Ab­dom­i­nal pain in women: when should you worry?

Chronicle (Zimbabwe) - - Front Page - Health Mat­ters Dr Anitha An­chan

Ab­dom­i­nal pain, or stom­achache, is a very generic term for pain in the tummy. The pain can be any­where be­tween the lower mar­gin of the ribs and the pelvic bone. The lo­ca­tion of the pain could be within the ab­domen or in the up­per, mid­dle or lower part of the belly.

You can hardly find a woman who has never ex­pe­ri­enced pain in her tummy. All women ex­pe­ri­ence pain in their ab­domen on many dif­fer­ent oc­ca­sions due to one rea­son or the other. Pelvic pain, i.e. pain in the low­est part of the tummy is more com­mon in women.

The causes of tummy pain in women are many. It could be due to in­flam­ma­tion, in­fec­tion, in­di­ges­tion, block­age, loss of blood sup­ply to an or­gan, ab­nor­mal growths, etc. The pain can arise from con­di­tions af­fect­ing the ab­dom­i­nal or­gans like stom­ach, liver, gall­blad­der, pan­creas, in­testines, blad­der, uterus, etc. Ab­dom­i­nal pain could be due to in­di­ges­tion, gas, in­jury, gas­troen­teri­tis, gall­stones, gall­blad­der in­flam­ma­tion (chole­cys­ti­tis), ap­pen­dici­tis, pan­cre­ati­tis, col­i­tis, kid­ney stones, her­nia, etc. Some­times, pain orig­i­nat­ing out­side the ab­domen may be re­ferred or felt in the ab­domen.

Pain aris­ing from the blad­der or kid­ney may man­i­fest as lower ab­dom­i­nal pain. All women ex­pe­ri­ence pelvic pain mostly due to a prob­lem with the re­pro­duc­tive sys­tem. The most com­mon rea­son is men­stru­a­tion. Pelvic in­flam­ma­tory dis­ease (PID), pelvic in­fec­tion, en­dometrio­sis, ir­ri­ta­ble bowel syn­drome (IBS), uri­nary tract in­fec­tion (UTIs), gen­i­tal tu­ber­cu­lo­sis and ec­topic preg­nancy are some of the other causes of pain in the pelvic re­gion.

Ab­dom­i­nal pain, most of the time, are not se­ri­ous. They can be di­ag­nosed and promptly treated.

Trapped wind may cause short-lived dull ache or cramps in the ab­domen. Belly pain ac­com­pa­nied with di­ar­rhoea may be a sign of in­fec­tion of the tummy (gas­troen­teri­tis). De­hy­dra­tion due to vi­ral gas­troen­teri­tis can be pre­vented by in­take of suf­fi­cient flu­ids. Bac­te­rial gas­troen­teri­tis can be treated with an­tibi­otics.

Con­sti­pa­tion may cause bloat­ing or stom­ach pain and may be re­solved with lax­a­tives and other medicines.

Pain in the lower back and ab­domen ac­com­pa­nied by burn­ing sen­sa­tion while uri­nat­ing, an urge to uri­nate fre­quently but pass­ing no or only small amounts of urine, smelly urine and fever could be a sign of cys­ti­tis (in­flam­ma­tion of the blad­der). Mild cys­ti­tis will re­solve it­self. Some women will ben­e­fit with a course of an­tibi­otics.

The size of a her­nia and its as­so­ci­ated symp­toms will likely be mon­i­tor over a pe­riod of time be­fore surgery is opted.

Some women may feel mild ache or con­trac­tion pain last­ing a few min­utes to a few hours dur­ing ovu­la­tion. This pain, usu­ally as­so­ci­ated with the pelvic re­gion, is called mit­telschmerz.

Al­most ev­ery woman suf­fers from cramps dur­ing those days of the month. There are some home reme­dies to beat men­strual pain.

