Sore Stomach in Pregnancy, Adults and Children

What is a sore stomach?

The stomach is located in the left upper quadrant of the abdomen, largely tucked in under the left ribcage and extending across the midline to slightly protrude into the right upper quadrant. It is part of the alimentary tract which is responsible for the digestion of food, absorption of nutrients and expulsion of waste material in the form of feces. The stomach lies just after the esophagus and leads through to the first part of the small intestine known as the duodenum. There are a number of diseases that can affect the stomach, which often involves the neighboring segments of the alimentary tract – the esophagus and/or duodenum. Discomfort or pain may therefore be present in this specific region and it may be referred to as a sore stomach.

The abdominal cavity contains the most amount of organs within any body cavity. Therefore discomfort or pain of the organs surrounding the stomach, including the overlying muscles and skin, may be also be attributed to the stomach.¬† However, it is not uncommon for a person to refer to the abdomen as a whole as the ‘stomach’. Therefore pain or discomfort of the abdomen may be referred to as stomach soreness despite the stomach not being involved in some instances.

Meaning of a Sore Stomach

Discomfort or pain are warning signals of some irritation or disease within a certain area. In most cases, the pain is localized to the affected area but sometimes can be referred from nearby regions or even distant sites. This referred pain is a result of common nerve pathways running through an area. In the true sense of the term ‘sore stomach’ the discomfort or pain would be in and around the location of the stomach.

However, even in these instances it is important to remember that the stomach is closely position to several other organs or structures. This includes :

  • Skin, subcutaneous fat and connective tissue in front of stomach.
  • Abdominal muscles in front of the stomach.
  • Ribcage in front of the stomach.
  • Intercostal muscles over the stomach in between the ribs.
  • Peritoneum around the stomach.
  • Spleen to the left of the stomach.
  • Diaphragm and esophagus above the stomach.
  • Pancreas behind and to the right side of the stomach.
  • Liver and gallbladder to the right of the stomach.
  • Parts of the small intestine particularly the duodenum.
  • Parts of the large intestine particularly the transverse colon ad left splenic flexure.
  • Right kidney behind¬† and to the left of the stomach
  • Posterior abdominal wall and spinal column behind the stomach
  • Abdominal aorta behind and to the right of the stomach

There are also a network of blood vessels, nerves, lymphatic vessels, lymph nodes, and ligaments that are also involved. Due to its close relation to all these structures, it is therefore difficult to identify that any soreness from this area is due to the stomach itself. Therefore it is important to take note of certain modalities of the soreness and concomitant symptoms that may be an indication of a sore stomach itself.

Sore Stomach Symptoms

Soreness in the stomach area is more likely to be associated with the stomach if the following features are also present :

  • Nausea with/without vomiting
  • Retching
  • Soreness that worsens after eating, when hungry or with deep inhalation (breathing in).
  • Excessive belching
  • Sensation of fullness in the upper abdomen (bloating)
  • Heartburn (burning pain in the esophagus)
  • Abdominal distention
  • Change in appetite

In prolonged cases, the loss of appetite and possibly the underlying disease may lead to weight loss and fatigue. Other symptoms may not be specific for the stomach but could indicate the possible cause. This includes :

  • Fever
  • Chills
  • Lethargy
  • Change in bowel habit – diarrhea or constipation
  • Excessive flatulence
  • Back pain

Causes of Stomach Soreness

The causes of stomach soreness may be divided into those conditions that specifically affect the stomach and those conditions that afflict the surrounding organs and structures. Most of the causes discussed below affect all age groups but are more likely in adults.

In The Stomach

The most common causes of soreness of the stomach includes :

  • Gastritis is the inflammation of the stomach lining. Common causes and risk factors : Helicobacter pylori (H.pylori) infection, NSAIDs, alcoholism, stress, trauma, advancing age, autoimmune disorders and bile reflux.
  • Gastroenteritis is an infection of the stomach and intestines which causes acute gastrointestinal symptoms such as nausea, vomiting and diarrhea. Common causes and risk factors : viruses and bacteria acquired through outbreaks, close contact with an infected person, contaminated food and water, poor sanitation, unhygienic practices and overcrowded areas.
  • Peptic ulcer disease is the formation of open sores in the lining of the stomach and duodenum, often involving the esophagus as well. Common causes and risk factors : chronic gastritis, H.pylori infection, NSAIDs, alcoholism, psychological stress and cigarette smoking.

