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Abdominal pain is one of those conditions that much debate could be given to when do you wait it out at home versus going to your doctor, an urgent care clinic or the emergency room.
There are over 120 different causes of abdominal pain. Some of the causes are easily found by doing an exam and maybe a few labs but some of these can be so challenging that patients go through years of visits and multiple doctors before the diagnosis can be made.
So you woke up with abdominal pain this morning. What do you do? First thing you do is decide how bad it is. Is this pain unbearable or can you first try taking a Tylenol to see if it goes away? Next thing to do is think about a possible cause. Did you go to the gym yesterday for the first time in a decade? The pain is likely from straining your abdominal muscles then. Did you go to Garcia’s last night and try the diablo tamales? There’s a good chance you are suffering from heartburn or gastritis. Try taking a Pepcid. Do you have a history of constipation and you have not gone in several days? Maybe you just need a good laxative.
Common causes of abdominal pain are often not serious and can be managed at home. Gastritis or heartburn can be treated with Tums or Pepcid. Do not drink milk to “neutralize” the acid because that doesn’t work. Gastroenteritis with vomiting and diarrhea may just go away on its own after a day or two and good hydration. Whether it’s from a virus or tainted food, usually once the vomiting subsides you can rehydrate with some Gatorade or water. Women often suffer from horrible menstrual cramps or ovarian cysts. Medicines like ibuprofen and naproxen work really well for gynecological pain. Constipation can be helped with laxatives like magnesium citrate or if it’s more chronic in nature using daily Metamucil. Abdominal muscle strains just need time and maybe some ibuprofen for a few days.
If you suspect your abdominal discomfort is from a gluten sensitivity, which is celiac disease, then you can experiment with changing your diet. If removing gluten from your diet makes your symptoms go away then you likely have your answer. If you ate ice cream and now you feel incredibly bloated and gassy then you may have lactose intolerance. Try avoiding dairy to see if symptoms improve. You can also take Gas-X during an episode of bloating for symptom relief.
So what if you thought you had a basic abdominal problem and you attempted those measures already discussed and you didn’t get any better? Time to get seen by a doctor. If you aren’t doubled over in pain then you can likely go see your doctor or an urgent care instead of the ER. They can do an exam and if needed can order labs and imaging. It will take a day or two to get the results back. When the results come back you will likely need a follow up visit to go over them and discuss a plan of care. I have even diagnosed an acute appendicitis from the urgent care by getting an outpatient CT scan and completely avoiding the emergency room. As long as someone is stable and not in crisis with his or her pain then abdominal pain can be evaluated in a clinic setting.
Now your pain is severe and nothing you’ve tried at home has helped. Time to go to the emergency department. Pain like this is going to be very difficult for a clinic or urgent care to evaluate and needs to be evaluated in the ER. Clinics can’t get lab results and imaging done all onsite for a quick diagnosis like you can get in the ER. CT scans and or ultrasound studies will likely be needed in the evaluation of severe abdominal pain. These studies allow us to detect serious life threatening causes of abdominal pain while the patient is onsite.
If you have pain in the upper middle or right upper quadrant of your belly you might be having an acute gallbladder attack or pancreatitis. With these conditions, you may have a fever and yellowing of your eyes or skin too. Appendicitis usually presents with right lower quadrant pain and tenderness but not always. Epigastric pain or pain in the upper middle abdomen can be lots of things like gastritis or esophagitis or pancreatitis but can also be an acute heart attack, especially in the elderly. Abdominal pain with bright red blood in your stool or dark black stool is usually from a gastrointestinal bleed and may need a blood transfusion. Abdominal pain that is also associated with no bowel movements or gas may be a bowel obstruction. Constipation may also be from impacted stool in the rectum and will need a digital disimpaction in the ER.
There are also lots of causes of abdominal pain that just aren’t easily diagnosed with a few labs and a CT scan or ultrasound, though. I know it is disappointing to go the doctor and get these tests done only to leave without a bona fide diagnosis but it happens all the time. But at least you know you have time to work on the diagnosis through your follow-ups with your doctor.
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Dr. John Turner is a family medicine and emergency medicine doctor with 25 years of experience. He is also the owner of My Primary Care Clinic and My Emergency Room 24/7 here in Hays County. Dr. Turner may be reached at 512-667-6087.
