Hesperian Health Guides

Hesperian Health Guides

Pain in the Belly or Gut

If there is pain, ask the person to point to the exact spot where it hurts. The location of the pain in the gut can be a clue as to what is causing it. It is also important to know if the gut is working – moving and digesting food. If it is not, that can be sign of real danger.

  1. Ask: has the person had any bowel movements or farted? Having normal bowel movements is a good sign. If the person has not had a bowel movement in a few days it could be constipation. If they have no bowel movements, cannot fart, and have pain, it might be obstruction.
  2. Listen: are there any sounds from the gut? Sounds are a healthy sign of digestion and you will hear some sounds even when there is constipation. No sounds are another dangerous sign of obstruction.
  3. Feel: is the belly hard, like a board? Is your touch very painful? These are signs of serious danger.
shirtless body showing pain in upper center of belly
pain in the ‘‘pit of the stomach’’
shirtless body showing pain at center and lower right side of belly
first it
hurts here
later it
hurts here
shirtless body showing small area of pain on upper right side and moving up right side of chest
the pain often reaches to the back
shirtless body showing large area of pain on right side under lower ribs
pain here, at times it spreads to the chest
shirtless body showing pain in sides and lower belly and wrapping around the back
Urinary System
mid or low back pain, often goes around the waist to the lower part of the belly
shirtless body showing pain in woman's lower belly and wrapping around the back
pain on one
side sometimes
with pain in the
shoulder or neck

Contents

How to listen

Listen to the belly with a stethoscope or your ear, to help find out if the person is in danger.

A healthy belly makes little gurgling sounds every few seconds. (If you are a health worker, practice listening to healthy people’s bellies to get to know these normal belly sounds. It takes practice to hear these quiet sounds.)

person listening to a woman's belly

Lots of loud gurgles may mean food is moving very quickly through the bowels. Does the person have diarrhea?

High-pitched noises, or no belly sounds for 2 minutes, are signs of acute abdomen. Feel the abdomen. If it is hard and painful, get to a hospital quickly.

How to feel

Boy points to painful left side of belly; health worker presses on right side of boy's belly.

Ask the person to touch the place where it hurts.

Beginning on the opposite side from the spot where he has pointed, press gently to try to learn which organ inside the body hurts. (Save the most painful place for last.) Use gentle, but firm pressure, and move in an organized pattern so you can feel each part of the belly.

Note also whether the belly is soft or hard, and whether the person can relax his stomach. If it is stiff like a board, he may have an obstruction.

How to check for rebound pain

Slowly but forcefully press the belly, just above the left groin, until it hurts a little. Then quickly remove your hand. Sharp pain when you remove your hand – worse than the pain from the pressure of your hand – is called rebound pain. If there is no rebound pain on the left, try on the right. Rebound pain is a sign of appendicitis or peritonitis. Go to a hospital right away.

hand pressing down on right side of man's belly
hand lifted from man's belly, causing pain

Severe, sharp pain in the gut (acute abdomen)

woman bent over with pain, holding her belly

Sudden onset of severe pain in the gut, that keeps getting worse, with no diarrhea, is likely acute abdomen. Acute abdomen can be caused by obstruction, appendicitis, ectopic pregnancy, or other dangerous problems. If you see these signs, you can save the person’s life by helping her get to a hospital right away.

Signs

  • Continuous, sharp pain — feels like a knife
  • Vomiting
  • Few or no bowel movements
  • A hard, quiet belly
  • Severely ill feeling

Usually the person with acute abdomen is writhing in pain, unable to get comfortable and protecting her belly with her arms.

Obstruction

When something blocks (obstructs) part of the gut, food and stool cannot pass. This can cause serious pain and infection.

Along with pain, the person may have constipation and vomiting. The belly can be silent, or can make a lot of high-pitched noises.

boy vomiting forcefully
Obstruction can cause very forceful vomiting.