Around The Stomach

Other common problems, not always involving the stomach, which may give rise to symptoms similar to that of common stomach disorders includes :

  • Gastroesophageal reflux disease (GERD) is the backward flow of the acidic stomach contents up into the esophagus. It is commonly referred to as acid reflux. GERD is mainly caused by the dysfunction of the LES to prevent back flow and the typical symptom is heartburn. Common causes and risk factors : obesity, pregnancy, cigarette smoking, alcohol, diabetes mellitus and certain medication.
  • Gallstones are small sedimentary masses (calculi) that form in the gallbladder and may obstruct the outflow of bile. Common causes and risk factors : high fat and cholesterol intake, low fiber diet, female, older age groups, obesity, pregnancy, diabetes mellitus, sudden weight loss, medication for lowering cholesterol or estrogen drugs.
  • Pancreatitis is the inflammation of the pancreas which may be acute or chronic. Common causes and risk factors : alcohol abuse, abdominal trauma, surgery, gallstones, cigarette smoking and certain medication.
  • Crohn’s disease (inflammatory bowel disease) is an immune-mediated inflammatory disorder affecting mainly the lower gut but may also occur in the stomach and duodenum. Common causes and risk factors : family history of IBD, cigarette smoking, young people and living in industrialized nations.
  • Hiatal hernia is an abnormal protrusion of a portion of the stomach through the diaphragmatic opening. Common causes and risk factors : family history, inherited abnormalities, abdominal injury, persistent increased intra-abdominal pressure, picking up heavy objects on a regular basis, obesity and cigarette smoking.
  • Abdominal muscle strain may be due to injury, overstretching or overworking of the abdominal muscles. Common causes and risk factors : weak abdominal muscles, strenuous physical activity, excessive exercise, repeated coughing and abdominal injury.

It is also important to consider other causes as discussed under :

Sore Stomach in Pregnancy

Pregnancy increases the risk of developing or aggravating several of the causative conditions of stomach soreness mentioned above. This is due to the expanding uterus and hormonal changes which may have have a host of effects even on organs outside of the reproductive system. Pregnancy causes the abdominal muscles to relax and stretch in order to cater for the growing uterus. Therefore abdominal muscle soreness is one of the most common causes of a sore stomach. Common conditions such as GERD, hiatal hernia and gallstones are also more likely to occur in pregnancy.

There are several causes of a abdominal pain and particularly pelvic pain that may be related to the pregnant state. Since the discomfort or pain associated with these causes are usually experienced in the lower abdomen or pelvis, it is not usually described as stomach pain or stomach soreness. Nevertheless, it is worth noting since some of these conditions can have serious implications.

  • Ectopic pregnancy
  • Miscarriage
  • Pre-eclampsia
  • Chorioamnionitis
  • Labor pain
  • Uterine pain
  • Round ligament pain

Sore Stomach in Children

Stomach soreness is a common complaint in childhood mirrored by the frequency of headaches in adulthood. Often there is no known cause for the pain and it passes shortly without any significant consequences. Children also tend to use stomach soreness and abdominal pain in general as a means of avoiding uncomfortable or undesirable situations. It may also manifest as a symptom of psychological stress. Younger children are often unable to accurately express symptoms and may use common terms such as a sore stomach to refer to nausea, indigestion, bloating and intestinal cramps. Some of the more common causes of a sore stomach in children includes :

  • Viral gastroenteritis – stomach flu.
  • Overeating or hunger.
  • Consuming inedible substances
  • Food intolerance.
  • Food allergies
  • Poisoning
  • Constipation
  • Appendicitis
  • Insect bites
  • Injuries such as falls

Two other possible causes that need to be taken into consideration is a blow to the abdomen which may be associated with play or assault when fighting. Bullying may often not be reported by children and should be suspected with repeated injuries or stomach soreness in the event of there being no other visible signs. A sore stomach should also be considered as a possible indication of abuse, whether verbal, emotional, physical or sexual.

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