Understand Abdominal Pain

Abdominal pain is a common complaint that can have a wide range of causes, from mild indigestion to life-threatening emergencies such as appendicitis or ruptured abdominal aneurysms. The location of the pain can provide important clues as to the underlying cause, which can guide diagnostic testing and treatment.

In this article, we will discuss abdominal pain based on three broad categories: upper, middle, and lower abdomen. We’ll also describe the nine regions of the abdomen and how they correspond to different internal organs and structures, helping to identify potential causes of pain.

Upper abdominal pain

Pain in the upper abdomen can be caused by a variety of pathologies, including disorders of the liver, gallbladder, stomach, pancreas, and duodenum. Liver disease, such as cirrhosis or hepatitis, can cause a dull ache or fullness in the upper right quadrant. Gallbladder disease, such as cholecystitis or gallstones, can cause sharp or crampy pain in the upper right quadrant that may radiate to the back or shoulder. Stomach ulcers can cause a burning or gnawing pain in the upper abdomen that may improve with eating, while pancreatitis can cause severe pain that radiates to the back and is often associated with nausea, vomiting, and fever.

Middle abdominal pain

Pain in the middle abdomen can be caused by a variety of pathologies, including disorders of the small intestine, colon, or appendix. Inflammation of the appendix, known as appendicitis, typically causes pain that starts in the middle of the abdomen and then moves to the lower right quadrant. Diverticulitis, which is inflammation of small pouches that develop in the colon, can cause pain in the middle of the abdomen that may be accompanied by fever, nausea, and changes in bowel habits.

Lower abdominal pain

Pain in the lower abdomen can be caused by a variety of pathologies, including disorders of the bladder, uterus, ovaries, or colon. Urinary tract infections can cause pain in the lower abdomen or pelvis, along with a frequent urge to urinate and a burning sensation during urination. In women, gynecological problems such as endometriosis, ovarian cysts, or pelvic inflammatory disease can cause pain in the lower abdomen that is often accompanied by irregular menstrual cycles, vaginal discharge, and pain during sexual intercourse. In men, prostatitis can cause pain in the lower abdomen or pelvis, along with difficulty urinating or a frequent urge to urinate. Colon cancer can cause pain in the lower abdomen that may be accompanied by changes in bowel habits, rectal bleeding, or weight loss.

In practice, the abdomen is often divided into 9 areas or regions for the purpose of describing the location of pain or other symptoms. These regions are:

1. Epigastric region: located in the upper middle part of the abdomen, just below the sternum (breastbone). This area contains the stomach and duodenum, and pain here may be related to gastritis, ulcers, or pancreatitis.
2. Right hypochondriac region: located on the upper right side of the abdomen, below the ribcage. This area contains the liver and gallbladder, and pain here may be related to hepatitis, cholecystitis, or gallstones.
3. Left hypochondriac region: located on the upper left side of the abdomen, below the ribcage. This area contains the spleen and part of the stomach, and pain here may be related to splenomegaly (enlarged spleen) or gastric ulcers.
4. Umbilical region: located in the center of the abdomen, around the belly button (umbilicus). This area contains parts of the small intestine and colon, and pain here may be related to appendicitis, inflammatory bowel disease, or abdominal adhesions.
5. Right lumbar region: located on the right side of the abdomen, between the lower ribs and the hip bone. This area contains the ascending colon and part of the small intestine, and pain here may be related to appendicitis or kidney stones.
6. Left lumbar region: located on the left side of the abdomen, between the lower ribs and the hip bone. This area contains the descending colon and part of the small intestine, and pain here may be related to diverticulitis or colitis.
7. Suprapubic region: located in the lower middle part of the abdomen, just above the pubic bone. This area contains the bladder and reproductive organs, and pain here may be related to urinary tract infections, ovarian cysts, or prostate problems.
8. Right iliac fossa: located on the lower right side of the abdomen, near the hip bone. This area contains the appendix and part of the small intestine, and pain here may be related to appendicitis or Crohn’s disease.
9. Left iliac fossa: located on the lower left side of the abdomen, near the hip bone. This area contains the sigmoid colon and part of the small intestine, and pain here may be related to diverticulitis or ulcerative colitis.

In conclusion, the location of abdominal pain is critical in identifying the underlying cause, which guides diagnosis and treatment. Pain in the upper abdomen may indicate liver, gallbladder, stomach, pancreas, or duodenal disorders. Pain in the middle abdomen may suggest small intestine, colon, or appendix inflammation. Pain in the lower abdomen can be caused by disorders of the bladder, uterus, ovaries, or colon. Understanding the location of abdominal pain and the corresponding nine regions in the abdomen is essential for better communication between patients and healthcare providers. It’s essential to seek medical attention if the pain is severe, persistent, or accompanied by other symptoms like fever, vomiting, or changes in bowel or urinary habits.