Abdominal pain at night

introduction

As is well known, abdominal pain can have many different causes. The causes of abdominal pain can be found in the abdomen itself, outside the abdomen, or even in the patient's state of mind.

If the abdominal pain occurs only or mainly at night, then the psychological state of the patient is probably not the main trigger, physical causes are then likely.

Causes of nighttime abdominal pain

Abdominal pain at night can have quite harmless causes and through

  • Flatulence,
  • Constipation,
  • a food intolerance or
  • too big a dinner the day before.

Abdominal pain at night can also have causes that require urgent treatment, including appendicitis, biliary or renal colic or HELLP syndrome in pregnant women.

Nocturnal abdominal pain in the child

Even if abdominal pain is a rather unspecific and mostly harmless symptom in children, severe nocturnal abdominal pain that makes the child wake up or that prevent them from falling asleep should be taken seriously.

If a fever occurs at the same time, an inflammatory cause is likely. Appendicitis is often the cause of sudden and severe abdominal pain at night. The typical abdominal pain associated with appendicitis begins around the belly button and then moves to the right lower abdomen. The pain is very strong, and smaller children cry because of it.

A home test is to have the child hop on their right leg. Children with appendicitis have severe pain or will not even want to hop on their right leg. If you suspect that your child has appendicitis, you should drive quickly to the doctor to have the child examined.

Of course, there can also be other reasons for abdominal pain at night in children: flatulence, gastrointestinal flu, urinary tract infections, constipation are just a few examples.

Read more on the subject at: Abdominal pain in children

Nocturnal abdominal pain during pregnancy

Abdominal pain during pregnancy that occurs at night can have various, mostly harmless causes.

The stomach often hurts because it is not supported when lying on its side and pulls on the body. This can be remedied by a flat pillow under the stomach or by changing the position.

As the pregnancy progresses, the uterus presses the internal organs against the costal arch, which causes problems especially on the right side because this is where the liver is located. This can be remedied by sleeping on the left side. Exercise and lowering labor are common towards the end of pregnancy.

At the beginning of pregnancy, implantation of the fertilized egg can cause pain, and the rapid growth of the uterus can cause pulling pain.

Abdominal pain during pregnancy can also have dangerous causes: to be mentioned are premature labor, which causes cramp-like pain in the lower abdomen, and HELLP syndrome, a metabolic disorder that causes pain in the upper right abdomen towards the end of pregnancy and disrupts blood clotting. In these cases, going to the gynecologist is very important.

Read more on the subject at: Abdominal pain in pregnancy

Abdominal pain at night while lying down

A common cause of nighttime abdominal pain when lying down is reflux disease. In reflux disease, acidic stomach contents flow back into the esophagus. The reflux can be more pronounced when lying down than, for example, when sitting, which is why the symptoms are then also more pronounced.

Symptoms include upper abdominal pain, heartburn, acid regurgitation, or pain behind the breastbone. Avoiding lavish and fatty meals in the evening can help, serious forms must be treated with medication.

Inflammation of the stomach lining can also cause nighttime abdominal pain. An ulcer in the mucous membrane of the small intestine triggers abdominal pain in fasting phases, including at night.

Some adults have adhesions in the abdomen that can tighten loops of intestine. As a result, intestinal gases can only be transported more difficultly and sometimes very painful flatulence with a distended stomach occurs. Severe constipation can also cause flatulence because the intestinal gases can no longer get past the intestinal contents. Other possible causes of stomach pain at night are gastrointestinal flu, constipation, gall stones or kidney stones.

Read more on the topic Abdominal pain when lying down, Stomach pain in the evening

Abdominal pain on the right side at night

Abdominal pain at night on the right side in the upper abdomen can be a symptom of biliary colic. In biliary colic, a gallstone from the gallbladder has settled in the biliary tract and "clogs" it. The pain is attack-like and very strong, it can last a few minutes to hours.

A gallbladder infection can cause similar problems, but it can also be accompanied by dull, long-lasting pain and fever.

Ureteral stones also trigger sudden, violent cramp-like pain that is felt in the back or in the lower abdominal area of ​​the affected side with radiation to the genital area.

Abdominal pain in the right lower abdomen can be caused by Crohn's disease or appendicitis, for example.

Read more on the subject at: Abdominal pain right

Abdominal pain on the left side at night

For example, abdominal pain on the left side at night can result

  • inflammation of the lining of the stomach,
  • an ulcer of the stomach lining or
  • caused by a stone in the kidney or ureter.

An inflammation of the stomach lining causes aching and burning pain that is accompanied by nausea, and an ulcer of the lining of the stomach causes similar symptoms.

Read more on the subject at: Stomach pain on the left

Abdominal pain in the lower abdomen at night

Abdominal pain in the lower abdomen, which occurs mainly at night, usually indicates an organic and more rarely a purely psychological cause. In both men and women, nocturnal pelvic pain may indicate a trigger localized in the intestine (appendicitis, diverticulitis, trapped intestinal gases due to kinked intestinal loop) or urinary organs.

In women, gynecological triggers such as weak pelvic floor muscles that cause the urinary bladder or uterus to sag should also be considered. Cysts on the ovaries can also exert painful pressure on neighboring organs as a result of changes in the force of gravity when lying down.

Other possible causes are spasms (arbitrary contraction of individual muscles or muscle groups) due to hormonal fluctuations or chronic muscle tension in the lower abdomen. After using a contraceptive device such as the copper IUD, pulling abdominal pain may occur at night.

The general rule is that sudden, severe nocturnal pelvic pain are warning symptoms that require immediate clarification.

Read more on the subject at: Lower abdominal pain - what are the causes?

