What are the causes of stomach aches?

There are some surgical conditions that may result in a tummy ache, but we will be focusing on these 4 conditions: Gallstones, Gastritis and Gastric ulcer, Swollen Piles and Painful Hernia.

1. Gallstones

Definition & Causes:

• They are a small, hard crystalline mass formed abnormally in the gall bladder

• Usually caused by

• A lack of physical activity

• Increased intake of oily food

Some facts on Gallstones:

• Majority of gallstones are cholesterol stones, formed by cholesterol aggregates
• Majority of individuals with gallstones do not have symptoms, which is why it is often discovered but surgery may not be offered from the get-go
• 15-20% of them will develop symptoms within 5 years of diagnosis, that’s where they start to experience some pain

Symptoms include:

• ‘Indigestion’; Feeling bloated and discomfort
• In severe cases, if the gallbladder is infected- pain in the right upper abdomen
• Acute setting - high fever followed by yellowing of skin and eyes
• ‘Tea’-coloured urine (bile duct blockage as a result of gallstones)
• Pain and fever- usually denotes a gallbladder or bile duct infection, at this point urgent medical attention is needed

Treatment and Diagnosis:

• Gallstones are usually detected on ultrasound or CT scan
• Keyhole surgery is the recommended treatment
• The gallbladder will have to be removed together with the gallstones as there is no way of removing the stones without damaging gallbladder
• Despite the presence of new technology that could remove gallstones without damaging the gallbladder, it will just continue to form gallstones
• No deleterious effects on health by removing the entire gallbladder

1. Gastritis and Gastric ulcer

Definition & Causes:

• Gastritis refers to the inflammation of stomach lining

• Increased secretion of gastric acid acting on a weakened protective layer -> Increased attack, decreased defence

• Can progress to ulcers and subsequent bleeding or perforation (hole in the stomach)

• Usually caused by

• Stress

• Smoking

• Drinking

• Stressful Lifestyle

Symptoms include:

• Pain over the upper central abdomen
• Nausea and vomiting with loss of appetite
• No definite relation to food - can occur before or after meals
• Black stools

Treatment and Diagnosis:

• Gastroscopy- To investigate, look at the lining of the stomach and also test for helicobacter pylori (bacteria that causes recurrent ulcers, the persistence of bacteria increases the risk of gastric cancer)
• Treatment includes anti-acid medications and eradication of H.pylori with antibiotics (triple therapy regime: takes about 6 weeks)

1. Swollen Piles

Definition & Causes:

• Piles are ‘anal cushions’ filled with blood vessels that are present in everyone, prevents faeces from leaking out

• Can be caused by an idle lifestyle, physical inactivity

• Becomes problematic when they get larger and become swollen

• Usually caused by

• long term constipation

• long term laxative use

Symptoms include:

• Lump at the edge of the anus
• Fresh blood on passing motion
• Itchiness around anus
• Prolapsed and thrombosed piles - piles are purplish and tender, the patient can’t sit down properly

Treatment and Diagnosis:

• Simple bedside examination can easily visualise and diagnose piles
• If there is bleeding, it is essential to get a colonoscopy especially individuals nearing 40 years old, to eliminate other colonic causes such as cancer
• Conventional hemorrhoidectomy
• Stapled hemorrhoidectomy (less painful option, when the piles are diagnosed early and small enough)
• Rubber band ligation (for even smaller piles)
• Total Hemorrhoidal Devascularisation (for piles with predominant bleeding)
• Avoid seeking treatment only when the piles become too large to tolerate
• Early treatment gives you more surgical options and reduces the complication rate
• Colonoscopy must not be delayed as bleeding may not always be from piles

1. Painful Hernia

Definition & Causes:

• Protrusion of abdominal contents (fat or intestine) through the abdominal wall

• Groin or inguinal hernia is the most common type of hernia and can occur in all age groups

• For older patients, it is a direct hernia where the muscle weakens when you get older and provides an area of weakness for the hernia to protrude

• In younger patients, it is an indirect hernia and the cause is not a weakness of muscle but a patent processus vaginalis (PPV), a congenital connection that is not closed up

• Usually caused by

• Jobs or daily lifestyle with prolonged heavy lifting and/or standing

• Chronic smokers with cough

• Chronic constipation or straining at urination

• Ageing

Symptoms include:

• Lump at the groin (can disappear when lying down or when pushed back in)
• Groin discomfort
• Large hernias (that have been left alone for years) can extend all the way to the scrotum (for males) -> at this stage recurrence is much higher

Treatment and Diagnosis:

• Avoid delaying to get your hernia confirmed or checked - contents can become strangulated or obstructed
• Open surgery (usually for single side) and laparoscopic surgery (for both sides)
• Surgery involves putting in an artificial plastic mesh (non-absorbable, stays in your body for life) to avoid recurrences
• Need to avoid heavy lifting and straining for 4-6 weeks after surgery

There are many reasons for the tummy ache and it really depends on the location of the pain.

As a general guide, upper tummy pain can be from the

• Stomach (gastritis or ulcer)
• Gallbladder (gallstones)
• Pancreas (pancreatitis or pancreatic tumour)
• Liver (hepatitis or liver tumour)
• And sometimes the lower portions of the lung

Central tummy pain is usually from the small intestines (food poisoning or IBS)while pain more towards the side/flank can be due to the colon (diverticulitis or colon tumour) or kidney (kidney stones or kidney tumour).

