What causes chronic abdominal pain?
Chronic abdominal pain can stem from a wide range of gastrointestinal conditions. Common causes include irritable bowel syndrome (IBS), often leading to cramping, bloating and alternating constipation and diarrhea. Inflammatory bowel diseases (IBD) such as Crohn’s disease and ulcerative colitis cause chronic inflammation in the digestive tract and can lead to severe abdominal pain. Other digestive-related causes include acid reflux (GERD), peptic ulcers and gallbladder disease, all of which can result in recurring discomfort or pain in different areas of the abdomen.
In some cases, chronic abdominal pain may not originate from the digestive system itself. Conditions such as endometriosis, pelvic inflammatory disease, or urinary tract infections can all cause abdominal or pelvic pain that feels gastrointestinal in nature. Additionally, stress, anxiety and other mental health conditions can manifest physically, leading to what is known as psychosomatic abdominal pain.
Types of chronic abdominal pain
Abdominal pain can be categorised into several different types, depending on its origin, nature, and duration.
Localised pain
Localised pain refers to discomfort that occurs in one specific area of the abdomen. This type of pain is often associated with problems in a particular organ, such as ulcers (typically felt in the upper middle or left abdomen), gallstones (upper right abdomen), or appendicitis (lower right abdomen).
Colicky pain
Colicky pain, on the other hand, is characterised by sharp, severe episodes that come in waves, often suddenly. This type of pain is typically seen in cases involving kidney stones, gallstones or intestinal obstructions, where something is blocking the normal flow within the digestive or urinary tract.
Generalised pain
Generalised pain is felt across a large portion or throughout the entire abdomen and may be caused by issues like indigestion, gas or infections, and sometimes points to more complex conditions like irritable bowel syndrome (IBS).
Functional pain
Functional abdominal pain refers to chronic discomfort that does not have a clear physical or structural cause, even after thorough medical evaluation. This type is often seen in conditions like functional dyspepsia or IBS, where the pain is believed to stem from disruptions in how the gut and brain interact.
Cramping pain
Another way to classify chronic abdominal pain is by its pattern. Cramping pain tends to come and go and varies in intensity. It’s commonly linked to bloating, gas, food sensitivities, or changes in bowel habits. It's frequently seen in conditions like IBS or during menstruation.
Treatments
- Ultrasound guided steroid injection for trigger points in anterior abdominal wall (abdominal cutaneous nerve entrapment syndrome)
- Pharmacological/ medication treatment for chronic abdominopelvic pain syndromes
- Ultrasound guided nerve blocks for scar pain post inguinal hernia repair (inguinodynia)
- Radiofrequency denervation of nerves (ilioinguinal, genitofemoral, iliohypogastric) to inguinal region for treatment of post-operative inguinal hernia repair pain
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Dr Adrian Dashfield
Consultant Anaesthetist & Pain Management Specialist
MB ChB MSc MSc MD FRCA FFPMRCA FAcadMEd