Chronic Constipation, Diarrhea, Abdominal Pain

What is chronic abdominal pain?

Chronic abdominal pain is pain in your abdomen that lasts longer than three months.

What causes chronic abdominal pain?

The cause of chronic abdominal pain may not be found. The following are possible causes:

• Anxiety or stress.
• Lactose intolerance or celiac disease.
• Liver disease, cancer, or chronic pancreatitis.
• Irritable bowel syndrome, ulcerative colitis, or Crohn’s disease.
• An ulcer in your esophagus or stomach, or an infection.
• A hernia or tissue growth that causes organs and tissues to stick together.

What is chronic abdominal pain in children?

Children aged 4 to 17 years may have chronic abdominal pain. The pain occurs in your child’s abdomen at least three times in three months.

What are different types of chronic abdominal pain in children?

• Abdominal migraine is severe abdominal pain with nausea, vomiting, or loss of appetite.
• Functional abdominal pain is pain that has no known cause. Your child may not want to do his or her daily activities because of the pain.
• Functional dyspepsia is upper abdominal pain that does not go away when your child has a bowel movement.
• Irritable bowel syndrome (IBS) is abdominal pain that goes away when your child has a bowel movement. Your child’s bowel movements may also look different, or he or she may have more bowel movements than usual.

What causes chronic abdominal pain in children?

The following are some causes of chronic abdominal pain:

• Inflammation of the esophagus or stomach, or infections such as a parasite infection or a urinary tract infection.
• Menstrual cycle (period) for females.
• Anxiety and stress from problems at school or home.
• Constipation or lactose intolerance.
• A peptic ulcer, Crohn’s disease, or a urinary tract infection.
• Kidney stones or gallstones.

Abdominal Pain in Pregnancy

Abdominal pain during pregnancy is common. Some of the causes include heartburn, constipation, gas, false labor, and round ligament pain. Round ligament pain is caused by stretching of the ligaments that support your uterus. Abdominal pain may be caused by a health problem, such as a stomach virus or appendicitis (inflammation of the appendix). The pain may also be caused by a problem with your pregnancy, such as a threatened miscarriage or preterm labor.

What is obstipation?

Obstipation develops when you become so constipated you cannot have a bowel movement. You may feel like you need to have a bowel movement. You may have abdominal or rectal pain. You may also have bloating, nausea, or vomiting.

What increases my risk for obstipation?

Anything that causes constipation will also cause obstipation:

• Not enough water or high-fiber foods.
• Lack of physical activity.
• Medicine used to treat depression, pain, or high blood pressure.
• Medical conditions, such as diabetes, hypothyroidism, or multiple sclerosis.
• Pregnancy.
• A mass in your abdomen, such as a tumor.

How can I prevent obstipation?

• Drink liquids as directed. Liquids will help keep your bowel movements soft so you pass them with less pain. Ask your healthcare provider how much liquid to drink each day and which liquids are best for you.
• Eat high-fiber foods or take fiber supplements. Fiber adds bulk to your bowel movement and makes it easier to pass. Raw fruits, fresh vegetables, whole grains, and beans are examples of high-fiber foods. Adults should eat at least 20 grams of fiber a day. Your healthcare provider or dietitian can help you plan meals.
• Make time for your bowel movements. You may develop constipation if you ignore the urge or wait too long. Help train your body to have regular bowel movements by setting a bathroom time each day. The best time is after a morning meal, because your colon prepares for a bowel movement when you eat.
• Exercise regularly. Exercise may help your intestines pass bowel movements more often. Ask your healthcare provider about the best exercise plan for you.

What is chronic diarrhea?

Diarrhea is chronic when it occurs three or more times a day for more than four weeks.

What causes chronic diarrhea?

Chronic diarrhea is often a symptom of an illness, infection, or other condition.

• Trouble digesting foods, such as lactose (a sugar found in dairy products), fats, caffeine, or alcohol.
• Stomach or intestine conditions, such as inflammatory bowel disease, or an autoimmune disease such as celiac disease.
• Thyroid and pancreas disorders and cancers.
• Infections caused by bacteria, viruses, or parasites.
• Medicines such as laxatives, antibiotics, and some heart medicine, or certain minerals, such as magnesium.
• Surgery or procedures on your stomach or bowels, especially if it damages muscles that control bowel movements.

What are the signs and symptoms of chronic abdominal pain?

Signs and symptoms of chronic abdominal pain will come and go. You may feel pain in all areas of your abdomen, or just in one place. You may not want to eat. You may not want to do your daily activities. You may also have any of the following:

• Cramping.
• Acid reflux.
• Bloating and gas.
• Constipation or diarrhea.
• Nausea and vomiting.

How is the cause of chronic abdominal pain diagnosed?

