Is stomachache also a sign of "involution"? This article explains many hidden symptoms!

1. Introduction

Stomach pain, medically known as abdominal pain, is an extremely common symptom that almost everyone has experienced in their lifetime. However, many people tend to take it lightly, thinking that it will pass if they just endure it. In fact, the hidden causes behind stomach pain are complex and diverse, and may involve lesions in multiple systems, ranging from mild indigestion to life-threatening acute abdomen. Therefore, in-depth knowledge about stomach pain is crucial for correctly diagnosing the condition and seeking medical treatment in a timely manner.

2. Classification of stomach pain

1. Classification by pain location

- Upper abdominal pain: Pain here is often related to organs such as the esophagus, stomach, duodenum, liver, gallbladder and pancreas. For example, gastric ulcers often present with periodic and rhythmic pain in the upper abdomen, which occurs some time after eating. The pain is usually dull, bloating or burning. Cholecystitis often presents with pain in the right upper abdomen, which can radiate to the right shoulder and is more severe. It is often triggered after eating greasy food.

- Pain in the middle abdomen: mainly involves the small intestine, colon and other intestinal organs. When the small intestine is obstructed, paroxysmal colic will occur, accompanied by nausea, vomiting, abdominal distension, cessation of gas and defecation, etc.; while the abdominal pain caused by enteritis is usually pain around the umbilicus, accompanied by diarrhea, abdominal distension and other symptoms.

- Lower abdominal pain: Lower abdominal pain in women may be related to reproductive system diseases, such as pelvic inflammatory disease, which often manifests as lower abdominal distension and pain, accompanied by increased vaginal discharge and odor, etc.; in men, it may be related to diseases such as prostatitis and epididymitis. In addition, the initial pain of appendicitis is mostly in the upper abdomen or around the navel, and after a few hours it moves to the right lower abdomen and presents persistent pain.

2. Classification by pain nature

- Colic: usually caused by spasm or obstruction of hollow organs, with severe pain, such as biliary colic and renal colic. Biliary colic is mostly caused by incarceration of gallbladder stones or obstruction of the gallbladder duct, and the pain is paroxysmal and aggravated; renal colic is caused by the movement of kidney stones or ureteral stones, which leads to ureteral spasm, pain like a knife cutting, and patients often toss and turn.

- Dull pain: generally caused by the stretching of the capsule of solid organs or inflammatory stimulation, the pain is relatively mild, such as the pain in the early stage of hepatitis and pancreatitis. Hepatitis patients often feel dull pain and distension in the right upper abdomen, and the pain may persist; the dull pain in the early stage of pancreatitis may gradually worsen.

- Tingling: It is mostly caused by lesions on the abdominal wall or the surface of internal organs stimulating nerve endings. The pain is sharp and short-lived. For example, in the early stages of herpes zoster on the abdominal wall, tingling may occur along the course of the nerves, followed by a rash.

- Bloating and pain: often caused by gas accumulation in the gastrointestinal tract, organ enlargement and other reasons. For example, indigestion leads to gas accumulation in the gastrointestinal tract, which will cause abdominal distension and pain, accompanied by belching, flatulence and other symptoms. When the liver is enlarged, the patient will feel bloating and pain in the right upper abdomen or the entire abdomen.

3. Common causes of stomach pain

1. Digestive system diseases

- Gastritis and gastric ulcer: mainly caused by Helicobacter pylori (Hp) infection, long-term use of nonsteroidal anti-inflammatory drugs, alcoholism and other factors. The gastric mucosa is damaged, and gastric acid stimulates the lesion, causing pain. Gastric ulcer pain is rhythmic, usually occurring half an hour to an hour after eating, and lasting for one to two hours before being relieved; gastritis pain is relatively irregular, often accompanied by symptoms such as nausea, vomiting, and loss of appetite. According to statistics, about half of the world's population is infected with Helicobacter pylori, which is an important pathogenic factor of gastritis and gastric ulcer.

- Cholecystitis and gallstones: Gallstones are easily formed due to imbalanced bile composition and abnormal gallbladder contraction function. Gallstones irritate the gallbladder or block the bile duct, causing cholecystitis. A high-fat diet is a common cause of cholecystitis and gallstones. In addition to right upper abdominal pain, patients may also experience symptoms such as fever and jaundice. Among adults, the incidence of gallstones is about 10% - 15%, and it is higher in women than in men.

- Appendicitis: Obstruction of the appendix lumen is the most common cause of appendicitis. Bacteria invade the appendix wall and cause inflammation. Typical appendicitis is characterized by migratory right lower abdominal pain, which may also be accompanied by systemic symptoms such as fever, nausea, and vomiting. Appendicitis is a common surgical acute abdomen that can occur in any age group, but is more common in young and middle-aged people [3].

