Bowel pain
Intestinal pain occurs with a functional disorder — irritable bowel syndrome, common organic diseases — intestinal infections, chronic enteritis and enterocolitis, Crohn’s disease and ulcerative colitis (ulcerative colitis). Less often, symptoms indicate neoplasms, diverticula, acute surgical pathology. Laboratory tests, ultrasound, endoscopic, radiological methods are used to diagnose the causes of intestinal pain. For the treatment of pain syndrome, dietary therapy, medications (antibiotics, antispasmodics, probiotics), surgical methods are used.
Causes of intestinal pain
Irritable bowel syndrome
Dysbiosis
Intestinal infections
Chronic enteritis
Crohn’s disease
Nonspecific ulcerative colitis
Diverticulosis
Intestinal neoplasms
Urgent conditions
Complications of pharmacotherapy
Rare reasons
Diagnostics
Treatment
Help before diagnosis
Conservative therapy
Surgical treatment
Prices for treatment
Causes of intestinal pain
Irritable bowel syndrome
IBS is characterized by moderate abdominal pain of various types — pulling, spastic, stabbing. Pain syndrome increases in the morning, with psychoemotional overstrain. A typical symptom of the syndrome is a sharp increase in pain before defecation. In addition to severe cramping pains on the left in the iliac region, there is an urge to empty the intestines. After defecation, a person’s well-being immediately improves.
Pain in irritable bowel syndrome persists for several months. Women note an increase in pain before menstruation. With this pathology, the pain syndrome is combined with stool disorders: patients complain of alternating constipation and diarrhea, a feeling of incomplete bowel emptying. There is increased gas formation, belching, nausea.
Dysbiosis
With intestinal dysbiosis, spasms and colic occur throughout the abdomen, but the most severe pain is localized in the left iliac region. Pain syndrome is combined with heaviness, discomfort and rumbling in the stomach. Diarrhea is noted. Fecal masses are liquid, abundant, have a greenish tint. The clinical picture unfolds when taking antibacterial drugs, chronic gastroenterological diseases, immune disorders.
Intestinal infections
Abdominal pain develops with salmonellosis, escherichiosis, dysentery and other infectious processes. With a predominant lesion of the small intestine, it is determined in the umbilical region. When the large intestine is involved in the process, soreness in the lower abdomen on the left is characteristic. The pains have a sharp, cramping character. They are accompanied by diarrhea (up to 20 times a day), nausea and vomiting.
Chronic enteritis
With intestinal inflammation, patients experience pain around the navel, in the lateral parts of the abdomen. Pain is dull or aching, it increases with errors in nutrition, after drinking alcohol. The intensity of pain decreases after the discharge of gases, defecation. Chronic diarrhea is typical for enteritis. Feces are abundant and fetid, contain particles of undigested food.
Crohn’s disease
In this disease, pain is most often localized in the right iliac region, which is due to the defeat of the terminal parts of the small intestine. The intensity of symptoms is determined by the severity of Crohn’s disease. During remission, abdominal discomfort is characteristic, with exacerbation, sharp pains are observed, which are often accompanied by the appearance of blood in the feces. Patients are concerned about diarrhea, lack of appetite, weakness and decreased performance.
Nonspecific ulcerative colitis
Pronounced cramping pains in the left parts of the intestine, which indicate a lesion of the sigmoid colon, are characteristic of NYAK. Total colitis is manifested by diffuse intense pain. With an increase in pain syndrome, bright red blood is noticeable in the bowel movements. Painful tenesmus is also a concern. In those suffering from NYAK, in addition to pain, extra-intestinal symptoms are possible: nodular erythema, damage to the eyes, joints and the biliary system.
Diverticulosis
With intestinal diverticula, indefinite aching or pulling pains are noted, in which patients rarely seek medical help. Increased symptoms occur with gastrointestinal motility disorders, chronic constipation. The patient experiences severe paroxysmal pains localized in the area of the diverticulum. They decrease after bowel emptying, gas discharge.
Intestinal neoplasms
With intestinal polyps, pain occurs when the tumor reaches a large size. Bursting and dull pains are caused by a violation of the passage of chyme and feces. With the progression of the tumor process, severe spasms appear near the navel or in the lateral parts of the abdomen. Diffuse polyposis is characterized by severe diffuse pain in combination with tenesmus, diarrhea. The clinic of the disease resembles a severe intestinal infection.
With malignant neoplasms, the pain syndrome manifests itself in the later stages, when inflammation or ulceration joins. The pain has a permanent character, is not associated with errors in the diet or other external factors. With intestinal cancer, tenesmus and constipation are often found. When the rectum is affected, patients note a feeling of incomplete emptying during defecation. Common symptoms include weakness, pallor of the skin, sudden weight loss.
Urgent conditions
Acute severe pain is characteristic of intestinal infarction. They occur suddenly against the background of full health. The patient feels sharp cramps in the abdomen, which after a few hours turn into constant excruciating pain. Their localization is affected by which part of the intestine is affected. The weakening of the pain syndrome in parallel with the increase in general symptoms is a prognostically unfavorable sign.
Sharp pains develop with intestinal obstruction. They do not have a clear localization, are not associated with eating. Typically, a periodic increase in pain due to the activation of peristalsis. With mechanical obstruction, the pain syndrome is constant, with a dynamic form of pain, it can subside after the elimination of the etiological factor.