Lower abdominal pain can be due to the

• Appendix (appendicitis or appendix tumor),
• Bladder (urinary tract infection or bladder tumor),
• Ovaries and fallopian tubes (ovarian cyst or ovarian tumor or pelvic inflammatory disease)
• And the colon or rectum (diverticulitis or colon and rectal tumor).

The key message here is that there are myriad causes of a tummy ache and a consultation with a General Surgeon is essential in teasing out the cause

There are some surgical conditions that may result in a tummy ache, but we will be focusing on these 4 conditions: Gallstones, Gastritis and Gastric ulcer, Swollen Piles and Painful Hernia.

1. Gallstones

Definition & Causes:

• They are a small, hard crystalline mass formed abnormally in the gall bladder

• Usually caused by

• A lack of physical activity

• Increased intake of oily food

Some facts on Gallstones:

• Majority of gallstones are cholesterol stones, formed by cholesterol aggregates
• Majority of individuals with gallstones do not have symptoms, which is why it is often discovered but surgery may not be offered from the get-go
• 15-20% of them will develop symptoms within 5 years of diagnosis, that’s where they start to experience some pain

Symptoms include:

• ‘Indigestion’; Feeling bloated and discomfort
• In severe cases, if the gallbladder is infected- pain in the right upper abdomen
• Acute setting - high fever followed by yellowing of skin and eyes
• ‘Tea’-coloured urine (bile duct blockage as a result of gallstones)
• Pain and fever- usually denotes a gallbladder or bile duct infection, at this point urgent medical attention is needed

Treatment and Diagnosis:

• Gallstones are usually detected on ultrasound or CT scan
• Keyhole surgery is the recommended treatment
• The gallbladder will have to be removed together with the gallstones as there is no way of removing the stones without damaging gallbladder
• Despite the presence of new technology that could remove gallstones without damaging the gallbladder, it will just continue to form gallstones
• No deleterious effects on health by removing the entire gallbladder

1. Gastritis and Gastric ulcer

Definition & Causes:

• Gastritis refers to the inflammation of stomach lining

• Increased secretion of gastric acid acting on a weakened protective layer -> Increased attack, decreased defence

• Can progress to ulcers and subsequent bleeding or perforation (hole in the stomach)

• Usually caused by

• Stress

• Smoking

• Drinking

• Stressful Lifestyle

Symptoms include:

• Pain over the upper central abdomen
• Nausea and vomiting with loss of appetite
• No definite relation to food - can occur before or after meals
• Black stools

Treatment and Diagnosis:

• Gastroscopy- To investigate, look at the lining of the stomach and also test for helicobacter pylori (bacteria that causes recurrent ulcers, the persistence of bacteria increases the risk of gastric cancer)
• Treatment includes anti-acid medications and eradication of H.pylori with antibiotics (triple therapy regime: takes about 6 weeks)

1. Swollen Piles

Definition & Causes:

• Piles are ‘anal cushions’ filled with blood vessels that are present in everyone, prevents faeces from leaking out

• Can be caused by an idle lifestyle, physical inactivity

• Becomes problematic when they get larger and become swollen

• Usually caused by

• long term constipation

• long term laxative use

Symptoms include:

• Lump at the edge of the anus
• Fresh blood on passing motion
• Itchiness around anus
• Prolapsed and thrombosed piles - piles are purplish and tender, the patient can’t sit down properly

Treatment and Diagnosis:

• Simple bedside examination can easily visualise and diagnose piles
• If there is bleeding, it is essential to get a colonoscopy especially individuals nearing 40 years old, to eliminate other colonic causes such as cancer
• Conventional hemorrhoidectomy
• Stapled hemorrhoidectomy (less painful option, when the piles are diagnosed early and small enough)
• Rubber band ligation (for even smaller piles)
• Total Hemorrhoidal Devascularisation (for piles with predominant bleeding)
• Avoid seeking treatment only when the piles become too large to tolerate
• Early treatment gives you more surgical options and reduces the complication rate
• Colonoscopy must not be delayed as bleeding may not always be from piles

1. Painful Hernia

Definition & Causes:

• Protrusion of abdominal contents (fat or intestine) through the abdominal wall

• Groin or inguinal hernia is the most common type of hernia and can occur in all age groups

• For older patients, it is a direct hernia where the muscle weakens when you get older and provides an area of weakness for the hernia to protrude

• In younger patients, it is an indirect hernia and the cause is not a weakness of muscle but a patent processus vaginalis (PPV), a congenital connection that is not closed up

• Usually caused by

• Jobs or daily lifestyle with prolonged heavy lifting and/or standing

• Chronic smokers with cough

• Chronic constipation or straining at urination

• Ageing

Symptoms include:

• Lump at the groin (can disappear when lying down or when pushed back in)
• Groin discomfort
• Large hernias (that have been left alone for years) can extend all the way to the scrotum (for males) -> at this stage recurrence is much higher

Treatment and Diagnosis:

• Avoid delaying to get your hernia confirmed or checked - contents can become strangulated or obstructed
• Open surgery (usually for single side) and laparoscopic surgery (for both sides)
• Surgery involves putting in an artificial plastic mesh (non-absorbable, stays in your body for life) to avoid recurrences
• Need to avoid heavy lifting and straining for 4-6 weeks after surgery