2. Urinary system diseases

- Kidney stones and ureteral stones: The concentration of certain substances in urine is too high, and crystals are precipitated to form stones. The stones move in the urinary system, irritating or blocking the urinary tract, causing pain. Renal colic is its main symptom, which is severe and may be accompanied by hematuria, nausea, vomiting, etc. The incidence of kidney stones varies from region to region. The incidence in southern my country is relatively high, about 5% - 10%.

- Cystitis: mainly caused by bacterial infection. Women are more susceptible to cystitis because of their short and straight urethra. Patients often experience symptoms such as frequent urination, urgency, pain during urination, and lower abdominal pain. In severe cases, hematuria may occur. The incidence of cystitis in women is higher than that in men, especially in women who are sexually active and postmenopausal women.

3. Reproductive system diseases (female)

- Dysmenorrhea: It is divided into primary dysmenorrhea and secondary dysmenorrhea. Primary dysmenorrhea is mostly related to the increased synthesis and release of prostaglandins in the endometrium, which leads to excessive contraction of uterine smooth muscle and vasospasm, resulting in uterine ischemia and hypoxia, leading to dysmenorrhea. The pain usually starts after the onset of menstruation, and first appears 12 hours before menstruation. The pain is most severe on the first day of menstruation and lasts for 2-3 days before relief. Secondary dysmenorrhea is mostly caused by diseases such as endometriosis and adenomyosis. The degree and characteristics of pain vary depending on the cause.

- Ectopic pregnancy: The fertilized egg implants outside the uterine cavity, most commonly in the fallopian tube. As the embryo develops, the fallopian tube ruptures or miscarries, causing acute abdominal pain, often accompanied by vaginal bleeding. Ectopic pregnancy is a common acute abdomen in obstetrics and gynecology. If not treated in time, it can lead to heavy bleeding and endanger life. The incidence of ectopic pregnancy is about 2% - 3%, and has been on the rise in recent years [6].

4. Other reasons

- Abdominal trauma: such as car accidents, falls from heights, violent collisions, etc., can cause damage to abdominal organs and cause stomach pain. Different organ injuries have different manifestations. For example, liver rupture may cause pain in the right upper abdomen, accompanied by symptoms of hemorrhagic shock; spleen rupture is mostly left upper abdominal pain, and the early symptoms may be atypical, but shock may occur quickly when the amount of bleeding is large.

- Systemic diseases: Certain systemic diseases may also cause abdominal pain. For example, in diabetic ketoacidosis, patients not only have abdominal pain, but also have diabetes symptoms such as polydipsia, polyphagia, polyuria, weight loss, and their breath smells like rotten apples. Allergic purpura may cause abdominal pain, accompanied by skin purpura, swollen and painful joints, and other symptoms.

4. Diagnosis of abdominal pain

1. Detailed interview: The doctor will ask the patient about the specific location, nature, degree, onset time, duration, aggravating or relieving factors of the pain, and whether it is accompanied by other symptoms, such as fever, vomiting, diarrhea, hematuria, etc. In addition, the patient's past medical history, family history, eating habits, lifestyle and other information are also important references for diagnosis. For example, knowing whether the patient has a history of unclean food recently can help determine whether the abdominal pain is caused by intestinal infection; asking whether there are hereditary diseases in the family can help diagnose certain hereditary abdominal pain diseases.

2. Physical examination: including inspection, palpation, percussion and auscultation. Inspection observes the shape of the abdomen, the presence of gastrointestinal type and peristaltic waves, etc.; palpation is the key, through which the location and degree of abdominal tenderness, rebound pain, and muscle tension can be understood, and the diseased organs can be judged. For example, in appendicitis, there is tenderness at McBurney's point in the right lower abdomen; in cholecystitis, Murphy's sign is positive in the right upper abdomen. Percussion can determine whether there is gas or fluid accumulation in the abdominal cavity; auscultation can understand the bowel sounds. Hyperactive bowel sounds may indicate intestinal obstruction, while weakened or absent bowel sounds may be related to peritonitis, intestinal paralysis, etc.

3. Laboratory tests

- Blood test: Routine blood test can determine whether there is infection. Increased white blood cell count and neutrophil ratio often indicate bacterial infection. C-reactive protein (CRP) can also reflect the degree of inflammation and increases in cases of infection, trauma, etc. Blood amylase and lipase tests are helpful in diagnosing pancreatitis. These two indicators often increase significantly in pancreatitis. In addition, blood sugar, liver and kidney function tests are also important for determining systemic diseases or related organ functions.

- Urine test: Urinalysis can detect red blood cells, white blood cells, proteins and other components in urine. When the urinary system is infected, the white blood cell count increases; kidney stones, urinary system tumors and other diseases may cause hematuria.

- Stool examination: Understand the color, properties, presence of pus, blood, parasite eggs, etc. of the stool. In case of intestinal infection, white blood cells and red blood cells may appear in the stool; in case of indigestion, there may be undigested food residues in the stool.

