Pain in the intestine occurs with a functional disorder - irritable bowel syndrome, common organic diseases - intestinal infections, chronic enteritis and enterocolitis, Crohn's disease and ulcerative colitis (UC). Less commonly, symptoms indicate neoplasms, diverticula, acute surgical pathology. To diagnose the causes of pain in the intestines, laboratory tests, ultrasound, endoscopic, x-ray methods are used. For the treatment of pain, diet therapy, drugs (antibiotics, antispasmodics, probiotics), and surgical methods are used.
IBS is characterized by moderate pain in the abdomen of a different nature - pulling, spastic, stabbing. The pain syndrome intensifies in the morning, with psycho-emotional overstrain. A typical symptom of the syndrome is a sharp increase in pain before defecation. In addition to strong cramping pains on the left in the iliac region, there is an urge to empty the bowels. After defecation, the person's well-being immediately improves.
Pain in irritable bowel syndrome persists for several months. Women note increased pain before menstruation. With this pathology, the pain syndrome is combined with stool disorders: patients complain of alternating constipation and diarrhea, a feeling of incomplete emptying of the intestine. There is increased gas formation, belching, nausea.
With intestinal dysbiosis, spasms and colic occur throughout the abdomen, but the most severe pain is localized in the left iliac region. The pain syndrome is combined with heaviness, discomfort and rumbling in the abdomen. Diarrhea is noted. Fecal masses are liquid, plentiful, have a greenish tint. The clinical picture unfolds when taking antibacterial drugs, chronic gastroenterological diseases, immune disorders.
Abdominal pain develops with salmonellosis, escherichiosis, dysentery and other infectious processes. With a predominant lesion of the small intestine, it is determined in the umbilical region. When the large intestine is involved in the process, pain in the lower abdomen on the left is characteristic. The pains are sharp, cramping in nature. They are accompanied by diarrhea (up to 2 times a day), nausea and vomiting.
With inflammation of the intestines, patients experience pain around the navel, in the lateral sections of the abdomen. Pain is dull or aching, aggravated by errors in nutrition, after drinking alcohol. The intensity of pain decreases after passing gases, defecation. Enteritis is characterized by chronic diarrhea. The stools are copious and offensive, containing particles of undigested food.
In this disease, pain is most often localized in the right iliac region, which is due to damage to the terminal sections of the small intestine. The intensity of symptoms is determined by the severity of Crohn's disease. During remission, discomfort in the abdomen is characteristic, with exacerbation, sharp pains are observed, which are often accompanied by the appearance of blood in the stool. Patients are concerned about diarrhea, lack of appetite, weakness and decreased performance.
NUC is characterized by pronounced cramping pains in the left sections of the intestine, which indicate damage to the sigmoid colon. Total colitis is manifested by diffuse intense pain. With increased pain in the stool, bright red blood is noticeable. Also disturbed by painful tenesmus. In patients with UC, in addition to pain, extraintestinal symptoms are possible: erythema nodosum, damage to the eyes, joints, and biliary system.
With intestinal diverticula, vague aching or pulling pains are noted, in which patients rarely seek medical help. Strengthening of symptoms occurs with gastrointestinal motility disorders, chronic constipation. The patient experiences severe paroxysmal pain localized in the area of the diverticulum. They decrease after emptying the intestines, passing gases.
With intestinal polyps, pain occurs when the tumor reaches a large size. Fullness and dull pain are caused by a violation of the passage of chyme and feces. With the progression of the tumor process, severe spasms appear near the navel or in the lateral parts of the abdomen. Diffuse polyposis is characterized by severe diffuse pain in combination with tenesmus and diarrhea. The clinic of the disease resembles a severe intestinal infection.
With malignant neoplasms, the pain syndrome manifests itself in the later stages, when inflammation or ulceration joins. The pain is permanent, not related to errors in diet or other external factors. Tenesmus and constipation are common in bowel cancer. With damage to the rectum, patients note a feeling of incomplete emptying during defecation. Common symptoms include weakness, pallor of the skin, sudden weight loss.
