Abdominal Pain in Women: What can it be?

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Abdominal Pain in Women: What can it be?

At some point of time, everyone experiences abdominal pain. Women are more likely to experience abdominal pain primarily because of relatively more frequent infection of the urinary tract and reproductive organs. Sometimes it settles by popping a medicine and sometimes it needs a visit to a family doctor. Rarely an abdominal pain, either chronic or severe acute can bring one to a clinic of Gastroenterologist, Surgeon or Gynaecologist. What is chronic and what is acute? Good question! Chronic pain is defined as pain lasting more than 3 months and acute means pain of shorter duration. Sometimes differentiation between acute and chronic is done by arbitrary interval of time since onset. Chronic or acute does not reflect the severity of the disease, but only timelines. The severity of pain is represented as mild, moderate and severe. In addition to this, an abdominal pain may need urgent surgical intervention or can be managed over time by medications.  Cause of abdominal pain can be estimated by the location of pain, acute or chronic onset and severity.

Most frequent reason for abdominal pain arising from the reproductive organ is a menstrual pain. Others can be Premenstrual Syndrome, Poly Cystic Ovarian Disease (PCOD), endometriosis, infection, pelvic inflammatory disease. A woman expected to be pregnant can also have abdominal pain due to pregnancy, ectopic pregnancy or miscarriage. Most common non-reproductive cause of abdominal pain is gastroenteritis, followed by irritable bowel syndrome, urinary tract infection, gastric problem and constipation. About 10% of cases which need emergency intervention include gallbladder stones, pancreas problems, appendicitis. In elderly women, small bowel obstruction, reduced blood supply to the intestine, hernia, cancer can present as abdominal pain. Even a heart attack can sometimes present with abdominal pain since the pain due to the reduced blood supply to heart radiates to shoulder, arm, neck, and abdomen. We will now see each cause of pain one by one and what to do in each scenario.

Reproductive organ related pain

Menstrual pain is most commonly abdominal pain in women of reproductive age. Contraction of the uterus during menstruation leads to pain, which mostly attenuates with age. In some it may be severe requiring a painkiller or visit to Gynaecologist.

Premenstrual syndrome can lead to pain and discomfort one or two days prior to menstruation.

Pelvic Inflammatory Disease or PID is usually a sexually transmitted bacterial infection. Vaginal infection spreading to the uterus and Fallopian tubes causes pain in pelvic region, back and lower abdominal. Gynaecologist manage this condition by antibiotics before it progresses to irreversible damage to Fallopian tubes and uterus.

Endometriosis occurs when menstruating inner lining of uterus growing outside it. Accumulating blood clots and adhesions lead to repetitive pain, usually managed by hormones and pain killers.

Poly Cystic Ovarian Disease (PCOD) is the most common endocrine disorder in reproductive women and leading cause of infertility.  Elevated androgen (male hormones) level leads to irregular or no menstrual periods, heavy periods, excess body and facial hair, acne and difficulty getting pregnant. It is characterized by episodes of cramping pain in lower abdomen and pelvic region. Weight reduction, birth control bills, anti-diabetes medicines under supervision of Gynaecologist are recommended for control of PCOD.

Pregnancy-related abdominal pain

Ectopic pregnancy is implantation of embryo outside uterus, most commonly in Fallopian tubes. It can be a cause of severe abdominal pain, on left or right side. This life threatening condition needs emergency surgery.

A pregnant woman with pain in lower abdominal pain with spotting or bleeding should watch out for miscarriage.

Gastroenteritis

Gastroenteritis mean inflammation of stomach and intestine. It can occur due to infection by eating stale food, contaminated food or water. Abdominal pain in gastroenteritis is usually accompanied with vomiting and/or diarrhoea. Dehydration and subsequent lack of energy may occur to loss of water and electrolytes in vomiting and diarrhoea. Priority is to replenish water and electrolytes immediately equal to the amount lost. WHO (World Health Organisation) recommends ORS or Oral Rehydration Solution for treatment of diarrhoea. Start food as early as possible. No antibiotic is usually required and this can be managed at home unless patient is unable to drink ORS, having continuous vomiting or loss of fluid is significant. In such scenario patient may need to be given intravenous fluids or saline to restore electrolyte balance. Gastroenteritis can be easily prevented by proper hand washing with soap and water, drinking clean water water, eating hygienic food and avoiding contamination of eatables.

