premature baby for birth.

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12

What should a pregnant woman take with her to the hospital?

Every pregnant woman needs to have a “duty” bag ready at home, which she needs to take with her to the maternity hospital or gynecological department in case complications arise, you call an ambulance and hospitalization is required. This bag should contain copies of documents – a passport, a compulsory medical insurance policy, SNILS, personal hygiene items, clothes and removable shoes that are necessary for a stay in the hospital, and those drugs that a pregnant woman regularly takes as prescribed by a doctor. Do not forget the original documents and the pregnant woman’s exchange card. You should always have an exchange card with you, wherever you go: for a walk, on a trip, to the store. Even if a pregnant woman feels well, let everything that will be useful to her in an emergency be prepared in advance.