Obstruction may be caused by:

  • a ball of roundworms.
  • a hernia.
  • a loop of intestine twisting around an old scar. This can happen to someone who had an injury or surgery to the gut.
  • cancer (see Cancer - in development).


If you think there may be obstruction, do two things:

  1. Get the person to a hospital right away. Surgery may be needed.
  2. If there are roundworms where you live, treat the person for roundworms on the way to the hospital, in case worms are causing the obstruction. Click here for worm medicines.
illustration of the below: pain of appendicitis
The pain may start
around the belly
button.
Then it moves to the
lower right side.

Appendicitis and peritonitis

Appendicitis is an infection of the appendix, a little sac attached to the large intestine in the lower right side of the belly. There is no way to prevent appendicitis. It just happens to some people.

The main sign of appendicitis is a sharp pain in the belly that gets worse and worse.

Someone with appendicitis usually does not want to eat. There usually will not be diarrhea. Fever is common, and walking or riding over bumps in the road hurts a lot. There is rebound pain.

Get medical help. If not treated, the infected appendix may burst, spreading germs inside the belly. This can cause a deadly infection called peritonitis.

Peritonitis can also be caused by an injury to the gut – for example, being hit very hard or stabbed in the belly.

If the belly is quiet, hard, and painful all over, there is peritonitis.

two people carrying a sick person on a stretcher

If you think the person has appendicitis or peritonitis:

  • get him to a hospital.
  • give 2 medicines: metronidazole AND ciprofloxacin OR ceftriaxone, OR ampicillin. Click here for doses.
  • do not give any food or drink except medicines and small sips of water.

Watch for signs of shock such as weak, rapid pulse; pale, cold skin; or confusion or loss of consciousness.

Ectopic pregnancy

illustration of the below: pregnancy in the tube
Usually, a pregnancy grows in the uterus.
An ectopic pregnancy grows in the tube – but it does not fit there. As the pregnancy grows, the tube stretches and can burst. This causes severe pain and bleeding inside the body.

As with a miscarriage, signs of an ectopic pregnancy happen early in pregnancy — often before the woman even knows she is pregnant. There is pain in the lower belly and some bleeding after having no menstruation for one or more months.

Signs

  • Bleeding from the vagina is usually light – called spotting (bleeding from miscarriage is heavier).
woman with pain holding her belly and neck
  • Pain may become stronger on one side.
  • If the pregnancy breaks through the tube, the pain becomes severe.
  • The woman may also have pain in her shoulder or neck.
  • The woman may feel dizzy or light-headed because she is bleeding inside.

Severe pain in the lower belly can have many causes, including bladder infection, appendicitis, and others. If possible, ask the woman to take a pregnancy test. If the test is positive, or if you cannot test but think there may be an ectopic pregnancy, get her to a hospital – you can save her life. If the pregnancy test is negative, it is not an ectopic pregnancy.

On the way to the hospital, treat for signs of shock such as weak, rapid pulse; pale, cold skin; or confusion or loss of consciousness.

Stomach cramps

Most cramps are not very dangerous. They can be caused by:

  • eating food that has been left out too long or spoiled.
  • drinking water that has germs in it.
  • worms.
  • ulcers.
  • stress or nervousness.
  • hunger.
  • menstruation.
a hot drink


Usually, stomach cramps will get better on their own in a day or two.
To help:

  • drink tea of boiled ginger, mint, chamomile, or another tea that calms the stomach.
  • eat papaya. It helps break down food in your gut.
  • take a hot bath, or use a warm compress on the belly, or simply rest in a dark, quiet place. See Care for Sick People (in development) to learn how to make a warm compress.
  • avoid foods that can cause gas. Milk, cheese, cabbage, peppers, onions, or beans might be the problem.
woman rubbing her belly
Gently massage the belly, or rub it in a slow, clockwise circle.


