Common causes of abdominal, pelvic and anal pain

Pain is one of the most common symptoms of illness but also one of the most ignored by patients. If you are in persistent pain, it is always worth seeing a doctor to find out the underlying cause and get appropriate treatment. As a Consultant Laparoscopic General and Colorectal Surgeon I often see patients struggling with pain and these are the five most common causes of their discomfort.

Gallstones

Gallstones are small, hard, fatty lumps in your gallbladder. Your gallbladder sits under your liver on the right side of your body. It stores and concentrates a liquid called bile, which it releases into your bowel to help digestion. If there is an imbalance in your bile make-up, gallstones can form.

In most cases, gallstones don’t cause any symptoms. However, if a gallstone gets stuck in a bile duct, it can cause sudden, severe pain in your upper right abdomen called biliary colic. The pain can come and go, lasting for several minutes or up to half an hour.

Treatment for biliary colic usually involves taking over-the-counter painkillers and antispasmodics (eg hyoscine N-butylbromide), and avoiding eating fatty foods.

Hernias

A hernia refers to part of a tissue within your body, which is normally held inside, pushing outwards. The most common types of hernia are inguinal and femoral hernias, where part of your intestines push through a weakness in the abdominal muscle wall in your groin. Hernias do not go away on their own and need surgery to be repaired. Left untreated, hernias, in particular those caused by protruding intestines, can cause complications, some of which are life-threatening.

Acid indigestion

Acid indigestion can cause upper, central abdominal pain that can spread to your back. It is caused by a disruption in the balance between the acid released by your gut for digestion and the protective lining of your gut. Acid reflux is a type of acid indigestion where the acid escapes upwards into your gullet (oesophagus) causing chest pain, or what is often called heartburn.

Diet, alcohol, stress and infection with the bacteria Helicobacter pylori can all contribute to acid indigestion. H. pylori infection can sometimes be diagnosed by testing your stools but is more reliably diagnosed by testing a tissue sample (biopsy) collected from your stomach lining.

Acid indigestion can be managed by taking antacids. However, if you have a H. pylori infection, which can cause recurring acid indigestion, you may need other treatments, including antibiotics.

Diverticular disease

Diverticular disease affects around two thirds of adults at some point in their life, becoming more common with age. However, it usually causes no symptoms.

Diverticulae are little pouches in the wall of your bowel. As larger or greater numbers of pouches develop, you may experience symptoms of diverticular disease. This includes lower abdominal pain and changes in your bowel habits. Treatment involves eating a healthy, balanced diet rich in fibre and staying hydrated to prevent constipation.

Diverticular disease can cause rectal bleeding and an infection called diverticulitis that can be treated with antibiotics. You will need to see a gastroenterologist (a doctor specialising in treating the bowel) to discuss how to manage these complications.

Perianal problems

Pain around the anus (perianal pain) is common but usually not serious. There are three main conditions that cause perianal pain: piles, anal fissures and anal fistulas.

Piles, also called haemorrhoids, are swellings that develop inside your back passage (rectum) or around your bottom (anus), which can cause bleeding, irritation and pain. Treatment usually involves taking painkillers and anti-inflammatory drugs, as well as having soothing baths and/or applying a cool compress.

Anal fissures are small tears in the skin tissue that lines the opening of your anus. They cause a burning pain, which worsens when passing stools and lasts for an hour or two afterwards — it is often described as trying to pass glass. Treatment involves taking painkillers and temporarily using laxatives, until the fissure heals on its own.

An anal fistula is a tunnel or network of tunnels that develop between your anus and rectum. It is often caused by an infection near your anus, which leads to pus collecting in the surrounding tissue. When the pus drains out, an anal fistula is left behind. Treatment almost always requires surgery to close off the tunnels so your anal fistula can heal.