Central Abdominal Pain

Causes, Diagnosis & Treatment Of Central Abdominal Pain (Or Pain In The Middle Of The Abdomen)

What is Central Abdominal Pain?

If you have pain in your central or middle abdomen it could be as a result of gastritis, indigestion, pancreatitis, hiatus hernia, trapped wind,  constipation, food poisoning, bowel obstruction or even early stages of appendicitis. 

Let's be very clear - central abdominal or tummy pain refers to any ache, irritation or unpleasant sensation, whether colicky, dull, sharp or burning in nature that is felt in the middle of the abdomen, anywhere within a hands length of the umbilicus or belly button.

This means pain anywhere on the belly button or within a span of up to two inches around the belly button.

If you have pain in your abdomen above this area it is an  upper central (epigastric) pain and below the area it is a  lower central (or suprapubic) pain. 

Like in other parts of the abdomen, pain in the centre of the abdomen happens when things go wrong with one of the organs or structures in that area. Organs in this region are mainly:

• Parts of the small and large intestines, including the glands on the wall of the small intestines
  
• The lower part of the stomach and pancreas
  
• Big blood vessels from and to the heart (abdominal aorta and inferior vena cava)
• Muscles in that region
  
• Skin, nerves, blood vessels and lymph glands within this region
  

Pain in this part of the abdomen could also be an extension of pain from the upper or lower central abdomen. It could also come from the heart, lungs, the spinal cord as in tabes dorsalis or even the eye as in acute glaucoma.

Common Causes Of Central Abdominal Pain

The most common cause of central abdominal pain is problems with the small or large bowels. Such problems could be one or more of the following:

• An infection
• Inflammation
• Blockade (partial or complete)
• Twisting
• Reduced blood flow to the bowel
• Or tumour of any kind, including cancer, affecting the bowel loops within that region (please note that bowel cancer is a very common cause of abdominal pain; it accounts for less than 1 percent of the causes of pain in this area

Any of the above problems could also affect the other organs listed above as these are found in the middle of the abdomen causing pain here.

In evaluating the possible causes of pain in the centre of the abdomen, more serious causes like heart attack, ruptured abdominal aortic aneurysm, abdominal pain associated with diabetes (diabetic keto acidosis), blood loss to part of the bowels (acute mesenteric ischemia), perforation of a peptic ulcer, lower lobe pneumonia especially in children, and early stage of acute appendicitis need to be excluded.

Common Causes Of Central Abdominal Pain

Do you or your loved one have pain in the middle of the abdomen? Let's take a brief look at the five most common causes of central abdominal pain and then a more comprehensive list below. 

1. Trapped Wind

As mentioned earlier, the area of the abdomen around the belly button houses the small intestine and the early part of the large intestine. Sometimes following a hurried meal or after eating certain kind of foods, air can become trapped inside the bowel which distends it and causes central abdominal pain.

If you have:

• Sudden sharp central abdominal pain within half an hour after eating
• A tight and bloated sensation in your tummy
• Your tummy making some loud gurgling noises
• A tummy pain that is partly relieved by farting or belching or you feel like doing so to relieve the pain

It is most likely that you have trapped wind.

Please note that trapped wind will not usually cause nausea, vomiting, constipation, fever or diarrhoea. So, if you suffer with vomiting, diarrhoea or fever with the above symptoms, it is unlikely that it is trapped wind.

Taking peppermint capsules or drink and some pain killers like Paracetamol (Tylenol) may help the pain.

2. Food Poisoning (Also Referred to Food Borne Infection Or Tummy Bug)

This is a very common cause of central abdominal pain. The typical story goes like this:

• You go out for a meal the previous night
• You then wake up with a dull ache in the centre of the abdomen
• As the day goes by, the pain becomes more severe
• You hear your tummy make some horrible loud noises and it sounds like your tummy is going to explode
• You develop diarrhoea, several times that day
• You feel like vomiting or actually vomit
• The pain worsens
• You take Imodium or a similar medicine to stop your diarrhoea
• The diarrhoea is stopped or reduced but your pain continues or worsens

Is that you? The solution might be to take some simple pain killer like paracetamol or Tylenol and see your family doctor, for a one-to-one assessment. You may or may not need some additional medications like antibiotics or antispasmodic.

3. Food Intolerance

Does this sound like you?

• You notice that every time you eat a certain type of food that you develop a pain in the middle of your abdomen
• You feel bloated and perhaps have episodes of diarrhoea feel uncomfortable throughout the day. You may even develop a strange rash on your body that nothing seems to cure
• You feel very tired most of the time 

If this sounds like you then you may have a food intolerance. You can get strips from reputable online laboratories to find out what food you might be intolerant to. It might even be that you have a condition referred to as coeliac disease.