You can prevent a lot of stomach cramps by cooking food thoroughly to kill germs, eating food while it is still hot, and washing your hands before cooking and eating. For more on preparing and storing food, click here.

woman with hand on chest, looking uncomfortable
Heartburn causes burning or pain in the chest, and sometimes in the throat.

Heartburn, acid reflux

Heartburn, acid indigestion, and reflux are all names for a burning feeling or pain in the middle of the chest or food pipe caused by stomach acid getting up into the throat. It can be very painful. It tends to happen when you lie down or after you eat – especially after eating a lot, or eating something fatty or spicy.

The name “heartburn” is confusing: it has nothing to do with the heart. (Real heart pain often feels “heavy” or “tight.” It may spread to the jaw, shoulder, or belly. See Heart Problems - in development.)

Treatment and prevention

  • Do not eat for at least 3 hours before you go to sleep.
  • Eat smaller meals, but eat more often.
  • Avoid fatty and spicy foods.
  • Avoid alcohol and smoking, which make heartburn worse.
  • Try an antacid to ease the pain.
  • Eat papaya or drink a teaspoon of vinegar mixed in water after the evening meal.
woman propped up by pillows in bed
Sit upright after eating, and prop yourself up to sleep at night (or raise the head of your bed with a few blocks). This keeps the acid down in the stomach.
location of stomach and intestine and sores caused by ulcers inside the body
An ulcer is an open sore inside the stomach or intestine.

Ulcer

Stomach pain that comes again and again may be caused by an ulcer. Ulcer pain is usually burning or gnawing, like hunger, and is felt in the upper middle part of the belly. Often, an ulcer will cause pain for a few weeks, and then will go away for weeks or months before coming back again. The pain may lessen when the person eats or drinks. (Or eating may make the pain worse, depending on where the ulcer is.)

Treatment: To lessen the pain and help the ulcer heal

pill bottle with large X drawn through it
No!
  • Stop taking ibuprofen, aspirin, and other pain medicines. Taking these frequently hurts the stomach and is one of the main causes of ulcers. (Paracetamol is better for people with stomach pain because it does not harm the stomach, but it should also not be taken in large quantities or every day.)
  • Do not smoke. People who smoke have more ulcers, and their ulcers take longer to heal.
  • Eating smaller meals and drinking a lot of water throughout the day can help lessen the pain.
  • You may find certain foods make the pain worse. Try avoiding acidic foods like lemon, vinegar, and coffee. Chili, fatty foods, and alcohol also worsen the pain for some people.
  • Stress might be one reason people get ulcers, and stress tends to make them hurt more. Finding ways to be less anxious and upset may help. For ideas about relaxation, see Mental Health (in development).

If after a few weeks of making the changes above there is still a lot of pain, try a low-cost antacid. Pain may be reduced by calcium carbonate, 4 times a day for 1 week. A class of medicines called proton pump inhibitors (PPI), such as omeprazole, work even better. They reduce acid in the stomach enough to relieve pain and often allow the ulcer to heal. However, if the pain comes back, you will need to cure the ulcer with antibiotics.

For ulcers that keep coming back, you will need to give a combination of antibiotics, proton pump inhibitors, and antacids for 2 weeks. This is a lot of medicine, but if taken correctly the ulcers will usually stop coming back.

Treatment: To cure the ulcer

To cure an ulcer, a combination of medicines is needed. Click here.

If there is still stomach pain after this treatment, the problem is likely something else – not an ulcer. Get help.

Danger signs

Are there signs of bleeding ulcers? Watch for bloody or black, grainy vomit – like coffee grounds. Feces may be bloody or black – like tar or motor oil. This is an emergency. Get help.

baking soda being poured into a spoon
Some people take sodium bicarbonate (baking soda) for belly aches. This works quickly, but causes the stomach to make more acid later, so do not use it often. Do not use sodium bicarbonate if you have heart problems or swollen legs, it can make these problems worse.

