Diagnosis: Intestinal pain

It is better to refer to "intestinal pain" as abdominal pain, because a person can rarely tell that the pain originates exactly from the intestines. Although intestinal or abdominal pain can arise from the tissues of the abdominal wall that surrounds the abdominal cavity, the term abdominal pain is used to describe the pain originating from organs within the abdominal cavity.

What are the borders of the abdomen? Well, the abdomen is an anatomical area that bounds the lower margin of the ribs above, the pelvic bone below, and the flanks on each side. [1]

These organs include:

• Organs related to digestion — the stomach, the end of the esophagus, the small and large intestines, the liver, the gallbladder, and the pancreas.
• The abdominal aorta — a large blood vessel that runs straight down from the thorax into the inside of the abdomen.
• The appendix — an organ in the lower right abdomen that no longer has a function (and is, as such, an evolutionary remnant).
• The kidneys — two bean-shaped organs that lie deep within the abdominal cavity. [1]

However, the pain may originate from somewhere else like your chest or pelvic region. You may also have a generalized infection affecting many parts of your body, like the flu, candida or strep throat. 

“Referred” Pain 

In some rare cases, the pain felt in the abdomen isn’t related to any organ in the abdominal cavity. There is a theory that explains this conclusion. Abdominal pain has the unusual ability to travel along the deep nerve pathways and emerge at sites away from the source of the problem. For example, the lower lungs, the kidneys, and the uterus or ovaries can project pain into the abdomen. We call this type of pain "referred pain". Although the pain originates outside the abdomen, we attribute it to the abdominal area. [2]

Some examples of referred pain are [2]:

• The right shoulder can project into the diaphragm, gallbladder, and liver capsule
• The left shoulder can project into the diaphragm, spleen, the tail of the pancreas, stomach, splenic flexure, and pneumoperitoneum
• The right scapula can project into gall bladder, biliary tree
• Left scapula projects into spleen and tail of the pancreas

Types of pain

Abdominal pain can be acute and sudden in onset, or it can be chronic and longstanding. By intensity, abdominal pain may be minor and of no importance, or it can reflect a significant problem involving one of the organs in the abdomen.

Intestinal or as we call it, abdominal pain, can also be:

• Visceral pain, related to the organs, which is often dull, crampy and aching
• Parietal pain, related to the walls of the abdomen, which is often sharp, secure and persistent. The pain associated with inflammation of the abdominal pain is steady and aching. The pain worsens by changes in the tension of peritoneum. Pressure or positional change cause this type of pain. 
• The pain associated with abdominal vascular disturbances (thrombosis or embolism) can be sudden or gradual in onset and can be severe or mild. Pain that we link with the rupture of an abdominal aortic aneurysm may radiate to the back, flank or genitals. [3]

The problem is that the intensity of the pain does not always reflect the seriousness of the condition causing it. That is why individuals should report every pain to their health provider. The severity of the condition has more to do with the suddenness of the pain, especially if it is sharp and localized to one region, rather than spread throughout your abdomen.

Possible Causes Of 'Intestinal Pain'

Non-abdominal causes: [3]

• Pneumonia (lung infection)
• Myocardial infarction (heart attack)
• Pleurisy (irritation of the lining around the lungs)
• Pulmonary embolism (blood clots in the lungs)

Abdominal wall pain:

• Shingles (herpes zoster infection)
• Costochondritis (inflammation of the rib cartilages)
• Injury (blunt trauma, muscle pulls)
• Nerve irritation (neuropathy)
• Hernias (protrusions of structures through the abdominal wall)
• Scars

Inflammatory conditions of the upper abdomen:

• Ulcer disease (duodenal ulcer, gastric ulcer)
• Esophagitis (Gastroesophageal reflux disease)
• Gastritis (irritation of the lining of the stomach)
• Pancreatitis (inflammation of the pancreas)
• Cholecystitis (inflammation of the gall bladder)
• Choledocholithiasis (passage of gallstones through the bile duct)
• Hepatitis (infection or inflammation of the liver)
• Colitis (infection or inflammation of the colon)

Functional problems of the abdomen:

• Non-ulcer Dyspepsia (discomfort after eating not due to ulcers)
• Sphincter of Oddi dysfunction (problems with the bile duct valve)
• Functional abdominal pain (pain without apparent cause)
• Irritable bowel syndrome (pain associated with bowel movements)

Cancers of the upper abdomen:

