Abdominal pain or “Stomach pain” or “Tummy ache” is a common condition and is used to describe any pain felt anywhere below the rib cage and above the pelvis. Pelvic pain can affect up to 15% of people and is felt in the lower part of the tummy and are associated with uro-gynaecological and rectal symptoms. Sudden onset pains should be treated promptly as they could be surgical emergencies like acute appendicitis, rupture of ectopic pregnancies and bowel obstruction. Pain associated with bleeding or passing blood in urine or stools or vomiting blood or associated with weight loss also need urgent medical attention. However, most of the stomach pains are mild and self-limiting without any surgical management. Some of these pains can persist even in the absence of investigations and would require the expertise of a pain consultant for its long-term management as it is a major cause of sickness absenteeism and disability.
Chronic Pelvic Pain
Many words can be used to describe abdominal pain – dull-ache, cramp, sharp, knotted & twisting, spasmodic and burning. The pain can be constant or intermittent coming as waves. It could be associated with nausea and vomiting or as in pelvic pains with bladder and bowel dysfunction. Upper abdominal pain are felt in the centre of the stomach and can spread to the back, up into the chest and feel diffuse around the belly-button. It can be sudden onset (following blunt trauma or bowel perforation) or gradually getting worse. Some pains are worse on movement as in peritonitis and is associated with guarding. Pelvic pain symptoms may be related to the menstrual cycle, being a dull or spasmodic pain; it can be diffuse or localised. The presence of infection could be identified with foul smelling discharge or signs of inflammation including redness and swelling. The severity of these pains could be described as mild, moderate or severe.
The abdomen and pelvis contain many organs and any condition affecting them could cause pain. The commonest causes are infection/ inflammation, obstruction, perforation, ischaemia (lack of adequate blood flow) and malignancy. The surrounding tissues, muscles, bone and nerves can also be causing pain.
Causes of abdominal pain:
Causes of pelvic pain:
Sudden onset or acute pain especially if you feel unwell could be a serious condition and should seek urgent medical attention to rule out surgical emergency. Chronic pain in the absence of a specific treatment could be complex and needs a full assessment. Common investigations include blood tests, urine and stool studies; imaging tests might include X-rays, Ultrasound scans, CT scan and MRI scans. Internal examination include upper and lower endoscopies, colonoscopy, colposcopy, cysto-ureteroscopy and diagnostic laparoscopy.
Treatment of the pain depends on whether there is an identifiable problem as in many acute conditions. This could be conservative with the use of analgesics and antispasmodics or it may require surgical intervention.
Chronic Abdomino-pelvic Pain
This is best approached by a multi-modal treatment approach led by a specialist pain consultant with a biopsychosocial approach involving analgesia, interventions, psychological strategies, physiotherapy and rehabilitation.
Each injection can have different side-effects. Please refer to appropriate injections information leaflet in the section of treatments.
In situations where the pain is disabling severe and not allowing you to do the day-to-day chores, medications have proven inadequate to reduce the pain; injections are targeted to be given either under x-ray guidance or ultrasound guidance at the presumed sources of pain. Injections mainly consist of local anaesthetic with or without steroid. This works as anti-inflammatory at the source of pain.
Injections are not a permanent cure. Injections help by reducing the intensity of pain. The aim is to reduce pain and break the cycle of pain, allow you to carry out rigourous physiotherapy and help and healing. We may have to repeat injections in order to achieve the goals.
There are other injections available when nerves can be ablated (burnt) or we can apply what is called a radio-frequency lesioning at lower temperatures. These treatments have intermediate to long-term benefits and also work to reduce inflammation. These can be offered if the initial injection does not last long enough to follow on with strengthening Physiotherapy. These injections are not operations or permanent treatments. They are used to improve your condition of pain in order for you to carry out rehabilitative strengthening physiotherapy and come out of the vicious cycle of pain.
We can offer you Non-injection interventions such as acupuncture. We can introduce you to other means of self management of pain such as using a TENS machine . We have a modalities to offer at our clinic for example Medical yoga therapy, deep electrical muscle stimulation, TENS treatment. If the pain is unbearable, not responding to medications, or you do not want to try the non-invasive modalities ; we could offer you injection therapies.
You will have a detailed consultation, examination and then be given information and advice about your condition. We may also organise investigations. We may be able to prescribe you medication and give you details about how to manage pain and other interventional options can be discussed.
You will be reviewed only by MACS clinic senior Pain Consultants for your condition.
If your pain is very severe, not responding to over-the-counter painkillers you should contact your GP and get an appointment for review. If you are in severe disabling pain, unable to carry out any routine tasks, you could book an emergency appointment with your GP or go to the local A&E for a review.
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