4. Constipation

• Have you noticed that in the past few days you have this nagging central abdominal pain?
• You feel somehow bloated but not quite?
• You are not as hungry as you used to be?
• You go to open your bowels but it only comes in small amounts or maybe you have even skipped a day or two without going, and you seem to be farting more than usual (which smells more than usual as well)?

Constipation may be the cause of the pain.

5. Bowel Obstruction

This is one of the serious causes of pain in the central abdominal area and this type of pain must always be excluded by a doctor.

The story goes like this:

• You develop pain in the middle of your abdomen around the belly button. The pain starts as a dull ache and over the next few hours or days, it progressively worsens
• The pain starts to come and go in waves
• The waves gets stronger and more painful
• In between, you feel some sense of relief but still have a mild to moderate tempo of pain or in some cases may be pain-free
• You notice your tummy become bloated and progressively enlarges
• You started feeling sick (nauseated) and as time goes on, actually start to vomit
• The vomit is initially of food recently eaten and then becomes green and bitter (bile)
• You want to fart but cannot
  
• You not able to open your bowels and you realise that you haven't been able to go to the toilet for a few days
• The pain continues to worsen

This is almost certainly a bowel obstruction or intestinal obstruction.

What should you do? Go to the hospital now. No more, no less.

If you have had a previous abdominal operation, a hernia repaired or caesarean section, your bowel obstruction could have been caused by old scar tissue formation from the surgery you had in the past. This scar tissue could twist your bowels and have caused the blockade. This is a condition called abdominal adhesions. Bowel cancer, unusually long or short bowel loops and worms are other things that could cause bowel obstruction.

Causes of Central Abdominal Pain In Children

Most children under the age of 8 will point to the centre of their tummy, in or around the belly button when they are feeling unwell. Many times, the cause of their pain may actually be far away from the abdomen. They tend to point to the tummy because of poor ability to localise pain (which improves as they grow up).

It is important to take a complaint of central abdominal pain seriously in a child and to locate the possible causes of pain, which are often not serious, but to identify and address any potential serious cause.

The following are the most common causes of central abdominal ache in children:

Causes of Central Abdominal Pain In Older Children And Adults

Central abdominal pain in older children and adults is caused by similar conditions causing pain in the middle part of the abdomen in small children, including:

Tests For Central Abdominal Pain

To find out the causes of your central abdominal pain it is likely that tests and investigations need to be done. The following are the common tests you will expect to be done and why they are done:

Blood Tests

These will include:

• Full blood count - FBC (called complete blood count - CBC, in North America) will show your haemoglobin level and tell you if you are losing blood or not. This test will also show the response of your white blood cells which are your "soldiers" that fight infection. If there is an infection or inflammation their number will be remarkably raised, as the body recruits them from the bone marrow and organs into the blood to fight for you.

• UE (Urea and Electrolyte in the UK) or BUN (Body Urea and Nitrogen in North America). This test reveals how the kidneys are dealing with the salts in the body as well as the balance of salt and water in the body.

• CRP - referred to as Cryo-Reactive Protein. This is a marker of infection or inflammation and when significantly raised it may dictate the level of aggressiveness with which you need to be treated.

• Amylase. This is a measure of a type of enzyme released when certain tissues in the abdomen are injured, especially the pancreas. The amylase could also be raised due to many other conditions.

• Blood sugar levels to exclude diabetes.

Urine Test

It is important to do a urine test and certainly a pregnancy test in any woman of child bearing age.

X-Ray

This is the least expensive, easily available and quickest way to demonstrate that there is a bowel obstruction or not. Constipation, bowel obstruction and many other conditions may also require the taking of an x-ray.

Ultrasound

An ultrasound will exclude gallstones, pancreatitis (pancreatic cysts etc.).

Stool Test

A stool test will exclude things like H. pylori, worms, or parasites.

References:

Chiche L, Roupie E, Delassus P., Management of adult abdominal pain in the Emergency RoomJ Chir (Paris). 2006 Jan-Feb; 143(1):6-14

Dang C, Aguilera P, Dang A, Salem L.Acute abdominal pain. Four classifications can guide assessment and management.Geriatrics. 2002 Mar;57(3):30-2, 35-6, 41-2.

Mayo-Smith WW, Imaging the patient with acute abdominal pain: current concepts. 

Med Health R I. 1999 Jun;82(6):202-6.

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