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Chronic Abdominal Pain and Recurring Abdominal Pain

By

Jonathan Gotfried

, MD, Lewis Katz School of Medicine at Temple University

Last full review/revision Mar 2020
CLICK HERE FOR THE PROFESSONAL VERSION
Topic Resources

Chronic abdominal pain is pain that is present for more than 3 months. It may be present all the time (chronic) or come and go (recurring). Chronic abdominal pain usually occurs in children beginning after age 5 years. About 10 to 15% of children aged 5 to 16 years, particularly those aged 8 to 12 years, have chronic or recurring abdominal pain. It is somewhat more common among girls. Chronic abdominal pain is also common among adults, affecting women more often than men.

People with chronic abdominal pain may also have other symptoms, depending on the cause.

Causes

Usually by the time abdominal pain has been present for 3 months or more, people have been evaluated by a doctor, and typical disorders that cause abdominal pain (see Acute Abdominal Pain Acute Abdominal Pain Abdominal pain is common and often minor. Severe abdominal pain that comes on quickly, however, almost always indicates a significant problem. The pain may be the only sign of the need for surgery... read more ) have already been identified. If people have been evaluated and the cause has not been identified by this time, only about 10% of them have a specific physical disorder (see Table: Physical Causes and Features of Chronic Abdominal Pain Physical Causes and Features of Chronic Abdominal Pain Chronic abdominal pain is pain that is present for more than 3 months. It may be present all the time (chronic) or come and go (recurring). Chronic abdominal pain usually occurs in children... read more ). The remaining 90% have what is called functional abdominal pain.

Functional abdominal pain is real pain that exists for more than 6 months and occurs with no evidence of a specific physical disorder or other gastrointestinal problem (for example, peptic ulcer disease Peptic Ulcer Disease A peptic ulcer is a round or oval sore where the lining of the stomach or duodenum has been eaten away by stomach acid and digestive juices. Peptic ulcers can result from Helicobacter pylori... read more Peptic Ulcer Disease ). It is also not related to a drug or a toxin. When functional abdominal pain occurs in people who have altered bowel habits, it is called irritable bowel syndrome Irritable Bowel Syndrome (IBS) Irritable bowel syndrome is a disorder of the digestive tract that causes recurring abdominal pain and constipation or diarrhea. Symptoms vary but often include lower abdominal pain, bloating... read more (IBS). Functional pain can be severe and typically interferes with the person's life. Exactly what causes the pain is unknown. But the nerves of the digestive tract may become oversensitive to sensations (such as normal movements of the digestive tract), which do not bother most people. Genetic factors, life stresses, personality, social situations, and underlying mental disorders (such as depression or anxiety) may all contribute to functional pain. Chronic abdominal pain in children may be related to a need for attention (as when a sibling is born or the family moves), the stress of starting school, lactose intolerance Lactose Intolerance Lactose intolerance is the inability to digest the sugar lactose because of a lack of the digestive enzyme lactase, leading to diarrhea and abdominal cramping. Lactose intolerance is caused... read more , or sometimes child abuse Overview of Child Neglect and Abuse Child neglect is withholding essential things from children. Child abuse is doing harmful things to children. Some factors that increase the risk of child neglect and abuse are poverty, drug... read more Overview of Child Neglect and Abuse .

Common physical causes

In children, the most common causes are

In young adults, common causes include

Evaluation

Doctors first focus on whether the pain is functional pain or is caused by a disorder, drug, or toxin. Making this distinction may be difficult. However, if warning signs are present, functional pain is unlikely (but not impossible).

Warning signs

The following symptoms are cause for concern:

When to see a doctor

If people with chronic abdominal pain develop warning signs, they should see a doctor right away unless the only warning signs are loss of appetite, jaundice, and/or swelling. People with loss of appetite, jaundice, and/or swelling or with steady, worsening pain should see a doctor within a few days. When warning signs are present, a physical cause is very likely. People without warning signs should see a doctor at some point, but a delay of a few days or so is not harmful.

What the doctor does

Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the pain and the tests that may need to be done (see Table: Physical Causes and Features of Chronic Abdominal Pain Physical Causes and Features of Chronic Abdominal Pain Chronic abdominal pain is pain that is present for more than 3 months. It may be present all the time (chronic) or come and go (recurring). Chronic abdominal pain usually occurs in children... read more ).

Doctors ask particularly about activities (such as eating, urinating, or having a bowel movement) that relieve or worsen the pain. Whether the pain or other digestive upset occurs after eating or drinking dairy products is important because lactose intolerance is common, especially among blacks, Hispanics, Asians (particularly East Asian countries), and American Indians. Doctors also ask about other symptoms (such as vomiting, diarrhea, or constipation), about diet, and about any surgery involving the abdomen, drugs used, and previous tests and treatments for the pain. Whether any family members have disorders that cause abdominal pain is also important.

Doctors also ask about a person's diet because ingesting large amounts of cola beverages, fruit juices (which may contain significant quantities of the sugars fructose and sorbitol), or gas-producing foods (such as beans, onions, cabbage, and cauliflower) can sometimes be the cause of otherwise puzzling abdominal pain.

Between the initial visit and follow-up visits, people are often asked to record information about the pain, bowel movements, diet, any activities that seem to trigger pain, any remedies tried, and the effects of the remedies.

