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Intestinal pain - causes, diagnosis and therapy

Intestinal pain - causes, diagnosis and therapy



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Intestinal pain - causes and therapies

Everyone has experienced slight bowel pain. Short-term digestive complaints such as flatulence or constipation are often responsible for the pain symptom. Occasionally, however, there are serious health problems behind the pain in the intestine. The exact localization of the source of pain is a particular complication when assessing the severity of such complaints.

How do intestinal pains arise?

In the medical sense, bowel pain belongs to the viscera pain, the so-called visceral pain or visceral pain. The term roughly describes a very broad spectrum of pain symptoms of various types that occur in the area of ​​the abdominal organs

  • the pancreas,
  • the liver,
  • the kidneys,
  • the uterus,
  • the stomach
  • and the gut itself.

Visceral pain is usually caused by special irritation in said organs, which cause the nerves located there to send out pain signals. Corresponding pain stimuli are provoked, for example, by harmless flatulence or by the female period. But serious inflammatory processes or other tissue damage in the organs can also trigger visceral pain, which is why a medical clarification is absolutely necessary if symptoms persist.

The so-called intestinal peristalsis often plays an important role in the development of intestinal pain. It describes the interplay of the intestinal muscles, which shape the digestive process through routine muscle contractions. Very often there is pain in the intestine if this peristalsis of the intestinal muscles is disturbed in any way. The muscles then mostly send out uncontrolled contractions, which also involve the surrounding nerves and thus lead to pain symptoms. In this case, one also speaks of an intestinal colic if the pain has a cramp-like character.

Due to the anatomical proximity and the synchronized supply of blood and nerve vessels of organs in the abdominal cavity, the causes of visceral pain in general and of intestinal pain in particular can often not be immediately localized. Sometimes it is just radiation pain from adjacent organs, which is however so severe that intestinal pain is suspected behind it. Especially when there is pain in the stomach or uterus, it is often very difficult to clearly determine the pain symptoms. In addition, due to the wide range of possible causes of pain in the intestinal area, the actual cause can also be masked at the beginning.

One of the following reasons is usually responsible for actual pain in the intestine itself:

  • Inflammation,
  • Infectious diseases,
  • Food intolerance,
  • nervous stress like stress,
  • Tumor diseases or cancer,
  • or indigestion.

Indigestion as the main cause

In the majority of all cases, intestinal pain is a temporary affair and is due to temporary indigestion. It is enough to eat unripe or very flatulent foods such as beans, peas or onions, and this causes flatulence (Flatulence) to have provoked These arise in the intestine when intestinal bacteria responsible for digestion produce too much gas, which happens too easily, for example, when onions have a high sulfur content. This means that air collects in the stomach. Usually the intensity of the intestinal pain is limited, since the gas accumulations in the intestine are a one-time thing, are not too substantial and the resulting irritation of the intestinal walls, muscles and nerves is limited. But there are also special cases in which the pain becomes unbearable due to flatulence. We are talking about chronic bloating, or bloating (Meteorism).

It is also often associated with certain eating habits, such as a high-fiber diet, which is not a problem in itself. Because fiber, like many flatulent foods, is in and of itself very healthy, even if it provokes the increased gas emissions from intestinal bacteria. Occasionally, flatulence is also based on chronic intestinal diseases and is then no longer to be regarded as a harmless consequence of the diet.

Pain intensity and pain duration are also decisive for constipation (Constipation) not infrequently about whether the complaint is harmless or questionable. Most of the pain symptoms here are based on hasty food, which puts the digestive system under pressure for a short time. The food porridge builds up in the intestine because the intestinal peristalsis cannot keep up with the muscle contractions necessary for digestion. It is also conceivable that too many stuffing foods, for example white flour products such as bread rolls or pasta, have been consumed, which then hinder trouble-free digestion. Inadequate hydration can also cause constipation from constipation. Intestinal pain, like constipation itself, does not pose a health problem once and on its own. However, should a corresponding nutritional behavior manifest itself permanently, health complications can occur.