• Hepatoma (liver cancer)
• Cholangiocarcinoma (bile duct or gall bladder cancer)
• Pancreatic cancer
• Stomach cancer
• Lymphoma (cancer of the immune cells)

Vascular problems:

• Mesenteric vascular insufficiency (blocked arteries or veins)
• Abdominal aortic aneurysm (swelling of the main artery in the belly)

Inflammatory conditions in the mid-and lower abdomen:

• Enteritis (infections of the small bowel, Crohn’s disease)
• Colitis (infection or inflammation of the colon)
• Diverticulitis (inflammation of pouches that form in the colon)
• Appendicitis

Bowel obstruction:

• Adhesions (scars in the belly that form after surgery or inflammation)
• Tumor
• Inflammation
• Colon Cancer

Urinary tract problems:

• Kidney stones
• Urinary tract infections (kidneys, bladder)
• Tumors of the kidneys or bladder

Pelvic problems in women:

• Ovarian cysts or cancer
• Infection of the tubes (salpingitis)
• Ectopic pregnancy
• Fibroid tumors of the uterus (womb)
• Malignant tumors of the uterus or cervix
• Endometriosis
• Adhesions (scars)

There are several possible causes of intestinal and abdominal pain and the seven most common causes are:

• Intestinal illness
• Food poisoning
• Gas
• Upset stomach or heartburn
• Sore abdominal muscles
• Menstrual cramps
• Constipation

Localization of pain

Navel area [3]

Pain that is localized near the belly button can be related to a small intestine disorder or an inflammation of the appendix. This condition is called appendicitis. The appendix is a small, finger-like organ that projects out from colon on the lower right side of your abdomen. If it becomes obstructed, it may become inflamed and filled with pus.

Upper middle abdomen

The middle area of the abdomen is called the epigastric area. Pain in this region is in most cases associated with stomach disorders. Persistent pain in this area may also signal a problem with the duodenum, pancreas or gallbladder.

Upper left abdomen

Pain in the upper left abdomen may suggest a colon, stomach, spleen or pancreas problem.

Upper right abdomen

Inflammation of the gallbladder often causes intense pain in the upper right abdomen.

Lower middle abdomen

Pain below the navel may indicate that there is some underlying colon disorder. In women, pain in this area may also indicate a urinary tract infection or pelvic inflammatory disease.

Lower left abdomen

Pain in the lower left abdomen most often suggests a problem in the lower colon. Several conditions influence this area such as inflammatory bowel disease or an infection in the colon known as diverticulitis.

Lower right abdomen

Inflammation of the colon may cause pain in your lower right abdomen. The pain of appendicitis may also spread to the lower right abdomen.

When Should You Be Concerned About Abdominal Pain?

A patient should know that pain is always an abnormal condition, but no one should panic. Although some kinds of pain may indicate a serious condition, it isn’t necessarily a medical emergency. Mild pain or chronic pain should be discussed with your doctor when convenient. A physician should examine severe pain immediately.

Some of the serious signs associated with abdominal pain are:

• Fever
• Diarrhea
• Persistent constipation
• Blood in the stools
• Persistent nausea or vomiting
• Vomiting blood
• A tender belly
• Jaundice
• Abdominal swelling [4, 5]

Treatment Of Intestinal Pain

Medications

The drugs used most commonly for this purpose are:

• Antidepressant drugs, like Amitriptyline® or Trazadone®. Patients can take these medicines in tiny doses that minimize side effects and have little or no antidepressant effects. [6]
• Anti-inflammatory drugs. Sometimes these medications are used to reduce inflammation or affect the function of an organ, thereby relieving pain. [7]
• Analgesics. Occasionally, a doctor treats the pain with Analgesics, drugs that reduce pain. [8]

Tips For Soothing Pain At Home 

• Intestinal illnesses, food poisoning or sore abdominal muscles in children: warm your child with a hot bath, and gently rub his tummy. 
• Gas pain: massage the belly to try to move the gas bubbles along. A warm bath may also help.  
• Upset stomach or heartburn: Antacids are usually used to relieve heartburn. A glass of water with a few teaspoons of sodium bicarbonate can also soothe heartburn.
• Menstrual cramps: the most common medication used for relieving menstrual cramps is Ibuprofen.
• Peppermint tea is often the best choice when trying to soothe the intestinal pain. 
• Place a hot water bottle or heated wheat bag on your abdomen.
• Reduce your intake of coffee, tea, and alcohol as these can make the pain worse.