Recurrent Abdominal Pain
It is widely acknowledged that most individuals experience abdominal pain at least once in their lives. However, if someone encounters this pain more than three times in a span of three consecutive months, it can be said that they are suffering from recurrent abdominal pain (RAP) or chronic abdominal pain. There are two primary types of recurrent abdominal pain: functional and physical. Functional abdominal pain, which constitutes approximately 90% of cases, lacks a clear identifiable cause, whereas physical abdominal pain accounts for the remaining 10%. It is noteworthy that children, particularly those between the ages of eight and fourteen, frequently experience recurrent abdominal pain, especially girls. Conversely, only about 2% of adults, mostly women, are reported to suffer from chronic or recurrent abdominal pain.
Symptoms of Recurrent Abdominal Pain
The symptoms of recurrent abdominal pain can vary significantly from one patient to another, and even within the same individual, the nature of the pain can differ from episode to episode. Common symptoms include:
- Crying, particularly in children, along with signs of sweating and pallor.
- Duration of the pain can range from a few minutes to several hours.
- The pain may be sharp or dull.
- Pain may relate to eating, or it may occur independently of food intake.
- Associated symptoms may include vomiting, headaches, or pain in other body areas such as the arms and legs.
- Pain can occur at any time of day, whether at night or during the day.
- The location of the pain in the abdomen can vary based on the underlying cause.
- Lack of the usual appetite, although significant weight loss is not typically observed.
There are certain symptoms that require immediate medical attention, such as:
- Fever.
- Presence of blood in vomit, stool, or urine.
- Difficulties swallowing.
- Waking from sleep due to pain.
- Severe or recurrent vomiting or diarrhea.
Symptoms that warrant a consultation with a physician within a few days to a week include:
- Loss of appetite and weight loss.
- Abdominal and lower limb swelling.
- Jaundice.
Causes of Recurrent Abdominal Pain
As mentioned earlier, recurrent abdominal pain can be classified into functional and physical pain, with distinct causes associated with each type:
Causes of Functional Recurrent Abdominal Pain
This type of pain is real and felt by the patient but occurs without any identifiable physiological cause. It is not related to bodily changes such as bowel movements, menstrual cycles, food intake, or medications, and it can persist for more than six months. Although there is no definitive cause, psychological stressors in a person’s life, even from childhood—such as the start of school or vying for attention when a sibling is born—along with genetic predispositions, personality traits, and psychological ailments like depression, can play significant roles in triggering this type of pain. Some common manifestations include:
- Functional abdominal pain: This refers to intermittent or continuous abdominal pain that does not correlate with any other gastrointestinal disorder. Diagnosis requires thorough medical evaluation to rule out other underlying issues.
- Functional abdominal pain syndrome: This relatively poorly understood syndrome is characterized by acute abdominal pain that affects daily activities due to heightened sensitivity to pain where the nervous system becomes overly responsive to minor discomforts, leading to prolonged pain even after the initial cause has resolved. Psychological factors like depression and psychosocial stress are influential in this type of pain.
- Functional dyspepsia: This includes postprandial pain syndrome, where patients experience early satiety and fullness after normal-sized meals, often accompanied by excessive belching and upper abdominal bloating. Nausea may also follow meals. The epigastric pain syndrome features intermittent or burning pain in the upper abdominal region, with pain severity varying and sometimes directly related to food intake.
Causes of Physical Recurrent Abdominal Pain
Several physical disorders and conditions can lead to recurrent abdominal pain, including:
- Childhood Irritable Bowel Syndrome: The most common cause of recurrent abdominal pain in children, characterized by constipation, diarrhea, or alternating symptoms. Abdominal pain typically correlates with changes in bowel habits, often alleviated after bowel movements, though some may feel incomplete evacuation after using the restroom.
- Adult Irritable Bowel Syndrome: Also a common disorder among adults.
- Constipation.
- Lactose Intolerance.
- Gastroesophageal reflux disease (GERD).
- Gastric irritation due to spicy foods, carbonated beverages, aspirin, or non-steroidal anti-inflammatory drugs (NSAIDs).
- Gallbladder disorders such as cholecystitis.
- Inflammatory bowel diseases (IBD) such as Crohn’s disease.
- Dyspepsia resulting from peptic ulcers or certain medications.
- Liver disorders, including hepatitis.
- Parasitic infections, for instance, Giardiasis.
It is important to note that cancers, such as gastric, pancreatic, colon, and ovarian cancers, are common causes of recurrent abdominal pain in adults. Additionally, menopause may exacerbate abdominal pain in women experiencing:
- Irritable bowel syndrome.
- Inflammatory bowel disease.
- Endometriosis.