Pain Under the Diaphragm Through to the Back With Eating or Drinking

Pain in the stomach (abdomen) is common. Usually it doesn't last long and is often due to a gut infection or a small upset - but there are many other possible causes. Pain that is severe or doesn't settle quickly may need attention from a doctor. The most common causes of abdominal pain are mentioned below.

What is abdominal pain?

The abdomen is that part of your body which is below your ribs and above your hips. Some people call it the tummy, trunk, belly or gut. When you have a pain in that area, doctors will call it abdominal pain. However, other popular terms for abdominal pain include tummy pain, tummy ache, stomach ache, stomach pain, gut ache, belly ache and gut rot.

Usually, pain that you feel here will be caused by a problem in your gut. Sometimes it can be caused by problems in other organs.

What is the gut?

The gut (gastrointestinal tract) starts at the mouth and ends at the anus. When we eat or drink, the food and liquid travel down the gullet (oesophagus) into the stomach. The stomach churns up the food and then passes it into the small intestine.

The small intestine - sometimes called the small bowel - is several metres long and is where food is digested and absorbed. Undigested food, water and waste products are then passed into the large intestine - sometimes called the large bowel. The main part of the large intestine is called the colon, which is about 150 cm long. This is split into four sections: the ascending, transverse, descending and sigmoid colon. Some water and salts are absorbed into the body from the colon. The colon leads into the back passage (rectum) which is about 15 cm long. The rectum stores stools (faeces or poo) before they are passed out from the anus.

What types of pain are there?

Doctors have different words to describe the different types of pain you can feel in the gut. Very broadly, pains may be sharp or stabbing, crampy, colicky or a general dull ache. Colicky means gradually becoming worse, then easing off again. This may happen repeatedly.

Doctors may also be interested in where the pain is and whether the pain seems to be travelling (radiating) in a certain direction. Having this information and putting it together with other information, such as whether you have been being sick (vomiting) or have had diarrhoea, will help the doctor work out what is wrong.

Pain that comes on suddenly may be called acute. Longer-standing pain is called chronic.

What problems can cause intestinal pain?

This list does not include all the possible causes of gut pain but some of the more common causes include the following:

Indigestion

Indigestion means different things to different people. You might feel pain in your upper abdomen or behind your breastbone. This usually happens after eating certain types of food. The foods might be fatty or very rich. You may feel like burping a lot or have a nasty acid taste coming into your mouth. It usually goes in a few hours. Most people will find relief from simple remedies they can buy at the chemist.

If you are older, or are known to have heart disease, indigestion-type pains that come on with exertion or stress are worrying. Sometimes it can be difficult to tell angina or a heart attack from indigestion. If you have pain that goes into your jaw or down your left arm, it might be angina. If it goes off quickly, try to see your GP to discuss it. If it doesn't settle and you feel unwell, phone 999/112/911 for an ambulance.

Wind

Crampy pains after eating may be wind. Your abdomen may feel swollen or bloated. If you are able to go to the toilet and open your bowels or pass wind, the pain usually goes. If not, a chemist may be able to recommend some medication to ease the pain.

Constipation

Constipation is common. It means either going to the toilet less often than usual to empty the bowels, or passing hard or painful stools. Sometimes crampy pains occur in the lower abdomen. You may also feel bloated and sick if you have severe constipation. See the separate leaflets called Constipation and Constipation in Children for more information.

Irritable bowel syndrome (IBS)

IBS is a common gut disorder. The cause is not known. Symptoms can be quite variable and include abdominal pain, wind, bloating, and sometimes bouts of diarrhoea and/or constipation. Symptoms tend to come and go. There is no cure for IBS but symptoms can often be eased with treatment. See the separate leaflet called Irritable Bowel Syndrome for more details.

Diverticular disease

Diverticular disease is common in older people. It is thought to be caused by eating a diet too low in fibre for a long time. It commonly causes no symptoms at all but some people have an ongoing lower abdominal aching, and it can also cause flares of more severe pain which require treatment with painkillers and antibiotics. See the separate leaflet called Diverticula (Diverticulosis, Diverticular Disease, Diverticulitis) for more details.

Appendicitis

Appendicitis means inflammation of the appendix. The appendix is a small pouch that comes off the gut wall. Appendicitis is quite common. Typical symptoms include abdominal pain and being sick (vomiting) that gradually become worse over 6-24 hours. The pain usually starts in the middle of the abdomen but over time seems to move towards the right hip. Some people have less typical symptoms. See the separate leaflet called Appendicitis for more details.

Kidney stones

Pain that starts in your back and seems to travel around the side of your abdomen to your groin, may be a kidney stone. The pain is severe and comes and goes. This is called renal colic. The pain goes when the stone is passed. Sometimes the stone cannot be passed and you may need to have the stone broken into small pieces at the local hospital. There may be blood in your urine too. See the separate leaflet called Kidney Stones for more details.

Urine infection

This is a common cause of aching lower abdominal pain in women. It is much less common in men. Along with pain, you may feel sick and sweaty. There may be a sharp stinging when you pass urine and there may be blood in the urine. See the separate leaflets called Cystitis in Women, Urine Infection in Men and Urine Infection in Children for more details.

