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Abdominal painAbdominal pain
Reassure the person and make them comfortable.
Abdominal pain is a broad term meaning pain felt anywhere in the belly. Acute abdominal 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 result of 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 lying down 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 may relieve period pain. **
Good practice points
The first aid provider should reassure the person and help them to be more comfortable. Paracetamol may be effective to relieve mild period pain. Non-steroidal anti- inflammatory drugs (ibuprofen, diclofenac, naproxen, etc.) may also be effective on period pain, however, they may have side effects (e.g., upset stomach or conflict with other medications). The person should take painkillers with fixed regularity on the days with pain according to the recommended dose and time interval. Aside from period pain, the person should not take ibuprofen, painkiller or laxatives for abdominal pain. A hot water bottle or heated wheat bag held against the abdomen may relieve abdominal pain. Abdominal massage with essential oils (aromatherapy) may relieve period pain.
International first aid, resuscitation, and education guidelines 2020. https://www.globalfirstaidcentre.org/ Abdominal pain | 2
If the person has heartburn, it may help to lie down on their back with their upper body raised. The person should be kept well hydrated, but should avoid coffee, tea or alcohol as these can make the pain worse. Also, advise them to avoid fizzy drinks. 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 bowel movements 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 progressively worsen, the medication is not as effective as usual, or severe period pain starts after 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
International first aid, resuscitation, and education guidelines 2020. https://www.globalfirstaidcentre.org/ Abdominal pain | 3
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 the abdominal pain is an emergency and determine the first aid that will be most effective, 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 or cramping. Stomach bug – (sometimes intense) pain accompanied by nausea, bloating, vomiting. Inflamed appendix – sudden abdominal pain that often begins around the belly button area and moves to the right lower part of the abdomen, progressively getting worse.
First aid steps
Reassure the person and help make them comfortable.1. Access emergency medical services if the person:2.
> vomits blood
International first aid, resuscitation, and education guidelines 2020. https://www.globalfirstaidcentre.org/ Abdominal pain | 4
> 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 bowel movements 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.
_____________________________
NOTE
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Access help
Sudden, severe abdominal pain can occasionally indicate a more serious disorder, such as appendicitis. This condition can quickly worsen and requires an operation, so it is important to access EMS. Medical care should also be accessed 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 or the person has a fever (higher than 38°C). In older people and females, severe stomach pain could indicate a heart attack
International first aid, resuscitation, and education guidelines 2020. https://www.globalfirstaidcentre.org/ Abdominal pain | 5
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 with pain with fixed regularity according to the recommended dose and time interval. Taking painkiller before the pain has developed reduces overall discomfort.
Education considerations
Context considerations
In contexts with limited resources, emphasise that most situations do not need much equipment (if any). Having the person rest with their feet raised and placing a heat pack on the abdomen will help to relieve the pain. Research the local regulations on who can administer painkillers (for period pain only) and ensure the education follows those regulations.
Facilitation tips
Consider teaching this topic to school nurses, parents, teachers, camp councillors. 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 are considered an emergency and when medical care is required. Draw on learners’ own experiences of abdominal pain, including pain caused by anxiety, to contextualise their learning.
Learning connections
Make links to other topics such as Dehydration, vomiting and diarrhoea and ensure learners understand any relevant human functions such as indigestion.
Scientific foundation
Systematic reviews
The Centre for Evidence-Based Practice (CEBaP) developed and updated several evidence summaries in 2020.
Posture
Ten studies were included in an evidence summary concerning a specific posture immediately after having a meal. There is limited evidence in favour of the sitting position or alternately sitting and standing after having a meal. It was shown that sitting or alternately sitting and standing resulted in a statistically significant improved gastric emptying, compared to laying on the back or a head-down tilted position. A statistically significant faster gastric emptying time, when standing, lying on a left side position or lying down compared to sitting, could not be demonstrated.
A statistically significant decreased retention of the feeds and a decreased number of reflux episodes, when lying down with head and upper body slightly raised or when lying in a head-down tilted position, compared to lying flat on the back, could not be demonstrated. When comparing different side-lying positions, it was shown that the right side position resulted in a statistically significant decreased gastric volume and a faster gastric emptying time, compared to the left side position. All evidence is of low certainty and results cannot be considered precise due to limited sample size and lack of data.
