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Abdominal pain

Reassure the person and make them comfortable.

Abdominal pain is a broad term meaning pain felt anywhere in the belly. Acuteabdominal pain can be caused by a variety of conditions such as gas, constipation,overeating, period pain or a stomach bug. Occasionally abdominal pain is the resultof a more serious disorder affecting the organs in the abdomen, like kidney stones,an inflamed appendix, or an inflamed gallbladder.

Guidelines

In case of pain after eating a meal, it may help to keep moving instead of lyingdown or staying seated. If a person with pain after a meal decides to lie down,it may help to let them lie on their right side. *A hot water bottle or heated wheat bag held against the lower abdomen mayrelieve period pain. **

Good practice points

The first aid provider should reassure the person and help them to be morecomfortable.Paracetamol may be effective to relieve mild period pain. Non-steroidal anti-inflammatory drugs (ibuprofen, diclofenac, naproxen, etc.) may also beeffective on period pain, however, they may have side effects (e.g., upsetstomach or conflict with other medications). The person should take painkillerswith fixed regularity on the days with pain according to the recommendeddose and time interval. Aside from period pain, the person should not takeibuprofen, painkiller or laxatives for abdominal pain.A hot water bottle or heated wheat bag held against the abdomen may relieveabdominal pain.Abdominal massage with essential oils (aromatherapy) may relieve periodpain.

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If the person has heartburn, it may help to lie down on their back with theirupper body raised.The person should be kept well hydrated, but should avoid coffee, tea oralcohol as these can make the pain worse. Also, advise them to avoid fizzydrinks.Emergency medical services (EMS) should be accessed if the person:> vomits blood> has chest pain> was involved in an accident> has sharp and severe abdominal pain> shows signs and symptoms of shock> has blood with bowel movements (this can appear as black, tarry bowelmovements or red blood)> experiences high fever (higher than 40°C for babies, children and older)> is bleeding while pregnant> has an altered level of responsiveness.First aid providers should access medical care if:> the pain does not subside> abdominal pain is accompanied by severe diarrhoea and repeated vomiting,which can lead to dehydration especially in older people or young children> the person has a fever (higher than 38°C).If period pain disrupts daily life every month, the symptoms progressivelyworsen, the medication is not as effective as usual, or severe period pain startsafter age 25, the person should seek medical advice.To prevent stomach bugs and to avoid infecting others, personal (and group)hygiene should be practised. See Hand hygiene.

Guideline classifications explained

Chain of survival behaviours

Prevent and prepare

Keep hydrated.

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Practise food hygiene.Practise hand hygiene.Avoid contaminated or rotten food.Take part in regular physical activity.

Early recognition

Abdominal pain is identified by pain in the abdomen. To help decide if theabdominal pain is an emergency and determine the first aid that will be mosteffective, establish what type of pain it is by asking questions such as:

Is the pain sudden or severe?What does the pain feel like?How long have you had the pain?What do you think may be causing the pain?Do you have gas or feel constipated?Are you having or expecting your period?What have you eaten recently and how much?Are you experiencing any other symptoms? If so, what are they?

Common types of abdominal pain

Period pain – throbbing or cramping pains in the lower abdomen.Gas – pain that sometimes moves throughout the abdomen, bloating orcramping.Stomach bug – (sometimes intense) pain accompanied by nausea, bloating,vomiting.Inflamed appendix – sudden abdominal pain that often begins around the bellybutton area and moves to the right lower part of the abdomen, progressivelygetting worse.

First aid steps

Reassure the person and help make them comfortable.1. Access emergency medical services if the person:2.

> vomits blood

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> has chest pain > was involved in an accident > has sharp and severe abdominal pain > shows signs and symptoms of Shock > has blood with bowel movements (this can appear as black, tarry bowelmovements or red blood) > experiences high fever (higher than 40°C for babies, children and older) > is bleeding while pregnant > has an altered level of responsiveness.

3. Give the person a hot-water bottle or a heated wheat bag to hold against theirabdomen.

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NOTE

If the abdominal pain is accompanied by vomiting or diarrhoea, ensure the person keepshydrated by drinking small sips of water regularly. See Dehydration. If the pain is period pain, help the person take the recommended dose of painkiller.If the person is experiencing pain following a meal, advise them to keep moving instead oflying down or staying seated. If the person needs to lie down, advise them to lie on theirright side.