Abdominal pain at night and in the morning

Morning abdominal pain may be caused by an ulcer in the lining of the small intestine.The pain in the small intestine ulcer typically gets worse when fasting, especially in the morning after waking up this can be painful. Typical is a pressing, burning pain that disappears or becomes significantly better after breakfast.

A feeling of fullness, nausea and vomiting are also common. Abdominal pain that starts in the morning after breakfast can be an indication of a food intolerance. If breakfast consists of muesli with a lot of milk, for example, lactose intolerance may be the cause. If the pain occurs after a high-carbohydrate breakfast, it may be due to celiac disease. Pain after a breakfast with lots of fruit may indicate fructose malabsorption.

Abdominal pain in the morning that gets better right after getting up can also be caused by the spine.

Other explanations for abdominal pain in the morning are a high-fat meal in the evening that is still heavy in the stomach and causes nausea, or a gastrointestinal infection that starts with abdominal pain the morning after waking up. Patients with irritable bowel syndrome often have abdominal pain in the morning, which improves after a bowel movement, but still accompanies them throughout the day and only disappears in the evening or at night.

Possible accompanying symptoms with abdominal pain at night

In addition to the nocturnal abdominal pain, the following symptoms can also occur:

  • nausea

  • Vomit

  • constipation

  • diarrhea

  • Flatulence

  • heartburn

  • Pain when urinating and more frequent urination

  • fever

Abdominal pain and gas at night

Nocturnal flatulence can have various causes: a large meal in the evening, for example, that is not good for the stomach or an as yet unrecognized food intolerance to food that has been eaten in the evening. Other possible causes are bowel loops kinked by adhesions in the abdominal cavity, which prevent the intestinal gases from being transported further. The intestinal gases then remain in the intestine and virtually inflate the stomach from the inside, causing flatulence.

Constipation can be another reason for flatulence at night, the stool remaining in the intestine blocks the transport of intestinal gases to the outside.

Read more on the subject at: Flatulence

Flatulence occurs more often at night because the muscles of the rectum relax. The digestive gases escape spontaneously. The gas can be reduced by eating early evening meals. To some extent, nocturnal gas is normal. But if these occur together with abdominal pain or other symptoms such as a bloated stomach, this can indicate increased gas development in the intestine.

The doctor receives initial information on the underlying trigger during the anamnesis and will initiate further diagnostic steps accordingly. In many cases, a change in diet and early evening meals can help. One-sided diet that consists primarily of carbohydrates, sugar or proteins should be avoided.

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Abdominal pain and diarrhea at night

Cramp-like abdominal pain at night followed by diarrhea are unusual and may indicate an organic disease. Depending on the temporal classification - whether it is a short-term or chronic event - different causes come into consideration. An acute gastrointestinal infection is often associated with symptoms that are independent of the time of day. Unilateral eating habits with, for example, a high proportion of sugar, as well as food intolerances and allergic reactions can also act as triggers for diarrhea at night. These are usually related in time to evening meals.

In the context of irritable bowel syndrome, diarrhea is usually not observed at night, while this is definitely the case in chronic intestinal diseases (ulcerative colitis, Crohn's disease). The stool may have a slight build-up of blood.

Read more on the subject at: Abdominal pain and diarrhea

Treatment of abdominal pain at night

There are different treatment methods depending on the underlying cause of the abdominal pain at night.

  • If the cause of the abdominal pain is reflux disease with heartburn, it is advisable to change your diet:
    • In many cases, avoiding alcohol, nicotine, fatty, sour and spicy foods is sufficient remedy.
    • Fennel or chamomile tea helps soothe the irritated lining of the stomach and esophagus.
    • Serious forms must be treated with medication (proton pump inhibitors) at least temporarily.
  • A stomach ulcer is also treated with proton pump inhibitors.
  • An inflammation of the gastric mucosa must be treated with antibiotics after the diagnosis. Patients with stomach problems should avoid Aspirin®.
  • If severe flatulence is the cause of abdominal pain at night, chamomile or fennel tea can help, and a hot water bottle or anticonvulsant medication (e.g. Buscopan®) can help.
  • Constipated patients should take care to drink enough during the day and consume enough fiber to keep their stool soft.
  • If the abdominal pain is caused by appendicitis, gall stones, kidney stones or ureter stones, further treatment should be carried out after consulting a doctor.

Read more about this:

  • Therapy for stomach pain
  • What to do with stomach pain

Duration and prognosis for abdominal pain at night

The duration and prognosis of abdominal pain that occurs at night can vary significantly depending on the cause.

While a simple gastrointestinal flu or urinary tract infection can be expected to have a very good prognosis and a short duration under therapy, diseases such as the HELLP syndrome can have a significantly poorer prognosis in pregnant women.

In many cases, the early detection of the disease is also crucial for the duration and prognosis of the disease.

For example, if appendicitis is detected early, it can be treated surgically at an early stage and a very good prognosis can be assumed. Without a doctor's presentation or if the disease is recognized too late, there is a risk of a significantly more complicated course of the disease.

What options are there to diagnose abdominal pain at night?

One of the best means of medical diagnosis is the collection of the medical history and the physical examination. Valuable information about the exact spectrum of symptoms, their course or known diseases can be collected here. In many cases, this information can be used to make a suspicious diagnosis.

There are numerous other methods to confirm this. A laboratory test of the blood is usually carried out, which can provide evidence of inflammation or diseases such as HELLP syndrome.

Furthermore, an ultrasound is often carried out, for example to detect appendicitis or gallstones. In some cases, cross-sectional imaging, such as MRI or CT, may also be necessary.

In older women, the presence of a heart attack should still be excluded if the symptoms are appropriate. Because in women, the heart attack often presents with diffuse symptoms. A suitable blood test (troponin test) and writing an EKG are used for this.

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