Physical activity
Four experimental studies were included in an evidence summary concerning physical activity after having a meal. There is limited evidence in favour of being active (walking) after having a meal. It was shown that physical activity resulted in a statistically significant faster gastric emptying time and reduced reflux in people with gastroesophageal reflux disease, compared to no physical activity. A
International first aid, resuscitation, and education guidelines 2020. https://www.globalfirstaidcentre.org/ Abdominal pain | 7
statistically significantly decreased reflux in healthy volunteers could not be demonstrated. Evidence is of low certainty and results cannot be considered precise 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 heat application 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 a statistically significant reduction of period pain intensity and pain duration. However, in two other smaller randomised controlled trials, a statistically significant decrease in period pain and cramps could not be demonstrated. Evidence is of very low certainty and results cannot be considered precise due to limited sample size and lack of data.
The same two studies also measured the effect of aromatherapy massage, which resulted in a statistically significant decrease in period pain and cramps, compared to no massage. Evidence is of low certainty and results cannot be considered precise due to limited sample size and lack of data.
Additional information
Gastrointestinal distress is often due to an irritation in the digestive system and can cause abdominal pain and vomiting. It is a common problem when travelling to tropical locations.
Sudden abdominal pain may be a sign of an inflamed appendix (appendicitis). It typically begins around the belly button area and moves to the lower part of the abdomen, progressively getting worse. The person may also experience a low fever.
Abdominal pain | 8
International first aid, resuscitation, and education guidelines 2020. https://www.globalfirstaidcentre.org/ Abdominal pain | 8
If vomiting, constipation or diarrhoea accompanies the pain, this is an indication that 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 causes diarrhoea, nausea, vomiting and abdominal pain, is one of the most commonly documented. Individuals can also contract illnesses when participating in recreational water activities. This occurs when swimmers swallow water in which a stool has been released before chlorine or another disinfectant kills the infective organisms.
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 the stomach itself – pain can come from another part of the body (e.g., upper belly pain may 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 person through dirty hands. Occasionally abdominal pain is the result of a more serious disorder affecting the organs in the abdomen, like an inflamed appendix, gallbladder or kidney stone. Abdominal pain accounts for 5% to 10% of all presentations 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 affect education, social activities and work negatively. Approximately 60% to 80% of young 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 a reason for failing school. About 42% of working women cannot work during their menstrual 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
Abdominal pain | 9
International first aid, resuscitation, and education guidelines 2020. https://www.globalfirstaidcentre.org/ Abdominal pain | 9
women are also somewhat quicker to be sad or irritated before and during menstruation. However, menstrual cramps will pass by themselves.
Contractions in the uterus cause menstrual cramps. Every month an egg is released from one of the two ovaries and the uterine lining becomes thicker so that a fertilised egg can settle in there. If pregnancy does not occur, the uterus contracts to release the mucous membrane, resulting in blood. There is no clear link between the amount of blood loss and pain.
References
Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidence summary 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). Evidence summary Dysmenorrhea – Heat application. Available from: https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summarie s/
Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidence summary 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 for primary dysmenorrhea: a systematic review and meta-analysis of randomized controlled trials. American journal of obstetrics and gynecology, 219(3), 255-e1.
International first aid, resuscitation, and education guidelines 2020. https://www.globalfirstaidcentre.org/ Abdominal pain | 10
Viniol, A., Keunecke, C., Biroga, T., Stadje, R., Dornieden, K., Bösner, S., … & Becker, A. (2014). Studies of the symptom abdominal pain—a systematic review and 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 among secondary school girls in Italy: A questionnaire study on 3,783 students. Indian journal 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 18–45 years attending University in Uganda: A crosssectional multicenter study of three Universities in Uganda. Nursing Open, 6(2), 268-275. DOI 10.1002/nop2.207
Natesan, S., Lee, J., Volkamer, H., & Thoureen, T. (2016). Evidence-based medicine approach to abdominal pain. Emerg Med Clin North Am, 34(2), 165-90.
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