Conversely, bowel pain can also be associated with diarrhea (Diarrhea) arise. Here, however, there is already a disturbed digestion, which ultimately provokes the diarrhea. In this case, the absorption of liquid from the food porridge is fundamentally hampered, which is why the bowel movements are highly liquefied. The intestinal pain associated with this in most cases is often cramp-like and indicates extreme irritation of the intestinal walls, including the intestinal muscles and intestinal nerves located there. For example, food poisoning or an intestinal infection is conceivable as the cause, which is why persistent diarrhea is always a case for the doctor. The same applies to the drainage of the body that occurs in the case of permanent diarrhea, which can lead to dangerous dehydration and therefore requires the fastest possible treatment of the digestive complaints.

It becomes apparent that indigestion, as well as the associated intestinal pain, are not always as harmless as it initially appears. This is especially true for nausea and vomiting, two digestive problems that are also often accompanied by a downy feeling and pain in the intestinal area. As a sign of an existing gastrointestinal disease or food intolerance, intestinal pain combined with nausea and vomiting can be a clear indication of a doctor's visit.

Intestinal pain from bowel diseases

Serious digestive problems often arise from underlying bowel diseases. And intestinal pain can always be traced back to inflammation or infections in the intestine. The pain here arises from an irritation of the intestinal mucosa, which in the later course of the disease penetrates into the intestinal walls and thus to the intestinal muscles and nerves. Since this often results in cramp-like muscle contractions when the intestinal muscles react irritably to the inflammation or infection process, any pain often manifests itself as intestinal colic, at least in the advanced stage of the disease.

The reasons for inflammation or infection in the intestine are many. On the one hand, such diseases can be triggered by classic pathogens such as

  • Coli bacteria such as Escherichia Coli (enterohaemorrhagic colitis),
  • Salmonella (Salmonellosis),
  • Candida mushrooms (Candidiasis)
  • or intestinal parasites (Tapeworm infestation)

If the colon is improperly colonized with the relevant pathogens, the intestinal flora first becomes out of balance, which leads to general digestive problems. The pathogen populations then gradually attack the intestinal tissue and provoke inflammatory processes and tissue damage.

On the other hand, nutritional aspects often play an important role, especially in intestinal inflammation. For example, if you regularly eat very spicy or acidic food, you risk weakening your intestinal mucosa, which can further develop into painful intestinal wall infections. Likewise, radiation damage (radiation colitis) as the cause of the inflammation-related pain cannot be excluded. In addition, poisoning from chemicals and substance abuse, such as alcohol, can also be the cause of the painful bowel inflammation. Bowel diseases that lead to intestinal pain in this way are considered

  • Intestinal inflammation (Enteritis),
  • Colon inflammation (Colitis),
  • chronic colon inflammation (Ulcerative colitis),
  • Gastrointestinal inflammation / gastrointestinal flu (Gastroenteritis),
  • Irritable bowel syndrome (RDS),
  • Colon cancer and intestinal metastases,
  • Intestinal obstruction (Ileus)

Poisoning as a cause of intestinal pain

If you suddenly experience severe abdominal pain in the intestines after eating, this may also be due to food poisoning. In both cases, whether bacterial germs get into the intestine and multiply rapidly, whether food has not been insufficiently cleaned beforehand or was bad at the time of consumption. Since the bacteria tend to secrete toxic gases as breakdown products, they almost always cause food poisoning, which is characterized by diarrhea, nausea and vomiting, but also by severe intestinal pain and intestinal cramps.

However, poisoning does not necessarily have to be based on spoiled or contaminated food. Sometimes chemical toxins are also responsible for the intestinal pain. Parents of small children should be particularly alert to this. Again and again, children complain of apparently harmless abdominal pain if they have accidentally sipped toxic cleaning agents. Environmental pollutants in the air or in drinking water also provoke pain symptoms in the gastrointestinal area if the organism continues to be polluted.

Nervous strain

The stomach and intestines are known to be the organs that react first to stress and worries. It is therefore not surprising that intestinal pain, like some intestinal infections, is favored by persistent nervous strain. The exact mechanism for the development of inflammation has not yet been fully clarified, but at least the intestinal pain can be justified simply by the fact that nervous tension also leads to disturbed and painful contraction behavior of the intestinal muscles. If you suffer from intestinal pain for no apparent reason, you may also be fighting

  • Anxiety,
  • Depressions,
  • inner unrest,
  • Fear of exams or stage fright,
  • Nervousness,
  • Panic attacks,
  • psychological trauma,
  • a stressful everyday life
  • or stress at work.