Your healthcare provider may ask about your family history of abdominal pain. Tell your healthcare provider what medicines you take, and what your symptoms are. Tell the provider what makes your symptoms better or worse, and if you have tried any treatments. The provider will examine you. Based on what your provider finds after the exam, and your symptoms, you may need any of the following:

• Blood tests may be done to check for inflammation, liver function, blood cell levels, or get information about your overall health.
• A sample of your bowel movement may be tested to see if you are absorbing nutrients from your diet. It can also be tested for germs that may be causing your illness.
• X-ray, ultrasound, CT, or MRI pictures may be used to check the organs inside your abdomen. You may be given contrast liquid to help the organs show up better in the pictures. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the healthcare provider if you have any metal in or on your body.
• An endoscopy is a test to look inside your esophagus, stomach, and small intestine. During an endoscopy, healthcare providers may find problems in your esophagus, stomach, or small intestine. Some problems may be fixed with small tools. Samples may be taken from your esophagus, stomach, or small intestine, and sent to a lab for tests.
• A colonoscopy is a test that is done to look inside your colon. During a colonoscopy, healthcare providers may find problems in your colon. Some problems may be fixed with small tools. Samples may be taken from your colon and sent to the lab for tests.

How is chronic abdominal pain treated?

Healthcare providers may not find a medical problem that is causing your abdominal pain. If no problem is found, they will prescribe treatments to decrease your symptoms. With treatment, your abdominal pain may decrease, happen less often, or go away. You may need any of the following:

• Medicines may be given to decrease pain and manage your symptoms. Medicines may also be given to manage anxiety.
• Therapy can help you learn to cope with stress and anxiety. This may help decrease your abdominal pain.
• Surgery is rarely needed, but may be done if there is a problem with an organ in your abdomen. Examples include an organ that is stuck to tissue or a hernia.

What are the signs and symptoms of chronic abdominal pain in children?

Signs and symptoms of chronic abdominal pain will come and go. Your child may have them for a day or more, and they may go away but return. Your child may feel pain in all areas of his of her abdomen, and he or she may not want to eat. He or she may not want to do his or her daily activities, such as school or sports. He or she may also have any of the following:

• Cramping.
• Bloating and gas.
• Constipation or diarrhea.
• Slow growth or growth failure.
• Nausea or vomiting.
• Weight loss without trying.

How is chronic abdominal pain diagnosed in children?

Your child’s healthcare provider will ask about your family history of abdominal pain or problems. Tell him or her if your child takes any medicines, and how well he or she eats and sleeps. Tell him or her if your child has any other health problems or has missed activities because of his or her pain. Tell your provider if your child has been stressed or worried lately. He or she will examine your child, and may have your child rate his or her pain using a pain scale.

• Ultrasound, X-ray, CT, or MRI pictures may be used to check the organs inside your child’s abdomen. Healthcare providers use these pictures to look for problems such as blocked intestines. Your child may be given contrast liquid to help healthcare providers see the pictures better. Tell the healthcare provider if your child has ever had an allergic reaction to contrast liquid. Do not let your child enter the MRI room with anything metal. Metal can cause serious injury. Tell the healthcare provider if your child has any metal in or on his body.
• A colonoscopy is a test that is done to look at your child’s colon. A tube with a light on the end will be put into your child’s anus. The tube is then moved up into his or her colon for healthcare providers to see if there are any problems.
• An endoscopy uses a scope to see the inside of your child’s digestive tract. A scope is a long, bendable tube with a light on the end. A camera may be hooked to the scope so the healthcare provider can take pictures. During an endoscopy, healthcare providers may find problems with how your child’s digestive tract is working. Samples may be taken from your child’s digestive tract and sent to a lab for tests.
• A bowel movement and urine sample may be collected and sent to a lab for tests. The test may show which germ is causing your child’s illness.
• A pregnancy test may be done for your daughter if she has started having periods.

How is chronic abdominal pain treated in children?

Healthcare providers may not find a medical problem that is causing your child’s abdominal pain. If no problem is found, they will work to decrease your child’s symptoms so he or she can return to his normal activities. With treatment, your child’s abdominal pain may decrease, happen less often, or go away. Your child may need any of the following:

• Medicines may be given to decrease stomach acid or treat a bacterial infection. Your child may also be given medicine to decrease diarrhea or to calm his or her stomach and control vomiting. Antidepressants may also be given to help decrease your child’s anxiety or help relax his or her upper abdomen. Do not stop giving this medicine to your child unless his or her healthcare provider tells you to.
• Cognitive behavioral therapy can help your child learn to cope with stress. Your child will learn how to decrease or cope with his or her pain if it happens when he or she is scared or worried.
• Surgery is rarely needed, but may be done if there is something wrong with your child’s abdomen. This could be because an organ in your child’s abdomen is out of place, or not working correctly. A blocked intestine is an example of why your child may need surgery.

How is obstipation diagnosed?