Table
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Testing

Usually, doctors do certain tests. These tests include urinalysis Urinalysis and Urine Culture Urinalysis, the testing of urine, may be necessary in the evaluation of kidney and urinary tract disorders and can also help evaluate bodywide disorders such as diabetes or liver problems. A... read more Urinalysis and Urine Culture , a complete blood cell count Complete blood count Doctors select tests to help diagnose blood disorders based on the person's symptoms and the results of the physical examination. Sometimes a blood disorder causes no symptoms but is discovered... read more , and blood tests to evaluate how the liver, kidneys, and pancreas are functioning. Usually if people are over 50 or have risk factors for colon cancer (such as a family history of the disease), a colonoscopy Endoscopy Endoscopy is an examination of internal structures using a flexible viewing tube (endoscope). Endoscopy can also be used to treat many disorders because doctors are able to pass instruments... read more is also recommended. Some doctors recommend computed tomography (CT) of the abdomen Computed Tomography (CT) In computed tomography (CT), which used to be called computed axial tomography (CAT), an x-ray source and x-ray detector rotate around a person. In modern scanners, the x-ray detector usually... read more Computed Tomography (CT) if people are under 50, but other doctors wait for specific symptoms to develop. Other tests are done depending on results of the history and physical examination (see Table: Physical Causes and Features of Chronic Abdominal Pain Physical Causes and Features of Chronic Abdominal Pain Chronic abdominal pain is pain that is present for more than 3 months. It may be present all the time (chronic) or come and go (recurring). Chronic abdominal pain usually occurs in children... read more ).

Additional tests are done if any test results are abnormal, if people develop new symptoms, or if new abnormalities are detected during the examination.

Treatment

Treatment of abdominal pain depends on the cause and the symptoms. For example, if people have lactose intolerance, a lactose-free diet (eliminating milk and other dairy products) can help. If people are constipated, using a laxative for a few days plus adding fiber to the diet can help.

Functional abdominal pain

Treatment of functional pain depends on the symptoms and is focused on helping people return to normal daily activities and lessening the discomfort. Usually, treatment involves a combination of strategies. Several visits to the doctor may be needed to develop the best combination. Doctors often arrange follow-up visits, depending on people's needs. Visits are continued until well after the problem has resolved.

After functional pain is diagnosed, doctors emphasize that the pain, although real, usually does not have a serious cause and that emotional factors (for example, stress, anxiety, depression) may trigger or worsen an episode of pain. Doctors try to avoid repeating tests after thorough testing has failed to show a physical cause of the symptoms.

Although there are no treatments to cure functional chronic abdominal pain, many helpful measures are available. These measures depend on a trusting and understanding relationship between the doctor, person, and person's family members. Doctors explain how the laboratory and other test results show that the person is not in danger. Doctors encourage people to participate in work, school, and social activities. Such participation does not worsen the condition but instead encourages independence and self-reliance. People who withdraw from their daily activities risk having their symptoms control their life rather than having their life control their symptoms.

Doctors may recommend a high-fiber diet and fiber supplements. People may need to avoid foods that trigger their pain. For example, some people should avoid eating large amounts of foods that are difficult to digest and produce a lot of gas and avoid drinks that are high in sugar.

Many drugs have been tried with varying success. They include drugs that reduce or stop muscle spasms in the digestive tract (antispasmodics) and peppermint oil.

Sources of stress or anxiety are minimized as much as possible. Parents and other family members should avoid reinforcing the pain by giving it too much attention. If people continue to feel anxious or depressed and this seems to be related to the pain, doctors may prescribe antidepressants or drugs to reduce anxiety. Therapies that help people modify their behavior, such as relaxation training, biofeedback, and hypnosis, may also help reduce anxiety and help people better tolerate their pain.

For children, help from parents is essential. Parents are advised to encourage the child to become independent and to fulfill the child’s normal responsibilities, particularly attending school. Allowing the child to avoid activities may actually increase the child’s anxiety. Parents can help the child manage pain during daily activities by praising and rewarding the child’s independent and responsible behaviors. For example, parents could reward the child by scheduling special time with the child or a special outing. Involving school personnel can help. Arrangements can be made to let the child rest briefly in the nurse's office during the school day, then return to class after 15 to 30 minutes. The nurse can sometimes allow the child to call a parent, who should encourage the child to stay in school.

Key Points

  • Usually, chronic or recurring abdominal pain is functional pain (that is, people have pain but no specific physical disorder and no other gastrointestinal problem).

  • Symptoms that require a doctor’s immediate attention include a high fever, loss of appetite or weight, pain that awakens the person, blood in stool or urine, jaundice, severe nausea and vomiting, difficulty swallowing, and swelling of the legs and/or abdomen.

  • Blood and urine tests are usually done to check for disorders that may cause the pain.

  • Additional tests are needed only if people have abnormal test results, warning signs, or symptoms of a specific disorder.

  • For functional pain, treatment involves learning to minimize stress or anxiety, participating in normal daily activities, a trial of fiber supplements, drugs that reduce or stop muscle spasms in the digestive tract, and sometimes taking drugs or using behavioral modification therapies to relieve anxiety, and/or altering the diet.

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