Acute severe pain is characteristic of intestinal infarction. They arise suddenly against the background of full health. The patient feels sharp cramps in the abdomen, which after a few hours develop into constant excruciating pain. Their localization is affected by which part of the intestine is affected. The weakening of the pain syndrome in parallel with the increase in general symptoms is a prognostically unfavorable sign.
Sharp pains develop with intestinal obstruction. They do not have a clear localization, are not associated with food intake. Typically, a periodic increase in pain due to the activation of peristalsis. With mechanical obstruction, the pain syndrome is constant, with a dynamic form of pain, it can subside after the elimination of the etiological factor.
With appendicitis, pain comes on suddenly. Usually at first it is felt in the epigastric region or near the navel, then it becomes diffuse, and after a few hours it concentrates on the right in the iliac zone. Pain sensations are constant, their intensification is provoked by coughing, laughter. The severity of pain decreases when the patient lies on the right side. Nausea, vomiting, flatulence, diarrhea are observed. The temperature rises to subfebrile and febrile numbers. The pulse quickens.
The most serious consequence of taking antibacterial agents is the development of pseudomembranous colitis, which is caused by opportunistic microflora. Patients complain of cramping pain in the projection of the sigmoid colon, the symptom intensifies before the onset of defecation. Simultaneously with the pain, severe diarrhea worries, which reaches 2 times per day. In the stool appears a large amount of mucus, streaks of blood.
The examination begins with the collection of complaints and anamnesis of the disease, palpation of the abdomen. It is important to establish how long the pain in the intestines lasts, what is the reason for their occurrence. To exclude surgical pathology, the doctor checks for peritoneal symptoms. Of the laboratory methods, a coprogram, fecal culture, general and biochemical blood tests are used. For diagnostic search, instrumental methods are the most informative:
The volume of therapeutic measures depends on the patient's condition. If intestinal infections are suspected, it is necessary to do a gastric lavage, give sorbents, in order to avoid dehydration, provide a person with plenty of fluids. With sharp cramping pains, you need to see a doctor as soon as possible, before his arrival it is better not to take painkillers so as not to distort the clinical picture.
For pain in the intestines, before the diagnosis is clarified, the gastroenterologist gives recommendations on nutrition. Foods that irritate the gastrointestinal mucosa, extractives, fatty and heavy foods are excluded from the diet. With constipation in the diet, increase the amount of plant foods, cereals and bread with bran. With diarrhea, cereals (especially rice and oatmeal), dry cookies, baked vegetables are added to the diet.
The treatment plan is selected after the final diagnosis is made. It includes etiopathogenetic and symptomatic therapy. With severe intoxication syndrome, intravenous infusions of saline and colloidal solutions are used. When depleted, for example, in the presence of tumors, parenteral nutrition is carried out. Basic treatment regimens in gastroenterology include a number of drugs:
In IBS, drug therapy is supplemented with herbal sedatives, mild tranquilizers. Physiotherapeutic methods are effective: reflexology, neurosedative massage, aromatic baths. Patients with chronic diseases in remission are prescribed balneological treatment. It is recommended to add exercise therapy to strengthen the muscles of the abdominal wall.
The intervention of an abdominal surgeon is required for advanced and complicated forms of chronic intestinal lesions, neoplasms, intestinal obstruction, and a number of acute conditions. The volume of the operation is determined taking into account the leading pathology and the general condition of the patient. Most often, organ-preserving interventions are performed: appendectomy for appendicitis, resection with anastomosis for diffuse lesions of the intestinal area.
Removal of benign tumors can be performed in a minimally invasive way while maintaining the integrity of the intestinal wall. In severe cases of UC, with widespread diverticulosis and polyposis, a radical approach is justified - total colectomy. Most major interventions and surgeries for malignant neoplasias end with a stoma followed by stoma closure.