Irritable Bowel Syndrome (IBD)

Some people complain of long standing abdominal pain with alternating patterns of bowel movements like diarrhea and constipation, with no identifiable underlying cause. Pain is cramping in nature. It often affects the quality of life and leads to chronic fatigue. Though there is no cure for IBD, dietary changes, medications, probiotics, curd and hygienic food can improve symptoms. Visit to Gastroenterologist helps improving the quality of life.  10 to 15% of people are affected with IBD, but it does not affect life expectancy or lead to other serious diseases.

Gastric problem

Gastric problems can include gastric ulcer, gastro-esophageal reflux disease or gastritis. All gastric problems typically present with upper abdominal pain, burning sensation in stomach, discomfort and feeling of fullness.

Gastric Ulcer

Mucosal lining of the stomach protects it from acidic gastric juice. When there is damage or inflammation to this mucosal lining it leads to gastric ulcer or gastritis. Burning pain in gastric ulcer gets aggravated with eating. Patient may also have dull pain, bloating, loss of appetite, vomiting and weight loss. It can lead to complications like bleeding, perforation or blockage of stomach.

Gastro-esophageal reflux disease or GERD is a long-standing problem of reflux of gastric contents into esophagus. This leads to burning pain in upper abdomen and lower chest also called heartburn. Obesity, smoking, pregnancy, alcohol and certain medicines aggravate it. Treatment is with lifestyle changes, diet control, medications, and sometimes surgery.

Gastritis is inflammation of the inner lining of the stomach, due to autoimmune disease, Vitamin B12 deficiency, smoking, alcohol, parasitic infection. When symptomatic, it presents with upper abdominal pain and sometimes vomiting, bloating, nausea, loss of appetite and heartburn. It can lead to ulcer, bleeding or cancer. Hence needs evaluation and proper treatment.

Over the counter medicines though might relieve symptoms of gastric ulcer, gastro-esophageal reflux disease and gastritis, cannot cure it. An evaluation by gastroenterologist and treatment with medications is required for permanent treatment of this repetitive annoying problem.

Constipation

Constipation refers to infrequent bowel movements or difficult, painful defecation. It can be short onset or long standing. It can occur due to obstruction, less fiber diet, hormonal imbalance like hypothyroidism or as side effect of certain medicines. It badly affects the mood, appetite, quality of life and patient always complain of not feeling well. Treatment includes high fiber diet, laxatives, enema and rarely surgery. A long standing constipation is obstructive can hint towards underlying malignancy. Hence needs evaluation and rightly treatment.

Urinary tract infection

Women are relatively more prone to urinary tract infection. Urinary tract infection can affect kidney, ureters, urinary bladder and urethra, but most commonly involves urinary bladder and urethra. Patient typically complaints of pain in pubic region, frequent urination and burning sensation during urination. It can be treated easily with antibiotics, before it spreads to kidneys.

Abdominal pain needing emergent intervention

An abdominal pain due to appendicitis, gall bladder stones, pancreatitis may need emergency surgery.

Appendicitis is inflammation of appendix leading to right lower abdominal pain, nausea and vomiting. Diagnosis is based on signs and symptoms. USG and CT scan can facilitate the diagnosis. Standard treatment is surgical removal of appendix before it ruptures leading to serious complications.

Gall bladder stone is a stone formed out of bile juice within the gallbladder. 80% times it is symptomless and only minority of patients complain of sour burping, mild pain in upper right abdomen. It presents with severe pain and needs urgent surgical intervention when complicated with inflammation of gall bladder, liver, pancreas or surrounding ducts. Rapid weight loss, liver disease, obesity, diabetes, pregnancy, birth control pills, family history can increase the risk of developing gall bladder stones.

Pancreatitis

Yes, you know it right! Pancreas secrete insulin, deficiency of which is responsible for diabetes. It also secretes pancreatic juice necessary for digestion of dietary fats. Inflammation of pancreas is called pancreatitis. It presents with sudden onset of upper abdominal pain radiating to back and accompanied by nausea and vomiting. Chronic pancreatitis can also present with weight loss, fatty stools and diarrhea. It can complicate with infection, bleeding or diabetes mellitus. It is treated with intravenous fluids, antibiotics, painkillers and relieving obstruction if caused by gallstones. Alcohol and gallbladder stones are the most common culprits leading to pancreatitis, others being trauma, tumor and mumps. Right! Mumps can be prevented with vaccination. Even adults need a shot!

This differential diagnosis of pain might help you shortlist the cause and speculate a diagnosis. But do not hold it there. Visit a gastroenterologist or gynecologist for expertise treatment. Gastroenterologist are doctors who after completing MD study 3 more years to specialize in managing diseases of the abdomen. Take advantage of full time experienced Gastroenterologist at Currae hospital.

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