ABDOMINAL PAIN

Abdominal pain is very common.. Mostly it does not represent any serious problem at all however there are a few causes of abdominal pain which are important. How is it possible to tell the difference? It is difficult to lay down hard and fast rules. At the extremes it is obvious. A few stomach cramps, some indigestion  - then there are home remedies to try such as an antacid or even powerful drugs like Tagamet and Colpermin available over the counter at the chemist. At the other extreme the patient may be in severe pain and collapsed so hospital admission is inevitable. As with all the other acute health problems - if you are really concerned ring for advice as to what to do.

A FEW GUIDELINES

Before ringing there are a few questions worth asking and things to try:

• DURATION.
  • If the pain has just come on, you are otherwise feeling quite well and your general health is normally quite good it is worth waiting half an hour or so to see if it goes off. Colic spasms can be quite severe while they last but this would rarely be more than 20 minutes or so. The only situations where this policy could be dangerous are in women of reproductive age (i.e. 11 or so up to 50+) where sudden severe lower abdominal pain could be due to a pregnancy outside the womb (even in sterilised women) and people over 50 with severe pain going through to the back which might be due to a burst main blood vessel (aorta). In both cases the patient is likely to feel faint and dizzy as well - but if in doubt ring to discuss your concerns.
  • If the pain has been present more than 24hrs., is not particularly severe and you are otherwise fairly well it is likely that you can safely wait till normal working hours and come to surgery.
• SEVERITY. Obviously severe pain which is unchanged or getting worse after half an hour is likely to need attention if only to provide relief so ring to discuss with the duty doctor who will advise whether a visit is required.
• ASSOCIATED SYMPTOMS.
  • Gastroenteritis is often associated with quite severe spasms of pain around or below the tummy button or in the lower left part of the abdomen. These are not usually very prolonged, there is usually little or no pain between spasms and sometimes a bowel action gives fairly immediate relief. If these spasms get more severe and/or the pain becomes continuous then it would be wise to call.
  • Faintness or dizziness is a worrying symptom if associated with abdominal pain and certainly warrants the patient being seen promptly by the duty doctor.
  • Bleeding from the vagina, back passage, waterworks or in the vomit may be important. Bleeding from the stomach usually turns black causing a black stool (melaena) or black "coffee-ground" vomit. It is not often associated with much pain but unless the bleeding and the pain are both trivial it is worth discussing it with the duty doctor - even trivial bleeding and pain needs checking out in surgery. Severe pain associated with bleeding or severe bleeding on its own or with pain need urgent attention and may be best dealt with by summoning a 999 ambulance.
  • Tenderness. If the patients tummy seems very tender to touch it would be wise to speak to the duty doctor.
  • Temperature. A mild temperature is quite common with viral tummy bugs but if the patient has an abdominal pain and feels very hot it would be wise to seek advice.
• PREGNANCY. Indigestion, heartburn and general discomfort can be quite common - especially in the latter stages  - but a new pain should be checked out with the midwife or duty doctor and certainly if you don't feel well.
• EXISTING CONDITIONS and previous surgery. Some patients with known abdominal conditions or a history of surgery may be prone to bouts of abdominal pain and have treatment for it. If symptoms depart significantly from the usual pattern or normally effective treatment is tried and fails to work then ring for advice. Remember if you normally have treatment make sure you keep well supplied - the emergency doctor is not there to provide routine repeat prescriptions.
• INDIGESTION and heartburn. A burning discomfort in the centre of the upper abdomen which may extend behind the breast bone. It usually settles, if only temporarily, with antacid medicine or with milk. If mild then antacid remedies from the chemist are quite sufficient but more severe and persistent symptoms warrant a trip to see the doctor at the surgery.

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