Intestinal pain with allergy or intolerance

It is also conceivable that intestinal pain may occur as an allergic reaction. This applies in particular to food or food allergies, since these lead to irritant reactions in the digestive tract immediately after eating a critical food.

The reason for the pain in existing allergies is that the immune system mistakenly interprets certain food components as foreign bodies to be controlled in such a case. Antibodies are therefore formed that are sent into the intestine to ward off the supposed dangerous substances. The transmission of pain signals, together with other typical allergy symptoms such as diarrhea or vomiting, form part of the body's immune response. While vomiting or diarrhea should ensure that the foreign bodies are removed from the digestive tract as quickly as possible, the pain is an erroneous warning signal to the body .

In this context, food intolerance is to be distinguished from food allergy. There is no faulty reaction of the body to food here, but there is a fundamental inability of the body to digest certain food components, which consequently provokes indigestion and pain. A good example is lactose intolerance, better known as lactose intolerance. Often mistakenly referred to as food allergy, this is actually a relatively natural intolerance of the human body. Because that young people and adults still tolerate milk after weaning is primarily due to the introduction of dairy farming in the last millennium. It is particularly widespread in Europe and here it ensured that the enzyme lactase necessary for the breakdown of lactose is still produced by our organism far beyond infancy. In other parts of the world, where dairy products do not have such an essential position in the daily diet, lactose intolerance is still present. Having bowel pain after eating milk because the digestive tract is irritated by the milk sugar is therefore completely normal in said regions.

Far from the distinction between food allergy and food intolerance, almost all foods can contribute to both types of defense. The foods that cause the most problems include:

  • certain types of vegetables such as celery, soy or mustard,
  • cereals containing gluten, especially wheat and barley,
  • Marine animals such as fish, crab or mussels,
  • Dairy products, especially high-lactose cow's milk products,
  • and nuts such as peanuts, hazelnuts or walnuts.

In addition, food additives and chemical sprays in under-washed foods should not be underestimated as triggers of allergic intestinal pain.

Concomitant symptoms

The abdominal and pelvic organs have some special anatomical features:

  • They are distributed very space-saving in the abdomen.
  • They are cared for by numerous nerve and blood vessel networks.
  • To protect them, they are covered by a network of connective tissue (Peritoneum) surround.

These three factors mean that intestinal pain can only be classified as such in very rare cases. As a rule, these visceral pains are perceived as diffuse, dull and difficult to localize. In some cases, they are even colic-like at intervals or are felt as unbearable permanent pain.

Pain intensification during food intake can also be very different. In some cases, the pain can be temporarily reduced in intensity, but in some cases it is exacerbated by food and drink intake.

In addition to the actual bowel pain, there are some accompanying symptoms that can occur depending on the cause of the pain. For example, gastrointestinal infections are known to cause diarrhea, nausea and / or vomiting in addition to cramp-like intestinal pain. In addition, food allergies often fall due to other allergic reactions, such as narrowing of the esophagus due to swelling of the mucous membranes (especially with peanut allergy), Dizziness or reddening of the skin. The following symptoms can be considered as accompanying symptoms for intestinal pain:

  • Nausea and vomiting,
  • Fever and fatigue,
  • Sweating,
  • Diarrhea or constipation (Constipation),
  • Discomfort when urinating,
  • Reddening of the skin,
  • Swelling of the skin and mucous membranes
  • as well as sensory disturbances in the intestinal area.

As the causative disease progresses, the pain usually increases in intensity. This can sometimes lead to the development of a complex of symptoms, which in medical parlance is referred to as an acute abdomen or an acute abdomen and can worsen to a life-threatening state of shock. It can indicate internal bleeding, perforations, occlusions or inflammation. Typical, alarming symptoms of an acute abdomen include:

  • Severe, acute abdominal pain.
  • Defense tension of the abdominal wall muscles, noticeable through an exciting abdominal wall, which yields resiliently from outside when palpated.
  • Decompensation of the circulatory situation up to shock, which is characterized by hypotension, tachycardia, tachypnea and cold sweat.

