Abdominal Ache

Eat Regularly
Release Wind
Loosen trousers

This may seem trivial and tongue in cheek,  but there are simple common aggravating factors for abdominal pain. I am not ignoring the serious here,  which is what is always considered first by a doctor whenever a person walks into a doctors surgery. A lot of people do present with these simple causes.

Eat Regularly

Eating late brings on abdominal ache and wind. The digestive tract is expecting food and generates more digestive juices including acids. If there is no food to occupy and mop up these digestive juices they start generating wind and irritating the bowel. Regular eating when your body expects this helps. Work out when you body usually expects to eat and offer it a snack at least when the time is due to prevent the build up of digestive juices, cramps, bloating and wind

Release Wind

Wind is a frequent cause of abdominal ache and aggravates other causes. It is usually attributed to gas generated by bacteria in the bowel which help you break down your food.  This may be one key factor in irritable bowel. If you feel wind might be trapped let it out early. Perhaps better away from others! Sitting down on the toilet releases more wind than standing. Belching releases wind. Drinking fluid then belching relieves more wind. Peppermint sweets and drinks and some forms of alcohol (do not overdo this one) help relieve

Loosen trousers

This will affect everyone with abdominal pain at some point, if your ever wear trousers! It is a combination of excess wind and, often, gaining fatty tissue around the abdomen. It may seem a joke but it is one of those things that presents to doctors in surgeries. The first steps are to get a new trouser belt. ! When you are at the last notch then get a new belt, bigger trousers and focus on loosing weight.

Abdominal pain is a challenging consultation for all GPs because it is a matter of probability and safety netting whilst being comfortable with uncertainty based using these two tools.
Bear in mind the commonest cause of abdominal pain is unknown cause as above, often labelled by default as Irritable bowel syndrome.. Inflammatory bowel disease and cancer being the things to exclude by looking for bloods, recent onset stool frequency and night symptoms
The duration, frequency and pattern are key features to explore early on
In children, especially, we are often left with abdominal migraine. Sharing the warning signs with patients or parents often helps to safety net and give patients/parents greater understanding

Case study

A fifty six year old man presented to his doctor with persistent abdominal discomfort worse at certain times of the day. This had been a nuisance over the last year and tended to be worse after meals. He found it difficult to pass wind. There was no indication of reflux and no episodes of severe pain. He was calmly anxious and wanted to know the cause.

History  revealed no other serious cause. His bowels were regular with no blood. He had gained weight. Examination of the abdomen showed no focal pain and was normal except he wasoverweight with his stomach bulging over his trousers and his belt on the last notch. The options were discussed including possible referral for tests such as endoscopy or colonoscopy. Investigations were arranged and included a check for anaemia and liver function which were normal. He was advised to try a larger trouser belt and trousers

On review to discuss his results he remained concerned, but commented that things had improved considerably after changing to larger belt size.  The subject of his weight was brought up again and he was initially defensive,  but accepted it may contribute to pressure on his stomach. He tended to snack and did not have a regular pattern to his meals, often missing the midday meal and varying the evening mealtime due to work committments and travel as a salesman.

Things improved further when he achieved some weight loss, by eating less, avoiding snacks and on a more regular basis. A few years later he was still overweight but had managed to keep his weight below his previous level and did not report any abdominal pain.