Se­vere tummy pain that starts sud­denly and un­ex­pect­edly could be a med­i­cal emer­gency. It may in­di­cate a se­ries of prob­lems. See your doc­tor at the ear­li­est if your pain is con­tin­u­ous and se­vere, wakes you up from your sleep and ag­gra­vates when you move. Tummy pain ac­com­pa­nied by nau­sea, vom­it­ing, loss of ap­petite, dizzi­ness and black, tarry stool is also worth wor­ry­ing about.

It could be the symp­tom of ap­pen­dici­tis which needs prompt treat­ment. An un­treated in­flamed ap­pen­dix may burst and spill the pus to sur­round­ing ar­eas which can be life-threat­en­ing. In­flam­ma­tion of the tis­sue lin­ing the in­side of the ab­domen (peri­toni­tis) could be­come more se­vere and re­quire im­me­di­ate med­i­cal at­ten­tion.

Se­vere pain in the tummy with a hard lump that can be felt by press­ing your belly must be in­ves­ti­gated. The early warn­ing signs of stom­ach can­cer are so sub­tle that may over­lap with mi­nor com­plaints like acid­ity, con­sti­pa­tion, etc.

Pain in the lower ab­domen dur­ing your pe­ri­ods is quite com­mon. How­ever, dys­men­or­rhoea or se­vere men­strual pain needs to be mon­i­tored closely. It could be a sign of pre­men­strual syn­drome, fi­broids, en­dometrio­sis, poly­cys­tic ovar­ian syn­drome (PCOS/ PCOD), pelvic in­flam­ma­tory dis­ease or gen­i­tal tu­ber­cu­lo­sis.

Pre­men­strual syn­drome or PMS is a col­lec­tion of phys­i­cal and emo­tional symp­toms that oc­cur a week or two be­fore your pe­ri­ods and usu­ally re­duce when your menses start. When PMS oc­curs on a reg­u­lar ba­sis with very se­vere symp­toms and you find no re­lief with the medicines, you may need sur­gi­cal in­ter­ven­tion.

Fi­broids are non-can­cer­ous growths in the uterus which usu­ally cause no symp­toms. But it can cause per­sis­tent pelvic pain if it grows and presses on the ad­ja­cent or­gans or it be­gins to die and re­leases pain and fever caus­ing chem­i­cals. Med­i­ca­tions can help shrink it in size. Larger fi­broids may need surgery. If un­treated, they can re­duce the chances of get­ting preg­nant. Fi­broids can be quite danger­ous to a preg­nant woman.

In en­dometrio­sis, the cells lin­ing the uterus (en­dometrium) start grow­ing in other or­gans out­side the uter­ine cav­ity like ovaries, blad­der, etc. Around 10–15 per­cent of women are af­fected by this con­di­tion dur­ing their re­pro­duc­tive years. It is a very pro­gres­sive and dam­ag­ing painful con­di­tion af­fect­ing all the or­gans in the pelvic cav­ity. It causes im­paired fer­til­ity. Un­for­tu­nately, there is no per­ma­nent cure for en­dometrio­sis till a woman hits menopause.

Stop ig­nor­ing ir­reg­u­lar and painful men­strual cy­cle. Poly­cys­tic ovar­ian syn­drome (PCOS or PCOD) is one of the most com­mon hor­monal dis­or­ders in women of the re­pro­duc­tive age group. It is a col­lec­tion of symp­toms that man­i­fest to­gether and is com­monly seen as a hor­monal im­bal­ance in women. Hav­ing PCOS puts you at a higher risk of suf­fer­ing from com­pli­ca­tions dur­ing preg­nancy.

Do you have dull, aching pelvic pain that has been present for more than six months? The pain could be a sign of a se­ri­ous con­di­tion called pelvic con­ges­tion syn­drome (PCS), where the mal­func­tion­ing valves in the vein of ovary cause the blood to flow back into the ovaries. Do not ig­nore it till it be­comes un­bear­able.

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