Conditions
Understanding pain in the abdomen—and finding a way forward
Persistent abdominal pain can affect eating, sleep, movement and confidence in everyday life. It can also be frustrating when investigations have not provided a clear explanation.
Abdominal pain does not always come from the bowel or other internal organs. It may arise from the abdominal muscles, small nerves, surgical scars or the lower ribs. Sometimes several mechanisms contribute together. At Wye Sanctuary, assessment focuses on understanding these possibilities and developing an individual plan to reduce pain and improve daily life.
What is chronic abdominal pain?
Chronic abdominal pain persists or recurs for more than three months. It may be localised to one small area or spread across the abdomen. Some people experience a deep ache or cramping; others describe burning, stabbing or sensitivity around a scar. The relationship between pain, meals, bowel movements, posture and activity can provide useful clues. Normal investigations can be reassuring, but they do not mean that the pain is imagined.
Some causes of persistent pain, particularly abdominal wall pain and altered pain sensitivity, may not be visible on routine scans. Pain management works alongside your GP, gastroenterologist or surgical team, with further investigation where needed.
IBS and visceral pain
Visceral pain arises from internal organs, including the stomach and bowel. It can be difficult to pinpoint and may feel deep, diffuse or cramping. Irritable bowel syndrome, or IBS, commonly causes abdominal pain alongside constipation, diarrhoea or a combination of both. Bloating and changes in bowel habit are also common. IBS is a disorder of gut–brain interaction: normal stretching or movement of the bowel may feel unusually painful, even when investigations do not show structural damage.
Managing IBS-related pain
Treatment is tailored to symptoms and may include support with regular meals, activity and bowel habits; dietary advice; medicines for bowel spasm, constipation or diarrhoea; selected low-dose medicines that help regulate pain signalling; and gut-directed hypnotherapy or other approaches that address gut–brain communication.
Abdominal wall pain
The abdominal wall contains muscles, connective tissue and nerves, all of which can become painful. This is an important possibility when pain is concentrated in a small area, particularly if it changes with movement or pressure. Features may include a tender spot you can identify with one finger, pain when sitting up, twisting or coughing, discomfort from clothing or light touch, and burning, stabbing or altered sensation.
ACNES and muscle-related pain
Anterior cutaneous nerve entrapment syndrome, or ACNES, occurs when a small nerve becomes irritated or compressed as it passes through the abdominal wall. It can cause intense, sharply localised pain, sometimes with increased skin sensitivity or numbness. A carefully placed local anaesthetic injection may help establish whether the nerve is contributing and can also provide relief. Pain may also arise from abdominal muscles and surrounding connective tissue after surgery, injury, prolonged muscle guarding or changes in movement.
Slipping rib syndrome
Slipping rib syndrome causes pain around the lower rib margin and upper abdomen. Excessive movement of the cartilage connecting lower ribs can irritate nearby tissues and intercostal nerves. Symptoms may include sharp pain with bending, twisting, coughing or taking a deep breath. Diagnosis relies on the history and examination; dynamic ultrasound can sometimes help. Treatment may include adapting aggravating activities, physiotherapy and selected pain medicines.
Persistent pain after abdominal surgery
Pain sometimes continues beyond the expected recovery period after abdominal or pelvic surgery. Possible contributors include irritation of small nerves, scar sensitivity, muscle guarding and changes in pain processing. Before attributing pain to the operation itself, it is important to consider other explanations, including a hernia, a surgical complication or recurrence of the original condition.
How we assess chronic abdominal pain
A consultation brings together your symptoms, previous investigations and the effect pain has on your life. We explore where the pain is and how it feels; its relationship to meals, bowel movements, movement and touch; previous operations, injuries and treatments; skin sensation or scar sensitivity; sleep, activity and your treatment goals. Where appropriate, examination assesses the abdomen, abdominal wall, scars and lower ribs.
Treatment at Wye Sanctuary
Treatment is guided by the likely source of pain. Your plan may include a clear explanation of the findings, medication review, rehabilitation, support with sleep and pain sensitivity, targeted abdominal wall, scar or nerve injections where there is a suitable localised source, and collaborative care with your GP and relevant specialists.
When might an injection help?
An injection may be useful when assessment identifies a specific painful nerve, scar or area of the abdominal wall. It may provide temporary relief, support the working diagnosis or create an opportunity to move more comfortably. The duration of benefit varies, and abdominal wall injections are not a routine treatment for IBS or diffuse visceral pain.
When abdominal pain needs urgent assessment
Seek emergency help for sudden severe abdominal pain, collapse, vomiting blood, black tarry stools, or a swollen abdomen with vomiting and an inability to pass stool or wind. Arrange prompt medical review for unexplained weight loss, blood in the stool, persistent vomiting, fever, jaundice or a new persistent change in bowel habit. A significant change in previously investigated pain also deserves reassessment.
If persistent abdominal pain is affecting your daily life, a consultation can help clarify whether the bowel, abdominal wall, nerves, scars or lower ribs may be contributing. The focus is on a clear explanation, carefully selected treatment and a plan built around what matters to you.
Discuss your abdominal pain