______________________________

Access help

Sudden, severe abdominal pain can occasionally indicate a more seriousdisorder, such as appendicitis. This condition can quickly worsen and requiresan operation, so it is important to access EMS.Medical care should also be accessed if the pain does not subside, abdominalpain is accompanied by severe diarrhoea and repeated vomiting, which canlead to dehydration especially in older people or young children or the personhas a fever (higher than 38°C).In older people and females, severe stomach pain could indicate a heart attack

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and may need to be seen by a medical professional. See Chest pain.

Recovery

Drink water regularly to stay hydrated.If taking a painkiller for period pain, the person should take it on the days withpain with fixed regularity according to the recommended dose and timeinterval. Taking painkiller before the pain has developed reduces overalldiscomfort.

Education considerations

Context considerations

In contexts with limited resources, emphasise that most situations do not needmuch equipment (if any). Having the person rest with their feet raised andplacing a heat pack on the abdomen will help to relieve the pain.Research the local regulations on who can administer painkillers (for periodpain only) and ensure the education follows those regulations.

Facilitation tips

Consider teaching this topic to school nurses, parents, teachers, campcouncillors.Adapt this topic to the most common conditions relevant to the learner.Incorporate prevention education around food hygiene and hand washing.Explore different causes of abdominal pain and focus on which instances areconsidered an emergency and when medical care is required.Draw on learners’ own experiences of abdominal pain, including pain causedby anxiety, to contextualise their learning.

Learning connections

Make links to other topics such as Dehydration, vomiting and diarrhoea andensure learners understand any relevant human functions such as indigestion.

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Scientific foundation

Systematic reviews

The Centre for Evidence-Based Practice (CEBaP) developed and updated severalevidence summaries in 2020.

Posture

Ten studies were included in an evidence summary concerning a specific postureimmediately after having a meal. There is limited evidence in favour of the sittingposition or alternately sitting and standing after having a meal. It was shown thatsitting or alternately sitting and standing resulted in a statistically significantimproved gastric emptying, compared to laying on the back or a head-down tiltedposition. A statistically significant faster gastric emptying time, when standing,lying on a left side position or lying down compared to sitting, could not bedemonstrated.

A statistically significant decreased retention of the feeds and a decreased numberof reflux episodes, when lying down with head and upper body slightly raised orwhen lying in a head-down tilted position, compared to lying flat on the back, couldnot be demonstrated.When comparing different side-lying positions, it was shown that the right sideposition resulted in a statistically significant decreased gastric volume and a fastergastric emptying time, compared to the left side position. All evidence is of lowcertainty and results cannot be considered precise due to limited sample size andlack of data.

Physical activity

Four experimental studies were included in an evidence summary concerningphysical activity after having a meal. There is limited evidence in favour of beingactive (walking) after having a meal. It was shown that physical activity resulted ina statistically significant faster gastric emptying time and reduced reflux in peoplewith gastroesophageal reflux disease, compared to no physical activity. A

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statistically significantly decreased reflux in healthy volunteers could not bedemonstrated. Evidence is of low certainty and results cannot be consideredprecise due to limited sample size, lack of data and large variability in results.

Heat application for period pain

Two randomised controlled trials were found in an evidence summary about heatapplication for dysmenorrhea (period pain). It was shown that using a heat patch(placed on the lower abdomen) resulted in statistically significant pain relief,compared to unheated (no patch). Evidence is of moderate certainty.

Massage for period pain

It was shown in one randomised controlled trial that massage resulted in astatistically significant reduction of period pain intensity and pain duration.However, in two other smaller randomised controlled trials, a statisticallysignificant decrease in period pain and cramps could not be demonstrated.Evidence is of very low certainty and results cannot be considered precise due tolimited sample size and lack of data.

The same two studies also measured the effect of aromatherapy massage, whichresulted in a statistically significant decrease in period pain and cramps, comparedto no massage. Evidence is of low certainty and results cannot be consideredprecise due to limited sample size and lack of data.

Additional information

Gastrointestinal distress is often due to an irritation in the digestive system andcan cause abdominal pain and vomiting. It is a common problem when travelling totropical locations.

Sudden abdominal pain may be a sign of an inflamed appendix (appendicitis). Ittypically begins around the belly button area and moves to the lower part of theabdomen, progressively getting worse. The person may also experience a low fever.

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If vomiting, constipation or diarrhoea accompanies the pain, this is an indicationthat the person should access medical care.

