Abdominal Pain: Chronic/Recurrent

Many children complain of abdominal pain that lasts for long or comes and goes over a period of time. If the pain lasts for longer than 1 or 2 months then it can be considered chronic or recurrent.

Most recurrent abdominal pains in children are functional. This means no evidence that the symptoms are caused by an underlying organic disease.

Children with abdominal pain may experience distress and anxiety. This can interfere with their ability to get on with their regular activities. For some it could be the reason for missing school. It also causes worry to the parents and other caregivers.

Why does my child get abdominal pains?

The gut is enveloped in a rich and complex network of nerves called the Enteric Nervous System (ENS), or “gut brain”. This nervous system controls movement, blood flow, transport and secretions, defence and hormonal activities in the gut.

Communication occurs between the gut brain and the central brain that allows processes to occur without problems. Problems of  communication between the two may lead to the bowels being more sensitive than usual  causing even normal processes like intestinal movements to feel painful. Events that physically stretch the gut, substances  or germs that irritate the bowels and psychological stress or anxiety could cause one to feel pain in the tummy.

Conditions that cause irritation in the gut like infections, allergies and those that cause injury, swelling and damage to the gut tissues may make the gut more sensitive to stretch or pressure. It’s similar to a burn or scar on the skin. One may feel sensitive on the affected area long after the injury occurred.

There are complaints that increase the likelihood that the abdominal pain is caused by an organic disease. They are called alarm signs. These include unintended weight loss, lagging behind in gaining height, blood in stool, anaemia, prolonged vomiting, pain that is fixed at a specific part of the tummy, and prolonged diarrhoea.

During examination there are signs that the doctor may find that could suggest organic disease. These might include finding an enlarged organ,  a swelling ,or unusual tenderness in a specific part of the abdomen or back

Will my child need any tests?

Most children will not need tests. If no alarm symptoms are observed tests are unlikely to show a specific problem. However, testing may still be performed to reassure the patient, parent, and doctor that an organic disease is not the cause of problems that significantly diminish the quality of life of the patient.

The presence of alarm signs usually prompts the doctor to do tests to find out what is causing the tummy pains. The following tests may be considered depending on what the history and physical exam reveal:

  • Urine analysis +/- culture
  • Blood tests to check the health of the liver, pancreas and kidneys
  • Stool tests
  • Abdominal imaging may be done if certain conditions are suspected.
  • Endoscopy may be helpful with certain diagnoses.

What if the tests do not reveal any problem?

When an underlying cause cannot be found it is called a functional pain disorder. Examples include:

Functional dyspepsia. This causes pain or discomfort in the upper part of the belly. The discomfort is usually a general feeling of pain or burning that is not accompanied by change in bowel movements. One may feel full or bloated even after eating small amounts of food.

Irritable bowel syndrome (IBS) . This is a long term illness that causes cramping abdominal pain that is accompanied by changes in bowel habits. This includes constipation or diarrhea or alternating diarrhea and constipation. Bloating, gas, and belching may accompany these complaints.

Abdominal migraine. This causes intense pain in the mid abdomen that lasts at least one hour. In between the pain episodes the child can be well for weeks or months. Loss of appetite, nausea, vomiting, headache, or sensitivity to light may occur during the painful spells.

Functional abdominal pain . Pain here typically lasts less than an hour and is not usually accompanied by other specific complaints. Nausea, dizziness, headache, and fatigue may accompany complaints of abdominal pain. Pain is often triggered by anxiety and stress.

How is recurrent abdominal pain treated?

A reasonable treatment goal for functional abdominal pain is to get the child back to normal daily activity and a return to school rather than a complete disappearance of the pain.

Behavioral therapies may be recommended for children and adolescents whose pains are affecting their daily activities.

In some children a two-week trial of change in diet may help to see if they obtain any relief of symptoms. This might include avoiding dairy products and including fibre rich diet. Those who don’t feel any changes after the trial should resume regular diet.

Some children may find that certain foods,drinks or medicines triggers their pains.Common triggers include fatty foods, caffeine containing drinks,and foods that increase gas like beans, cabbage, onions, and bananas. Medications such as aspirin and ibuprofen could cause tummy irritation in some children. Avoiding some of these may help ease symptoms.

Medicines may be needed to treat some types of abdominal pain. These medicines help to decrease the frequency or severity of symptoms. Treatment might include drugs that reduce acid; medicines that relax gut smooth muscles and reduced spasms, stool softeners for those with an altered bowel pattern.

When should I see the doctor?

You should bring your child to hospital immediately If your child has recurrent abdominal pain and you observe the following problems:

  • Blood in stool,urine or vomit
  • Severe diarrhea or frequent vomiting
  • Severe or continuous abdominal pain
  • Refusing to eat or drink
  • Very high body temperature or persistent fever.
  • Pain when passing urine or getting pressed frequently.
  • Significant reduction in energy levels,movement or play

You should make plans to visit your doctor if you notice changes in bowel habits, loss of appetite, or if the child appears to get full after taking small amounts of food.