An acute stomach can also lead to the following accompanying symptoms:

  • Vomiting, even when sober,
  • Vomiting of stool (Miserere),
  • Tar chair outlets or black chair,
  • Bowel movements with obvious or hidden blood admixtures,
  • Fever,
  • and change in bowel sounds.

Diagnosis

Since intestinal pain is often very diffuse with little specific symptoms, many different diagnostic procedures often follow the first visit to the doctor until the treating doctor can make a final diagnosis. Depending on the acuteness of the event, the various examination measures sometimes run in very quick succession, for example to be able to get a quick focus on the acute abdomen. Even if there is suspicion of poisoning or in the context of allergic reactions with very violent symptoms, quick action must be taken. The diagnosis is therefore based on a systematic step-by-step procedure.

1. Medical history

During the medical history, the doctor first tries to collect the first indications of a possible cause by questioning the patient. For example, questions are asked about the duration, frequency and intensity of the intestinal pain as well as the situations in which the pain occurs. Information about the last meal, existing basic illnesses and the general condition of the patient should also be discussed in detail, for example to check the possibility of an allergy, infection or acute stress.

2. Physical examination

In the subsequent physical exam, the doctor will mainly focus on palpation (Palpate) focus on the abdominal area, but if there is concrete suspicion other areas of the body can become the focus of the examination. A look at the skin, for example, can reveal signs of allergic skin reactions. A rectal examination, in turn, can provide evidence of rectal bleeding or ulcers, for example in the context of a tumor.

3. Laboratory chemical tests

Various methods of laboratory chemical diagnostics are available to the doctor. These focus primarily on the examination of various body fluids to assess certain health values:

  • Blood test:
    Inflammation parameters, liver values, kidney values, electrolytes, tumor markers and antibodies can be determined in the blood. If inflammation is considered, blood cultures can also be created that unmask the suspected bacterial strains and enable appropriate antibiotic therapy.
  • Examination of gastric juice:
    Here the concentration of gastric acid, the pH value, the presence of pathogenic bacteria, such as Helicobacter pylori or tuberculosis bacteria, and large amounts of blood can be determined.
  • Stool samples
    Stool examinations allow conclusions to be drawn about ongoing internal bleeding (Hemoccult). The colonization of the intestinal mucosa with pathogenic bacteria and viruses, such as Clostridium difficile, noroviruses or Salmonella, is also evident and inflammatory processes become visible when examining stool samples.

4. imaging procedures

In imaging diagnostics, doctors are now able to use many methods to be able to reliably narrow down the diagnoses in question. Depending on the characteristics and presumed focus, the following procedures can be used:

  • Sonography, duplex sonography,
  • Computed Tomography,
  • Magnetic resonance imaging
  • and endoscopic procedures (Gastroscopy, colonoscopy, ERCP) for sighting and sampling.

Even if the technologists meanwhile give the treating doctors a very detailed look through the closed abdominal wall, there are cases in which all diagnostics do not provide a sufficient treatment focus. Diagnostic abdominal mirroring can be done here after a detailed consideration of the benefits and risks (Laparoscopy) be a further step in securing the diagnosis. Small incisions in the abdominal wall are used to insert instruments into the abdomen so that the abdominal organs can be inspected from the outside. This can also be used for the peritoneum, for example (Peritoneum) to be examined.

Treatment of bowel pain

Of course, the therapy for intestinal pain depends on the underlying cause. For example, drug measures to treat infections, nutritional measures or those that counteract allergic reactions are possible. Finally, a brief overview:

Nutritional measures

If one-time bloating, constipation or diarrhea are responsible for the intestinal pain, it can help to relieve the intestine by eating gently. Vegetable broths and teas are often used here. In the event of constipation, the light food causes the stool to soften and thus clear the intestinal peristalsis. In the case of diarrhea, the electrolyte balance can be replenished with the liquid food and thus prevent dehydration. All in all, for painful digestive problems, as well as intestinal infections and inflammation, one should resort to easily digestible foods that do not contain too many additives and do not clog the intestine due to sharpness or a high acid content. Some recommendations include brown rice, oatmeal and semolina porridge.