Certain viruses, such as the norovirus, can cause nausea, bloating and diarrhoea.Stomach conditions that cause vomiting or diarrhoea can lead to dehydration,especially in children and older adults. Gastroenteritis, a stomach bug that causesdiarrhoea, nausea, vomiting and abdominal pain, is one of the most commonlydocumented. Individuals can also contract illnesses when participating inrecreational water activities. This occurs when swimmers swallow water in which astool has been released before chlorine or another disinfectant kills the infectiveorganisms.

Pain in the abdomen usually has a minor cause, such as food poisoning. However,sometimes complaints about stomach pain may have nothing to do with thestomach itself – pain can come from another part of the body (e.g., upper belly painmay indicate a heart attack).

Abdominal pain can be a result of eating or drinking contaminated food or water.Hand hygiene is critical as infection can pass directly from person to personthrough dirty hands. Occasionally abdominal pain is the result of a more seriousdisorder affecting the organs in the abdomen, like an inflamed appendix,gallbladder or kidney stone. Abdominal pain accounts for 5% to 10% of allpresentations in the emergency department (Natesan et al., 2016).

Period pain (dysmenorrhea) is a throbbing or cramping pain in the lower abdomen.Globally, the prevalence of period pain varies from 20% to 90% (De Sanctis, 2015).Many women have period pain just before and during their menstrual periods.Often the pain is also felt in the back or legs and can be severe enough to affecteducation, social activities and work negatively. Approximately 60% to 80% ofyoung women between the ages of 12 and 24 suffer (Nakame et al., 2019; Proctor,2003) while around 35% of female schoolchildren with dysmenorrhea use it as areason for failing school. About 42% of working women cannot work during theirmenstrual periods (De Sanctis et al., 2015; Marjoribanks et al., 2003).

Before or during menstruation, other symptoms can appear, such as headaches,painful breasts, bloating, nausea, diarrhoea, dizziness or fatigue. Sometimes

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women are also somewhat quicker to be sad or irritated before and duringmenstruation. However, menstrual cramps will pass by themselves.

Contractions in the uterus cause menstrual cramps. Every month an egg is releasedfrom one of the two ovaries and the uterine lining becomes thicker so that afertilised egg can settle in there. If pregnancy does not occur, the uterus contractsto release the mucous membrane, resulting in blood. There is no clear link betweenthe amount of blood loss and pain.

References

Systematic reviews

Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidencesummary Stomach/abdominal pain – Posture. Availablefrom: https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/

Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidencesummary Stomach pain – Physical activity. Available from:https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/

Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidencesummary Dysmenorrhea – Heat application. Availablefrom: https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/

Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidencesummary Dysmenorrhea – Massage. Available from:https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/

Matthewman, G., Lee, A., Kaur, J. G., & Daley, A. J. (2018). Physical activity forprimary dysmenorrhea: a systematic review and meta-analysis of randomizedcontrolled trials. American journal of obstetrics and gynecology, 219(3), 255-e1.

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Viniol, A., Keunecke, C., Biroga, T., Stadje, R., Dornieden, K., Bösner, S., … &Becker, A. (2014). Studies of the symptom abdominal pain—a systematic reviewand meta-analysis. Family practice, 31(5), 517-529.

Non-systematic reviews

De Sanctis, V., Bernasconi, S., Bianchin, L., Bona, G., Bozzola, M., Buzi, F., … &Perissinotto, E. (2014). Onset of menstrual cycle and menses features amongsecondary school girls in Italy: A questionnaire study on 3,783 students. Indianjournal of endocrinology and metabolism, 18(Suppl 1), S84.

Marjoribanks, J., Proctor, M., Farquhar, C., Sangkomkamhang, U. S., & Derks, R. S.(2003). Nonsteroidal anti-inflammatory drugs for primary dysmenorrhoea.Cochrane database of systematic reviews, (4).

Nakame, R. M., Kiwanuka, F., & Robert, A. (2019). Dysmenorrhoea among students aged 18–45years attending University in Uganda: A cross‐sectional multicenter study of threeUniversities in Uganda. Nursing Open, 6(2), 268-275. DOI 10.1002/nop2.207

Natesan, S., Lee, J., Volkamer, H., & Thoureen, T. (2016). Evidence-based medicineapproach to abdominal pain. Emerg Med Clin North Am, 34(2), 165-90.

Related topicsHand hygieneDehydrationChest pain

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Published: 15 February 2021

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