4. Imaging examination

- Ultrasound examination: It has a high diagnostic value for lesions of solid organs such as the liver, gallbladder, pancreas, spleen, and kidney, as well as the urinary system and female reproductive system. It can detect diseases such as gallstones, cholecystitis, kidney stones, and ovarian cysts. Ultrasound examination has the advantages of being non-invasive, convenient, and repeatable, and is a commonly used examination method for abdominal diseases.

- X-ray examination: Abdominal upright plain film can be used to observe whether there is free gas under the diaphragm, which is used to determine gastrointestinal perforation; it can also detect intestinal dilatation and gas-liquid level in intestinal obstruction. However, X-ray has low resolution for soft tissues and has limited diagnostic value for some solid organ lesions.

- CT examination: It can show the shape, structure and pathological changes of abdominal organs more clearly, and its diagnostic accuracy for abdominal tumors, trauma, inflammation and other diseases is higher than ultrasound and X-ray. In particular, multi-slice spiral CT has fast scanning speed and high resolution, and can perform multi-plane reconstruction, providing more detailed information for disease diagnosis. However, CT examination has certain radiation, and special groups such as pregnant women should use it with caution.

- Magnetic resonance imaging (MRI): It has a very high resolution for soft tissues and has unique advantages in diagnosing lesions of organs such as the liver, pancreas, uterus, and ovaries, and is especially suitable for detecting tumors and vascular lesions. MRI has no radiation, but the examination time is long and the cost is relatively high. In some cases, patients with metal implants in their bodies cannot undergo the examination.

5. Treatment principles for stomach pain

1. General treatment: For patients with mild symptoms, such as abdominal pain caused by indigestion, symptoms can be relieved by adjusting diet, such as avoiding spicy, greasy, and irritating foods, eating small meals frequently, and taking adequate rest. At the same time, keeping the abdomen warm can also help relieve gastrointestinal spasms and reduce pain.

2. Etiological treatment: This is the key to treating stomach pain. Take corresponding treatment measures for different causes. For example, patients with gastritis and gastric ulcers, if infected with Helicobacter pylori, need to undergo standardized anti-Helicobacter pylori treatment. Commonly used treatment options include proton pump inhibitors (such as omeprazole, lansoprazole, etc.) bismuth (such as potassium bismuth citrate) and two antibiotics (such as amoxicillin, clarithromycin, etc.); patients with cholecystitis and gallstones can choose conservative drug treatment or surgical removal of the gallbladder according to their condition; patients with appendicitis, once diagnosed, usually need to surgically remove the appendix as soon as possible.

3. Symptomatic treatment: While treating the cause, appropriate analgesics can be used for pain symptoms. However, before a clear diagnosis, strong analgesics should be used with caution to avoid masking the condition and delaying the diagnosis. For patients with abdominal pain accompanied by vomiting and diarrhea, attention should be paid to replenishing water and electrolytes to prevent dehydration and electrolyte imbalance.

6. Measures to prevent stomach pain

1. Maintain good eating habits: Eat regularly, at regular times and regular amounts, and avoid overeating. Eat less raw, cold, greasy, spicy and other irritating foods, eat more fresh fruits and vegetables, and maintain a balanced diet. Pay attention to food hygiene, do not eat unclean food, wash your hands before and after meals to prevent intestinal infections.

2. Keep your abdomen warm: especially when the seasons change and the temperature changes greatly, add clothes in time to prevent your abdomen from getting cold. Cover yourself with a blanket when sleeping at night to prevent your abdomen from being exposed to cold air.

3. Moderate exercise: Appropriate exercise helps promote gastrointestinal motility, enhance digestive function, and improve body immunity. You can choose a form of exercise that suits you, such as walking, jogging, yoga, etc., and exercise 3 to 5 times a week, about 30 minutes each time.

4. Maintain good living habits: quit smoking and limit alcohol consumption to avoid long-term heavy drinking which may damage the gastrointestinal tract, liver and other organs. Keep a regular schedule and ensure adequate sleep, which is beneficial to the normal function of various organs in the body.

5. Regular physical examination: Regular comprehensive physical examinations should be conducted to timely detect and treat potential diseases. For patients with chronic diseases, such as gastric ulcers and cholecystitis, they should follow the doctor's advice for regular check-ups and standardized treatment to prevent the condition from getting worse.

VII. Conclusion

Although stomach pain is common, the reasons behind it are complex and varied, and may involve lesions in multiple systems. When stomach pain occurs, you should not blindly take medicine on your own or ignore it. You should seek medical attention in time, and through detailed interviews, physical examinations, laboratory tests, and imaging tests, the cause of the disease should be clarified, and targeted treatment measures should be taken. At the same time, in daily life, you should pay attention to maintaining good eating habits, keeping your abdomen warm, and exercising moderately to prevent the occurrence of stomach pain. Only by paying enough attention to and correctly understanding stomach pain can we better protect our health.