Tip: If there is no lactose intolerance, probiotic yoghurts can also help. They strengthen the intestinal flora and thus offer better protection against inflammatory processes in the intestine.

Allergy sufferers should, of course, avoid foods that are proven not to be tolerated and supplement their menu with well-tolerated alternatives. Lactose intolerant patients can switch to alternative milk products such as goat cheese or almond milk. People with gluten intolerance, on the other hand, have to switch to gluten-free cereals such as amaranth, buckwheat, millet or qinoa.

Medication

Depending on the underlying cause, various medications can be used to treat intestinal pain. If inflammation is the cause, a suitable antibiotic, for example, can fight the pathogenic bacterial strains. However, it should be noted that antibiotic therapies also destroy the good bacteria on the intestinal mucosa, which in turn increases the likelihood of further diarrheal diseases.

Chronic inflammatory processes, such as ulcerative colitis and Crohn's disease, also respond well to spa treatments with corticosteroids. However, the benefits and risks should be checked here, since permanent and repeated cortisone treatments can also cause many side effects, such as changes in blood sugar and lipid levels, weight gain and an increase in blood pressure.

In the case of intestinal pain due to indigestion, for example due to a lack of digestive enzymes, the oral intake of the relevant enzymes can help. For example, the missing enzyme lactase in case of lactose intolerance or other missing digestive enzymes (Amylase, protease, lipase) in the presence of pancreatic diseases, the body can be made available in this way.

Surgical treatment

More serious disease processes sometimes require surgical intervention. Although you try to be as invasive as possible and therefore perform many operations laparoscopically, a major abdominal surgery is sometimes unavoidable. For example, if there is an intestinal obstruction or if the supplying blood vessels are blocked by an obstruction, the entire abdomen must be opened in the sense of a life-supporting operation. This is often followed by long recovery processes, which aim at both good wound healing and regular diet.

Home remedies

People with non-acutely life-threatening intestinal pain, which are caused by digestive and absorption disorders, such as lactose intolerance, gluten intolerance or irritable bowel syndrome, can also become active themselves and contribute to the relief.

For example, if you have diarrhea, you should make sure that you drink at least enough fluids to avoid dehydration. As mentioned, light broths and unsweetened teas or simply water are particularly suitable.

To relieve cramp-like symptoms in the abdominal area, external heat treatments can provide relief. For example, a hot water bottle, a grain pillow or a warm bath are well suited for this.

Since the intestine is closely interwoven with the human psyche, intestinal pain often arises even in stressful everyday situations. From exam stress to special stress in the workplace to mental problems, the pain can be an expression of various occasions that affect our psyche. Such a diagnosis does not always make it easy for those affected in terms of a cure, since there is no uniform treatment regime and in many cases, different therapeutic measures must first be tried out.

Very often, besides conversation and behavioral therapy, patients help measures that are conducive to inner relaxation. These include, for example, courses such as meditation, yoga, Qi Gong, progressive muscle relaxation or movement therapy. Private relaxation measures such as regular walks in the fresh air, massages, sound and aromatherapy are definitely worth trying.

Medicinal measures

Herbalists fortunately know a lot of medicinal plant options for complaints in the gastrointestinal area, which can help to relieve pain and digestive problems. The general rule:

  • Chamomile, fennel and anise have an antispasmodic effect.
  • Flax seeds and coriander can bloat.
  • Myrrh and blueberries relieve diarrhea.
  • Lavender, lemon balm and valerian help with nervousness.

The medicinal herbs can be used as tea, as an outer wrap in the abdominal region or in tablet form.

Diseases that cause intestinal pain

Intestinal inflammation, colon inflammation, ulcerative colitis, gastrointestinal flu, irritable bowel syndrome, colon cancer, intestinal obstruction, food intolerance, food allergy, poisoning, stress, depression, anxiety. (ma)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Swell:

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  • P. Layer et al .: S3 guideline irritable bowel syndrome: definition, pathophysiology, diagnostics and therapy, German Society for Digestive and Metabolic Diseases (DGVS), German Society for Neurogastroenterology and Motility (DGNM), (accessed August 13, 2019), AWMF
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