Gallbladder problems

The gallbladder is a small sac that collects bile, which helps digest fatty foods. The bile can harden, causing an obstruction in the gallbladder. This can cause pain that lasts several hours. Gallbladder problems are more common in women 40 years or older, people who are fat, and people with diabetes. But any adult can get this problem.

Signs

  • Steady pain in the center or right edge of the rib cage, This pain may spread up to the right side upper back or the shoulder.
woman with pain spreading from belly to shoulder
pain
  • Pain that gets worse and worse, then stays the same for a while, then after a few hours it slowly goes away.
  • Pain that comes soon after eating fatty foods. It may wake the person in the night.
  • Nausea and vomiting.
  • Taking aspirin or paracetamol, changing positions, or farting does not make it feel better.

While these signs can help to identify a gallbladder problem, an ultrasound or x-ray is needed to know for sure.

Treatment

Gallbladder pain can be very uncomfortable, but if there is no fever or other danger signs listed below, it is not immediately dangerous. Ibuprofen may help relieve pain.

Danger signs

If a person has gallbladder problems, watch for these danger signs. The person will need surgery.

  • Gallbladder pain that lasts more than 4 hours at one time.
  • Gallbladder pain with fever.
  • Gallbladder pain with jaundice (yellow skin or eyes).

Prevention

Avoid fatty meat, deep fried food, or other very fatty foods which often trigger gallbladder pain in someone who has this problem. (It is OK to eat a small amount of fat or oil in each meal and doing so helps the gallbladder empty itself. Vegetable oils are better than palm oil, butter, or lard.)

If you are fat, losing weight may help, but do so slowly by exercising often and eating smaller amounts. Losing a lot of weight very fast can cause gallstones.

people of different ages exercising together
People who exercise most days are less likely to get gallstones.

Menstrual cramps

Many women have cramps or pain in their lower bellies right before or during their monthly bleeding (menstruation). Rest, use gentle massage or take a pain reliever such as ibuprofen. For more on menstruation and how to reduce pain, click here.

hot water bottle and warm cloths
A hot water bottle or warm compress on the belly can help with the pain.

Pelvic infection

When a woman has pain in her lower belly, she might have an infection of the uterus called pelvic infection. There are 2 causes of pelvic infection, both dangerous. It can happen when harmful germs get inside a woman's body, either after childbirth or after the loss of a pregnancy (miscarriage or abortion), or when a sexually transmitted infection is left untreated and spreads into the uterus.

Signs

  • Pain in the lower belly (pelvis) – it can be mild or severe.
  • Pain or bleeding during sex.
  • Tenderness when you press on the lower belly.
  • Fever.
  • Unusual bleeding or bad-smelling discharge from the vagina.

Treatment

Treat the infection with antibiotics right away to prevent serious illness, infertility or even death. If this infection came after a pregnancy or birth, click here. If the woman was not recently pregnant, she needs different medicines, listed in Genital Problems and Infections: Medicines (in development).

Bladder infection, kidney infection

A bladder infection (urinary tract infection, cystitis) causes pain or burning when urinating, or pain just behind or above the front of the pelvic bone. But if the infection spreads into the kidneys, the pain may be felt along the side or in the back. Bladder infections are especially common in women. For more about bladder and kidney infections, see Difficulties with Urinating (in development).

back of woman's body, showing painful kidney areas
Pain when you tap on one side of the lower back could mean an infection or stone in the kidney.

Kidney stones

Kidney stones are tiny rocks that form inside the kidney, urine tube, or bladder and cause a lot of pain as they pass out with the urine. Usually the pain slowly gets worse and worse, and then stops. The pain lasts 20 minutes to an hour each time. It is often more on one side and might be felt anywhere from the back to the urethra (the tube urine travels through). In men, the pain can also be felt in the testicles. There may be blood in the urine. There is usually no fever and the belly is soft. The regular treatment is to take a pain medicine and drink a lot of water until the stone passes, but see Difficulties with Urinating (in development) for more information on how to prevent and treat this.