Pelvic inflammatory disease (PID)

PID is an infection of the womb and/or Fallopian tubes. Treatment is with antibiotics. Pain in the lower abdomen (pelvic area) is the most common symptom. It can range from mild to severe. Pain during sex can also occur. Women commonly also have vaginal discharge with PID. See the separate leaflet called Pelvic Inflammatory Disease for more details.

Gallstones

Many people do not know they have gallstones. Symptoms include severe pain in the upper right side of the abdomen. This is called biliary colic. The pain is usually worst to the right-hand side, just below the ribs. The pain eases and goes if the gallstone is pushed out into the bile duct (and then usually out into the gut) or if it falls back into the gallbladder.

Pain from biliary colic can last for just a few minutes but, more commonly, lasts for several hours. A severe pain may only happen once in your lifetime or it may flare up from time to time. Sometimes less severe but niggly pains occur now and then, particularly after a fatty meal when the gallbladder contracts most. See the separate leaflet called Cholecystitis for more details.

Period pain

Most women have some lower abdominal pain during periods. The pain is often mild but for some women, the pain is severe enough to affect day-to-day activities. The pain can be so severe that they are unable to go to school or work. Periods tend to become less painful as you get older. An anti-inflammatory painkiller often eases the pain. See the separate leaflet called Period Pain (Dysmenorrhoea) for more details.

Food poisoning

When we think of food poisoning, we usually think of the typical gastroenteritis - an infection of the gut (intestines) - that usually causes diarrhoea with or without vomiting. Crampy pains in your tummy (abdomen) are common. Pains may ease for a while each time you pass some diarrhoea. See the separate leaflets called Food Poisoning and Food Poisoning in Children for more details.

Stomach and duodenal ulcers

The pain from an ulcer may come and go. The pain is in the top part of your gut but may also feel like it goes through into your back. The pain often comes at night and wakes you up. Food may make it better in some types of ulcer, or may make it worse. See the separate leaflets called Stomach Ulcer (Gastric Ulcer) and Duodenal Ulcer for more details.

Inflammatory bowel disease

There are two main types of inflammatory bowel disease: Crohn's disease and ulcerative colitis. They are both conditions which cause inflammation in the gut. The symptoms can flare up from time to time. Symptoms vary, depending on the part of the gut affected and the severity of the condition. Common symptoms include bloody diarrhoea, abdominal pain and feeling unwell.

Gastritis

Gastritis is inflammation of the stomach lining. It may cause upper abdominal pain (just below your breastbone). The pain is often described as a burning feeling. There are usually other symptoms as well, such as feeling sick (nausea), vomiting and feeling full after eating.

Cancer

People often worry that gut pain is caused by cancer. If you have pain that doesn't settle quickly or with simple remedies, then you should go and see your doctor. Some of the questions they ask will be to make sure there is not any serious cause, such as cancer, for the pain you are having.

Bowel cancer can cause abdominal pain. It commonly also causes weight loss, a change in bowel habit and blood in the stools.

Pancreatic cancer can cause upper abdominal pain which goes through to the back, but more commonly starts with other symptoms such as jaundice.

Stomach cancer can cause upper abdominal pain similar to the symptoms of gastritis but it does not get better with simple remedies.

The list does not include every condition that causes abdominal pain. These are just some of the most common causes.

What investigations might be advised?

Some conditions may not need any investigations. Otherwise, the type of investigation will depend on which part of the gut is affected. Blood tests sometimes provide useful information about what is causing abdominal pain. Sometimes an X-ray or ultrasound scan will be carried out, which will look for specific things your doctor may suspect. The gut can be looked at directly with endoscopy. A gastroscopy will look at the oesophagus and stomach, and a colonoscopy will look at the large bowel. More details can be found in the individual condition leaflets, mentioned above.

What treatments for abdominal pain may be offered?

Again, this will depend on what the likely cause of your pain is. Some types of pain can be treated simply with over-the-counter remedies you can buy at the chemist. Others may need treatment at a hospital.

Follow the links to the individual condition leaflets for more details.

What should you do next?

You may recognise your type of pain from the descriptions here. However, if you have a pain that is not going away quickly (within a few hours) or that you cannot cope with, you should see a GP. This may be your own GP, or an on-call GP if out of hours.

How can I prevent abdominal pain?

Eat plenty of fruit and vegetables

It is recommended that we eat at least five portions of a variety of fruit or vegetables each day. If you eat a lot of fruit and vegetables then your chances of developing heart disease, a stroke or bowel cancer are reduced. In addition, fruit and vegetables:

Contain lots of fibre, which helps to keep your bowels healthy. Problems such as constipation and diverticular disease are less likely to develop.
Contain plenty of vitamins and minerals, which are needed to keep you healthy.
Are naturally low in fat.
Are filling but are low in calories.

Eat plenty of roughage (fibre)

Fibre is the part of food that is not digested. It is filling but has few calories. It helps your bowels to move regularly, which reduces constipation and other bowel problems. Fibre may also help to lower your cholesterol level.

Starchy foods, and fruit and vegetables contain the most fibre. So the tips above on starchy foods and fruit and vegetables will also increase fibre. If you switch to wholemeal rice and pasta and wholemeal bread, this can significantly increase your fibre intake. Pulses like lentils and beans are also full of fibre.

Have plenty to drink when you eat a high-fibre diet (at least 6-8 cups of fluid a day).

Pain Under the Diaphragm Through to the Back With Eating or Drinking

Source: https://patient.info/signs-symptoms/abdominal-pain-leaflet