Your healthcare provider will ask about your medical history. Tell him or her if you are taking any medicine. He or she may ask how often you use laxatives, suppositories, or enemas to pass a bowel movement. Your healthcare provider will also do a physical exam of your rectum or vagina. He or she will check muscle tone and look for bleeding or damage to your rectum. You may need any of the following tests:

• Blood tests may be used to find signs of infection, or to check thyroid and kidney function.
• An ultrasound uses sound waves to show pictures of your intestines on a monitor. The pictures may show the location and cause of your obstipation.
• An X-ray or CT scan may be used to take pictures of your intestines. The pictures may show the location and cause of your obstipation. You may be given a dye to help healthcare providers see your intestines better. Tell the healthcare provider if you have ever had an allergic reaction to contrast dye.
• A barium enema is used to help your colon show up better on the x-ray. A tube is put into your anus, and a liquid called barium is put through the tube. Then X-rays are taken.
• A colonoscopy may be needed so healthcare providers can see if you have tissue damage inside your intestines. A long, thin tube with a tiny camera on the end is put into your rectum. A small tissue sample may be taken from your bowel and sent to a lab for tests.
• A bowel function test is used to check for muscle tone and nerve sensitivity of your intestines and anus.

How is obstipation treated?

• Medicines can soften your bowel movement and make it easier to pass. They may also keep moisture in your bowel movement and increase the motion of your intestines. Medicines may be taken orally or as a suppository or enema.
• Manual removal is a procedure to take out your impacted bowel movement. Your healthcare provider will use a gloved hand to remove the impaction. He or she will use lubricant to make the removal easier.
• Surgery may rarely be needed to remove your impaction or to repair damage caused by your obstipation.

What are the signs and symptoms of chronic diarrhea?

• Abdominal tenderness.
• Urgent need to have a bowel movement, or loss of bowel control.
• Itchy blistering rash.
• Weight loss.
• Anal irritation and inflammation.

How is chronic diarrhea diagnosed?

Your healthcare provider will examine you and ask you about your symptoms. Tell him or her if you have noticed any unusual color or smell to your bowel movements. Tell him or her if you have blood, mucus, or oil droplets in your bowel movement. He or she may ask if you have noticed symptoms after you eat certain foods. Tell your healthcare provider if you have travelled recently or been around others with the same symptoms. You may need the following tests:

• Blood tests may show infection. They will also give information about your overall health.
• A bowel movement sample may be sent to a lab to help find the cause of your chronic diarrhea.
• Colonoscopy, or sigmoidoscopy, is a procedure to examine the inside of your colon (large intestine). A flexible tube with a small light and camera on the end is used.

How is chronic diarrhea treated?

Your treatment will depend on the condition causing your chronic diarrhea. Treatment may include any of the following:

• Drink more liquids to replace body fluids lost through diarrhea. You may also need to drink an oral rehydration solution (ORS). An ORS has the right amounts of sugar, salt, and minerals in water to replace body fluids. ORS can be found at most grocery stores or pharmacies. Ask how much liquid to drink each day and which liquids are best for you.
• Medicines may be given to slow your diarrhea, or to treat an infection. You may also be given medicines to decrease inflammation in your intestines.

When should I seek immediate care for chronic abdominal pain?

• Your abdominal pain gets worse, and spreads to your back.
• You vomit blood or what looks like coffee grounds.
• You have blood or mucus in your bowel movement.
• You cannot stop vomiting.
• You have diarrhea for more than one week.
• You feel weak, dizzy, or faint.
• Your abdomen is larger than usual, more painful, and hard.

When should I contact my healthcare provider for chronic abdominal pain?

• You have a fever or chills.
• You have new symptoms.
• You lose weight without trying.
• Your pain prevents you from doing your daily activities.
• You have questions or concerns about your condition or care.

When should I seek immediate care for my child?

• Your child’s abdominal pain gets worse and spreads to his or her back.
• Your child’s bowel movement has a large amount of blood in it, or looks like black tar.
• Your child cannot stop vomiting, or vomits blood.
• Your child has diarrhea for one to two weeks.
• Your child has trouble breathing, and his skin looks pale.

When should I contact my child’s healthcare provider?

• Your child has abdominal pain that wakes him or her up at night.
• Your child has pain on his or her right side that does not go away.
• Your child has a fever.
• Your child has new mouth sores, trouble swallowing, or is losing weight without trying.
• Your child is not drinking liquids, and he or she is not urinating.
• You have questions or concerns about your child’s condition or care.

When should I contact my healthcare provider for obstipation?

• You are losing weight without trying.
• You have a change in the color, amount, size, or consistency of your bowel movement.
• You have a fever.
• You have questions or concerns about your condition or care.

When should I seek immediate care for obstipation?

• You have severe abdominal pain.
• You have a bloody or black bowel movement.
• You vomit more than once.
• You have a fever and back, stomach, muscle, or joint pain.

When should I seek immediate care for chronic diarrhea?

• Your skin, mouth, and tongue are dry, and you feel very thirsty.
• You have blood or pus in your bowel movement.
• You have trouble eating, drinking, or keeping food down.
• You have severe abdominal pain.
• You feel lightheaded, weak, or you faint.
• Your heart beats faster than normal or you have trouble breathing.
• You are confused or cannot think clearly.

When should I contact my healthcare provider for chronic diarrhea?

• You have a fever.
• You have new symptoms.
• Your symptoms do not improve, or they get worse.
• You have questions or concerns about your condition or care.