Abdominal pain is one of the most common symptoms that both children and adults experience in life. However, it is not always pain but sometimes a discomfort, also described as an ache, or cramping that is the cause of the unpleasant feeling in the abdomen. Most of the time it is associated with the digestive tract and particularly the bowels since the small and large intestines take up most of the space in the abdominal cavity. Cramping in the bowels is a common symptom that is seen in many bowel disorders.
Reason for Bowel Cramping
A cramp is a common term to describe muscle spasm. The length of the gastrointestinal has smooth muscles which contract and relax in a coordinated manner to propel food and waste from the mouth to the anus. This action is known as peristalsis and it is an integral part of normal bowel motility. The muscles within the bowel walls can sometimes contract excessively. The contraction may be sudden and forceful thereby leading to discomfort or pain. However, the difference between pain for other reasons and a spasm cannot always be differentiated.
Bowel cramping occurs when the wall of the bowels are irritated and inflamed. It can also occur when the nerve stimulation to these muscles is abnormal and excessive. There are many causes of bowel cramping but given the number of different organs and structures in the abdominal cavity, it is not always possible to differentiate bowel cramping from cramps elsewhere. For example, women may experience menstrual cramping which can sometimes be confused with bowel cramps.
Signs and Symptoms
Bowel cramps are a symptom and not a disease on its own. It can occur on its own or may be accompanied by other signs and symptoms like:
- Alterations in bowel movements – constipation or diarrhea.
- Abdominal tenderness – pain/discomfort when pressing on the abdomen.
- Excessive bowel noises (borborygmi) or absent bowel sounds.
- Bloated feeling in the stomach – sensation of fullness.
- Abdominal distention – enlargement of the abdomen.
- Excessive gas – flatulence and/or bloating.
- Nausea and/or vomiting.
- Changes in appetite.
The collection of symptoms may vary from condition to condition. However, many bowel conditions present in a very similar manner and are often confused with one another. It is important to note that abdominal pain and cramping overlaps to a large degree so the causes may be similar. Many of us also refer to abdominal cramping as stomach cramps which is specific to just a single organ, namely the stomach. Usually we cannot pinpoint the cramping to a specific organ. But with the bowels being so long, and with other symptoms like alterations in bowel movement, it may be easier to identify cramping that is originating from the bowels.
Causes of Bowel Cramps
It is first important to differentiate bowel cramping from spasm in other organs or systems, for example from menstrual cramping. Abdominal cramping that is associated with the one or more of the symptoms above and tends to worsen or ease after eating is most likely originating from the bowels. It is difficult to identify the cause of bowel cramping on its own. The causes of bowel cramping can be divided according to concomitant symptoms, specifically constipation, diarrhea and vomiting. There are many other bowel problems that may not have been discussed below.
Bowel Cramps With Constipation
- Fecal impaction
- Irritable bowel syndrome (constipation-predominant)
- Obstruction in the bowels
Bowel Cramps With Diarrhea
- Food intolerance
- Gallbladder disease
- Gastroenteritis/food poisoning
- Irritable bowel syndrome (diarrhea-predominant)
- Inflammatory bowel disease (IBD)
Bowel Cramps with Vomiting
- Gastroenteritis/food poisoning
- Gastrointestinal obstruction
- Hiatal hernia
Bowel Cramping in Food Poisoning/Gastroenteritis
Food poisoning or gastroenteritis are probably the most common digestive causes of acute abdominal cramps. It is particularly common among children and infants. Here a virus, bacteria, protozoa or toxins secreted by these organisms irritate and inflame the gut. This can extend from the stomach all the way down to the colon. The symptoms may start hours to days after consuming a food contaminated with these microbes/toxins, or after contracting the infection through other modes of transmission.
A fever is not always present. Nausea is usually intense but vomiting does not always occur in these conditions. Diarrhea is usually present in all cases and can be profuse and watery. Bowel cramping typically starts from the onset of the first symptoms, like vomiting, right till diarrhea stops. Most cases resolve within a few days even without treatment. However, it is important to ensure adequate bed rest, balanced nutrition and plenty of fluid intake. Dehydration is a major complication that can be deadly if severe and left untreated.
Bowel Cramping in Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome (IBS) is a functional bowel disorder, meaning that there is no underlying abnormality that is typical of diseased states. Instead there is an abnormality of bowel motility leading to constipation and/or diarrhea in addition to other symptoms like bowel cramping. It is believed that it may occur due to the overactivity or underactivity of the nervous system regulating normal bowel motility. The condition usually starts before the age of 40 years and is often seen in adolescents and young adults.
Abdominal pain is a hallmark feature of irritable bowel syndrome (IBS). This is most likely due to bowel cramping. It sometimes relieved by passing stool. The exact cause of IBS is unknown and there is no definitive treatment for the condition. Instead the focus of treatment is to manage the symptoms and reduce episodes/flareups. IBS is a chronic condition with repeated flareups at variable intervals. A colonoscopy, stool test or related bowel examination procedures will reveal no abnormality despite the symptoms.
Bowel Cramping in Diverticulitis
Diverticulitis is a common condition. It affects almost 2 out 3 adults over the age of 65 years. Diverticulosis means inflammation of the diverticula. It is therefore important to understand what diverticula are. A diverticulum (plural ~ diverticula) is a pouch that forms in the colon wall due to herniations. The pouches are not normal but very often occurs with advancing age. The pouch may then become obstructed with feces and undigested material which allows colonic bacteria to overgrow.
Diverticula itself are usually asymptomatic. However, diverticulitis presents with several acute symptoms. This includes sudden and severe bowel cramps/pain especially on the lower left side of the abdomen, tenderness of the abdomen, constipation/diarrhea, bloating, abdominal distention, fever, nausea and sometimes vomiting. Often these symptoms are mistaken for gastroenteritis but diverticulitis usually does not present with as profuse diarrhea and excessive vomiting like in gastroenteritis.