Digestive Health - Where is the pain?

When someone tells me they have stomach pain I always ask them to point to where the discomfort is, since we tend to use that reference loosely. The abdomen is complex with lots of parts (remember the game Operation?!) therefore pointing to the area of pain gives me the best reference of which area or organ is the actual issue. 

I continue to see a lot of digestive concerns in my practice and treat it differently depending on the area of discomfort. An abdominal exam also gives me an idea of what to treatโ€ฆsomething that many of my patients claim no one has done yet throughout their years of abdominal complaints! 

So where is your pain?

Letโ€™s go through the main areas of the abdomen along with the common issues in those areas. This is quite simplified, however it may help you zone in on the true cause of your concern and possible treatment options.

Upper abdomen: 

  • Esophagus 
  • Stomach

Common concerns:

  • Heartburn, reflux, GERD - Pain in the upper chest or under ribs in the middle is typically due to low stomach acid instead of high stomach acid (refer to this blog for a full explanation if your mind is blown!), creating a weak lower esophageal sphincter (LES). We want to strengthen the sphincter, sooth the stomach and ultimately increase stomach acid.
  • Food feeling heavy or sits there - This is a common symptom of low stomach acid, or silent reflux.
  • H.pylori - This bacteria has run rampant in your stomach and is now causing damage. It is treated with triple or quadruple antibiotic therapy along with natural remedies to sooth and protect the stomach lining. Some options are DGL, marshmallow root, melatonin and even broccoli sprouts.

Middle abdomen:

  • Liver
  • Gallbladder
  • Pancreas
  • Upper intestines 

Common concerns:

  • Gallbladder insufficiency - Is there a mild pain under your right lower ribcage, worse when eating fat or fibre? When the digestive juices (HCl, bile, digestive enzymes) are not stimulated properly there is stagnation in the liver/gallbladder causing issues. We need to stimulate bile production and release with bitters, choline or other herbs. 
  • Gallbladder stones or sludge - Prolonged stagnation eventually creates stones or sludge. People on an oral contraceptive pill, taking a heartburn medication such as Nexium, or have a history of parasites have a higher risk of creating stones. We need to be more careful with treatment in this case.

Lower abdomen:

  • Lower intestines/colon 
  • Appendix 
  • Uterus/Ovaries 

Common concerns:

  • SIBO (Small intestine bacterial overgrowth) - To put it simply, bacteria that should only be in your large intestines has ascending upwards into the small intestine. There are several causes of SIBO to long to discuss here. Symptoms could vary from bloating and heartburn, to chronic constipation and/or diarrhea. Getting tested with your ND is helpful.
  • Constipation - If SIBO is not the root cause, common reasons for constipation would be lack of routine, bacteria imbalance, magnesium deficiency, lack of fibre in the diet or even dehydration. 
  • Chronic bloating - The more common reasons for chronic bloating are food sensitivities, bacteria imbalance, or SIBO. A simple detox or elimination diet can do wonders in decreasing bloating at times.
  • Endometriosis - Do you have disperse pain, worse during your menstruation? Endometriosis can cause scarring and adhesions within the abdomen leading to more pain during certain times of the month. These cases require more extensive testing and treatment. 

These concerns are covering the more common and simple causes of digestive complaints. I suggest consulting with a Naturopathic Doctor like myself to help with correct treatment or with support for more complex cases. 

In health & happiness,

Dr. Karen