Hepatitis

woman pointing to where her liver is, on the right side of her upper belly
The liver cleans the blood. When the liver is not working well, toxins and wastes build up in the body, causing sickness.

Hepatitis is the name for inflammation of the liver. Hepatitis can be caused by a virus, drinking too much alcohol, or chemical poisoning. All types of hepatitis have similar signs. But a person gets the different kinds of hepatitis in different ways, and some are more dangerous or longer lasting than others. Hepatitis A and E usually go away within a few months. Hepatitis B and C can last for many years and can lead to liver cancer.

Signs

  • Nausea and vomiting.
  • Itching skin.
  • Dark urine – the color of Coca-Cola.
  • Light, whitish stools.
  • Pain on the right side. Or sore muscles and joints all over.
  • Weakness and exhaustion that can last for months.
  • Yellow eyes and skin.

You may be able to feel the swollen liver from the outside, on the right side, just under the ribs.

To help the liver heal

There are now medicines that can help treat Hepatitis B and C, however they are not yet widely available. Check at your health center to see if you can get them where you live. Even without medicines, rest, plenty of fluids, and avoiding certain things that harm the liver can help it heal.

person resting in a bed
Hepatitis makes you very tired. Listen to your body and rest.
woman drinking liquid through a straw
  • Drink throughout the day – 8 cups or more. Water, fruit juices, and soup broth are all healthy choices.
  • Do not drink any alcohol for at least 6 months. Alcohol is very hard on the liver. If you need help to stop drinking alcohol, see Drugs, Alcohol, and Tobacco (in development).
  • Avoid paracetamol because it can build up in the liver and cause problems. Take a different pain medicine if you need one.
  • If you have tuberculosis, you may need to wait to start treatment until the liver heals. Get medical advice. (If you develop signs of hepatitis while taking tuberculosis medicines, stop treatment immediately and get medical help.)
  • Be cautious about using medicines. Avoid medicines that are not essential. Many medicines harm the liver, especially when taken in large amounts or over a long period.

Prevention

Hepatitis A and E are spread because of poor sanitation and can be prevented by using toilets and washing hands.

Wash your hands many times each day to protect others from infection. Everyone who lives in your house should wash their hands more often too.

Hepatitis B and C are found in blood and sexual fluids. These forms of hepatitis spread during sex or when tools for scarring, tattooing, cutting, or injecting are used on more than one person without cleaning them each time. This allows blood, and the virus inside the blood, to pass from one person to the next. Hepatitis B and C can also pass from a mother to her baby during pregnancy, birth, or after birth.

In places where hepatitis B is very common, including many parts of Africa and Asia, it passes among children and within families even without sharing blood. This is more likely to happen when the family lives in a small, crowded home and are in very close contact most of the time.

Prevent hepatitis B and C:

condom package

  • Avoid injections unless necessary. Always use a brand new needle and syringe for each injection. If you cannot get new ones, you must sterilize needles and syringes between each use. See Medicines, Tests, and Treatments (in development).
  • Use condoms when you have sex.

Hepatitis A and B can be prevented with vaccines. Hepatitis B vaccine is especially important for those who live where the Hepatitis B virus or liver cancer are common.

If you are caring for a person sick with hepatitis, keep yourself healthy by washing your hands often and protecting yourself from his blood and stool.

Liver abscess

Liver abscess can be caused by an infection of amebas that has spread to the liver. This is much more common in men.

Signs

Tenderness or pain in the right upper belly with a fever. The pain may also go into the right chest. It is worse when the person walks. Compare this with hepatitis, cirrhosis (see Drugs, Alcohol, and Tobacco - in development), and gallbladder pain.

If someone with signs of liver abscess begins to cough up a brown liquid, the abscess is draining into his lung. This requires medical help.

Treatment

Treat as for amebic dysentery. Then give diloxanide furoate for 10 days.


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