With appendicitis, pain occurs suddenly. Usually, it is first felt in the epigastric region or near the navel, then it becomes spilled, and after a few hours it concentrates on the right in the iliac zone. Pain is constant, their intensification is provoked by coughing, laughing. The severity of the pain decreases when the patient lies on his right side. Nausea, vomiting, flatulence, diarrhea are observed. The temperature rises to subfebrile and febrile digits. The pulse quickens sharply.
Complications of pharmacotherapy
The most serious consequence of taking antibacterial agents is the development of pseudomembranous colitis, which is caused by conditionally pathogenic microflora. Patients complain of cramping pain in the projection of the sigmoid colon, the symptom increases before the onset of defecation. Simultaneously with the pain, severe diarrhea worries, which reaches 20 times a day. A large amount of mucus and streaks of blood appear in the bowel movements.
Rare reasons
Hernial protrusion: white abdominal line, spigelial line, postoperative ventral hernias.
Inflammatory processes: mesadenitis, omentitis.
Congenital anomalies: Pyre syndrome, Hirschsprung’s disease, malrotation.
Chronic intestinal ischemia.
Diagnostics
The examination begins with the collection of complaints and anamnesis of the disease, palpation of the abdomen. It is important to establish how long the pain in the intestine lasts, what is the reason for their occurrence. To exclude surgical pathology, the doctor checks peritoneal symptoms. From laboratory methods, a coprogram, fecal backfilling, general and biochemical blood tests are used. Instrumental methods are the most informative for diagnostic search:
Ultrasound of the abdominal cavity. It is performed as a screening study for differential diagnosis of lesions of various parts of the intestine. Sonography allows you to detect neoplasms, inflammatory changes, effusion into the abdominal cavity.
Endoscopic methods. To examine the entire surface of the colon, a colonoscopy is performed. If necessary, with the help of an endoscope, the doctor takes a biopsy of suspicious areas of the intestinal wall. If you are concerned about pain in the upper abdomen, it is advisable to perform EFGDS.
Irrigoscopy. The technique is used to study the anatomical and functional features of the large intestine. Detailed visualization of the intestinal mucosa is provided by double contrast — barium suspension and air.
X-ray examination. To assess the state of the digestive tract, radiography is performed with oral administration of a contrast agent. According to the results of the study, anomalies of the structure of the intestine, motor disorders, filling defects, which indicate volumetric formations, are revealed.
Treatment
Help before diagnosis
The amount of therapeutic measures depends on the patient’s condition. If intestinal infections are suspected, gastric lavage should be performed, sorbents should be given, and in order to avoid dehydration, a person should be provided with abundant drinking. With sharp cramping pains, you need to consult a doctor as soon as possible, before his arrival it is better not to take painkillers, so as not to distort the clinical picture.
In case of intestinal pain, a gastroenterologist gives recommendations on nutrition before clarifying the diagnosis. Products that irritate the gastrointestinal mucosa, extractive substances, fatty and heavy foods are excluded from the diet. With constipation in the diet, the amount of vegetable products, cereals and bread with bran is increased. With diarrhea, porridge (especially rice and oatmeal), dry biscuits, baked vegetables are added to the diet.
Conservative therapy
The treatment plan is selected after the final diagnosis. It includes etiopathogenetic and symptomatic therapy. With severe intoxication syndrome, intravenous infusions of saline and colloidal solutions are used. In case of exhaustion, for example, in the presence of tumors, parenteral nutrition is carried out. Basic treatment regimens in gastroenterology include a number of drugs:
Antibiotics. Preference is given to intestinal antiseptics that are not absorbed into the systemic circulation and do not have side effects. In serious bacterial processes, oral or parenteral administration of antibiotics is prescribed, under the influence of which pain and other symptoms quickly disappear.
Anti-inflammatory drugs. Drugs from the group of corticosteroids are used in NYAK and Crohn’s disease as pathogenetic therapy. They reduce the frequency of exacerbations, relieve pain and contribute to improving overall well-being. With insufficient effectiveness, therapy is enhanced with cytostatics.
Antispasmodics. They are indicated for normalization of peristalsis and rapid relief of pain syndrome, which is associated with spastic contraction of the intestinal muscular membrane. Recommended for acute and chronic enteritis, IBS.
Probiotics. Medications are used to restore the intestinal microflora at the end of the course of antibiotic therapy, for chronic diseases accompanied by malabsorption. The drugs normalize the frequency and consistency of bowel movements, which helps to relieve pain in the large intestine.
In IBS, drug therapy is supplemented with herbal sedatives, light tranquilizers. Physiotherapy techniques are effective: reflexology, neuro-sedative massage, aromatic baths. Patients with chronic diseases in remission are prescribed balneological treatment. It is recommended to add physical therapy classes to strengthen the abdominal wall muscles.
Surgical treatment
The intervention of an abdominal surgeon is required for advanced and complicated forms of chronic intestinal lesions, neoplasms, intestinal obstruction, and a number of acute conditions. The volume of the operation is determined taking into account the leading pathology and the general condition of the patient. Organ – preserving interventions are most often carried out: appendectomy for appendicitis, resection with anastomosis with diffuse lesion of the intestine.
Removal of benign tumors can be performed in a minimally invasive way while preserving the integrity of the intestinal wall. In severe cases of NAC, with widespread diverticulosis and polyposis, a radical approach is justified — total colectomy. Most volumetric interventions and operations for malignant neoplasia are completed by stomy followed by closure of the stoma.
